Experiences from implementing value-based healthcare at a Swedish University Hospital – a longitudinal interview study

Abstract

BackgroundImplementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013.MethodsAn explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis.ResultsValue for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical.ConclusionsHealthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

Opportunities and Risks of Terminological Ambiguity: The Perception of Value in Value-Based Healthcare – A Multi-Method Study

“…This could impact the chances of other logics to be heard in both the strategic and operational levels of VBHC, for example, the logic of care (such as nursing) or the logic of control (such as managers). We therefore argue that the implementation of VBHC needs to balance different logics, and not least give room to further listen to the patients' voice in this co-creational change process [23].…”

“…The implementation of VBHC challenges both the institutional and professional logics of different professional groups. Among healthcare providers, VBHC is in itself a concept touching on both management and professional logics, which means the success of implementing VBHC may be affected by how well the VBHC concept is aligned with the professional logic of providing value for the patients [23]. The perception of value in healthcare is of crucial importance because it is likely to determine the future direction of care.…”

Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy

“…Value-Based Health Care (VBHC) is a strategic management framework that maximizes the ratio between health outcomes and costs [14][15][16][17][18]. Developed in 2006, it is based on three acting principles: (i) building value for the patients; (ii) basing the organization of medical practice on medical conditions and care cycles; (iii) measuring outcomes and economic costs [19]. To implement VBHC within the organizations, there is a 6-step approach [14] (Appendix 1).…”

“…To implement VBHC within the organizations, there is a 6-step approach [14] (Appendix 1). Case studies have been published, mainly in northern Europe, to describe the method and potential benefits in the application of the approach [19][20][21][22][23][24][25]. Up to this date, no studies have been performed in Italy and for obese patients worldwide to our knowledge.…”

Value-based healthcare translated: a complementary view of implementation

“…In order to put innovations into practice and achieve improved outcomes in new settings, the process of implementation is critical [2]. However, implementation is difficult, and the challenges involved in putting innovations into practice is a frequent topic of journals and conferences for researchers and practitioners [3–5]. …”