Sustainable Healthcare Systems: How Close Are We? A Multi-Phase Mixed-Methods Evidence Synthesis

Abstract

Background: /Objectives: Shifting to telehealth care model, care’s migration to low-cost settings and value-based care expansion, which are currently the leading trends in the healthcare sector, healthcare executives know that digital investment will be required, apart from the rising-demand costs they have to address, making immediate operational resilience and sustainability the top concern for healthcare systems (HCSs), globally. Care coordination and sustained care can’t be efficiently materialized, without the existence of a reliable and efficient monitoring system. Hence, this study addresses the following questions: Do recent healthcare organizations monitor effectively their sustainable performance? Do the current monitoring tools have the required properties, to enable organizations operate as part of a sustainable healthcare system? This study’s objective is to establish a common ground in monitoring, for healthcare organizations, that enables them to sustain their mission. Methods: A 3-phase Integrated Evidence Synthesis was conducted, following Equator-Network guidelines, including a Systematic Review of peer-reviewed studies from two large scientific databases, a Scoping Review of grey literature on the monitoring approaches applied by healthcare organizations in the USA and an Evidence Synthesis of the previous studies’ outcomes into a framework synthesis. Results: Only 18 over 138 most relevant peer-reviewed scientific articles/reports, published in the last 5 years in this area, are describing a valid monitoring framework (MFW) for sustainable performance, revealing that this area of study is relatively unexplored. 72% of them use conventional techniques. Only 39% monitor both short-to-mid-term and long-term sustainability and 83% can’t scale neither cross-sector nor cross-border. Healthcare centres in the USA use a mix of MFWs in practice. Although the monitoring approaches, between high-performing and low-performing organizations vary, both sides are struggling for sustaining the quality level of their operations. The lack of a unified approach that would enable organizations to monitor efficiently their sustainable performance, this study tries to address, through a framework synthesis. Conclusions: The conceptual framework that emerges encourages the adoption by healthcare organizations of an operational monitoring mechanism -infrastructure-, with the systemic properties required, for promoting sustainable institutional performance.

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