Value-based healthcare as a trigger for improvement initiatives

Abstract

Purpose This study explores four pilot teams' experiences of improvements resulting from the implementation of value-based healthcare (VBHC) at a Swedish University Hospital. The aim of this study is to gain a deeper understanding of VBHC when used as a management strategy to improve patients' health outcomes. Design/methodology/approach An exploratory design was used and qualitative interviews were undertaken with 20 team members three times each, during a period of two years. The content of the interviews was qualitatively analysed. Findings VBHC worked as a trigger for initiating improvements related to processes, measurements and patients' health outcomes. An example of improvements related to patients' health outcomes was solving the problem of patients' nausea. Improvement related to processes was developing care planning and increasing the number of contact nurses. Improvement related to measurements was increasing coverage ratio in the National Quality Registers used, and the development of a new coding system for measurements. VBHC contributed a structure for measurement and for identification of the need for improvements, but this structure on its own was not enough. To implement and sustain improvements, it is important to establish awareness of the need for improvements and to motivate changes not just among managers and clinical leaders directly involved in VBHC projects but also engage all other staff providing care. Originality/value This study shows that although the VBHC management strategy may serve as an initiator for improvements, it is not enough for the sustainable implementation of improvement initiatives. Regardless of strategy, managers and clinical leaders need to develop increased competence in change management.

Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies

“…Improvement initiatives that do not have sufficient management commitment have low chances of success. [55][56][57] Top-down leadership might, however, facilitate bottomup engagement. Engagement of physicians and other stakeholders can be increased by project ownership, bottomup project design and implementation, and dual management.…”

“…39 Conversely, perceived emphasis on cost containment and administrative aspects of the program, potentially reducing resources for patient care, was found to be a barrier in implementation. 33 Leadership Overall, case studies indicate leadership should be supportive and aware of existing power dynamics to successfully 35,[40][41][42][43] At the operational level, the appointment of champions, such as key surgeons, is recommended to increase support. 37 Resistance to shifts in power could, however, present a barrier for implementation for doctors and managers.…”

Value-based healthcare translated: a complementary view of implementation

“…However, the label VBHC is sometimes used without deeper understanding of the original concept [ 64 ], though some promising results have also been presented. For example, the focus in VBHC on patient-reported health outcomes has led to reduced nausea after surgery, and the focus on integration of care within and across facilities has led to an increase of available beds for patients in need of admission [ 65 ].…”

Identifying cost-saving opportunities for surgical care via multicenter time-driven activity-based costing (TDABC) analysis as exemplarily shown for cholecystectomy

“…Learning from best practices can reveal how much time and money can be saved and can guide healthcare delivery redesign initiatives. It can incentivize continuous improvement for the healthcare system, making it more homogeneous between centers (7).…”