Driving Efficiency Improvement (EI): Exploratory Analysis of a Centralised Model in New South Wales

Abstract

Introduction Public healthcare systems face rising demand coupled with reducing funding growth rates, necessitating ongoing approaches to efficiency improvement (EI). Centrally coordinated EI approaches l may support EI leaders, yet few such approaches exist internationally. This study provides evidence to inform system-wide EI by harnessing understanding of the perceptions, role demands and support requirements of key EI stakeholders in the centralised EI model implemented in New South Wales. Methods A purposive sample of key informants within NSW Health with responsibility for EI in their organisation were invited to participate. Semi-structured interviews were conducted, recorded and transcribed. A thematic analysis was undertaken using a theoretical deductive approach. Results Seventeen respondents participated who occupied EI leadership roles in metro (8) and rural (6) health services as well as non-clinical support (3) services. Four primary themes emerged on the perceptions and experiences of participants in 1. holding a unique skillset which enables them to undertake EI; 2. inheriting EI accountabilities as additional duties rather than holding dedicated EI roles; 3. the importance of senior support for EI success; and 4. feelings of isolation in undertaking EI. An additional underpinning theme that EI is not well conceptualized in public health systems also emerged, whereby EI planners felt that frontline staff generally do not consider efficiency as a component of their duties. Conclusion EI leaders provide points of authority, experience and influence across organisations within public health systems. This study finds that EI planners possess a unique skillset, can feel isolated both within their health organisation and within the broader public health system and believe that EI is poorly conceptualized amongst health staff. Centralised support for EI stakeholders across a public health system can promote knowledge sharing and capability development. Addressing the role and support requirements of key EI stakeholders is essential.

Efficiency Improvement Strategies for Public Health Systems: Developing and Evaluating a Taxonomy in the Australian Healthcare System

“…In alignment with contemporary theoretical improvement frameworks founded on the concept of value, this study reaffirms the imperative that a focus on cost improvement is balanced with a requirement to ensure that service quality, outcomes and experiences are not adversely impacted [1]. In further alignment with established theoretical foundations in continuous quality improvement, the approach taken in this study closely follows the key steps in benchmarking methodology regarding the organisation of data to support the development of action plans [1].…”

“…In the current environment of ongoing increases in demand for healthcare amidst ongoing economic uncertainty, the increasing requirement for public health systems to maximise service outcomes achieved for resource investment is likely to persist. A gap in the literature exists regarding the design and delivery of centralised EI models, with a review of the recent literature noting a lack of comprehensive frameworks for driving EI at the whole-of-system level [1]. This study adds new knowledge towards filling this gap by providing a taxonomy for the classification and structuring of EI knowledge, as well as providing a catalogue of public health efficiency improvement strategies.…”

“…Despite great focus on efficiency improvement (EI) in public health systems, there has been a lack of focus on establishing processes to support EI at a whole-of-system level internationally [1]. A general focus on EI at hospital and clinical-unit levels has led to siloed work to generate EI strategies, resulting in duplication of work to tackle similar challenges within organisations in the same public health system [2].…”

“…A general focus on EI at hospital and clinical-unit levels has led to siloed work to generate EI strategies, resulting in duplication of work to tackle similar challenges within organisations in the same public health system [2]. Efficiency is conceptualised in a variety of ways in theoretical models [1]. In contemporary health system paradigms, it is recognised as a central component of value-based care.…”

“…In contemporary health system paradigms, it is recognised as a central component of value-based care. In this characterisation, efficiency represents the outcomes achieved for resources invested [1,3]. This exists in balance with other core elements of value, with a requirement to uphold or maintain or improve clinical, quality and experience outcomes in balance while reducing the cost of health service delivery [1].…”