Defining Health Management: A Conceptual Foundation for Excellence Through Efficiency, Sustainability and Equity

ABSTRACT

The practice of healthcare management is essential for the efficient operation of health services, encompassing leadership, management, and direction within healthcare organisations. ‘Health management’ extends beyond healthcare management by integrating principles of public health and health policy. As health management is commonly practised but not cohesively recognised, the European Health Management Association (EHMA) conducted this study to develop a cohesive definition of health management. Developed through a qualitative methodology comprising focus group discussions and validation through quantitative expert interviews, this study proposed a holistic definition of health management, incorporating social, environmental and economic determinants of health, cross‐sector collaboration, and the ‘One Health’ approach. The publication of this unified definition has important implications for professional training, policy development, and health outcomes. It provides a foundational framework for curricula, informs precise policy formulation, and promotes excellence through health service delivery that reflects efficiency, sustainability, and equity.

Summary.

• Healthcare management does not encapsulate many management activities being practised in our health systems

• Health management refers to these activities reaching outside of traditional healthcare facilities with a holistic approach

• Health management as a discipline requires an accepted definition to build professional cohesion

• A definition of health management creates a conceptual foundation for excellence through efficiency, sustainability and equity

1. Introduction

‘Healthcare management’ is well‐established as the practice of providing leadership, management, and direction to healthcare organisations and their various internal units [1]. It is broadly agreed that healthcare management is centred around three core principles: effectiveness, efficiency, and equity [2, 3]. Healthcare managers typically carry out seven key functions: planning, organising, staffing, controlling, directing, risk‐assessment, and decision‐making [4]. These functions are critical in enhancing organisational efficiency, financial sustainability and the quality of patient care.

Having a clear and specific definition for ‘healthcare management’ has allowed various groups of professionals to identify as ‘healthcare managers’, with medical directors, clinical managers, nursing home administrators, and laboratory managers being selected examples. This clear identity has also allowed for ‘healthcare management’ to flourish as a professional speciality, with growing numbers of accredited educational programs and an expansion of scientific efforts dedicated to its growth as a discipline [5, 6]. These developments have had a substantial and positive impact on the performance of our healthcare facilities, which are essential in maintaining and improving the health of citizens.

However, population health relies on much more than healthcare facilities alone. According to the Ottawa Charter for Health Promotion, health is ‘created and lived by people within the settings of their everyday life; where they learn, work, play and love. Health is created by caring for oneself and others, by being able to take decisions and have control over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members’. [7] This can be expanded upon even further by considering integrated conceptualisations of health such as One Health, which recognises the interconnection between the health of humans, animals and ecosystems [8].

To fully integrate a broader vision of health into more sustainable and equitable health systems, there is a need for a dedicated professional speciality that transcends traditional healthcare management. This speciality must incorporate principles from public health, health policy development, and governance structures to address the underlying social and environmental determinants of health. While many professionals within health systems are already engaging in such work ‐ whether in government health departments, civil society organisations, or research institutions—the field lacks a cohesive identity and a clear definition [9].

An accredited, published definition of ‘health management’ would facilitate the creation of a shared professional identity for health managers, improving and standardising practices through common understanding and providing clear direction for scientific efforts aimed at enhancing their professional capacity [5]. A clear definition of health management is also vital for guiding policy development, professional training, and the creation of health systems that promote efficiency, sustainability and equity. The European Health Management Association (EHMA) initiated this study to develop such a definition, recognising that it is foundational to a wider framework that can enhance the capacity of health systems to address the challenges of today's complex global health landscape, including climate change, pandemics, and health inequalities.

EHMA is well‐placed to understand and address this gap, as its function as an organisation is to provide a bridge between health managers and other stakeholders from both within the health system and beyond, ensuring that the latest research and best practices are integrated into health management across Europe. EHMA also promotes excellence in health management by providing a platform for professional exchange, knowledge dissemination, and collaboration among health managers. Finally, EHMA's continuous interactions with practicing health managers provides access to real‐world data that offers meaningful insight into the professional world of health management for the purposes of developing an effective and representative definition.

2. Methods

This study, undertaken by EHMA with the guidance of its Board of Directors and Scientific Advisory Committee, employed a qualitative research methodology consisting of focus group discussions and interviews with recognised leaders and managers in the health sector with the aim of developing and validating a comprehensive definition of health management. The methodology was divided into two stages based on scientific best practice: focus group discussions to refine a preliminary working definition, and a validation phase involving expert interviews [10].

2.1. Focus Group Discussions

Through a rapid literature review, a preliminary definition of health management was developed, and expert focus group discussions were conducted with the aim of refining this definition. A purposive sample of nine experts from EHMA's professional network was selected based on their relevant academic qualifications, professional health management experience in line with the preliminary definition, and publication records. Specifically, the minimum selection criteria included holding a PhD or equivalent degree in health management or related fields, possessing a minimum of 10 years of experience in health management roles, and having at least five peer‐reviewed publications on the topic of health and healthcare management. Consideration was also given to ensure the focus group had a balance of gender, geographic origin and experience level, and that it represented perspectives from both clinical and administrative health management experience.

