Understanding value-based healthcare – an interview study with project team members at a Swedish university hospital

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

doi:10.5430/jha.v4n4p64

Cited by 26 publications

(46 citation statements)

References 32 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%

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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%

“…[31] Health professionals' wish to create value for the patients constitutes the main reason for working according to the strategies in VBHC. [8,10,32] This is in line with health professionals' in-trinsic motivation to strive to do their best for the patients as well as to develop their medical and care competence.…”

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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“…The second author (EW) is a researcher who has extensive experience of organization studies and implementation research in the healthcare sector (Grill et al 2014 ; Arman et al 2014 ; Wigert and Wikström 2014 ; Grill et al 2015 ; Liff and Wikström 2015 ). The third author (AEA) is a researcher who has specialized in implementation research in hospital settings (Andersson et al 2012 , 2014 , 2015 ; Erichsen Andersson et al 2015 , 2018 ).…”

Section: Methodological Considerations For the Studymentioning

confidence: 99%

“…Like the Health Foundation ( 2014 ), we contend that person-centred care is not simply a model that can be applied but is a philosophy of care whose implementation requires structural and organizational adaptation and strong leadership. It is therefore important for the facilitators of implementation programmes to first and foremost involve management leaders in learning about iterative collective learning processes (Erichsen Andersson et al 2015 ) and increase awareness of the relationship between ethics and methods (Schuster 2006 ).…”

Section: Healthcare Workers’ Need To Learn Person-centred Ethicsmentioning

confidence: 99%

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden

Dellenborg

Wikström

Erichsen

2019

Adv in Health Sci Educ

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While person-centred care has gained increasing prominence in recent decades as a goal for healthcare systems, mainstream implementation remains tentative and there is a lack of knowledge about how to develop person-centred care in practice. This study therefore aimed to explore what may be required in order for person-centred care programmes to be successful. The study used an ethnographic method of data collection. This consisted of closely following an implementation programme on a medical emergency ward in a Swedish hospital. Data consisted of participant observation and informal interviews with healthcare providers and their management leaders while they were in the process of training to use person-centred care. These interlocutors were using action learning methods under the guidance of facilitators. Our findings revealed that although the programme resulted in some of the processes that are central for person-centred care being developed, organisational factors and a lack of attention to ethics in the programme counteracted these positive effects. The study highlights the importance of facilitating mechanisms to produce desired results. These include management leaders’ learning about the dynamic and collective nature of learning processes and change. They also include allowing for inter-professional dialogue to enable managers and professionals to reflect deeply on professional boundaries, disciplinary knowledge and power relations in their teams. Teamwork is essential for the development of person-centred care and documentation, in accordance with this specific implementation programme, is also indispensable. The space for inter-professional dialogue should also accommodate their various perspectives on the aims of care and organizational reality.

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“…So while value could be discussed as a universal perception that combines attitudes, tradition and symbols, it may not be directly associated with the experienced outcomes [15]. The concept of value could therefore be interpreted differently between clinicians [16], as well as between clinicians and nonclinicians, de ned as personnel not directly interacting with the patients.…”

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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Understanding value-based healthcare – an interview study with project team members at a Swedish university hospital

Cited by 26 publications

References 32 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

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden

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

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