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Background  Producing high-quality, relevant systematic reviews and keeping them up to date is challenging. Cochrane is a leading provider of systematic reviews in health. For Cochrane to continue to contribute to improvements in heath, Cochrane Reviews must be rigorous, reliable and up to date. We aimed to explore existing models of Cochrane Review production and emerging opportunities to improve the efficiency and sustainability of these processes.    Methods  To inform discussions about how to best achieve this, we conducted 26 interviews and an online survey with 106 respondents.    Results  Respondents highlighted the importance and challenge of creating reliable, timely systematic reviews. They described the challenges and opportunities presented by current production models, and they shared what they are doing to improve review production.  They particularly highlighted significant challenges with increasing complexity of review methods; difficulty keeping authors on board and on track; and the length of time required to complete the process. Strong themes emerged about the roles of authors and Review Groups, the central actors in the review production process.  The results suggest that improvements to Cochrane’s systematic review production models could come from improving clarity of roles and expectations, ensuring continuity and consistency of input, enabling active management of the review process, centralising some review production steps; breaking reviews into smaller “chunks”, and improving approaches to building capacity of and sharing information between authors and Review Groups.  Respondents noted the important role new technologies have to play in enabling these improvements.    Conclusions  The findings of this study will inform the development of new Cochrane Review production models and may provide valuable data for other systematic review producers as they consider how best to produce rigorous, reliable, up-to-date reviews.

Producing Cochrane systematic reviews—a qualitative study of current approaches and opportunities for innovation and improvement