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The Strategy That Will Fix Health Care
... This premise suggests a positive relationship between CSR and FP (firm's performance) and SDOH and FP to encourage firms and their management to support social initiatives for a win-win proposition with an optimal mix of pecuniary and non-pecuniary benefits. The growing recognition amongst healthcare stakeholders that their firms and policies will need to mitigate health inequities due to SDOH to cost-effectively manage population health supports these propositions [6,7]. ...
... CSR refers to a firm's strategic actions in planning and executing its business activities in an ethical and social boundary [9]. The focal concept of CSR is to empower stakeholders to leverage the available firm-based and market-based resources to accomplish the firm's economic, environmental, and social objectives [7]. The CSR framework encourages collaboration with supply chain partners, employee and stakeholder empowerment, and the protection of natural resources [10]. ...
... The concentric circles of CSR imply that a firm must create a better future for subsequent generations [11]. CSR is a critical marketing tool that contributes to the competitive advantage, prestige, and performance for-profit and not-for-profit firms [7]. However, unlike CSR activities in other sectors, focusing primarily on the environment or philanthropy [11], healthcare CSR investments need to be organized to balance community wellness programs and systematic SDOH initiatives for the most vulnerable populations [13]. ...
Purpose:
Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare system has struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes the CSR construct, there is a paucity of research on SDOH integration with the CSR framework.
Design:
We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA.
Findings:
Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage.
Originality:
Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.
... To address this aim, we have conducted an international interview study with senior managers at 18 large academic hospitals to explore how they perceive patient flows from a system-wide perspective and to understand their strategies on how to improve the flow across their organizations. Hospitals are acknowledged as highly complex organizations comprising strong professional groups with oftentimes different views on improving the healthcare sector [31,32,36]. Process improvement models originating from the industrial environment are therefore seldom easy to implement in healthcare organizations [32,33]. ...
... The presented categories of solutions can be found in previous research concerning parts of the hospital patient flow, as needed developments, or as implemented interventions. The need for "better organizational alignment" is highlighted by several studies [29,34,36,47,48] to make the organization process-oriented [34] and better integrated with clear organizational goals [36]. Having "better coordination and transfer structures" has been identified [12,20,22,31,34], highlighting the need to have patient flow managers with strong mandates [20] and central patient and transfer coordinators [22]. ...
... The presented categories of solutions can be found in previous research concerning parts of the hospital patient flow, as needed developments, or as implemented interventions. The need for "better organizational alignment" is highlighted by several studies [29,34,36,47,48] to make the organization process-oriented [34] and better integrated with clear organizational goals [36]. Having "better coordination and transfer structures" has been identified [12,20,22,31,34], highlighting the need to have patient flow managers with strong mandates [20] and central patient and transfer coordinators [22]. ...
Background
Hospital productivity is of great importance for patients and public health to achieve better availability and health outcomes. Previous research demonstrates that improvements can be reached by directing more attention to the flow of patients. There is a significant body of literature on how to improve patient flows, but these research projects rarely encompass complete hospitals. Therefore, through interviews with senior managers at the world’s leading hospitals, this study aims to identify effective solutions to enable swift patient flows across hospitals and develop a framework to guide improvements in hospital-wide patient flows.
Methods
This study drew on qualitative data from interviews with 33 senior managers at 18 of the world’s 25 leading hospitals, spread across nine countries. The interviews were conducted between June 2021 and November 2021 and transcribed verbatim. A thematic analysis followed, based on inductive reasoning to identify meaningful subjects and themes.
Results
We have identified 50 solutions to efficient hospital-wide patient flows. They describe the importance for hospitals to align the organization; build a coordination and transfer structure; ensure physical capacity capabilities; develop standards, checklists, and routines; invest in digital and analytical tools; improve the management of operations; optimize capacity utilization and occupancy rates; and seek external solutions and policy changes. This study also presents a patient flow improvement framework to be used by healthcare managers, commissioners, and decision-makers when designing strategies to improve the delivery of healthcare services to meet the needs of patients.
Conclusions
Hospitals must invest in new capabilities and technologies, implement new working methods, and build a patient flow-focused culture. It is also important to strategically look at the patient’s whole trajectory of care as one unified flow that must be aligned and integrated between and across all actors, internally and externally. Hospitals need to both proactively and reactively optimize their capacity use around the patient flow to provide care for as many patients as possible and to spread the burden evenly across the organization.
... The aim of VBHC is to increase patient value, which is defined as the best possible patient-relevant health outcomes and patient experience divided by the costs to achieve those outcomes [1,2]. To support the value transformation, Porter and Lee [3] introduced the strategic value agenda with six steps: 1. 'Organize into integrated practice units (IPUs)' , 2. 'Measure outcomes and costs for every patient' , 3. 'Move to bundled payments for care cycles' , 4. 'Integrate care delivery across separate facilities' , 5. 'Expand excellent services across geography' , and 6. 'Build an enabling information technology platform' . The value agenda provides first guidance on the implementation of VBHC in a healthcare organization but it is still insufficient with regards to detailed information on how to practically implement VBHC in a healthcare organization. ...
