Analysis of Centralized Efficiency Improvement Practices in Australian Public Health Systems.

Aim: Analysis of centralized efficiency improvement practices in Australian public health systems. Introduction: Public health systems seek to maximize outcomes generated for resources used through efficiency improvement (EI) in response to funding and demand pressures. Despite this focus, evidence for EI approaches at the whole-of-system level is lacking in the literature. There is an urgent need for evidence-based approaches to centralized EI to address these pressures. This study aims to address this gap by answering the research question "How is EI conceptualized and managed by central public health system management entities in Australia?". Material and Methods: Document analysis was selected due to its suitability for systematically searching and appraising health system documentation, with this study following Altheide's approach focusing on whole-of-system strategic plan and management framework documents originating from Australian public health organizations. Results: Conceptualization of efficiency varied substantially with no consistent definition identified, however common attributes included resource use, management, service and delivery. Forty-two of 43 documents contained approaches associated with improving efficiency at the whole of system level. Discussion: While no comprehensive framework for centralized EI was evident, we identified nine core approaches which together characterize centralized EI. Together these approaches represent a comprehensive evidence-based approach to EI at the whole of system level. Conclusion: The approaches to whole-of-system EI identified in this study are likely to be highly transferable across health systems internationally with approaches including strategic priority setting, incentivization, performance support, use of EI evidence, digital enablement and workforce capability development.