Pseudo-understanding: an analysis of the dilution of value in healthcare

Fredriksson, Jens Jacob; Ebbevi, David; Savage, Carl

doi:10.1136/bmjqs-2014-003803

Cited by 44 publications

(52 citation statements)

References 41 publications

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“…[21] This study does not seek to answer whether this was done or not in this case, but other studies have shown that VBHC as a management strategy has been understood in different ways. [31,47] Understanding the concept is fundamental. Therefore it is important for a hospital management team that decides to implement a management innovation as VBHC in its organization to set explicitly defined goals and to state clearly what work is expected of the team members.…”

Section: Discussionmentioning

confidence: 99%

Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital

Nilsson

Sandoff

2017

JHA

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Objective: The aim of this study is to explore medical and care staff's experiences of leading the implementation of the management innovation, named value-based healthcare (VBHC) at a large Swedish University Hospital. Methods: In this study an explorative design was used. Data was collected with individual open-ended repeated interviews with 20 members of four teams leading the implementation of VBHC. The interviews were transcribed verbatim and qualitatively analysed. Results: Findings from this interview study showed that not all participants were comfortable with being appointed as leaders for the VBHC implementation process. Some found it rather too challenging instead. Participants described characteristics such as openness, visibility, approachability, and the ability to be a role model as necessary when leading implementation work. Leadership strategies emphasized were participation and involvement but also the ability to control implementation processes. Anchoring was effectuated by means of a pedagogical approach including dialogues and feedback before making step-by-step changes in everyday work itself. Conclusions: This study shows that leadership is a challenging experience in the context of a team responsible for implementing VBHC, however commendable the management innovation in itself may be. The expectations connected to the leadership role in the context of VBHC implementation must be clarified. Awareness is needed of the extent of the mandates accorded to the care and medical staff appointed as leaders of VBHC teams, especially since care and medical staff are formally speaking not as managers.

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Section: Discussionmentioning

confidence: 99%

Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital

Nilsson

Sandoff

2017

JHA

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“…Also, VBHC is gaining substantial interest in relation to several patient groups (including cancer [58], spinal disorders [59], and people living with complex long-term conditions [60]) and in many parts of the world (such as the US [61], Europe [5, 62], and Asia [63]). 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].…”

Section: Theoretical Backgroundmentioning

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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“…DO SOMETHING ABOUT IT. NOW.” Such pseudo‐understanding of complexity science did not help the Region amplify any desirable patterns; what was amplified was the cacophony of incongruent initiatives. (A complexity‐informed analysis of the Region's vacillation between centralization and decentralization will be presented separately.…”

Section: Discussionmentioning

confidence: 99%

Planning without action and action without planning? Examining a regional health system's efforts to improve patient flow, 1998–2013

Kreindler

2017

Health Planning & Management

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Most health care organizations engage in formal and informal planning, yet their improvement initiatives may remain disjointed and reactive. Research on organizational decision-making has found that the "discovery" approach (seek and assess multiple options before selecting one) outperforms "idea imposition" (identify 1 option, then gather information to [dis]confirm it), yet is observed relatively infrequently. Might this imply that discovery frequently collapses before fruition? This qualitative study sought to better understand the planning-action disjunction, as observed in 1 organization, by comparing its planning processes against the discovery approach. It focused on a Canadian regional health system's recurrent, unsuccessful attempts to improve patient flow. Through extensive document review supplemented by interviews with 62 managers, it identified all relevant regional plans/reports produced during a 15-year period and followed each recommendation forward in time to discover its fate. Each report presented a lengthy, unprioritized list of disparate recommendations, few of which progressed to full implementation. It appeared that decision-makers repeatedly embarked on a discovery approach, but rapidly allowed it to splinter into multiple idea-imposition approaches; numerous options were generated, but never evaluated against each other. Thus, the product of each planning process was not a coherent strategy but a list of disconnected actions.

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Pseudo-understanding: an analysis of the dilution of value in healthcare

Cited by 44 publications

References 41 publications

Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital

Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital

Value-based healthcare translated: a complementary view of implementation

Planning without action and action without planning? Examining a regional health system's efforts to improve patient flow, 1998–2013

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