... The aim of VBHC is to increase patient value, which is defined as the best possible patient-relevant health outcomes and patient experience divided by the costs to achieve those outcomes [1,2]. To support the value transformation, Porter and Lee [3] introduced the strategic value agenda with six steps: 1. 'Organize into integrated practice units (IPUs)' , 2. 'Measure outcomes and costs for every patient' , 3. 'Move to bundled payments for care cycles' , 4. 'Integrate care delivery across separate facilities' , 5. 'Expand excellent services across geography' , and 6. 'Build an enabling information technology platform' . ...
... The Santeon Improvement Cycle was developed by Santeon and the Boston Consulting Group (BCG) [5,14]. In the Santeon Improvement Cycle, each improvement team goes through three-to-five stages: Forming a multidisciplinary group of healthcare professionals involved in the care for patients with the medical condition in question (0.1), defining which outcomes and case-mix variables need to be measured (0.2), collecting data and finding variation in outcomes between the seven networking hospitals (1), analyzing the variation in outcomes by looking at potential practice variation between the hospitals and adopt a best practice from one of the hospitals or select an improvement initiative from literature (2), implementing the improvement initiatives (3). When the third stage is completed, the cycle starts over again with collecting data and evaluating the impact of the implemented improvement initiative. ...
Background
In recent years, value-based healthcare (VBHC) has become one of the most accepted concepts for fixing the ‘broken’ healthcare systems. Numerous hospitals have embraced VBHC and are trying to implement value-based quality improvement (VBQI) into their practice. However, there is a lack of knowledge on how to practically implement VBHC and organizations differ in their approach. The aim of this study was to explore the main factors that were experienced as hindering and/or supporting in the implementation of VBQI teams in hospital care.
Methods
A qualitative study was performed with semi-structured interviews with 43 members of eight VBQI teams in a large Dutch top-clinical teaching hospital. Participants included physicians, physician assistants, nurses, VBHC project leaders, managers, social workers, researchers and paramedics. Interview grids were structured according to the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). A thematic content analysis with open coding was used to identify emerging (sub)themes.
Results
We identified nine main factors divided over three domains (organization, culture and practice) that determined whether the implementation of VBQI teams was successful or not: 1). Practical organization of value-based quality improvement teams, 2). Organizational structure 3). Integration of VBHC with existing quality improvement approaches and research 4). Adoption and knowledge of the VBHC concept in the hospital 5). Multidisciplinary engagement 6). Medical leadership 7). Goal setting and selecting quality improvement initiatives 8). Long-cycle benchmarking and short-cycle feedback 9). Availability of outcome data.
Conclusions
Overall, this study goes beyond the general VBHC theory and provides healthcare providers with more detailed knowledge on how to practically implement value-based quality improvement in a hospital care setting. Factors in the ‘organization’ and ‘practice’ domain were mentioned in the strategic value agenda of Porter and Lee. Though, this study provides more practical insight in these two domains. Factors in the ‘culture’ domain were not mentioned in the strategic value agenda and have not yet been thoroughly researched before.
... Another improvement methodology tried at some hospitals is called Value-Based Healthcare (VBH) which takes a slightly different view on how to tackle the challenges facing the healthcare sector. VBH circles around the notion that the healthcare service should, to a much larger extent, focus on value-adding activities and make them measurable, where after healthcare providers are compensated based on the result from these measures (Krohwinkel et al., 2019, Porter, 2013. This would enable health care services to strive towards continuous quality improvements and reduce non-value-adding activities, bringing cost reductions as a consequence (Porter, 2013). ...
... VBH circles around the notion that the healthcare service should, to a much larger extent, focus on value-adding activities and make them measurable, where after healthcare providers are compensated based on the result from these measures (Krohwinkel et al., 2019, Porter, 2013. This would enable health care services to strive towards continuous quality improvements and reduce non-value-adding activities, bringing cost reductions as a consequence (Porter, 2013). The methodology emphasizes the need to organize the healthcare service around the process of the patient instead of around the clinics of the hospital and specializations of doctors. ...
Demand for healthcare is increasing at a faster pace than hospitals’ capacity. In search of new paths to reverse this development policymakers and healthcare managers look for new methodologies or concepts to improve productivity. One such concept is flow efficiency, focusing on how to better support the throughput of patients, and productivity. Therefore, the aims of this thesis are to examine the phenomenon of hospital-wide patient flows and what is preventing or helping the patient flow to become swift and even across the hospital organization.
This thesis builds on a qualitative research design, where process theory and the theory of swift and even flows are used as points of departure when exploring the phenomenon of hospital-wide patient flows. Two papers are presented. The first paper explores barriers to swift and even patient flows and the second paper identifies solutions on how to overcome the identified barriers. This thesis visualizes how important it is to align the hospital around the patient flow for improved productivity. It also explains how hospitals can serve a greater part of their citizens and enable a more sustainable work environment by improving the capacity balance across the hospital to support patient flow. Lastly, a new framework on how to improve hospital-wide patient flows is developed connecting barriers, root causes, and solutions to swift and even patient flows based on a systematic literature review and on experiences from senior managers at the world’s leading hospitals.
