Figueroa Carah Alyssa, Harrison Reema, Chauhan Ashfaq, Meyer Lois
School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052, Australia.
BMC Health Serv Res. 2019 Apr 24;19(1):239. doi: 10.1186/s12913-019-4080-7.
Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers.
A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified.
Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers.
Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.
卫生系统复杂多样，且在各种环境和卫生服务层面不断变化。卫生管理者和领导者应对当前及新出现问题所需的能力尚未得到充分理解。迄今为止的研究都是针对特定国家的，尚未整合不同的国际和多层次见解。本综述在三个结构层面审视了不同环境和卫生系统中卫生领导力和劳动力管理当前及新出现的挑战，从总体宏观（国际、国家）环境到组织的中观环境，再到个体医疗保健管理者的微观环境。
通过对与卫生领导力和管理相关的各类文献的选定部分进行系统检索，开展了一项快速证据综述。针对全球卫生、卫生服务管理和卫生领导力的主要概念，制定了一系列文本词汇、同义词和主题词。对三个电子数据库（MEDLINE®、PubMed和Scopus）进行了探索性综述，以确定2010年1月至2018年7月期间相关内容的主要出版渠道。随后，除了对已确定的关键期刊进行手工检索以及对已确定的相关论文的参考文献列表进行检索外，还将检索策略应用于已确定的关键期刊。三位评审员独立将纳入标准应用于潜在相关文章。对数据进行叙述性综合，以突出所确定的关键概念。
纳入了63篇文章。在三个结构层面上体现了国际医疗保健部门卫生领导力和管理方面一系列一致的挑战和新出现的趋势。在宏观层面，这些因素包括社会、人口、历史和文化因素；在中观层面，人力资源管理挑战、不断变化的结构和绩效衡量以及强化管理；在微观层面，医疗保健管理者在工作场所的角色和期望不断变化。
全球卫生管理劳动力的当代挑战和新出现的需求围绕节省效率、变革和人力资源管理展开。卫生管理者的角色正在演变和扩大，以满足这些新的优先事项。确保当代卫生领导者和管理者具备应对当前形势的能力至关重要。
