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Background Implementation science has a core aim – to get evidence into practice. Early in the evidence-based medicine movement, this task was construed in linear terms, wherein the knowledge pipeline moved from evidence created in the laboratory through to clinical trials and, finally, via new tests, drugs, equipment, or procedures, into clinical practice. We now know that this straight-line thinking was naïve at best, and little more than an idealization, with multiple fractures appearing in the pipeline. Discussion The knowledge pipeline derives from a mechanistic and linear approach to science, which, while delivering huge advances in medicine over the last two centuries, is limited in its application to complex social systems such as healthcare. Instead, complexity science, a theoretical approach to understanding interconnections among agents and how they give rise to emergent, dynamic, systems-level behaviors, represents an increasingly useful conceptual framework for change. Herein, we discuss what implementation science can learn from complexity science, and tease out some of the properties of healthcare systems that enable or constrain the goals we have for better, more effective, more evidence-based care. Two Australian examples, one largely top-down, predicated on applying new standards across the country, and the other largely bottom-up, adopting medical emergency teams in over 200 hospitals, provide empirical support for a complexity-informed approach to implementation. The key lessons are that change can be stimulated in many ways, but a triggering mechanism is needed, such as legislation or widespread stakeholder agreement; that feedback loops are crucial to continue change momentum; that extended sweeps of time are involved, typically much longer than believed at the outset; and that taking a systems-informed, complexity approach, having regard for existing networks and socio-technical characteristics, is beneficial. Conclusion Construing healthcare as a complex adaptive system implies that getting evidence into routine practice through a step-by-step model is not feasible. Complexity science forces us to consider the dynamic properties of systems and the varying characteristics that are deeply enmeshed in social practices, whilst indicating that multiple forces, variables, and influences must be factored into any change process, and that unpredictability and uncertainty are normal properties of multi-part, intricate systems.

Objective To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. Data sources and study setting Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. Study design A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker’s Quality Assessment Tool. Data collection/extraction methods A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies. Results Of the 124 studies included in this review, almost half utilised qualitative designs ( n  = 52; 41.9%) and roughly one third were conducted in the USA ( n  = 43; 34.7%). Few studies ( n  = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting ( n  = 99; 79.8%), process ( n  = 99; 79.8%) and intervention characteristics ( n  = 72; 58.1%) were most frequently reported. Leadership/support ( n  = 61; 49.2%), training/support/supervision ( n  = 54; 43.5%) and staffing/turnover ( n  = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding ( n  = 26; 56.5%), external leadership by stakeholders ( n  = 16; 34.8%), and socio-political context ( n  = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation. Conclusions This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area. Trial registration https://bmjopen.bmj.com/content/7/11/e018568 .

BackgroundIncreasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.ObjectivesWe aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured.DesignScoping review of peer-reviewed articles and editorials published from database inception to February 2021.Data sourcesPubMed and Ovid Medline, and snowballing techniques.Eligibility criteriaWe included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS.Data extraction and synthesisAfter title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts.ResultsOf 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible.ConclusionsTo implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.

Design and objectivesEvery organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.SettingA variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.ParticipantsThe articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.Primary and secondary outcome measuresPatient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.ResultsThe search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.ConclusionsSynthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.

The sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations. We aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions. Systematic integrative review. We searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011-March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker's Quality Assessment Tool was applied to included studies. Of the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1-2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability. The body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.

ObjectivesPeople interact with their work environment through being, to a greater or lesser extent, compatible with aspects of their setting. This interaction between person and environment is particularly relevant in healthcare settings where compatibility affects not only the healthcare professionals, but also potentially the patient. One way to examine this association is to investigate person–organisation (P-O) fit and person–group (P-G) fit. This systematic review aimed to identify and synthesise knowledge on both P-O fit and P-G fit in healthcare to determine their association with staff outcomes. It was hypothesised that there would be a positive relationship between fit and staff outcomes, such that the experience of compatibility and ‘fitting in’ would be associated with better staff outcomes.DesignA systematic review was conducted based on an extensive search strategy guided by Preferred Reporting Items for Systematic review and Meta-Analyses to identify relevant literature.Data sourcesCINAHL Complete, EMBASE, Ovid MEDLINE, PsycINFO and Scopus.Eligibility criteriaArticles were included if they were empirical studies, published in peer-reviewed journals in English language, set in a healthcare context and addressed the association that staff outcomes have with P-O and/or P-G fit.Data extraction and synthesisIncluded texts were examined for study characteristics, fit constructs examined and types of staff outcomes assessed. The Quality Assessment Tool was used to assess risk of bias.ResultsTwenty-eight articles were included in the review. Of these, 96.4% (27/28) reported a significant, positive association between perception of fit and staff outcomes in healthcare contexts, such that a sense of compatibility had various positive implications for staff, including job satisfaction and retention.ConclusionAlthough the results, as with all systematic reviews, are prone to bias and definitional ambiguity, they are still informative. Generally, the evidence suggests an association between employees’ perceived compatibility with the workplace or organisation and a variety of staff outcomes in healthcare settings.

