Key takeaways

  • The term 'pressure' has been used in a variety of contexts to describe the status of healthcare systems since long before the COVID-19 pandemic. However, a formal definition of healthcare system pressure (HCSP) is currently lacking.
  • This work developed and tested a novel conceptual framework of HCSP.
  • HCSP occurs when the demand determining the utilised capacity of a resource exceeds its usable capacity.
  • Responses to HCSP include expansion of capacity in anticipation of pressure or as a pressure-mitigating action.
  • HCSP can be measured using direct metrics of utilisation of each resource, or indirect metrics of the impact of pressure.
  • Our framework has the potential to improve understanding of HSCP and may aid future decision-making on the use of interventions that prevent and mitigate pressure.

The COVID-19 pandemic demonstrated the consequences of resource scarcity within healthcare systems. The term ‘pressure’ has been invoked to describe the challenges faced, from overall healthcare system impacts to specific units, resources, and financial aspects.

We found a need for a formal conceptualisations of pressure within healthcare settings. Following a literature review, we defined HCSP as the scenario where the demand determining the utilised capacity of a resource surpasses its usable capacity. Responses to HCSP involve expanding capacity either in anticipation of pressure or as a pressure-mitigating action. The framework introduces the option to measure HCSP using direct metrics of resource use or indirect metrics reflecting the impact of pressure.

To validate the framework’s usefulness, we interviewed healthcare professionals focusing on respiratory syncytial virus (RSV) and Clostridioides difficile infections as case studies infections. The results upheld the comprehensiveness of our framework as a tool to describe pressure and responses to it.

Figure 1 Conceptual Framework of HCSP

Conceptual framework of HCSP

The framework establishes a shared language for policy and decision-makers to systematically define, address, and measure the impact of HCSP as Figure 1 shows. Furthermore, it offers valuable insights for future decision-making, particularly supporting Health Technology Assessment (HTA) bodies in measuring the value of health technologies that can prevent and mitigate pressure.

In conclusion, our conceptual framework for HCSP provides a foundational step towards a more systematic understanding of pressure in healthcare systems, especially in the context of infectious diseases. It calls for further research on metrics and data that enable effective measurement of pressure, contributing to informed decision-making and improved healthcare system performance.

This report, ‘Developing a conceptual framework of healthcare system pressure’, was commissioned and funded by Pfizer Inc.

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