# A novel policy dialogue to build sustainable and resilient health systems: findings from PHSSR Portugal

## TL;DR

This study explores how involving health experts in policy discussions can improve the sustainability and resilience of Portugal's healthcare system.

## Contribution

The study introduces a novel policy dialogue combining workshops, Web-Delphi processes, and Dialogue Mapping to generate health policy recommendations.

## Key findings

- 40 health stakeholders collaboratively generated and discussed 69 policy recommendations, selecting 43 with high agreement.
- Governance and Population Health recommendations were identified as critical for improving system sustainability and resilience.
- The policy dialogue method showed high convergence and interconnectedness among recommendations.

## Abstract

In the aftermath of the COVID-19 pandemic, health policymakers have been reflecting upon sustainability and resilience issues in health systems worldwide. Promoting sustainability and resilience requires policy changes built upon evidence and on the views of health stakeholders and experts. This study aimed to engage health stakeholders in designing and discussing policy recommendations with a high potential to improve sustainability and resilience in the Portuguese healthcare system.

As part of the Partnership for Health System Sustainability and Resilience initiative in Portugal (PHSSR-PT), this study proposes a novel policy dialogue that combines participatory methods—workshops and Web-Delphi processes—with content analysis tools—namely Dialogue Mapping—to promote agreement and help health stakeholders and experts to identify and discuss policy recommendations with high potential to improve health systems’ sustainability and resilience. Departing from the COVID-19 pandemic as a critical event and drawing on evidence and data, a group of health stakeholders and experts ideated and agreed upon high-value policy recommendations across seven domains: Governance, Financing, Workforce, Medicines and Technology, Service Delivery, Population Health and Environmental Sustainability.

40 top-level Portuguese health stakeholders and experts successfully collaborated to generate and discuss the benefits, risks and implementation issues of 69 policy recommendations, out of which 43 were selected as having gathered a high level of agreement on their potential to improve system sustainability and resilience. The adopted policy dialogue promoted high convergence. Many of these 43 recommendations were shown to entail interconnectedness with other policy recommendations.

This study provides actionable insights to advance discussions on sustainability and resilience in Portugal. It shows that Governance and Population Health policy recommendations are critical to improve sustainability and resilience in several domains, and there is a high level of agreement on the need to adopt many recommendations, but questions remain about their implementation. The study also shows that new ways of engaging health stakeholders and experts can be adopted to promote dialogue, consensus and transparent discussion in policy processes.

The online version contains supplementary material available at 10.1186/s12961-025-01329-5.