... Integrating health and social services has been seen as solution to the problems of both efficiency and effectiveness in health and social care (Kaehne, 2019;Nuno-Solinis, 2019;Williams, 2012a). Service integration requires enabling information technology (Porter and Lee, 2013), integrated data (Muirhead et al., 2016;Government UK, 2022), a common knowledge base and seamless flow of information between service providers, organiser (purchaser) and other health ecosystem actors (Laihonen, 2012). The literature identifies many knowledge-related obstacles to integration, including fragmented information systems (e.g. ...
... The literature highlights that successful integration requires information technology (Porter and Lee, 2013), integrated data (Government UK, 2022;Muirhead et al., 2016) and seamless flow of information (Laihonen, 2012). It also acknowledged that the management focus needs to be turned onto service systems (cf. ...
Purpose
This article analyses a major healthcare and social welfare reform establishing new regional and integrated wellbeing services counties in Finland. The authors approach the reform and service integration as a knowledge management (KM) issue and analyse how KM appears and contributes in the context of integrated care, specifically in the process of integrating social and health care.
Design/methodology/approach
The article analyses the case organisation's KM initiatives in light of the integrated care literature and recognises the tasks and requirements for effective KM when building integrated health and social care system. The empirical research material for this qualitative study consisted of the case organisation's strategy documents, the results of an external maturity assessment, KM workshop materials and publicly available documentation of the Finnish health and social care reform.
Findings
This study identifies the mechanisms by which KM can support health and social services integration. At the macro level, national coordination and regional co-operation require common information structures. At the meso level, a shared regional strategy with shared objectives guides both organisational decision-making and collaboration between professionals. At the micro level, technology supported and data-driven planning of service chains complements the experiences of professionals and may help remove obstacles to integration.
Originality/value
This study contributes to the literature on integrated care by providing a more comprehensive view of the role and tasks of knowledge and KM when reforming health and social services than approaches focussing solely on health informatics and internal efficiency.
... The next level of complexity is to consider structural changes for a full health system, such as implementing new care models across primary care, community services, and hospitals in England (Starling, 2018). Further complexity occurs when doing a full redesign of a health system, changing its structure, as reported for some USA and European hospitals (Lee & Porter, 2013;Nolte et al., 2016;van Harten, 2018). ...
... For example, a functional health structure changed into integrated practice units with specialized care lines -e.g. low back pain-in a USA hospital, replacing teams and pathways (Lee & Porter, 2013) and the design of specialized services lines for an Emergency Service in Chile (Barros, 2019). ...
This paper presents a proposal for Chile's health system innovation structure based on a formal service design approach, including management and process architecture definition. Such structure defines how to allocate innovation resources in the health system to increase its efficiency. It uses data envelopment analysis (DEA) to measure hospitals' efficiency, which also determines the variables that explain such efficiency. Thus, the architecture uses the knowledge about hospitals' efficiency and their determinants to define innovation projects and assign financial resources for them. It also assures their implementation to increase the efficiency of the hospitals. DEA measurements show great improvement potential since only six of 40 hospitals had an efficiency value of 1.0. Some of the projects with the best improvement potential were implemented with very good results, summarized in the paper. The main contribution of this work is to formalize and enlarge the scope of the structural design of health services to generate improved results for users at a lower cost.
... The overarching goal of healthcare providers, either human or veterinary, should be to achieve projected outcomes and improve value for patients (16). Value, however, is not the same as cost. ...
... Value, however, is not the same as cost. Instead, value refers to focusing on quality of service, as opposed to volume, and on maximizing outcomes that matter to patients relative to the incurred costs (16). Metrics of value are not mutually exclusive and multiple metrics may be represented within a study while addressing more than one stakeholder need. ...
Outcomes research is a relatively recent field of study in animal health and veterinary medicine despite being well-established in human medicine. As the field of animal health is broad-ranging in terms of animal species, objectives, research methodologies, design, analysis, values, and outcomes, there is inherent versatility in the application and impact of the discipline of outcomes research to a variety of stakeholders. The major themes of outcomes relevant to the animal health industry have been distilled down to include, but are not limited to, health, production, economics, and marketing. An outcomes research approach considers an element of value along with an outcome of interest, setting it apart from traditional research approaches. Elements of value are determined by the stakeholders' use of products and/or services that meet or exceed functional, emotional, life-changing, and/or societal needs. Stakeholder perception of value depends on many factors such as the purpose of the animal (e.g., companion vs. food production) and the stakeholder's role (e.g., veterinarian, client, pet-owner, producer, consumer, government official, industry representative, policy holder). Key areas of application of outcomes research principles include comparative medicine, veterinary product development, and post-licensure evaluation of veterinary pharmaceuticals and/or biologics. Topics currently trending in human healthcare outcomes research, such as drug pricing, precision medicine, or the use of real-world evidence, offer novel and interesting perspectives for addressing themes common to the animal health sector. An approach that evaluates the benefits of practices and interventions to veterinary patients and society while maximizing outcomes is paramount to combating many current and future scientific challenges where feeding the world, caring for our aging companion animals, and implementing novel technologies in companion animal medicine and in production animal agriculture are at the forefront of our industry goals.
