Table 1.

Summary of system-wide efficiency improvement approaches

Strategic aim	Specific strategies identified	Source
Centralised efficiency improvement management	Utilise peer performance benchmarking to identify and share high-performing services, models, initiatives and approaches	Allin, Grignon & Wang 2016 [1] Grimes et al. 2011 [25] Nuti et al. 2016 [25] Rumbhold et al. 2015 [23] White, 2015 [26] Alatawi, Niessen & Khan 2020 [27]
	Establish service level agreements and performance targets to set expectations and delivery accountabilities	Anderson & Catchlove 2012 [28] Christiansen & Vrangbaek 2018 [29] Zhang, Tone & Lu 2018 [30]
	Sponsor efficiency practice networks for system-wide collaboration and knowledge-sharing	Auerbach et al. 2014 [31]
	Provide financial incentives for adoption of efficient practices	Bradford et al. 2016 [32] Elshaug et al. 2017 [33]
	Establish system-wide policy guidance on which practices are most efficient and which lower-value practices should be replaced	Elshaug et al. 2017 [33] Garcia-Armesto, Campillo-Artero & Bernal-Delgado 2013
	Establish best practice guidance for financial and management decision-makers on resource allocation and reallocation	Elshaug et al. 2017 [33] Harris et al. 2017 [34]
	Establish a centralised efficiency improvement unit to support system-wide improvement processes	Hassanian, 2017 [2] Lavoie-Tremblay et al. 2012 [35]
	Address reducing duplication and maximising asset utilisation at a whole-of-system level	Pencheon, 2015 [36] Tsai et al. 2017 [37]
	Ensure timely, transparent performance reporting for improvement initiatives	Tataw, 2014 [38] Alatawi, Niessen & Khan 2020 [27]
Concurrently improving efficiency, quality and value	Establish system-wide policy for balancing expenditure, quality and value	Akinleye et al. 2019 [39]
	Integrate financial, workforce and clinical service data to model improvement impact	Birch et al. 2015 [40]
	Systematically identify and address health service overuse/underuse	Ellen et al. 2018 [6] Elshaug et al. 2017 [33] Kumar 2011 [41]
	Partner with primary care services to enable early intervention	Fiorentini et al. 2011 [42] Gaertner, Maier & Radbruch 2015 [43]
	Determine a sufficient time period within which efficiency improvement initiatives can be delivered and realised	Hebert et al. 2014 [44] Schakel, Wu & Jeurissen 2018 [45]
	Weigh costs of innovation with potential efficiency and value generated	Mussap, 2014 [46]
Engaging stakeholders in efficiency improvement	Include frontline staff and managers in designing efficiency improvement initiatives	Ashton, Bramley & Armstrong 2012 [47] De Rosis & Nuti 2018 [48] Elshaug et al. 2017 [33]
	Leverage evidence of combined cost and patient outcome improvements to promote stakeholder acceptance of efficiency approaches	Gans et al. 2012 [49] Murphy et al. 2016 [50]
	Link frontline staff performance goals with organisational improvement goals	Kämäräinen et al. 2016 [51]
	Continue to engage with improvement initiative stakeholders following implementation to promote improvement longevity	Lennox, Maher & Reed 2018 [52]
	Establish clear and transparent improvement targets at the health service level	Nuti et al. 2016 [53] Moberg & Fredrikkson 2020 [54] Christiansen & Vrangbaek 2018
	Tailor resource allocation and service optimisation messaging to promote frontline clinician and management engagement	Moberg & Fredriksson 2020 [54] Harris et al. 2017 [34] Wolfenden et al. 2019 [55]