Challenges and enablers in health care commissioning using the epis implementation framework: a scoping review.
Abstract
Objective
This scoping review synthesizes evidence on challenges and enablers influencing health care commissioning using the EPIS (exploration, preparation, implementation, sustainment) framework to examine contextual determinants across system-level (outer), organizational-level (inner), and bridging domains. INTRODUCTION: Health care commissioning is a strategic mechanism for aligning services with population needs through planning, contracting, and evaluation. Despite its critical role, implementation is often hindered by fragmented policies, unclear governance, and limited integration. ELIGIBILITY CRITERIA: Peer-reviewed empirical studies examining health care commissioning processes across any setting were eligible for inclusion in the review.
Methods
This review followed JBI methodology for scoping reviews and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A systematic search of Scopus, PsycINFO, MEDLINE, and Web of Science Core Collection was conducted. Data were thematically analyzed and mapped to EPIS domains and commissioning cycle stages.
Results
This review identified 82 eligible studies examining health care commissioning processes. Outer-context challenges included political influence, policy misalignment, and unstable funding. Inner-context challenges encompassed organizational fragmentation, leadership ambiguity, and resource constraints. Bridging challenges involved poor data sharing and weak inter-agency communication. Outer-context enablers included integrated governance; inner-context enablers included collaborative leadership and capacity-building; and bridging enablers included data interoperability and improved communication.
Conclusion
Strengthening governance, embedding participatory practices, and investing in digital infrastructure are actionable strategies to enhance responsiveness, equity, and efficiency in commissioning. These findings provide a practical framework for improving implementation and will inform future research on adaptive, integrated models of care. REVIEW REGISTRATION: OSF https://osf.io/cmrf3/.
