Processes, contexts, and rationale for disinvestment: a protocol for a critical interpretive synthesis

Area of Science:

• Health Services Research
• Health Policy and Management
• Health Economics

Background:

• Healthcare systems globally face pressure to maximize resource utilization ('do more with less').
• Reassessing and redirecting resources from obsolete, inefficient, or ineffective areas to more effective ones is a key strategy.
• This process is known as disinvestment, aiming to improve overall health system performance.

Purpose of the Study:

• To understand the conditions and decision-making processes for pursuing health system disinvestment.
• To investigate the methods employed by health systems to undertake disinvestment initiatives.
• To examine the implementation strategies and contextual factors influencing disinvestment approaches.

Main Methods:

• A critical interpretive synthesis (CIS) approach will be used to develop a theoretical framework.
• Systematic and purposive literature searches will identify relevant empirical and non-empirical articles.
• Key findings will be extracted and synthesized, incorporating stakeholder feedback through dialogue.

Main Results:

• Disinvestment is an emerging field requiring evidence-based strategies.
• A theoretical framework will be developed to guide disinvestment prioritization, development, and implementation.
• Stakeholder dialogues will refine the framework and identify barriers and strategies for implementation.

Conclusions:

• Disinvestment strategies need context-specific evidence for effective prioritization and implementation.
• The developed framework will support stakeholders in navigating and executing disinvestment initiatives.
• Further research and collaboration are essential for advancing health system disinvestment.