Are modern health systems built to last?

The cost of healthcare is rising globally. Ageing populations, the increasing prevalence of chronic diseases, and the advent of precision medicine are creating stronger demand than ever for health services. To meet these rising demands, new programs, innovations, and interventions are frequently implemented on the front lines of care. These changes are intended to increase system effectiveness and efficiency, which should improve the sustainability of the healthcare system. 

However, surprisingly little is known about the sustainability of the programs themselves.

In their article, Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review, published by BMJ Open, PCHSS researchers Professor Jeffrey Braithwaite and Associate Professor Yvonne Zurynski and colleagues took a look at how sustainability was defined, conceptualised, assessed, and discussed when evaluating programs used on the front lines of care.

‘Sustainability’ is still just a buzzword

As it turns out, while ‘sustainability’ the buzzword is ubiquitous in the health literature, in the context of implemented health innovations, sustainability is a nebulous term, infrequently treated as a measurable outcome, and poorly understood theoretically. Evidence identified by the authors suggests sustainability is probably still not a priority at the front lines of innovation. And this is a problem, as the authors explain:

“Healthcare delivery improvement programmes are considered among the essential building blocks of sustainable healthcare systems. The current lack of evidence consistency about the sustainability of implemented improvement programmes will inevitably limit the understanding of broader concepts such as social, economic and environmental benefits, increasingly expected from sustainable healthcare systems.”

How to create programs that are built to last

To achieve sustainability, we urgently need innovations which are built to last. However, the authors advise that before these can be implemented, we need to develop and embed theoretical frameworks, validated assessment tools, and clear time points to recognise and measure the sustainability of innovations. We also need to build capacity within the system to be able to evaluate programs effectively.

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