Most research on health systems examines contemporary problems within one, or at most a few, countries. Breaking with this tradition, we present a series of case studies in a book written by key policymakers, scholars and experts, looking at health systems and their projected successes to 2030. Healthcare Systems: Future Predictions for Global Care includes chapters on 52 individual countries and five regions, covering a total of 152 countries. Synthesised, two key contributions are made in this compendium. First, five trends shaping the future healthcare landscape are analysed: sustainable health systems; the genomics revolution; emerging technologies; global demographics dynamics; and new models of care. Second, nine main themes arise from the chapters: integration of healthcare services; financing, economics and insurance; patient-based care and empowering the patient; universal healthcare; technology and information technology; aging populations; preventative care; accreditation, standards, and policy; and human development, education and training. These five trends and nine themes can be used as a blueprint for change. They can help strengthen the efforts of stakeholders interested in reform, ranging from international bodies such as the World Health Organization, the International Society for Quality in Health Care and the World Bank, through to national bodies such as health departments, quality and safety agencies, non-government organisations (NGO) and other groups with an interest in improving healthcare delivery systems. This compendium offers more than a glimpse into the future of healthcare−it provides a roadmap to help shape thinking about the next generation of caring systems, extrapolated over the next 15 years.

IntroductionThe sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system.Methods and analysisThe protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies.Ethics and disseminationAs no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.

ObjectivesOrganisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare.Setting and participantsParticipants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia.Primary and secondary outcome measuresStaff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress.DesignA multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures.ResultsThe regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression.ConclusionsThe findings highlight that staff’s perception of their workplace and organisational culture can have implications for staff well-being.

Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book ‘Health Systems Improvement Across the Globe: Success Stories from 60 Countries’, we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment—defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the ‘acorn-to-oak tree’ principle (a small scale initiative can lead to system-wide reforms); the ‘data-to-information-to-intelligence’ principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the ‘many-hands’ principle (concerted action between stakeholders is key); and the ‘patient-as-the-pre-eminent-player’ principle (placing patients at the centre of reform designs is critical for success). A reforma da saúde envolve geralmente orquestrar uma mudança de política, mediada por alguma forma de intervenção operacional, de sistemas, financeira, de processo ou prática. O objetivo é melhorar as formas como o cuidado chega aos pacientes. No “Health Systems Improvement Across the Globe: Success Stories from 60 Countries” (Melhoria dos Sistemas de Saúde através do globo: histórias de sucesso de 60 países) reunimos estudos de caso bem-sucedidos de 60 países. Uma característica única da coleção é a diversidade de países incluídos, dos mais ricos e politicamente estáveis, como o Japão, o Qatar e o Canadá, a alguns dos mais pobres, mais densamente povoados ou politicamente complexos, incluindo o Afeganistão, a Guiné e a Nigéria. Apesar dos constrangimentos enfrentados pelos responsáveis pelas reformas da saúde em todos os lugares, todos os países conseguiram partilhar uma história de realização, definindo como o seu caso foi gerido, que serviços foram afetados e, por fim, como os pacientes, o pessoal ou o sistema em geral foram beneficiados. Os temas da reforma variaram entre os relacionados com a política, a cobertura do atendimento e a governança; à qualidade, padrões, acreditação e regulação; à organização dos cuidados; à segurança, mão-de-obra e recursos; à tecnologia e IT; até às formas práticas através das quais as partes interessadas forjaram colaborações e parcerias para alcançar objetivos mútuos. Fatores comuns relacionados com o sucesso incluíram o princípio da bolota-ao-carvalho (uma iniciativa de pequena escala pode levar a reformas em todo o sistema); o princípio dos dados para a informação para o conhecimento (o papel da IT e dos dados está a tornar-se mais crítico para prestar um atendimento eficiente e apropriado, mas deve ser convertido em conhecimento útil); o princípio das muitas mãos (ação concertada entre os principais interessados é fundamental); e o princípio do paciente como jogador proeminente (colocar os pacientes no centro dos projetos de reforma é crítico para o sucesso). La reforma de salud implica habitualmente la orquestación de un cambio de política, mediada por alguna intervención operacional, de sistemas, financiera, de procesos o de intervención práctica. El objetivo es mejorar las formas en cómo se brinda la atención a los pacientes. En “Mejora de los Sistemas de Salud en todo el mundo: historias de éxito de 60 países” (Health Systems Improvement Across the Globe: Success Stories from 60 Countries), recogimos estudios de casos de los logros de 60 países. Una característica de esta colección es la diversidad de los países incluidos, desde los más ricos y políticamente estables como Japón, Qatar y Canadá hasta algunos de los más pobres, más densamente poblados o con desafíos políticos, incluyendo Afganistán, Guinea y Nigeria. A pesar de las limitaciones a las que se enfrentan quienes están realizando la reforma de salud en todas partes, todos los países pudieron compartir una historia de logros-definiendo cómo su ejemplo de caso fue gestionado, qué servicios fueron afectados y en última instancia cómo los pacientes, el personal y el sistema en general, se beneficiaron. Los temas de reforma abarcaban desde aquellos relacionados con la política, la cobertura de atención y gobernanza; la calidad, las normas, la acreditación y la regulación; la organización de la atención; seguridad, fuerza de trabajo y recursos; hasta las tecnología y las tecnologías de la información; a través de formas prácticas en la que las partes interesadas colaboraron y se asociaron para lograr objetivos mutuos. Los factores comunes vinculados al éxito incluyeron el principio de bellota a roble (una iniciativa de pequeña escala puede conducir a reformas de todo el sistema); el principio de datos a información a inteligencia (el rol de las tecnologías de la información y los datos se está volviendo más crítico para proporcionar una atención eficiente y adecuada, pero debe convertirse en inteligencia útil); el principio de muchas manos (la acción concertada entre los principales interesados es clave); y el principio del paciente como el jugador más importante (colocar al paciente en el centro de los diseños de la reforma es crítico para el éxito). 