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Background Healthcare is amongst the most complex of human systems. Coordinating activities and integrating newer with older ways of treating patients while delivering high-quality, safe care, is challenging. Three landmark reports in 2018 led by (1) the Lancet Global Health Commission, (2) a coalition of the World Health Organization, the Organisation for Economic Co-operation and Development and the World Bank, and (3) the National Academies of Sciences, Engineering and Medicine of the United States propose that health systems need to tackle care quality, create less harm and provide universal health coverage in all nations, but especially low- and middle-income countries. The objective of this study is to review these reports with the aim of advancing the discussion beyond a conceptual diagnosis of quality gaps into identification of practical opportunities for transforming health systems by 2030. Main body We analysed the reports via text-mining techniques and content analyses to derive their key themes and concepts. Initiatives to make progress include better measurement, using the capacities of information and communications technologies, taking a systems view of change, supporting systems to be constantly improving, creating learning health systems and undergirding progress with effective research and evaluation. Our analysis suggests that the world needs to move from 2018, the year of reports, to the 2020s, the decade of action. We propose three initiatives to support this move: first, developing a blueprint for change, modifiable to each country’s circumstances, to give effect to the reports’ recommendations; second, to make tangible steps to reduce inequities within and across health systems, including redistributing resources to areas of greatest need; and third, learning from what goes right to complement current efforts focused on reducing things going wrong. We provide examples of targeted funding which would have major benefits, reduce inequalities, promote universality and be better at learning from successes as well as failures. Conclusion The reports contain many recommendations, but lack an integrated, implementable, 10-year action plan for the next decade to give effect to their aims to improve care to the most vulnerable, save lives by providing high-quality healthcare and shift to measuring and ensuring better systems- and patient-level outcomes. This article signals what needs to be done to achieve these aims.

IntroductionMisinformation refers to inadvertent misleading information that the public may be exposed and share without intent to cause harm, and can delay or prevent effective care, affect mental health, lead to misallocation of health resources and/or create or exacerbate public-health crises. There are many strategies to address misinformation, but there is a need to evaluate their effects. Our objective is to synthesise and routinely update evidence to assess the impact of strategies to mitigate health-related misinformation in diverse settings, and populations.Methods and analysisWe will search seven databases in May 2023 with planned updates at 6 and 9 months, which will be supplemented with searches for grey literature and reference lists of included studies and contacting experts. Two reviewers will independently screen all search results for studies that evaluate one or more approaches to addressing health-related misinformation. One researcher will conduct data extraction and risk of bias assessments, which will be reviewed by a second reviewer for accuracy. We will include experimental, quasi-experimental and observational studies for any populations, settings and diseases without language or publication restrictions. We will conduct quantitative analysis if meta-analytical pooling is possible. If pooling is not possible, we will synthesise quantitative data according to outcomes and interventions addressed, and present a narrative summary of findings disaggregated by sex and/or gender, irrespective of whether differences were found.Ethics and disseminationThere are no individuals or protected health information involved and no safety issues identified. Results will be published through the Global Commission on Evidence and COVID-END websites, in a peer-reviewed journal, as well as through plain-language materials.PROSPERO registration numberCRD42023421149.

Abstract Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care—all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens. In this first of two companion articles on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), in consultation with representatives from over 40 countries, we assess this situation and discuss the implications for safety and quality. Health systems will need to run ahead of the coming changes and learn how to cope better with more people with more chronic and acute illnesses needing care. This will require collective ingenuity, and a deep desire to reconfigure healthcare and re-engineer services. Chief amongst the successful strategies, we argue, will be preventative approaches targeting both physical and psychological health, paying attention to the determinants of health, keeping people at home longer, experimenting with new governance and financial models, creating novel incentives, upskilling workforces to fit them for the future, redesigning care teams and transitioning from a system delivering episodic care to one that looks after people across the life cycle. There are opportunities for the international community to learn together to revitalise their health systems in a time of change and upheaval.