Focus group discussions were organised into two sessions, each comprising all of the nine selected experts to achieve thematic saturation [11], Each session lasted approximately 2 hours. Sessions were facilitated by a moderator experienced in qualitative research methods and health management practice. The first session began with the moderator introducing the preliminary definition of health management and setting the objective of reaching a consensus on what a definition of health management should include. The moderator synthesised the ideas, grouping similar concepts and identifying key themes. The second session gave the experts space to discuss and collaboratively agree on which of the identified key themes should be added to the preliminary definition. The resulting suggestions were then synthesised into one cohesive working definition to be refined in the validation phase.

2.2. Validation

To incorporate triangulation into the study design following the focus group discussions, a purposive sampling technique was used to select additional experts for in‐depth interviews. The criteria for selecting this sample were similar to those used for the focus groups but were expanded to include additional considerations for diversity in geographical representation and sector‐specific expertise such as public health, hospital management, and health policymaking.

Interviews with 17 experts (including all 9 from the focus group discussions) were conducted using a semi‐structured format and each lasted approximately 15 min. At the beginning of each interview, the interviewer explained the study's purpose and presented the working definition of health management developed through the focus group discussions. Experts were then asked to review this working definition and provide feedback regarding its comprehensiveness, clarity, and applicability. They were also encouraged to offer specific suggestions for refinement, which were incorporated into the definition, leading to a final, validated definition.

By integrating insights from experts through focus group discussions and interviews, this study ensured an iterative and collaborative approach to defining health management, grounded in the expertise and practical experiences of leading professionals in the field.

TABLE 1. Visualising the methodological steps towards a definition of health management.

Preliminary definition	Health management encompasses the planning, organising, coordinating, and overseeing of resources, processes, and activities of health systems to achieve optimal health outcomes for individuals and populations.
Key concepts suggested for inclusion by focus groups	Broader than ‘healthcare management’—holistic—One Health—digital health—environmental health—intersectoral collaboration—multidisciplinary—different levels of governance—behavioural, social and economic determinants of health—governance structures
Working definition brought to experts for validation	Health management involves providing guidance and leadership to promote health at all levels. It adopts a holistic vision, recognising that health is shaped by behavioural, social, economic, and environmental determinants. Health management includes traditional healthcare management—spanning community, primary, secondary, and tertiary care—it extends beyond these settings to foster collaboration across related policy and societal domains in alignment with the One Health and related approaches.
	Health managers engage with a wide array of stakeholders, including patients, caregivers, patient organisations, policy makers, regulators, public health experts, researchers, and industry representatives. Together, they work to create shared health goals and develop the organizational, societal, and technological foundations necessary for achieving sustainable health outcomes. Health management also emphasises the importance of effective governance structures that support co‐design and co‐production with communities and stakeholders.

3. Health Management: A Definition

We define health management as the practice of providing guidance and leadership to promote and support health at the individual, organisational and systemic levels. Health management embraces a holistic vision of health that recognises the influence of behavioural, social, and environmental determinants. While it includes traditional healthcare management, covering community, primary, secondary, and tertiary care provision, health management also extends beyond care settings. Aligned with the ‘One health’ approach, health management fosters synergy with related policy and societal domains by integrating considerations of human, animal, digital and environmental health.

Irrespective of education, title or professional function, any person who engages in health management can be considered to be a health manager. Health managers lead, coordinate, and optimise health systems by applying specialised knowledge, formal training, and ethical standards to enhance health policy advocacy, establish effective governance structures that improve the performance of health organisations and professionals, foster multi‐institutional collaboration across public and private sectors, promote the involvement and participation of all stakeholders, and create a shared societal vision for optimal health. Given the critical functions they perform, health managers should be increasingly recognized as a distinct group of professionals around which specific training pathways and credentials can be developed.

4. Implications

The definition of health management proposed here has significant implications for the way health systems are structured, governed, and administered, particularly in the context of sustainability, equity, and cross‐sector collaboration. It offers a conceptual foundation for health management, which integrates One Health principles and focuses on building efficient, sustainable and equitable health systems, supporting excellence in both policy development and practice in ways that can lead to improved health outcomes and system resilience.

4.1. Healthy System Efficiency and Sustainability

Sustainability in health management refers to the capacity of health systems to maintain effective operations over the long term, even in the face of environmental, social, and economic challenges. Efficiency is the guiding principle through which sustainability is achieved and refers to the optimal use of resources—such as financial, human, and technological—to maximise health outcomes while minimising waste. By emphasizing a holistic approach, the new definition of health management ensures that health managers consider the interconnectedness of human, animal, digital and ecosystem health and the challenges this presents to maintaining efficient service delivery. Under this definition, health managers must consider complex problems like how environmental degradation (e.g. pollution, climate change) can directly impact human health and strain healthcare resources, and how the governance of digital technologies in health care can contribute to or alleviate health inequities [12].

