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:
  1. Definitions and concepts relating to efficiency improvement
  2. Central support and leadership for system-wide efficiency improvement
  3. Concurrently managing efficiency, service delivery and service quality outcomes;
  4. Stakeholder engagement
No evidence-based comprehensive frameworks for managing efficiency improvement in public health systems were identified.