Healthcare systems across the world are experiencing increased financial, organizational and social pressures attributable to a range of critical issues including the challenge of ageing populations. Health systems need to adapt, in order to sustainably provide quality care to the widest range of patients, particularly those with chronic and complex diseases, and especially those in vulnerable and low-income groups. We report on a workshop designed to tackle such issues under the auspices of ISQua, with representatives from Argentina, Australia, Canada, Columbia, Denmark, Emirates, France, Ireland, Jordan, Qatar, Malaysia, Norway, Oman, UK, South Africa and Switzerland. We discuss some of the challenges facing healthcare systems in countries ageing rapidly, to those less so, and touch on current and future reform options. Los sistemas de atención sanitaria en todo el mundo se hallan bajo presiones financieras, organizativas y sociales, atribuibles a una serie de temas cruciales, entre ellos el reto del envejecimiento de la población. Los sistemas de atención sanitaria necesitan adaptarse, con el fin de proporcionar de manera sostenible una atención de calidad al mayor número de pacientes, particularmente aquellos con enfermedades crónicas y complejas, y en especial a los grupos de personas vulnerables y de renta baja. Se informa de los resultados de un seminario diseñado para abordar estas cuestiones y amparado por la ISQua, con representantes de Argentina, Australia, Canadá, Colombia, Dinamarca, Emiratos Árabes, Francia, Irlanda, Jordania, Qatar, Malasia, Noruega, Omán, Reino Unido, Sudáfrica y Suiza. Se tratan algunos de los desafíos que enfrentan los sistemas de atención sanitaria en los países que envejecen rápidamente, y a los que no tanto, y menciona brevemente las opciones de reformas actuales y futuras. Os sistemas de saúde ao redor do mundo enfrentam o aumento de pressões financeiras, organizacionais e sociais atribuíveis a uma série de questões críticas, incluindo o desafio do envelhecimento da população. Os sistemas de saúde precisam se adaptar, para que possam prestar, de forma sustentável, cuidado de saúde de qualidade ao maior número possível de pacientes, particularmente àqueles com doenças crônicas e com complexas condições de saúde, especialmente, aqueles em grupos vulneráveis e de baixa renda. Nosso estudo trata de um workshop destinado a resolver essas questões realizado sob a tutela da ISQua, com representantes da Argentina, Austrália, Canadá, Colômbia, Dinamarca, Emirados Árabes, França, Irlanda, Jordânia, Qatar, Malásia, Noruega, Omã, Reino Unido, África do Sul e Suíça. Discutimos alguns dos desafios enfrentados pelos sistemas de saúde em países em rápido envelhecimento, como também em países com menor índice de envelhecimento, debatendo sobre as opções de reforma atuais e futuras. 全球的健康照护体系正面临不断增加的财务、组织与 社会压力,原因包括老年人口的一系列相关议题,为 了能持续地提供广泛的病人具质量的医疗照护,特别 是那些慢性与复杂疾病、尤其是弱势与低收入的族 群。 为了处理这样的议题,在国际健康照护质量协会 (ISOua)的资助下,我们与来自世界各国的代表团(阿根 廷、澳大利亚、加拿大、哥伦比亚、丹麦、阿联酋、 法国、爱尔兰、约旦、卡塔尔、马来西亚、挪威、阿 曼、英国、南非、瑞士)于研讨会上报告,并讨论在快 速老化的国家其健康照护系统面临的挑战,并提到目 前与与未来的改革方向。 全球的健康照護體系正面臨不斷增加的財務、組織與 社會壓力,原因包括老年人口的一系列相關議題,為 了能持續地提供廣泛的病人具品質的醫療照護,特別 是那些慢性與複雜疾病、尤其是弱勢與低收入的族 群。為了處理這樣的議題,在國際健康照護品質協會 (ISOua)的資助下,我們與來自世界各國的代表團(阿根 廷、澳大利亞、加拿大、哥倫比亞、丹麥、阿聯酋、 法國、愛爾蘭、約旦、卡塔爾、馬來西亞、挪威、阿 曼、英國、南非、瑞士)於研討會上報告,並討論在快 速老化的國家其健康照護系統面臨的挑戰,並提到目 前與與未來的改革方向。 医療システムは、増加する財政的、組織的、社会的 な圧力に世界中で直面しており、その圧力は高齢者 対策など広範囲にわたる喫緊の課題に起因する。医 療システムは、最大多数の多様な患者へ、質の高い ケアを持続的に提供できるよう、特に慢性化したり 複雑な病態をもつ患者や、とりわけ脆弱で収入の低 い集団に対応する必要がある。今回、ISQuaの支援の もと、アルゼンチン、オーストラリア、カナダ、コ ロンビア、デンマーク、アラブ首長国連邦、フラン ス、アイルランド、ヨルダン、カタール、マレーシ ア、ノルウェー、オマーン、イギリス、南アフリ カ、スイスの各国代表者とともに、これらの課題に 取り組むために企画されたワークショップの結果を 報告する。そして、高齢化が急速に進む国々のいく つかの医療システムの取り組みについて、高齢化の 速度が緩い国々に向けても議論し、また現在および 今後の改善策の可能性について触れる。 Les systèmes de soins de santé à travers le monde connaissent une augmentation de la pression financière, organisationnelle et sociale qui sont attribuables à un ensemble de problèmes incontournables, dont le défi des populations vieillissantes. Les systèmes de santé doivent s’adapter, dans l’objectif de fournir de manière durable des soins de qualité au plus grand nombre de patients, en particulier ceux touchés par des maladies chroniques et complexes, et en particulier ceux des groupes fragiles et à faible revenu. Nous dévrivons un atelier réalisé pour aborder ces questions sous les auspices de ISQua, avec des représentants de l’Argentine, de l’Australie, du Canada, de la Colombie, du Danemark, des Émirats Arabes unis, de la France, de l’Irlande, de la Jordanie, du Qatar, de la Malaisie, de Norvège, d’Oman, du Royaume-Uni, d’Afrique du Sud, et de la Suisse. Nous discutons de quelques-uns des défis auxquels sont confrontés les systèmes de soins de santé dans des pays où le vieillissement évolue rapidement, à ceux où il l’est moins, et nous évoquons les options relatives aux réformes actuelles et futures.

