Championing health systems management with digital innovation and applications in the age of artificial intelligence: protocol for a research program

Introduction

Facing a rising patient volume driven by population growth and demographic aging, diverse health needs, stringent regulations, and economic restrictions, health systems are under considerable pressure.^1–3 The escalating demand across global health systems is a prominent concern, with projections indicating an even more challenging and potentially unsustainable future. For instance, in low- and middle-income countries, an additional annual expenditure of 274 to 371 billion dollars is estimated to be necessary by 2030.⁴ This increase in expenses would significantly raise the average healthcare spending per person. However, alarmingly, a funding shortfall of 20 to 54 billion dollars per year is still anticipated.⁴

In this context, health managers are responsible for orchestrating the continuous operation of these complex systems across various levels, ensuring optimal patient care while simultaneously balancing financial, regulatory, and human resource challenges. Their role demands strategic vision, adaptability, and a deep understanding of both clinical and administrative domains, making them essential stakeholders in the constantly evolving healthcare landscape.⁵ For example, middle managers in healthcare organizations play a critical role in implementing healthcare innovations by disseminating and synthesizing information, as well as bridging the gap between strategy and the execution of daily activities.⁶ A study conducted to determine the key roles, functions, and responsibilities of health managers and administrators across various units and departments revealed that, regardless of the setting, these professionals dedicate significant time and effort to problem-solving and decision-making, collaborating with other disciplines, developing people, and cost containment.⁷

Since then, this scenario has followed the trend of digital transformation, which is now redefining how healthcare sectors can operate.^8,9 In the last decade, the healthcare industry has seen a surge in the development of specialized software systems and tools tailored to its specific needs. Systems and technologies designed for health management have become widespread.¹⁰ These technologies cover a broad range of functions, from complex patient management and strategic resource allocation to data-driven analytics and telehealth.^11,12 Nowadays, health managers are equipped with a diverse array of sophisticated software systems and technological tools.¹³ Commercial solutions and bespoke applications have transformed the ways in which healthcare systems confront their challenges. Among these digital advancements, artificial intelligence (AI) emerges as a particularly significant subset.^14,15 Techniques such as machine learning, predictive analytics, and natural language processing hold the potential to improve decision-making processes, enhance operational efficiency, and more accurately predict trends within healthcare systems.^16,17

Interestingly, despite a wealth of perspectives on digital tools for clinical professionals and patient-directed applications, the literature focused on their use by health managers remains underrepresented.^13,14,18,19 These professionals, endowed with significant decision-making responsibilities, influence structures that profoundly impact healthcare delivery and public health policies.^20,21 The narratives surrounding the strategic utility, implications, and challenges of these technologies from the perspective of healthcare system managers are still fragmented or primarily focused on clinical applications.²² Moreover, it is crucial to discern the gap between the potential benefits and the benefits realized in practice.^18,23 While many institutions have successfully leveraged AI and digital solutions, others face integration challenges ranging from technical obstacles to stakeholder resistance.²⁴

Given the transformative potential and inherent complexities of developing and adopting digital tools, it becomes imperative to gain insights to map the current landscape and devise future strategies. Health management, with its extensive implications, requires decisions based on evidence.²⁵ To this end, this project aims to delve into the current state of the field by providing a synthesized, taxonomized, and critical view of the existing evidence and, from there, to create solutions that can accelerate informed decision-making, support the dissemination of knowledge, and shape future research and technology development trajectories.

Objectives

Methods

This project stems from the core of a larger umbrella project: the CIARS Network - Artificial Intelligence Applied to Health, which was included in the Innovative Networks of Strategic Technologies (RITEs) program, sponsored by the State of Rio Grande do Sul Research Support Foundation (FAPERGS).²⁶

When applicable in the phase that will involve human participants, the study part will be submitted to the Research Ethics Committee of the University of Passo Fundo - RS through the Plataforma Brazil, in compliance with Resolution 466/2012 of the National Health Council regarding the participation of individuals in research.

Due to the involvement of mixed methods, each phase will have its own in-depth design, which will be elaborated upon at the time of execution. This protocol includes a general outline of the work scope and execution strategy. Figure 1 provides a detailed overview of the project’s methodology and action strategies across its phases.

Figure 1. Overview of study methods and phases.

Expected results and contributions

This project aims to advance the application and management of digital technologies, including artificial intelligence, within healthcare systems. By combining systematic reviews, analysis of commercial solutions, and in-depth interaction with health managers, it strategically addresses gaps in knowledge and practice. The methodology, particularly the inclusion of data triangulation and co-creation processes with professionals, ensures a multidimensional and innovative approach. This strategy not only guarantees the relevance and applicability of the developed guidelines but also sets a new standard for the integration of emerging technologies in health management, promoting tangible improvements in decision-making and operational processes.

The innovation of the project lies not only in its methodological approach but also in its ability to bring together diverse perspectives and expertise, spanning academia, the technology industry, and the healthcare sector. This enables the creation of a guidelines framework that is robust, inclusive, and adaptable to various healthcare contexts. The expectation is that this framework will serve as a reliable guide for health managers and technology developers, guiding the effective implementation of digital solutions that directly meet the needs of healthcare systems.

Furthermore, the execution of this project has the potential to result in high-impact academic publications, making a significant contribution to the scientific literature in the fields of health management and technology. These publications, already planned in the methodological design, will disseminate essential knowledge to the academic and practical community, stimulating future research and practical applications. The anticipation of articles derived from each phase of the project reinforces the expected academic and practical contribution, marking its presence in scientific discussions and relevant conferences in the field.

The expected impact of the project extends beyond academic boundaries, influencing health policies, management practices, and technology development. By addressing a critical gap in an innovative manner and producing a set of validated, evidence-based guidelines, the project promotes a real transformation in how digital technologies are conceived, implemented, and managed in healthcare systems. Thus, the project not only contributes to scientific and practical advancement at the intersection of technology and health management but also offers a viable pathway for the continuous improvement of the quality, efficiency, and sustainability of healthcare services.

Ethical approval

When appropriate in the segment involving human subjects, the component of the study will be presented to the Research Ethics Committee of the University of Passo Fundo - RS via Plataforma Brazil, in adherence to Resolution 466/2012 of the National Health Council concerning individual participation in research. The submission will include an analysis request by the ethics committee for the participation of individuals in qualitative interviews along with a solicitation for written consent concerning the use of images and assurances of confidentiality. Given that this study does not constitute a health intervention, it is anticipated that the ethics committee will exempt it from the requirement for approval.

Consent statement

Participants will be required to provide written consent to partake in the study, which entails engaging in interviews and qualitative activities. This consent will cover the direct use of images and ensure confidentiality concerning the information disclosed.

Data availability

No data are associated with this article.