Definition and key concepts of high performing health systems: a scoping review

Background : The COVID-19 pandemic identified the need to transform health systems globally. The meaning of a high performing health system is often shaped by specific priorities that may not be widely shared. The first step is to determine how high performing is defined in relation to a health system. The objective of this study is to chart the literature on the definitions and key concepts of high performing health care systems. Methods : A scoping review was conducted by searching the published and unpublished literature. Two reviewers independently screened titles and abstracts, then full-text articles. Data abstraction was performed independently by two investigators. Data were summarized descriptively by allocating concepts or characteristics into categories and reporting frequencies. Results: A total of 3441 citations and 485 full-text articles were screened independently by two reviewers, and we included 31 primary articles and 38 companion documents in the review . Three independent definitions for a high performance health system were identified. Eighteen research studies reported outcomes on the elements of a high performing health system (56%), system evaluation (33%), and tool development or validation (11%). Knowledge gaps identified were the lack of a common definition, a lack of common indicators, strategies for moving evidence into policy and practice, and difficulties with comparisons across health systems. Conclusions: We found limited definitions and a lack of empirical evidence on our topic. There is an opportunity for primary research in the area of health systems and high performance. Scoping review registration: https://osf.io/hdyrq