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Healthcare systems are facing increasingly complex challenges, including ageing populations, increasing levels of chronic disease, and expensive new technologies. Considering 30% of care is low-value, and 10% results in direct harm to the patient, it is more important than ever that we consider ways to improve healthcare system sustainability and ensure that healthcare is affordable and accessible to those who need it.

In their article How can the healthcare system deliver sustainable performance? A scoping review, published in BMJ Open, PCHSS researchers Yvonne Zurynski, Jeffrey Braithwaite and colleagues reviewed over 140 papers from high-income settings, to determine how the sustainable performance of healthcare systems (SPHS) has been conceptualised, measured and defined previously.

The authors found that sustainability was commonly defined in three groups: fiscal sustainability, human resource sustainability, and system adaptability, however less than a third of reviewed articles included any definition at all. Without a clear definition, it remains difficult to study, measure and improve sustainability within the system.

Multiple frameworks exist, or have been proposed, to assist with measuring the sustainable performance of health systems. Again, these frameworks could be categorised by three broad outcome levels: community, organisational, and individual. With the health system facing ever-complex challenges, measuring its sustainability is becoming complex as well. The most frequently discussed theme in the reviewed articles was challenges to sustainable performance. These challenges included: gaps between evidence, policy and practice, system fragmentation, and an increasingly complex patient population.

Opportunities for improvement, sustaining, and scaling change

Despite the numerous challenges that threaten the SPHS, many opportunities for improvement, and ways to sustain and scale positive change were identified. Continuous monitoring and adaption are key to maintaining a sustainable system. In a practical sense, funding novel interventions, improving workplace culture and strong leadership will enable system-wide change. The role of political leaders and policy makers as change agents was also highlighted as an important in enabling and sustaining change.

Whilst there is no simple answer to ensure that our health systems operate in a sustainable way, as the authors write

“The field of SPHS is expanding with recent publications defining SPHS in terms other than the traditional financial measures. This places more emphasis on acceptability of the system to patients, healthcare providers and other stakeholders, adaptation and resilience, and sufficient nimbleness to absorb new evidence and innovations to support continuous improvements.”