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Table 3 Overview and types of challenges and emerging trends for healthcare managers internationally within the included literature

From: Priorities and challenges for health leadership and workforce management globally: a rapid review

Level Challenge or emerging trend Aspects of the challenge or emerging trend References
Societal and system-wide (macro) Demographic and epidemiological transitions Population growth [34, 47, 48, 61]
Ageing populations [21, 47, 49, 53, 57, 61, 69]
Rise in chronic, non-communicable disease and lifestyle-related health issues [21, 46,47,48,49,50,51,52, 56]
High disease burdens and poor health indicators [46, 47, 51]
Growing and shifting supply and demand patterns More patients with complex needs requiring multiple healthcare providers [21, 46, 54, 55, 83]
Hospital capacity issues [50, 53]
More knowledgeable and health-literate consumers [34, 53, 54]
Higher expectations from healthcare organizations (value-for-money) [16, 34, 43, 53, 57, 60]
Increasing dissatisfaction with healthcare system [61]
Greater treatment affordability, increased medical tourism, growing health insurance use, rising incomes [48]
Inequalities in access to healthcare [51, 72]
Advances in science and technology New Information and communication Technology (ICT) systems [47, 48, 53, 54, 57, 69, 83]
Innovations in healthcare services and delivery (electronic medical records, telemedicine, internet-based care, hospital and ward redesign) [47, 54, 56,57,58]
New categories or specialization of service providers [54, 83]
Greater integration and interdisciplinary teams and collaborative healthcare practice [54, 55]
Political and economic change Adapting to changes in government and health sector reforms [18, 19, 24, 28, 31, 47, 53, 54, 59, 60]
Decentralisation of healthcare [24, 27, 35, 59, 72]
Budget constraints, measures to avoid deficits [16, 19, 53, 60, 61]
Disconnection between population needs and resource allocation [23, 27, 40, 47, 57, 72]
Lack of or increasing collaboration between governments, health providers, community representatives and other stakeholders to address the needs of healthcare systems [27, 40, 49]
Shifting to patient-focused care; greater attention to community health and addressing social determinants of health [16, 21, 28, 32, 34, 38, 53,54,55, 58]
Corporatisation and privatisation Emergence of new business models for healthcare; Public–Private Partnership (PPP) models [22, 48, 54, 59, 62, 63]
Move from independent health organisations to large, networked health systems [22, 59, 62]
High or uneven demand for specialist tertiary care [22, 49]
Growth of the private sector; competition for health professionals [22, 34, 35, 57, 61, 62]
Increasing costs Healthcare costs [21, 22, 53, 61, 64, 69]
Managerial costs [34, 64]
Costs associated with developing new programmes [19, 47, 53]
Crises in human resources for health Shortage of trained health personnel, out-migration of skilled health workers [23, 25, 41, 46, 47, 50, 51, 61]
Lack of effective retention strategies and poor working conditions [46, 80]
Challenge to maintain health services with appropriate skill mixes [35, 46, 47, 51, 61]
Limited resources and health infrastructure and their maintenance [46, 47, 50, 72]
Deficiencies in health information systems [23, 25, 49]
Organisational (meso) Human resource management challenges Inefficiency and insufficiencies in provision of health services and use of resources; increased demands for efficiency and cost-cutting [18, 21, 49, 53, 57, 61, 63,64,65]
Barriers to implementing lean healthcare: outsourcing hospital activities, limited knowledge of lean [17, 21]
Inadequate planning and performance evaluation systems; poor talent identification; poor deployment and underutilization of staff [23, 25, 28, 30, 43, 49, 69, 72, 80]
Lack of support and opportunities in management training and leadership development within organisations [22, 26, 28, 31, 41, 42, 46, 47, 67, 82]
Poor quality of services or concerns of declining quality; poor culture regarding patient safety [18, 33, 35, 46, 61, 69]
Changes in organisational structures and measures Dominant hierarchical culture [21, 22, 36, 43, 54, 63, 64, 72]
Selective recruitment into leadership positions; need for robust succession planning and management [44, 66, 67]
Excessive bureaucracy or lack of transparency in organisational rules and processes [21, 24, 30, 64, 67]
Inadequate systems to prevent and control healthcare associated infections (HAIs) [53, 68]
Target-driven approach to performance measurement [61]
Fee-for-service payment models encouraging volume not quality of care [18, 23, 57, 61]
Value-based payment models, other new payment models [24, 49, 62, 69, 70, 72, 83]
Intensification of front-line and middle management work Broad responsibility; balancing clinical, teaching, research and management roles [22, 28, 29, 42, 53, 64, 70, 81]
Long working hours, unpredictable work patterns, tight deadlines, stress and reduced productivity [22, 29, 37, 42, 51]
Difficulties of middle-level and front-line managers to operationalise executive strategic directions and initiatives (lack of incentives, lack of support, resource constraints, conflict between organisational priorities and employees’ own goals and values) [16, 21, 24, 26, 30, 31, 37, 42, 53, 65, 72, 81]
Informal and shared leadership in the front-line in the absence of formal management [20]
Individual (micro) Shifting health manager role No universal standard definition for a health manager nor defined competency standards [28, 59]
Lack of transparency and accountability [24, 28, 30, 31, 67]
Increasing dual clinician and manager and leadership roles [18, 28, 53, 63, 70, 71, 74, 75]
More physicians becoming senior healthcare managers [39, 63, 64]
More non-physician health managers, new types of professional healthcare managers [73, 74]