System approaches in governmental public health: Findings from an analysis of the literature

Abstract

The U.S. public health enterprise is a complex system of public and private partners, loosely coupled, which work together to improve the public's health.This scoping review utilized peer-reviewed and grey literature to understand systems approaches may be used in the design or enhancement of public health governance structures and service delivery mechanisms. Titles and abstracts were screened against the research question and retained materials were reviewed in full. The final analytic sample included 34 articles from an initial pool of 1128 unique citations that collectively described 25 systems approaches. The findings indicate that few avenues may be present to guide design or enhancement of public health systems when needs arise, such as in response to the COVID-19 pandemic. Scarcity of literature on this topic presents a challenge, and further analytical studies are needed to inform evidence-based systems design strategies and applications.

Pursuing sustainable performance in healthcare organizations: a sustainable business model perspective

“…Pursuing sustainable development in healthcare organizations is challenging due to multiple reasons. They range from the complexity of the healthcare service delivery (Noto et al, 2023;Orr et al, 2021) to the difficulty of managing the large and diversified number of actors involved, such as hospitals, private clinics, central and local healthcare authorities, patients and families (to mention a few of them), which in turn are likely to impact on the performance of a healthcare organization (Nuti et al, 2018). In addition, while there are existing metrics to measure care effectiveness from financial and quality perspectives (Lennox et al, 2018), there is no universally accepted framework to guide the development of these metrics to evaluate the sustainable value generated in the long run on the economic, social and environmental dimension (Vainieri et al, 2020).…”

“…Pursuing sustainable development in healthcare organizations is challenging due to multiple reasons. They range from the complexity of the healthcare service delivery (Noto et al ., 2023; Orr et al ., 2021) to the difficulty of managing the large and diversified number of actors involved, such as hospitals, private clinics, central and local healthcare authorities, patients and families (to mention a few of them), which in turn are likely to impact on the performance of a healthcare organization (Nuti et al. , 2018).…”

“…(Andrades et al, 2021;Barsanti and Nuti, 2014): mitigating risk factors to empower healthcare and enhance citizen wellbeing Although healthcare organizations increasingly recognize the importance of sustainable performance (Mortimer et al, 2018;Sherman et al, 2020), recent studies suggest that their efforts tend to be rarely implemented or only partially implemented (Hallam and Contreras, 2018;Manes-Rossi et al, 2020), involving symbolic initiatives rather than substantial improvements (Cavicchi et al, 2019;Andrades et al, 2021) In response to the need to build a sustainability approach to mitigate health risk factors (Mehra and Sharma, 2021, p. 5), the DBMfS (Cosenz et al, 2020) offers a dynamic and sustainability-oriented approach. This methodology supports the management of value creation processes in healthcare, encompassing the three dimensions of sustainability: social, environmental, and economic value Although the DBMfS can serve as a valuable tool to stimulate discussions on sustainable performance, it may be challenging to define all the key causal relationships without the full involvement and collaboration of the relevant key actors Sustainable performance to manage the complexity: balancing financial constraints and the rising demand for healthcare Services (Milne and Gray, 2013) Despite the need to provide a long-term vision of adequate quality of healthcare (United Nations, 2015), traditional approaches have been fostered to manage the financial equilibrium and/ or guarantee an adequate quality of care (Lennox et al, 2018), overlooking the sustainable development as a wicked problem (Rittel and Webber, 1973;Head and Alford, 2015) DBMfS can manage the dynamic complex nature of health systems (Braithwaite et al, 2017;Faggini et al, 2021;Mehra and Sharma, 2021), providing a holistic approach that can identify and tackle wicked problems (Cosenz et al, 2020;Orr et al, 2021) Collecting information is a critical process that may often limit the trustiness and reliability of the model, especially in measuring the magnitude of the causal relation between soft variables Effective sustainable business models foster the performance of healthcare organizations (Cosenz et al, 2020;Ramori et ...…”

“…Healthcare workers interact with each other and their equipment, creating networks and collaborating with other community players. Third, the healthcare sector is framed as a system characterized by dynamicity: it tends to change through learning mechanisms and feedback loops over time (Orr et al ., 2021). Lastly, the healthcare sector comprises informal rules, arrangements, and hierarchies.…”

“…Specifically, a dynamic business model – supported by a holistic perspective, incorporating measures of sustainability – has the potential to manage radical changes and, eventually, generate sustainable outcomes (Cosenz et al ., 2020; Cosenz and Noto, 2018). Indeed, wicked problems are generated by systems marked by complexities and non-linearities that require a systemic view to gauge responsible dynamics and an approach oriented to sustainable and balanced development over time (Cosenz et al ., 2020; Orr et al ., 2021; Noto et al ., 2023).…”