医疗改革通常涉及协调政策变革，通过某种形式的操作，系统，财务，过程或实践干预进行调解。目的是改善对病人提供服务的照护方法。 在全球健康体系改善： 60个国家的成功案例中，我们收集了来自60个国家的案例研究成果。有一个独特之处在于那些国家中的多样性，其中有从最富有和最政治稳定的国家，到人口最密集或具政治挑战的国家包括阿富汗，几内亚和尼日利亚在内的一些最贫穷，人口最密集或政治挑战的国家。 尽管卫生改革者面对无处不在的限制，每个国家仍可分享一个成就故事 - 界定他们的案例管理方式，其服务受到的影响，以及患者，工作人员或整个系统如何受益。改革主题范围从政策，护理保障和治理等方面;质量，标准，认证和监管;到组织护理;安全，劳动力和资源;技术和IT;以实际方式让利益相关者通过建立合作和伙伴关系实现相互目标。 与成功相关的常见因素包括橡木树原则（小规模的举措可导致全系统的改革）;数据到信息到智能原则（IT和数据的作用对于提供有效和适当的护理照护变得越来越重要，但必须转化为有用的智能）；多方面的原则（关键利益相关者之间的协调行动是扮演主要关键）;以患者为前提的原则（考虑病患利益将是改革设计的中心对成功至关重要）。 醫療改革通常涉及協調政策變革，通過某種形式的操作，系統，財務，過程或實踐干預進行調解。目的是改善對病人提供服務的照護方法。 在全球健康體系改善： 60個國家的成功案例中，我們收集了來自60個國家的案例研究成果。有一個獨特之處在於那些國家中的多樣性，其中有從最富有和最政治穩定的國家，到人口最密集或具政治挑戰的國家包括阿富汗，幾內亞和尼日利亞在內的一些最貧窮，人口最密集或政治挑戰的國家。 儘管衛生改革者面對無處不在的限制，每個國家仍可分享一個成就故事 - 界定他們的案例管理方式，其服務受到的影響，以及患者，工作人員或整個系統如何受益。改革主題範圍從政策，護理保障和治理等方面;質量，標準，認證和監管;到組織護理;安全，勞動力和資源;技術和IT;以實際方式讓利益相關者通過建立合作和夥伴關係實現相互目標。 與成功相關的常見因素包括橡木樹原則（小規模的舉措可導致全系統的改革）;資料到資訊到智慧原則（IT和數據的作用對於提供有效和適當的護理照護變得越來越重要，但必須轉化為有用的智能）；多方面的原則（關鍵利益相關者之間的協調行動是扮演主要關鍵）;以患者為前提的原則（考慮病患利益將是改革設計的中心對成功至關重要）。 医療制度改革は、ある種の操作、システム、財政、 プロセス、または実践の介入を通じた政策変更の統 合を典型的には含む。本研究の目的は、医療が患者 へ提供される方法を改善することである。 在全球健康體系改善： 「世界における医療システムの改善：60か国の成功 例」では、60か国で達成された事例を集めた。本収 集の独自性は、日本、カタールやカナダなど最も裕 福で政治面で安定している国から、アフガニスタ ン、ギニア、ナイジェリアなど最も人口密度が高 く、政治面で困難に直面している国まで、含まれる 国々が多様であることである。 どこの国の医療制度改革者も直面するいろいろな制 約にもかかわらず、どの国も、事例がどのようにマ ネージメントされ、どのサービスが影響を受けた か、また最終的にどのように患者、スタッフ、そし てシステムが全体として利益を得たかなど、達成の 経緯を共有することができた。改革のテーマは、政 策・ケアの範囲・ガバナンスに関するものから、医 療の質・標準化・認証・規制に関するもの、ケアの 組織化について、安全・労働力及び資源、技術と IT、そしてどの利害関係者が互いの目的を達成する ためにいかに共同とパートナーシップを培ったかと いう実践的方法にまで及んだ。 成功に至る共通の要因としては、ドングリから樫の 木への法則（小規模でも先んずることでシステムレ ベルの改革へ繋げられる）；データから情報、そし て叡智にいたる原則（ITとデータの役割は効果的で 適切なケアを提供する上でますます重要になってい るが、実際に使える叡智への変換が必要)；多くの手 原則(鍵となる重要な利害関係者間の調和的な行動が 重要)；そして患者を優れたプレイヤーの予備軍と位 置づける原則（改革デザインの中心に患者を位置づ けることが成功にとって重要）、が含まれた。 Une réforme des soins de santé implique généralement d’orchestrer un changement de politique par l’entremise d’une certaine forme d’intervention opérationnelle, de systèmes, financière, des processus ou des pratiques. Le but est d’améliorer les manières dont les soins sont fournis aux patients. Dans Health Systems Improvement Across the Globe: Success Stories from 60 Countries, nous avons rassemblé des études de cas réussis provenant de 60 pays. Une caractéristique unique de ce recueil est la diversité des pays inclus, des plus riches et stables sur le plan politique, comme le Japon, le Qatar et le Canada, à certains des plus pauvres, des plus densément peuplés ou de ceux présentant le plus de défis politiques, comme l’Afghanistan, la Guinée et le Nigeria. Malgré les contraintes auxquelles doivent faire face les réformateurs de la santé partout dans le monde, chaque pays a été capable de partager une histoire d’accomplissement—définissant comment son exemple de cas a été géré, quels services ont été concernés et enfin, comment les patients, le personnel ou le système en général en ont bénéficié. Les thèmes de réforme comprenaient ceux liés à la politique, à la couverture des soins et à la gouvernance; ceux liés à la qualité, aux normes, à l’accréditation et à la réglementation; ceux liés à l’organisation des soins; ceux liés à la sécurité, à la main d’œuvre et aux ressources; ceux liés à la technologie et aux TI; en passant par les moyens pratiques par lesquels les parties prenantes ont forgé des collaborations et des partenariats pour atteindre leurs objectifs mutuels. Les facteurs courants liés à la réussite comprenaient le principe du gland au chêne (une initiative à petite échelle peut conduire à des réformes à l’échelle du système); le principe des données à l’information à l’intelligence (les TI et les données ont un rôle de plus en plus crucial pour délivrer des soins efficaces et appropriés, mais doivent être converties en intelligence utile); le principe des nombreuses mains (l’action concertée entre les principales parties prenantes est la clé); et le principe du patient en tant qu’acteur principal (placer les patients au centre d