Implications and application
The current public health system climate is one of increasing demand and tightening resourcing, yet the vast majority of project-level sustainability approaches in healthcare do not include a cost-related definition of sustainability(44). System-level responses to the challenge presented by the increasing need for efficiency are often reactive, involving short-term actions such as reducing funding rates, setting short-term targets, reducing services and delaying non-essential activities(74). Such approaches are unlikely to result in sustainable improvements and are also likely to impact capacity for investment, capability development and innovation aimed at improving both quality and efficiency(79). Continuing with such approaches is unlikely to meet current and future sustainability pressures(7).
This study presents a synthesized view of current evidence relevant to efficiency improvement in public health systems. While studies aimed at improving efficiency were widespread, no single comprehensive frameworks were identified in this review. This paper addresses the gap in the literature in this space by outlining the range of current evidence-based factors and strategies associated with supporting efficiency improvement in public health systems. Evidence is also presented which supports tandem improvements in financial efficiency and health service outcomes. Public health systems in developed countries may find guidance in this study on which efficiency improvement approaches are linked with success. The findings of this study may also be used to guide reflection on current practice in order to identify approaches in place as well as potentially-successful approaches not currently in place for the purpose of validating and augmenting efficiency improvement practices.