... Иновативните организации в здравеопазването в световен мащаб трансформират здравните грижи чрез измерване на ползите в здравеопазването (VMHC, Value Measurement For Health Care), което цели да подобри резултатите за пациентите и да оптимизира разходите (1). Здравеопазването, основано на ползите (Value Based Health Care, VBHC), е подход, разработен в Harvard Business School (HBS), който изследва най-добрите практики за реорганизиране и координиране на здравните грижи, подобряване на ефективността на процесите, прилагане на иновативни подходи за заплащане на целия цикъл на лечение, с цел постигане на резултати, важни за пациентите, а не количество дейност, както и интегриране в практиката на системно ниво (2). ...
... Innovative healthcare organizations worldwide are transforming the sector by Value Measurement in Healthcare (VMHC), which aims to improve patient outcomes and optimize costs (1). Value-Based Health Care (VBHC) is an approach developed at Harvard Business School (HBS) that explores best practices for reorganizing and coordinating healthcare, improving process efficiency, and applying innovative payment approaches for the entire cycle of care to achieve results that are important to patients, rather than the amount of activity, and integration into practice at the system level (2). VBHC enables the transition from a fee-for-service model to a system of value-based care. ...
Value Based Health Care, VBHC), е подход, разработен в Harvard Business School (HBS), който изследва най-до-брите практики за реорганизиране и координиране на здравните грижи, подобряване на ефективността на процесите, прилагане на иновативни подходи за запла-щане на целия цикъл на лечение с цел постигане на резул-тати, важни за пациентите, а не количество дейност, както и интегриране в практиката на системно ниво. Цел: Провеждане на външна оценка, анализ на разходи-те, анализ на процесите, структурата на управленския екип и техническите решения в очна клиника, като кон-цепция при извършване на офталмологична процедура при пациенти с макулна дегенерация, чрез приложение на методологията за здравеопазване, основано на полза-та-остойностяване, базирано на дейността и нейното времетраене (TDABC). Материал и методи: Проведени са интервюта с част от персонала за установяване на ролите на участващия персонал, техния брой, както и отговорностите им, заедно с последователност на всички стъпки по про-цедурата. Проведено е и наблюдение на процеса по ин-травитреално приложение и измерване на времето за извършване на отделните стъпки от процедурата. Из-вършен е анализ, засягащ оптимизацията на управлен-ските и техническите решения, касаещи провеждането на процедурата. Резултати: Представени са последователността и времетраенето на процесите по процедурата (process mapping), финансов модел, изчисляващ заплащането на участващия персонал и анализ и препоръки, засягащи управленческите и техническите решения по извършва-не на процедурата. При извършване на анализа след по-сещение на очната клиника са направени препоръки за подобряване на производителността. Заключение: Използвайки мултидисциплинарна стра-тегия, обхващаща качествени и количествени изследо-ABSTRACT Introduction: Value Based Health Care (VBHC) is an approach developed at Harvard Business School (HBS) that explores best practices for reorganizing and coordinating health care, improving process efficiency, implementing innovative payment approaches for the entire cycle of care to achieve results that are important to the patients rather than the amount of activity, as well as integration into practice at the entire system level.
... A few examples of MIs that have influenced healthcare in the last decade are lean (D'Andreamatteo et al., 2015), value-based healthcare (VBHC) (Porter and Lee, 2013), and learning health systems (LHS) (Foley et al., 2021). ...
... As indicated in section 2.2, QM is a field that has produced several concepts that can be considered MIs, such as TQM (Yang, 2003), lean (D'Andreamatteo et al., 2015;Mazzocato et al., 2010;Belfanti, 2019), and six sigma (Lifvergren et al., 2010;Taner et al., 2007). But MIs also originate from other areas of management and some examples that have influenced healthcare in the last decades are Balanced Scorecards (Kaplan and Norton, 1992), Management-by-objectives (Traberg, 2011), value-based healthcare (VBHC) (Porter and Lee, 2013;Porter and Teisberg, 2006), learning health systems (LHS) (Foley et al., 2021;Plsek and Greenhalgh, 2001), and trust-based management (Bringselius, 2018;Elmersjö and Sundin, 2020). There are, of course, differences in themes, emphasis, and concrete solutions between different MIs but there are also significant similarities (Dale et al., 2002;Örtenblad, 2010;Örtenblad et al., 2015;van der Wiele et al., 2006) -to the extent that some scholars argue that (some) MIs can be seen merely as a repackaging of old knowledge using new labels (e.g., Mazza and Alvarez, 2000;Spell, 2001) or "pseudoinnovations" (Walshe, 2009). ...
In a context characterised by complexity and conflicting demands, healthcare managers at a meso-level struggle to pursue improvements in the quality and efficiency of care operations. An influential approach on how to pursue improvements is quality management (QM). QM adopts the view that systems are centred around a common aim and should be appreciated and managed to reduce undesired variation and improve performance incrementally. Nuancing this view, complexity science propels the idea of healthcare as a complex adaptive system (CAS), which refutes prediction and managerial control of development. As one component of the CAS of healthcare, various management innovations (MIs) provide suggestions on how to achieve improvements. However, achieving any improvement is not often as simple as portrayed and MIs can rarely be fully and exclusively applied in practice.
