Burger Nicola, Gilson Lucy
Genesis Analytics, 50 6th Street, Hyde Park, Johannesburg 2196, South Africa.
Division of Health Policy and Systems, University of Cape Town, Falmouth Road, Observatory, Cape Town 7925, South Africa.
Health Policy Plan. 2025 Mar 7;40(3):391-408. doi: 10.1093/heapol/czaf001.
Understanding health systems as comprising interacting elements of hardware and software acknowledges health systems as complex adaptive systems (CASs). Hardware represents the concrete components of systems, whereas software represents the elements that influence actions and underpin relationships, such as processes, values, and norms. As a specific call for research on health system software was made in 2011, we conducted a qualitative scoping review considering how and for what purpose the concept has been used since then. Our overall purpose was to synthesize current knowledge and generate lessons about how to deepen research on, and understanding of, health system software. The review consisted of two phases: first, for the period 2011-23, all papers that explicitly used the concept of health system software were identified and mapped; second, drawing on a subset of papers from Phase 1, we explored how the concept was purposively used within research. The databases PubMed, Scopus, EBSCOhost, Web of Science, and Google Scholar were systematically searched using a strategy developed by a skilled librarian. In Phase 1, data were extracted from 98 papers. Our analysis revealed that a third of the papers used the software concept rather superficially; a third used it to conceptualize the importance of selected software elements; and a third used it in examining a specific health system experience, such as preparedness or resilience. In Phase 2, our analysis confirmed that researchers have found value in proactively using the software concept within studies, demonstrating two patterns of use. However, a limited understanding of how to investigate interactions among hardware and software elements was also revealed. Future health policy and systems research should purposively investigate hardware-software interactions in order to gain a greater understanding of the complex, adaptive nature of health systems, understand their operations, and institutionalize thinking that considers health systems as CASs.
将卫生系统理解为由硬件和软件的相互作用元素组成，这承认了卫生系统是复杂适应系统（CASs）。硬件代表系统的具体组成部分，而软件代表影响行动并支撑关系的元素，如流程、价值观和规范。由于2011年有人专门呼吁对卫生系统软件进行研究，我们进行了一项定性范围审查，考虑自那时以来该概念是如何以及出于何种目的被使用的。我们的总体目的是综合当前知识，并总结关于如何深化对卫生系统软件的研究和理解的经验教训。该审查包括两个阶段：第一，在2011 - 2023年期间，识别并绘制所有明确使用卫生系统软件概念的论文；第二，利用第一阶段的一部分论文，我们探讨了该概念在研究中是如何有目的地被使用的。使用一位熟练的图书馆员制定的策略，系统地搜索了PubMed、Scopus、EBSCOhost、Web of Science和谷歌学术等数据库。在第一阶段，从98篇论文中提取了数据。我们的分析表明，三分之一的论文对软件概念的使用较为肤浅；三分之一的论文用它来概念化选定软件元素的重要性；三分之一的论文用它来研究特定的卫生系统经验，如准备情况或恢复力。在第二阶段，我们的分析证实，研究人员发现在研究中积极使用软件概念有价值，展示了两种使用模式。然而，也揭示了对如何研究硬件和软件元素之间的相互作用的理解有限。未来的卫生政策和系统研究应专门调查硬件 - 软件相互作用，以便更好地理解卫生系统的复杂适应性本质，了解其运作，并将将卫生系统视为CASs的思维制度化。