Abstract In Part 2 of this two-part contribution made on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), we continue the argument for refashioning health systems in response to ageing and other pressures. Massive ageing in many countries and accompanying technological, fiscal and systems changes are causing the tectonic plates of healthcare to shift in ways not yet fully appreciated. In response, while things remain uncertain, we nevertheless have to find ways to proceed. We propose a strategy for stakeholders to pursue, of key importance and relevance to the ISQua: to harness flexible standards and external assessment in support of needed change. Depending on how they are used, healthcare standards and accreditation can promote, or hinder, the changes needed to create better healthcare for all in the future. Standards should support people’s care needs across the life cycle, including prevention and health promotion. New standards that emphasise better coordination of care, those that address the entire healthcare journey and standards that reflect and predict technological changes and support new models of care can play a part. To take advantage of these opportunities, governance bodies, external assessment agencies and other authorities will need to be less prescriptive and better at developing more flexible standards that apply to the entire health journey, incorporating new definitions of excellence and acceptability. The ISQua welcomes playing a leadership role.

Abstract While it is widely recognized that accreditation enables an organization to improve its performance and sustain a culture of quality, changing healthcare practices to align with evidence-informed guidelines (clinical and administrative) is a complex process that takes time. The true value of accreditation lies in its contribution to healthcare safety and quality as a means to prompt and support ‘knowledge to action’, a key value of accreditation that ‘has yet to be articulated’. Using the ‘knowledge to action’ cycle, a planned action framework, we illustrate that accreditation is a knowledge translation (KT) or implementation intervention that seeks to improve and increase the uptake of evidence in healthcare organizations. The accreditation components, including the quality framework, standards, self-assessment process and on-site survey visit, ultimately serve to improve quality, decreasing variation in practice and strengthening a culture of quality. With a unique perspective and alignment obtained through the implementation lens, we examine the accreditation process and components relative to the ‘knowledge to action cycle’ with implications for enhancing the value of accreditation beyond current appreciation to both accreditation bodies worldwide and those organizations that participate in accreditation programs. Until organizations and accreditation bodies embrace the accreditation process as a knowledge to action intervention to bring about meaningful and sustained change, the full benefits of the process will not be optimized nor achieved.

Background Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of research. With IKT, knowledge users work with researchers throughout the research process, starting with identification of the research question. Knowledge users represent those who would be able to use research results to inform their decisions (e.g. clinicians, managers, policy makers, patients/families and others). Stakeholders are increasingly interested in the idea that IKT generates greater and faster societal impact. Stakeholders are all those who are interested in the use of research results but may not necessarily use them for their own decision-making (e.g. governments, funders, researchers, health system managers and policy makers, patients and clinicians). Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. This paper presents a protocol for a programme of research testing the assumption that engaging the users of research in phases of its production leads to (a) greater appreciation of and capacity to use research; (b) the production of more relevant, useful and applicable research that results in greater impact; and (c) conditions under which it is more likely that research results will influence policy, managerial and clinical decision-making. Methods The research programme will adopt an interdisciplinary, international, cross-sector approach, using multiple and mixed methods to reflect the complex and social nature of research partnerships. We will use ongoing and future natural IKT experiments as multiple cases to study IKT in depth, and we will take advantage of the team’s existing relationships with provincial, national and international organizations. Case studies will be retrospective and prospective, and the 7-year grant period will enable longitudinal studies. The initiation of partnerships, funding processes, the research lifecycle and then outcomes/impacts post project will be studied in real time. These living laboratories will also allow testing of strategies to improve the efficiency and effectiveness of the IKT approach. Discussion This is the first interdisciplinary, systematic and programmatic research study on IKT. The research will provide scientific evidence on how to reliably and validly measure collaborative research partnerships and their impacts. The proposed research will build the science base for IKT, assess its relationship with research use and identify best practices and appropriate conditions for conducting IKT to achieve the greatest impact. It will also train and mentor the next generation of IKT researchers.

Providing high quality and safe patient care is a challenge in the current rapidly changing and complex health care environment. A variety of independent tools and methodologies contribute to this effort, e.g. regulatory requirements, quality improvement tools and accreditation methodologies. A concern is that each alone will not achieve the tipping point in health care quality that is required. This paper suggests that the methodology and application of accreditation have the potential to be the force to bring these approaches into alignment and ultimately measurably improve the quality of care.

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.

Objective. To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Design. Web-based questionnaire survey. Participants. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. Main Outcome Measure(s). External relationships, scope and activity public information. Results. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. Conclusions. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.