Starting from the practical issue of how to achieve improvements in healthcare, this thesis seeks to explore how healthcare managers at a meso-level can understand and use MIs to handle complexity and achieve improvements. A qualitative and action research-inspired approach is adopted to investigate this issue, concentrating on the context of psychiatric care at the Sahlgrenska University Hospital in Gothenburg, Sweden.
Four studies, resulting in five appended papers, are presented. By investigating contemporary MIs, the studies contribute to an improved understanding of how MIs can be used, and complexity handled, in the pursuit of improvements. Study 1 starts by exploring the concept of value at a time when lean was succeeded by value-based healthcare (VBHC) as the MI in fashion in the context and the study follows the implementation of VBHC in an action research-inspired approach. Study 2 tests the utility of the value configurations framework to handle conflicting logics and pursue improvements in psychosis care. In study 3, literature on network configurations in different healthcare contexts is reviewed. Lastly, study 4 is an action research study focusing on contextualisation of learning health systems (LHS) as yet an example of an MI in healthcare.
Based on the findings of five appended papers and earlier literature from the fields of QM, complexity science, and MIs, a model is developed that points to the centrality and utility of logics to connect MIs and other system components to improve the understanding of both MIs and CASs. By investigating the logics underlying different MIs, actors in the healthcare system (e.g., politicians, physicians, and managers), and technical features of care (e.g., its predictability and inclination to standardised treatments), a relative appreciation of a CAS can be pursued, which can guide managers in how to use MIs and attract change that can lead to improvements. Furthermore, the thesis supports the view that MIs are often ambiguous concepts that can be translated and adapted to fit a local context in a process of contextualisation. For scholars, the thesis also contributes by integrating the perspectives of QM and complexity science, and of QM and MIs in general, as two parallel approaches to pursue improvements in healthcare.
... To this end, there is a need to change the objective; that is, to shift the focus of the study from the traditional supplier-side to the demand environment in which these relationships take place (McCann & Folta, 2009). This means focusing more on clients than on suppliers (Porter & Lee, 2013). This type of approach requires an examination of the influence of the strategies implemented by firms. ...
... Our empirical analysis drew on data gathered from firms located in the city of Cali, Colombia, which belonged to the healthcare industry according to the International Standard Industrial Classification (ISIC). We selected this context for our analysis for the following reasons: The first is methodological; every country has its own health system (Porter & Lee, 2013) and a welldefined cluster within the city, which is recognized by the market and community. The second reason is that the city of Cali has become a Latin American benchmark for plastic surgery and highly complex treatments (Molina & Martínez, 2005). ...
In the Latin American healthcare industry, there seems to be an association between the implementation of the marketing strategies and the firms' location that suggests the need to study the organizational performance under these aspects. To this end, this paper contrasts the relationships between an organization's market orientation (MO), its location (for example, within a service cluster), and performance. The quantitative analysis was carried out among managers' perceptions from 134 service companies belonging to the healthcare service companies operating in the city of Cali, Colombia. The results showed a positive association between being located in a service cluster and business performance. It was also shown that the strategic approach based on OM positively affects performance. Moreover, we noted that competitors' orientation is the only component of the OM construct that significantly influences performance. The conclusions of our study allow for guiding the strategic decision-making of the managers of these companies regarding the decisions of location and content of marketing strategies.
... Despite this advancement in outcome measurement, the transformation toward VBHC is not without obstacles. The lack of consensus on standardized outcome measures for many medical conditions [10], the debate regarding the use of administrative data (e.g., claims) versus obtaining meaningful clinical data [16,17], the argument over the validity and reliability of process measures in VBHC models and whether a causal process-outcome relationship exists [1,18,19], and the controversial approach in selecting, collecting, and reporting relevant PROMs measures [20], have all been highlighted as challenges. ...
... As process measures are not substitutes for outcome measures [5], other approaches support a combination of both measures. Indeed, although process measures are still used in different public reporting programs around the world [44], evidence is mounting on measuring patient-relevant outcomes that are reported by the patient, proxy, or clinician [1,5].. Data for either process or outcome measures are obtained via multiple data sources. Previous studies indicated that using easy-to-find administrative (e.g., death registry and claims data) and billing data for quality and performance improvement is insufficient and must be complemented by clinician-and patientreported measures [5]. ...
Background
This systematic literature review identifies hospital value-based healthcare quality measures, measurement practices, and tools, as well as potential strategies for improving cardiovascular diseases and cancer care.
Methods
A systematic search was carried out in the PubMed, Embase, CINAHL, and MEDLINE (OvidSP) databases. We included studies on quality measures in hospital value-based healthcare for cardiovascular diseases and cancer. Two reviewers independently screened titles and abstracts, conducted a full-text review of potentially relevant articles, assessed the quality of included studies, and extracted data thematically. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and four validated tools were used for methodological quality assessment.
Results
The search yielded 2860 publications. After screening the titles and abstracts, 60 articles were retrieved for full-text review. A total of 37 studies met our inclusion criteria. We found that standardized outcome sets with patient involvement were developed for some cardiovascular diseases and cancer. Despite the heterogeneity in outcome measures, there was consensus to include clinical outcomes on survival rate and disease control, disutility of care, and patient-reported outcome measures such as long-term quality of life.
