Value-based healthcare as a trigger for improvement initiatives

• Published in: International journal of health care quality assurance incorporating Leadership in health services 2017-10, Vol.30 (4), p.364-377
• Main Authors: Nilsson, Kerstin, Bååthe, Fredrik, Erichsen Andersson, Annette, Sandoff, Mette
• Format: Article
• Language: English
• Subjects: Care plans; Change management; Clinical outcomes; Costs; Health administration; Health Care Service and Management, Health Policy and Services and Health Economy; Health Services Research; Health status; Healthcare; Hospitals; Hospitals, University; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Implementation; Interviews; Interviews as Topic; Measurement; Measurements; Nausea; Nurses; Nursing; Omvårdnad; Outcome and Process Assessment (Health Care); Patients; Physicians; Processes; Qualitative analysis; Qualitative Research; Quality Improvement; Strategic management; Sweden; Teams; Value-based care; Value-based improvements; Value-Based Purchasing
• ISSN: 1751-1879; 1751-1887; 1751-1887
• DOI: 10.1108/LHS-09-2016-0045

Purpose This study explores four pilot teams’ experiences of improvements resulting from the implementation of value-based healthcare (VBHC) at a Swedish University Hospital. The aim of this study is to gain a deeper understanding of VBHC when used as a management strategy to improve patients’ health outcomes. Design/methodology/approach An exploratory design was used and qualitative interviews were undertaken with 20 team members three times each, during a period of two years. The content of the interviews was qualitatively analysed. Findings VBHC worked as a trigger for initiating improvements related to processes, measurements and patients’ health outcomes. An example of improvements related to patients’ health outcomes was solving the problem of patients’ nausea. Improvement related to processes was developing care planning and increasing the number of contact nurses. Improvement related to measurements was increasing coverage ratio in the National Quality Registers used, and the development of a new coding system for measurements. VBHC contributed a structure for measurement and for identification of the need for improvements, but this structure on its own was not enough. To implement and sustain improvements, it is important to establish awareness of the need for improvements and to motivate changes not just among managers and clinical leaders directly involved in VBHC projects but also engage all other staff providing care. Originality/value This study shows that although the VBHC management strategy may serve as an initiator for improvements, it is not enough for the sustainable implementation of improvement initiatives. Regardless of strategy, managers and clinical leaders need to develop increased competence in change management.