Impact of Governance, Risk Management and Compliance on Healthcare System: A Systematic Review

Abstract

Aim: To systematically review the role, implementation, and impact of governance, risk management, and compliance (GRC) practices in healthcare systems, identifying their benefits, barriers, and strategic approaches to enhance healthcare delivery and system sustainability. Materials and methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO. The studies from Jan 2010 to Mar 2025 were sourced from PubMed, MEDLINE, Google Scholar, and gray literature. Eligible studies examined GRC in health care using qualitative, quantitative, or review designs. Inclusion of review studies was critically assessed due to potential redundancy and bias. Thematic synthesis was employed to extract and organize findings across implementation strategies, settings, stakeholders, and outcomes, including care quality, safety, compliance, and organizational performance. Risk of bias was evaluated using tools appropriate to each study design. Results: Out of 85 screened records, 22 studies met the inclusion criteria: Three systematic reviews, one scoping review, four cross-sectional studies, four narrative reviews, four editorials/expert commentaries, five conceptual or policy papers, and one perspective article. Settings ranged from primary care institutions to national-level healthcare systems across the Netherlands, Australia, the UK, Italy, the USA, and international contexts. Integration of GRC was positively associated with improved patient safety, care quality, regulatory compliance, organizational efficiency, and financial outcomes. Key enablers included leadership support, stakeholder engagement, and tailored implementation strategies. Common barriers were cultural resistance, limited resources, concerns over data privacy, low trust in digital technologies, and the absence of standardized frameworks. Improved digital governance and cybersecurity contributed to better technology integration and long-term system sustainability. Conclusion: Effective implementation of GRC practices in healthcare systems contributes to improved care quality, patient safety, and operational sustainability. Customization to local contexts and active involvement of stakeholders are essential for optimizing the impact of GRC frameworks. Clinical significance: The study highlights the growing need for structured GRC integration in health care to address digital transformation challenges. Findings support its clinical translational value by emphasizing safer, more efficient, and regulation-compliant healthcare delivery, thereby contributing to long-term system resilience and global health security.