Systems of Systems Governance Frameworks: A Thorough Scoping Review and Synthesis Towards Enhancing Healthcare Delivery

The healthcare delivery system exhibits inherent complexities stemming from its composition of multiple autonomous constituent systems with intricate interdependencies, characterized by dynamic and often decentralized operations. In this context, systems of systems (SoS) governance emerges as a promising paradigm to address these multifaceted challenges and optimize system-wide performance. This article conducts a comprehensive scoping review of SoS governance frameworks, focusing on their applicability to healthcare systems. Through a rigorous review process, 45 studies were selected from three major databases, yielding 37 distinct governance frameworks. The review analyzes publication trends, research objectives, applied frameworks, domains of application, and methodologies, providing a multifaceted understanding of the SoS governance landscape. The study highlights one framework that aligns closely with our proposed construct for healthcare system governance, and the alignment is discussed. In addition, technical components and variations across frameworks are identified and discussed, revealing the complexity and diversity of approaches in SoS governance.