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

Nilsson, Kerstin; Bååthe, Fredrik; Andersson, Anna-Lena; Wikström, Ewa; Sandoff, Mette

doi:10.1186/s12913-017-2104-8

Cited by 75 publications

(159 citation statements)

References 24 publications

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“…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]. …”

Section: Introductionmentioning

confidence: 99%

Value-based healthcare translated: a complementary view of implementation

Colldén

Hellström

2018

BMC Health Serv Res

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BackgroundInterest in the implementation of various innovations (e.g. medical interventions and organizational approaches) has increased rapidly, and management innovations (MIs) are considered particularly complex to implement. In contrast to a traditional view that innovations are implemented, some scholars have promoted the view that innovations are translated into contexts, a view referred to as translation theory. The aim of this paper is to investigate how a translation theory perspective can inform the Consolidated Framework of Implementation Research (CFIR) to increase understanding of the complex process of putting MIs into practice. The empirical base is a two-year implementation of the MI Value-Based Health Care (VBHC) to a psychiatric department in a large Swedish hospital.MethodsIn this longitudinal case study, a qualitative approach was applied using an insider researcher with unique access to data, who followed the implementation starting in 2015. Data sources includes field notes, documents, and audio recordings of meetings and group reflections which were abridged into an event data file structured by CFIR domains. In a joint analysis, an outsider researcher was added to strengthen the analysis and mitigate potential bias.ResultsTwo themes were identified, for which CFIR did not satisfactorily explain the findings. First, the intervention characteristics (i.e. the content of the MI) were modified along the process and, second, the process did not follow predefined plans. However, the project was still perceived to be successful by internal and external stakeholders.ConclusionsThe paper proposes three ways in which translation theory can inform CFIR when applied to MIs: 1) strength of evidence is not as important for MIs as for medical and technical innovations; 2) adaptability of the MI can be emphasized more strongly, and 3) it can be more fruitful to view implementation as a dynamic process rather than seeing it as a matter of planning and execution. For managers, this implies encouragement to seize the opportunity to translate MIs to fit their organization, rather than to aim to be true to an original concept.

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Section: Introductionmentioning

confidence: 99%

Value-based healthcare translated: a complementary view of implementation

Colldén

Hellström

2018

BMC Health Serv Res

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“…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].…”

Section: Discussionmentioning

confidence: 98%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wolf¹,

Bååthe²,

Nilsson³

et al. 2020

Preprint

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BackgroundValue-based healthcare (VBHC) argues healthcare needs to be refocused to maximize value creation, defining value as the value quota (VQ) of outcomes important for the patient divided by the cost of the care. Value is central to the VBHC concept but could be an ambiguous term for professionals wanting to adopt the concept in an implementation process. We set out to explore the perception of value amongst different stakeholders who implement VBHC.Methods The perception of value, cost and VBHC was analysed using content analysis of semi-structured interviews from 19 clinicians and non-clinicians involved in implementation of VBHC. In addition, we exemplified the value quota (VQ) with data from a clinical trial to exemplify the possible association between patient reported outcome measurements (Kansas City Cardiomyopathy Questionnaire and the EQ5D ), their perception of care (n=248) and cost. ResultsClinicians described value as a dynamic concept dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. Value for non-clinicians appeared more driven by the interplay between the outcome and cost or resources. The quantitative data suggested a poor association between patients’ perception of value and VQ. ConclusionsOur findings indicate that there is great variation in how different stakeholders (clinicians, non-clinicians) perceive the key concept of value when implementing VBHC. The most dominant influence was the voice of clinicians, focusing on increasing treatment efficacy and improving medical outcomes but having a limited focus on cost and what matters to patients. Moreover, patients’ own perception of value provided during a care period was poorly connected to the calculated value quota. If the concept of value is defined primarly by clinicians’ own assumptions, there is a clear risk that history will simply be repeated and the need for innovation will not be met. A single-minded focus on value” could therefore result in missing the target. The patients’ and non-clinicians’ perception of value must also be integrated with the clinical perception, if VBHC is going to deliver on the promise to increase healthcare efficiency and effectiveness.

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“…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).…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients’ adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients’ engagement and outcomes. Method A multiprofessional team redesigned the process considering ERAS recommendations and patients’ feedbacks. Outcomes that matter to patients were defined with structured patients’ interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability. Results A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life. Conclusion Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients’ engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations.

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

Cited by 75 publications

References 24 publications

Value-based healthcare translated: a complementary view of implementation

Value-based healthcare translated: a complementary view of implementation

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

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

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