Conclusion
Hospitals that developed value-based healthcare or are planning to do so can choose whether they prefer to implement the standardized outcomes step-by-step, collect additional measures, or develop their own set of measures. However, they need to ensure that their performance can be consistently compared to that of their peers and that they measure what prioritizes and maximizes value for their patients.
Trial registration
PROSPERO ID: CRD42021229763 .
... Firstly, it must be realized that cultural transformation is a cumbersome process owing to the characteristic resistance and apprehensions for changing set ways. This challenge has also been highlighted by experts in developed countries where engaging physicians can be di cult due to apprehension of losing autonomy [51,52]. A pragmatic model of change is needed at the onset informed by a robust implementation framework (ToC in the current study) to ensure clarity of the process. ...
Background: A study from a tertiary care center in Pakistan demonstrated that a leadership strengthening intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods: A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.
Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.
The authors conclude that leadership strengthening through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
... Currently, different hospital healthcare services are often categorized under different medical specialties. In other words, services are divided into silos according to specialty departments (Vuorenkoski, 2008;Porter and Lee, 2013), which produce the different specialized services that patients require within the corresponding specialty (e.g. inpatient care in wards, outpatient care in the outpatient unit of the department). ...
The purpose ofthis paper is to perform structural analysis of facilitators of modular architecturein healthcare services by applying interpretive structural modeling (ISM).Inputs were taken from healthcare industry experts and academicians inidentifying and understanding interdependencies among facilitators of modulararchitecture in healthcare services. Further these interdependencies arestructured into a hierarchy in order to derive structural models to deliveruseful insights for theory and practice. Using the ISM approach the facilitatorsof modularity in healthcare services were clustered according to their drivingpower and dependence power. Patient centricity is at the bottom level of thehierarchy implying highest driving power and requires higher attention todeliver quality care outcomes. Facilitators like value dense environment, knowledgeand competence, goal alignment and le-agile strategies have medium driverand dependence powers. The study added insights to the theory of modularsystems. Theauthors recognize that modularity helps in enhancing the patientcentric orientation. The findings provide potentially important information tohealth service managers and providers, enabling them to understand therequisites of modular architecture. This is the first study exploring therelationships between facilitators of modularity in healthcare services. Thestudy complements literature on service modularity with reference to specializedcare unit of maternity services.
... Leading hospitals is a highly complex task (Glouberman and Mintzberg, 2001a;Plsek and Wilson, 2001). Research on the manager role in health care has identified the need for new approaches (Porter and Lee, 2013;Snell et al., 2011;Dickson and Owen, 2016;Reinertsen et al., 2008;Greenhalgh and Papoutsi, 2018;Kuhlmann and von Knorring, 2014;Glouberman and Mintzberg, 2001b;Porter, 2010), with the common denominator "to fix healthcare", as expressed by Mintzberg (2011). While managers most likely aspire to handle the inherent complexity arising from the relationships between the aspects, it seems from the prevailing health delivery research that something is amiss. ...
Purpose
This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals’ engagement.
Design/methodology/approach
Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method.
Findings
The top managers had the intention to balance between quality of patient care, economy and professionals’ engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus.
Practical implications
For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals’ engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals’ engagement. However, this study builds on a limited number of participants. More research is needed.
Originality/value
Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals’ engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.
... Value-Based Healthcare (VBHC) aims to maximise the value for patients by achieving the best outcomes at the lowest cost (Porter & Lee, 2013). Cossio-Gil et al. (2021) see four important areas in the roadmap for implementing Value-Based Healthcare: (1) organise care pathways, (2) collect a set of outcomes, including clinical outcomes and PROs, (3) build an information platform and (4) actively use shortterm and long-term outcomes for clinical decision and for improving care. ...
... For example, in the US, although the expenditure per capita is among the highest in the world, the life expectancy is relatively low (Squires and Anderson, 2015). Consequently, providers have started to move away from their traditional methods (van Velthoven, Cordon and Challagalla, 2019) and converted to value-based healthcare (VBHC) (Kokshagina, 2021;Peters, Blohm and Leimeister, 2015), which is defined as the ratio between the results that patients value and the costs involved in achieving them (Kaplan and Porter, 2011;Porter and Lee, 2013). Nevertheless, to date, research on how providers can practically shift from traditional models to VBHC is limited (Kokshagina, 2021). ...
Exceptional developments in digital technologies have made some of the old theories outdated; hence, there is a need to explore digital transformation through a holistic lens and within various industries and countries. Consequently, we introduced the case of digital transformation of business models as it takes shape in the Israeli HealthTech. We conducted 10 semi-structured expert interviews and complemented these with digital archival data for triangulation. External (e.g. shortage of workforce) and internal (e.g. low digital capabilities) challenges have highlighted the need for digital transformation of business models in healthcare. Thus, we introduce these challenges and the potential value creation in the industry. We also present how Israeli HealthTech start-ups solve challenges and create value in the process. In this way, we contribute to the business model innovation and digital transformation literature. Specifically, in healthcare, we show how value-based healthcare takes place in practice.
