Systems Engineering Tools Reshape Healthcare Services, Review Finds

A sweeping systematic review published in BMC Health Services Research has mapped how systems engineering and design methodologies are being applied across healthcare services and systems, and proposes a new conceptual framework for matching the right method to the right problem. The study, led by Yuan Yin, Thomas Richards, Ji Han and Saeema Ahmed-Kristensen, screened 1,752 papers after duplicate removal and ultimately included 32 reviews covering a total of 1,127 individual studies. The search was conducted on 4 November 2024 and covered reviews published within the previous five years, drawing on eleven databases including Embase, Medline, PsycInfo, CINAHL, SCOPUS and Web of Science.

The review’s central finding is that systems engineering and design approaches have been increasingly adopted in healthcare service contexts, with service design, service improvement and service development emerging as the most common areas of focus. According to the review, these approaches show promise towards increasing efficiency and reducing costs for health systems and services while preserving patient experience and health outcomes, yet their application across health systems has so far remained limited.

Methodologically, the team restricted inclusion to reviews of systems engineering methodologies applied at a systems level in healthcare, encompassing quantitative and qualitative secondary studies such as reviews, systematic reviews, overviews, meta-analyses and meta-syntheses. Primary studies were excluded, as were interventions that used systems engineering methods toward specific products such as healthcare apps rather than services or systems themselves. A framework synthesis methodology was used to extract data according to a framework developed a priori, and the risk of bias or quality assessment tools applied in each included review were catalogued.

Among the review’s most striking observations is the distinct role played by user-centred design and co-design approaches. The synthesis found that these approaches have enabled more inclusive and patient-responsive service frameworks, and are most effective for addressing patient-level challenges, enhancing usability, engagement and experiential outcomes at what the authors call the micro level of healthcare.

At the opposite end of the scale, the review found that system-level transformation demands a different toolkit. Systems thinking combined with structured stakeholder engagement is required to manage complexity and support sustainable organisational and policy change at the macro level. Meanwhile, systems approaches have provided tools for managing complexity at policy and organisational levels more broadly.

This distinction matters because healthcare operates simultaneously across micro, meso and macro levels, corresponding to the individual patient, the service and the system as a whole, and the new framework maps explicitly how different methodologies operate across these tiers. The authors emphasise that sub-methodologies within the systems engineering family differ in meaningful ways, including their degree of structure, the depth of user engagement they require, and the level of the system they intervene upon. These distinctions underscore the importance of aligning methodological choice with healthcare context and stakeholder needs.

The review also identifies significant gaps that temper enthusiasm. Outcome standardisation remains weak, meaning studies rarely measure success in comparable ways. Implementation evaluation is similarly underdeveloped, and adaptation of these methods for low-resource or culturally diverse settings remains limited. The conceptual framework developed from these findings is intended to offer practical guidance for healthcare leaders and researchers deciding which approach to deploy in a given scenario.

For patient-level improvement, the evidence supports design thinking and patient-engaged co-design approaches, with the notable caveat that effective co-design does not necessarily require following a formal design thinking process. The authors conclude that different methodologies offer distinct strengths across different levels of healthcare, and that recognising these strengths is a first step toward more integrated, patient-centred and system-responsive healthcare improvement.

As a systematic review of published reviews, the study synthesises secondary evidence rather than generating new patient outcome data, and its conclusions reflect the scope of the 32 included reviews and the 1,127 studies they contain. The authors position the framework as a foundation for future work, particularly given the identified gaps in outcome standardisation, implementation evaluation and adaptation across diverse settings.

Subject of Research: Systems engineering and design methodologies applied to healthcare services and systems

Article Title: Systems engineering interventions in healthcare services and systems – a systematic review and framework development

Article References: Yin, Y., Richards, T., Han, J., & Ahmed-Kristensen, S. (2026). Systems engineering interventions in healthcare services and systems – a systematic review and framework development. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15420-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15420-2

Keywords: systems engineering, healthcare services, systematic review, service design, co-design, systems thinking, patient-centred care, health systems, framework synthesis, quality improvement, user-centred design, Systems