Trauma systems in high socioeconomic index countries in 2050

Table 2 Governance challenges, perspectives, solutions and examples

	Governance
	Challenge	Perspective solution	Example
Quality control	Ensure safety and guideline compliance	Automatic feedback on process and clinical KPI Local and central audit	KPI Dashboard shared across network [8] Rating standardized mortality [8]
Compliance incentive	Reward or sanction performance and compliance Reward positive initiative	Structural, financial incentives Performance feedback to providers, local audit	Best Practice Tariff in UK, incentivized for MTC [74] Network event and tracking system [102]
Centralization versus subsidiarity	Balance between lead agency control and center autonomy	Sufficient resource allocation and competence to preserve subsidiarity	DGU Trauma Netzwerk, UK, Norway, Netherlands [12, 15]
Patient volume	Balance between center volume and exposure and skill level	Quality and KPI control, education	USA, Netherlands, Germany, UK, Norway, Australia, Canada [12, 15, 21, 24, 31]
Patient involvement	Keep care and process patient centered	Associate patients and NOK to governance, audits, priority setting	UK, Canada, Australia [8, 15, 31, 37, 103,104,105]
Rehabilitation capacity and pathway	Insufficient rehabilitation capacities	Calibrate rehabilitation capacity on patient volume Patient-centered trajectories	Australia [37, 95, 103,104,105]

KPI, Key Performance Indicator; MTC, Major Trauma Center; DGU, Deutsche Gesellschaft für Unfallchirurgie

ISSN: 1364-8535