... Any strategies that contribute to increasing the efficiency of the health care resource consumption increase value, by delivering qualified care to the population without increasing costs. 26 In the past 2 years, several studies have been performed at a national level recommending the use of synchronous teleconsultations in a complementary manner to provide care access to the population, a few examples are for orthopedics, 27 acromegalic, 28 and diabetes patients. 24 The results reported in this research are another example of how teleconsultation services may be included in the bundle of services offered in a national public health care system that looks for more sustainable strategies to better provide care to the population. ...
Introduction: Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service. Methods: From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs were estimated by time-driven activity-based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation with the in-person consultation: (1) only the length of time that patients spent with a clinician in an in-person consultation was accounted and (2) in addition to the medical consultation, nursing screening was accounted. The mean incremental access rate of the teleconsultation service was defined as a maximization objective in the model. Results: Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for 7 days costs, on average, Int$ 14. COVID-19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% (min 23% max 63%) for the scenarios (1) and (2), respectively, and considering the current consumed budget for this service. Discussion: A COVID-19 telehealth service contributes to increasing access to the health care system without increasing costs. These services can be included in the bundle of care strategies offered in a national public health care system that looks for more sustainable strategies to provide care.
... The VBHC framework consists of six components (49). As a second step of our development approach, the six components of the VBHC framework were adapted to the MNCH context in Kenya as listed in Appendix 2. Adaptation of the VBHC framework is necessary as health systems differ and effects of health system interventions depend on cultural, financial and social context. ...
Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of the United Nations Sustainable Development Goal 3. Value-based healthcare (VBHC) has the potential to outperform traditional supply-driven approaches in changing this dismal situation, and significantly improve maternal, neonatal and child health (MNCH) outcomes. We developed a theory of change and used a cohort-based implementation approach to create short and long learning cycles along which different components of the VBHC framework were introduced and evaluated in Kenya. At the core of the approach was a value-based care bundle for maternity care, with predefined cost and quality of care using WHO guidelines and adjusted to the risk profile of the pregnancy. The care bundle was implemented using a digital exchange platform that connects pregnant women, clinics and payers. The platform manages financial transactions, enables bi-directional communication with pregnant women via SMS, collects data from clinics and shares enriched information via dashboards with payers and clinics. While the evaluation of health outcomes is ongoing, first results show improved adherence to evidence-based care pathways at a predictable cost per enrolled person. This community case study shows that implementation of the VBHC framework in an LMIC setting is possible for MNCH. The incremental, cohort-based approach enabled iterative learning processes. This can support the restructuring of health systems in low resource settings from an output-driven model to a value based financing-driven model.
... In Ghana, notwithstanding the existence of the Mental Health Act (Act 846) since its passing in 2012 (14)(15)(16)(17), the infrastructure and public services have not been properly developed, including mental healthcare services to align with the population growth (7,18). For example whilst integration of mental health services in primary healthcare is a globally accepted approach to optimising healthcare in view of its capacity to meet multiple health and social needs from a single platform of care (19), mental health services are not integrated in primary healthcare in Ghana due to lack of resources and prioritisation (14,20). ...
Background: Few studies have examined the prevalence of mental, neurological and substance use disorders, case detection and treatment in primary healthcare in rural settings in Africa. We assessed needs and case detection rate at primary healthcare facilities in low-resource settings in Ghana.
Methods: A cross-sectional study was conducted at the health facility level in three demonstration districts situated in Northern, Middle and Southern belts in Ghana. These districts are Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region). Data were collected on five priority mental, neurological and substance use conditions of interest including depression, psychosis, suicidal ideation, epilepsy and alcohol use disorders.
Results: Nine hundred and nine (909) people participated in the survey. The prevalence of depression was 15.6% (142/909), psychosis was 12% (109/909), suicidal ideation was 11.8% (107/909), epilepsy was 13.1% (119/909) and alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, psychosis, epilepsy and alcohol use disorders (AUD) ranged from 94.4% to 99.2%, and was similar across study districts. Depression was associated with psychosis (RR: 1.68; 95% CI: 1.12-1.54). For psychosis, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal ideation was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) and attending a health facility in the Anloga district (RR: 0.43; 95% CI: 0.20-0.90) were associated with reduced risk of epilepsy, but not for those more than 35 years (RR: 3.06; 95% CI:1.14-8.24). Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education were associated with reduced risk of AUD (RR: 0.27; 95% CI: 0.08-0.92).
Conclusions: Our study found a relatively high prevalence of MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage mental health conditions, together with improved medication supply and referral pathways.
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
This chapter compares risk factors for lung cancer and their significance for 27 countries in the European Union (EU). Drawing on data from a variety of sources, this study uses K-mean cluster analysis to investigate potentially modifiable risk factors for cancer including tobacco use, alcohol consumption, air pollution, socioeconomic
status, and public expenditures on health care and their effects on lung cancer outcomes.