Health managers will need to develop strategies to efficiently address these environmental health threats, such as developing healthcare infrastructure resilient to climate‐related disruptions and ensuring that pharmaceutical practices do not contribute to environmental pollution. Furthermore, by promoting efficient resource management, health managers can ensure that health systems make sustainable use of the natural, financial and human resources on which they rely. This means planning for sustainable supply chains for medical products, reducing the carbon footprint of healthcare facilities, and fostering policies that support the sustainable use of water, energy, and other critical resources within health settings.

4.2. Health System Equity

Equity in health systems is another central implication of the proposed definition. Health systems are increasingly tasked with addressing health disparities that arise from unequal access to care and the unequal distribution of social determinants of health, such as education, housing, and income. The new definition places health management at the heart of addressing these inequalities by requiring health managers to engage not only with healthcare providers but also with policymakers, community organisations, and other stakeholders to create policies that promote health equity.

For example, in the context of health management, equity‐focused policies could involve expanding access to healthcare in rural or underserved areas, integrating social care with healthcare services to better address the needs of marginalised populations, and advocating for policy changes that reduce structural barriers to care (e.g., through subsidised healthcare for low‐income populations). By working across sectors, health managers can ensure that the health system addresses the full range of social and environmental factors that contribute to health disparities. Moreover, health managers can advocate for inclusive decision‐making processes that involve community members in planning and evaluating health services, ensuring that the perspectives of those most affected by health inequalities are represented.

4.3. Policy Development and Governance

From a policy perspective, the definition provides a framework that can guide the development of health policies that are sustainable and equitable. Policymakers can use this definition to establish clear guidelines for the integration of health management practices that address social, environmental, digital and economic determinants of health. This will be critical for the alignment of health policies with broader global agendas such as the United Nations Sustainable Development Goals (SDGs), which include goals related to health (SDG 3), clean water and sanitation (SDG 6), and climate action (SDG 13).

For example, policymakers can develop regulations that require health systems to monitor and report on their environmental impact, promote the adoption of green technologies, and ensure that healthcare delivery models are sustainable. Additionally, this definition can help health authorities create performance metrics that assess not only the clinical effectiveness of healthcare systems but also their equity and sustainability. These metrics can incentivise a reduction in environmental impact, increased accessibility of services, and greater interdisciplinary collaboration across sectors.

Moreover, this definition supports governance structures that facilitate co‐design and co‐production models, where communities and other stakeholders actively participate in the decision‐making process. This participatory approach ensures that health systems are more responsive to the needs of the population, leading to more equitable health outcomes. Health managers play a key role in fostering governance models that support collaboration across sectors and ensure that the policies implemented are inclusive, just, and sustainable.

4.4. Population Health Outcomes

The implications of the new definition of health management extend to population health outcomes. By promoting a holistic approach that considers both social and environmental determinants, health management can help mitigate the root causes of many preventable diseases. Reducing air pollution, promoting healthy diets through sustainable food systems, and addressing housing instability can all lead to improved population health outcomes and fall under the scope of health management. Health managers are critical in advocating for and implementing public health interventions that reduce the impact of these broader determinants on community health.

Furthermore, a definition of health management that prioritises equity ensures that vulnerable populations are not left behind. Health managers will be tasked with ensuring that health services are designed to meet the specific needs of different demographic groups, such as low‐income populations, ethnic minorities, and people with disabilities. By incorporating a focus on sustainability and equity into everyday health management practices, health managers can drive improvements in population health that are long‐lasting and far‐reaching, addressing not only immediate healthcare needs but also the upstream factors that shape health outcomes.

4.5. Training and Education

The integration of One Health and sustainability principles into health management also has significant implications for training and education in the health sector. The new definition of health management calls for curricula that extend beyond healthcare management to develop skills in public health, policy development, environmental science, and social justice. Health managers need to be equipped not only to manage hospitals and healthcare organisations but also to understand the broader context in which health systems operate, particularly regarding the environmental and social determinants of health.

For instance, educational programs should focus on teaching future health managers how to imbue health systems with resilience to environmental shocks (e.g. pandemics, extreme weather events), promote environmental stewardship (e.g. reducing hospital waste, implementing energy‐efficient practices) and adapt to a deeper integration of technology in how we understand health and healthcare [13]. Additionally, these programs should emphasise training in cross‐sector collaboration, as health managers will increasingly need to work with environmental agencies, agricultural stakeholders, urban planners, IT administrators, educators and public health organisations to develop comprehensive health strategies.

5. Conclusion

The definition of health management developed through this study has far‐reaching implications for the future of health systems globally. It provides the foundation for a conceptual framework that promotes efficient, sustainable, and equitable health systems that can address the complex challenges presented by modern health crises. By integrating One Health principles and focussing on the social and environmental determinants of health, this definition creates a pathway for health systems to become more resilient, adaptable, and inclusive. Health managers, equipped with the tools, knowledge, and shared identity provided by this new definition, will be better positioned to lead the transition towards more efficiency, sustainability and equity in our health systems, ultimately improving health outcomes for everyone.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.