Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

Abstract

Background A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign. Methods This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters. Results In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance. Conclusions Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care.

Relational coordination in value-based health care

“…We asked eligible employees to complete an online survey regarding the interprofessional collaboration in their IPU. The survey included measures of RC, team practices (team meetings and boundary spanning behavior), and organizational 1 Earlier research describes an IPU as an ideal type of organizational unit in that it matches VBHC theory concerning major organizational shifts (Porter & Lee, 2021;Steinmann et al, 2022). The IPUs in this study are similar to IPUs as described in VBHC theory but do not have the suggested financial accountability.…”

“…1Earlier research describes an IPU as an ideal type of organizational unit in that it matches VBHC theory concerning major organizational shifts (Porter & Lee, 2021; Steinmann et al, 2022). The IPUs in this study are similar to IPUs as described in VBHC theory but do not have the suggested financial accountability.…”

How to facilitate the introduction of value‐based payment models?

“…local decision‐making and experimentation with new care delivery models or technologies). A redesign of the healthcare organisation structure may also be important to accommodate the implementation of the pilot (e.g., regrouping care units around medical conditions and appointing value‐based healthcare managers) 11 …”

Evaluating patient participation in value‐based healthcare: Current state and lessons learned

“…Within VBHC, value has been defined as patient‐relevant outcomes relative to the costs needed to achieve these outcomes 2 . Different strategies to implement VBHC can be found, and an often adopted strategy is to set up multidisciplinary value improvement (VI) teams that are responsible for VIs in the care for a specific medical condition 1,3 . Patient participation within these VI teams is of great importance to facilitate the incorporation of their perspectives on value 4 …”