Value-based healthcare translated: a complementary view of implementation

Abstract

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.

Redefining value: a discourse analysis on value-based health care

“…The conceptual ambiguity surrounding VBHC is conspicuously evident in academic publications. To some scholars, VBHC is primarily a 'management concept' [1] or a 'management innovation' [2,6]; to others, it is basically a business 'strategy' for both providers and payers [7]; others see it as a 'governance regime' [3], or a 'health policy framework to integrated care' [8]. Additionally, while the importance of outcome measurements for VBHC is generally well established, the range of its utility remains debated.…”

“…In fact, the observation that the implementation of VBHC requires the concept to be 'translated' (i.e. adopted and adapted) into multiple local contexts is indeed brought forth to explain the ambiguity [2,3]. Another, perhaps slightly provocative explanation, is that the meaning of VBHC is being diluted due to a lack of understanding by knowledge producers, particularly within academic writings [1].…”

“…Another, perhaps slightly provocative explanation, is that the meaning of VBHC is being diluted due to a lack of understanding by knowledge producers, particularly within academic writings [1]. Alternatively, it has also been stated that VBHC is a highly ambiguous concept in and of itself [2].…”

“…Today's remarkable popularity of value-based health care (VBHC) is accompanied by considerable ambiguity concerning the very meaning of the concept. Several scholars have noted this ambiguity, with explanations ranging from the concept being diluted in academic literature [1], to VBHC being a highly ambiguous concept in and of itself [2], and to VBHC being adopted and adapted within various local contexts [2,3]. This paper elicits an alternative conception.…”

Evaluating the implementation of an early supported discharge (ESD) program for stroke survivors: A mixed methods longitudinal case study

“…A significant feature of this study was the various changes in perceptions of CFIR constructs over time, as the ESD model of care was adapted and further developed within the service. A longitudinal qualitative study of the implementation of values based health care in a psychiatric system [34] also found their intervention was adapted or changed over time, suggesting a less linear relationship between the planning and execution constructs than suggested by the CFIR Framework. Longitudinal methods in implementation research are currently in the minority, with less than half the studies in a recent review of CFIR application conducting sustained data collection [35].…”