Lessons learned on the experienced facilitators and barriers of implementing a tailored VBHC model in a Dutch university hospital from a perspective of physicians and nurses

Abstract

ObjectiveThis study aims to obtain insight into experienced facilitators and barriers of implementing a tailored value-based healthcare (VBHC) model in a Dutch university hospital from a perspective of physicians and nurses.MethodA descriptive qualitative study with 12 physicians, nurses and managers of seven different care pathways who were involved in the implementation of a tailored VBHC methodology was conducted. Thematic content analysis was used to analyse the data guided by all factors of the Consolidated Framework for Implementation Research (CFIR).FindingsThe method designed for the implementation of a tailored VBHC methodology was appointed as a structured guide for the process. Throughout the implementation process, leadership and team dynamics were considered as important for the implementation to succeed. Also, sharing experiences with other value teams and the cooperation with external Information Technology (IT) teams in the hospital was mentioned as desirable. The involvement of patients, that is part of the VBHC methodology, was considered useful in the decision-making and improvement of the care process because it gave better insights in topics that are important for patients. The time-consuming nature of the implementation process was named as barrier to the VBHC methodology. On top of that, the shaping of the involvement of patients and the ongoing changes in departments were established as difficult. Finally, working with the Electronic Health Records and acquiring the necessary digital skills were considered to be often forgotten and, thus, hindering implementation.ConclusionClinical Healthcare organisations implementing a tailored VBHC methodology will benefit from the use of a structured implementation methodology, a well-led strong team and cooperation with (external) teams and patients. However, shaping patient involvement, alignment with other departments and attention to digitisation were seen as a most important concerns in implementation and require further attention.

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

“…It is clearly essential to know how patients define value, otherwise the risk exists that care development will focus on what is easy to measure instead of what is most important and of greatest value to the patients. Some major factors affecting the implementation of measuring outcome and cost are (i) data infrastructure, (ii) a systematic approach for the identification of improvement potential and the selection and implementation of improvement initiatives, (iii) governance in which roles and responsibilities of physicians regarding outcome improvement are formalized, and (iv) implementation of outcomes within hospital strategy, policy documents, and the planning and control cycle (Ahmed et al, 2019;Allen et al, 2021;Amini et al, 2021;Bodar et al, 2020;Colldén & Hellström, 2018;Cossio-Gil et al, 2022;Goretti et al, 2020;Kuklinski et al, 2020;Lansdaal et al, 2022;Marotta et al, 2020;Nilsson et al, 2017;Ramos et al, 2021;Rutherford et al, 2021;Schraut et al, 2022;St John et al, 2021;Van Veghel et al, 2020;Varela-Rodríguez et al, 2021;Zipfel et al, 2019). In moving to bundled payments, many current initiatives have been successfully centered on creating bundled payments for surgical care to reduce cost.…”

Value-Based Integrated Care: A Systematic Literature Review

“…Comparing the factors that influence the successful implementation of VBIC with the facilitating factors for the implementation of VBHC or integrated care reveals many similarities. A well-functioning IT infrastructure, financial support, leadership, and cultural change are also frequently mentioned facilitators and barriers for the implementation of VBHC 49 - 52 or integrated care. 16 , 17 , 53 …”

Value-based healthcare implementation in the Netherlands: a quantitative analysis of multidisciplinary team performance

“…However, slightly lower scores were found for the question on patient participation within the VI teams. Yet, the importance of meaningful patient participation within VI teams had been pointed out by several studies, since patients can help to identify patient relevant outcomes and improvement initiatives [ 10 , 11 , 18 , 19 ]. There is, however, a lack of guidance concerning patient participation within VBHC implementation [ 10 ], which leaves many VI teams struggling with the incorporation of patient participation in their team, and may at least partially explain the lower score for this particular question in our results.…”