Background Until now, scholarship on innovation processes in healthcare systems lack an in-depth appreciation of tensions. Tensions often revolve around barriers and result from individual assessments and prioritizations that guide actions to eventually overcome these barriers. In order to develop a more differentiated understanding of tensions’ role in healthcare innovation processes, this paper aims to shed light on the multifaceted ways in which tensions emerge, are being dealt with, and how they hinder or, at times, facilitate innovation processes. Methods A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. The review involved searching three databases for original research articles and manually searching citations. Twenty-nine original full texts were identified, evaluated, and coded. These include papers on innovation in healthcare systems that investigated innovation-related organizational tensions. The findings were synthesized into different types of tensions in healthcare system innovation and the descriptions of the conflicting elements. We also analyzed the investigated innovations by type, process stages, and across different countries and healthcare systems. Results A total of forty-two tensions were identified and grouped into nine categories. Organizing tensions were predominant, followed by learning/belonging, performing, and performing/organizing tensions. Tensions most frequently occurred in the implementation phase and in the form of a dilemma. Included studies were conducted mainly in government-funded healthcare systems. Conclusion Our data suggest that innovation processes in healthcare systems are impaired by conflicts between contradictory elements, working cultures, and convictions and the organizational and regulatory context. Since the majority of the tensions we collected in our study can be addressed, future policy-making and research should take advantage of this fact and develop strategies that significantly influence the successful management of tensions and thus improve the implementation of innovations.

In the transition from fragmented to integrated care, tensions are inevitable. Contradictions between the actors of the different professions involved can have negative but also positive effects on change processes in the healthcare system. This is especially true for integrated care, where collaboration among the workforce is pivotal. Therefore, efforts should not be made to avoid tensions from the outset, if this is at all possible, but to deal with them constructively. The attention of leading actors must be increased to recognize, analyse, and successfully manage tensions. The creative potential of tensions can be harnessed to successfully implement integrated care and engage the diverse workforce. ZUSAMMENFASSUNGBeim Übergang von der fragmentierten zur integrierten Versorgung sind Spannungen unvermeidlich. Widersprüchlichkeiten zwischen den Akteuren der verschiedenen an der Versorgung beteiligten Berufsgruppen können sich sowohl negativ als auch positiv auf Veränderungsprozesse im Gesundheitswesen auswirken. Dies gilt insbesondere für die integrierte Versorgung, bei der die Zusammenarbeit zwischen den Arbeitskräften von zentraler Bedeutung ist. Es sollte daher nicht versucht werden, Spannungen von vornherein zu vermeiden, sofern dies überhaupt möglich ist, sondern konstruktiv mit ihnen umzugehen. Die Aufmerksamkeit der verantwortlichen Akteure muss erhöht werden, um Spannungen zu erkennen, zu analysieren und erfolgreich zu bewältigen. Das kreative Potenzial von Spannungen kann genutzt werden, um die integrierte Versorgung erfolgreich umzusetzen und die diversen Arbeitskräfte in diese einzubinden.