Results of data synthesis
A thematic analysis of each included study was undertaken to identify
key concepts related to the research question in order to inform the
description of these findings through a narrative
synthesis(12). Extracted data was themed twice;
firstly for major themes, and then for specific concepts relating to
health services efficiency within each major theme. Regular discussions
amongst the review team (JW, RH) regarding the structure, presentation
and content were scheduled to guide the synthesis of extracted data. The
systematic rigour and co-reviewed nature of this process grants a high
degree of validity to the depth and completeness of the evidence
synthesised in this review. A detailed data extraction summary table was
used to document extracted data.
The two database searches returned a result of 3,526 unique titles,
which were individually screened for potential relevance. 144 titles
were selected for full review to determine relevance, for which full
papers were obtained and reviewed. Following full-text review of these
144 papers, 73 papers were found to contain relevant material at a
whole-of-system level and were included in the final review. Three major
themes were identified:
- Definitions and concepts relating to efficiency improvement
- Central support and leadership for system-wide efficiency improvement
- Concurrently managing efficiency, service delivery and service quality
outcomes;
- Stakeholder engagement
No evidence-based comprehensive frameworks for managing efficiency
improvement in public health systems were identified.