Care transformation defined by conditions, mechanisms, and outcomes: a systematic literature review

Abstract Background Quality of care is under pressure due to demographic changes (shifting age of the population), epidemiological trends (more chronic diseases) and changes in the external environment (rapid development of technological innovations). Transformation in care is essential to deal with these changes. However, there is no consensus in the literature regarding the definition and factors contributing to care transformation. Methods This systematic review systematically searched the scientific databases Scopus, Web of Science and Pubmed until 22 January 2022. We included articles that focused on care transformation from a complex setting and multi-level perspective, with an empirical or theoretical rationale and methodology. Relevant data regarding the interconnection between contextual conditions, mechanism of change and outcomes were analysed using deductive coding. The generic contextual conditions-mechanisms outcome structure (CMO) as reported (Pawson and Tilly in Realistic Evaluation, Sage Publication Ltd, London, 1997) was used as a framework to synthesise the results. Results Nineteen articles were included. All related articles explain transformation from a complex systems perspective. Four of the 19 articles gave a definition of care transformation. These definitions of care transformation have the following in common: It involves radical and far-reaching change at an organisational and system-wide level, with the aim of improving performance, behaviour, efficiency, and quality of care, both at individual and population level. Relevant contextual conditions were the changing environment, organisational conditions, collaboration, direction of change and sources of funding. Relevant mechanisms for change were collaboration, leadership, interpersonal relationships, engagement, information technology and coordination. The key outcomes of care transformation are Integration of care, patient-centred care, and improvement of quality of care. Conclusions An important goal of care transformation is to deliver better quality of care and enable care integration. This study showed that effective collaboration among healthcare providers, supported by transformational leadership, strong interpersonal relationships, and coordination from multiple perspectives, play an important role in facilitating care transformation. Collaboration is an important mechanism for achieving the key outcomes of care transformation.