Findings from this study show that the EU is not homogeneous in terms of the effect of risk factors for lung cancer. Study results yielded four country groups, each
representing different patterns in risk factors for lung cancer. The lowest rates of lung cancer mortality occur among southern European countries that includes: Italy, Spain, Portugal, Malta, and Romania. These countries present with a pattern of risk factors
that include: relatively low alcohol consumption and low rates of smoking coupled with moderate population exposure to air pollutants. By contrast, another cluster of countries with the highest relative lung cancer rates includes Bulgaria, Cyprus, Greece, Croatia, Hungary and Poland. Here, rates of smoking and exposure to air pollutants
are highest from among all the population groups analyzed, potentially lending a signal that these risk factors for lung cancer are most significant for this country group.
Surprisingly, EU countries with the highest development levels and the highest ratio of health care spending relative to GDP, also present with a relatively high indicator of lung cancer mortality despite their relatively low rates of smoking and exposure to air pollutants. The heterogeneity among EU Member states regarding significant risk
factors for lung cancer implies that cancer prevention policy needs to be tailored to individual patterns in risk factors for cancer.
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
The aim of this chapter is to identify a pattern of international trade in medical products
in the context of tackling the COVID-19 pandemic. Medical products are grouped
according to classifications of the World Trade Organization into four categories:
pharmaceuticals, medical equipment, medical consumables, and personal protective
products. This study focuses on the international trade of pharmaceuticals, which
represents over a half of the total value of medical product trade. The United States,
Germany, and Switzerland are key players regarding exports of medical products; however,
the leaders differ in exports of the four medical product groups. Switzerland holds
a predominant position in exports of pharmaceuticals, the US leads in exports of both
medical equipment and medical consumables, while China is the world’s top exporter
of personal protective products, occupying the 7th place in total exports of medical
products. The analysis of Revealed Comparative Advantage (RCA) indices showed that
high trade values do not necessarily translate into specialization in trade. Switzerland
and Ireland are the world’s leaders in terms of relative trade specialization in medical
products, in particular they enjoy high comparative advantages in trade of pharmaceuticals. The US and China, although both have relative specialization in overall
medical exports, do not reveal comparative advantages in trade of pharmaceuticals.
... Experts design the various stages of the healthcare reform towards VBHC. One of the suggestions can be found in an article in which Porter and Lee described the next steps to introduce VBHC (Porter & Lee, 2013). According to their approach, the system should consist of the following components: ...
The definition of a healthcare system evolves continuously, becoming broader and more complex with each rendering. Healthcare systems can consist of many different elements, including but not limited to: access to comprehensive medical care, health promotion, disease prevention, institutional framework, financing schemes, government responsibility over health, etc. In light of its broad classification of healthcare, this book focuses on a wide spectrum of health-related issues ranging from risk factors for disease to medical treatment and possible frameworks for healthcare systems. Aging populations, increasing costs of healthcare, advancing technology, and challenges created by the COVID-19 pandemic require an innovative conceptual and methodological framework. By combining the experience and effort of researchers from a variety of fields including mathematics, medicine and economics, this book offers an interdisciplinary approach to studying health-related issues. It contributes to the existing literature by integrating the perspective of treatment with the economic determinants of health care outcomes, such as population density, access to financial resources and institutional frameworks. It also provides new evidence regarding the pharmaceutical industry including innovation, international trade and company performance.
... 11 Preventive screenings, primary care, and dental services were the most common services offered by MHCs. 13 Early findings have shown promising health care outcomes for patients who use MHCs, which include increased access to health care, reduced emergency department cost and use, lower hospital readmission rates, improved patient quality of life from expanded preventive services, diminished barriers to health care access, enhanced chronic disease management, and increased health literacy. 14 Mobile health clinics also provide convenient access for an increasing population of older patients who may have transportation and connectivity challenges. ...
Objective
To address the problem of limited health care access for patients in rural southern Minnesota, a digitally capable mobile health clinic (MHC) quality improvement initiative was launched in a rural community-based health system.
Methods
This project was designed and implemented according to our institutional strategic plan, guiding principles for virtual community care, and existing approved standards of care. A quality improvement development and pilot implementation framework was rapidly developed using Agile methodology.
Results
The resulting technology and equipment selection, overall clinic design, vehicle vendor selection, clinical schedule and workflows, staffing model, equipment and technology selection, and testing were achieved in 12 months. The pilot site communities were chosen on the basis of size, interest, and lack of existing access. Four underserved rural communities now have access to telehealth consultations, laboratory testing, and in-person primary care examinations. By April 30, 2022, the MHC had provided 1498 patient appointments while maintaining our standards of care. Newly established broadband internet access for these communities and their residents was a valuable secondary outcome.
Conclusion
By designing and implementing an MHC quality improvement intervention that provides both in-person and advanced telehealth options for patients in rural communities, our institution rapidly provided a potential solution for the rural health care crisis. The MHC not only replaces traditional brick-and-mortar facilities but also expands service offerings and access to technology for rural communities and the people who live and work in them.
... The implementation of VBRP varies between, but also within, different healthcare systems. 23 In the US, focus has been on moving away from fee-for-service, 24 whereas publicly financed healthcare systems in Europe mostly have focused on coordinating care among providers. 25 Thus, the introduction of the value-based reimbursement programme (VBRP) does not happen in a vacuum. ...
Reimbursement programmes are used to manage care through financial incentives. However, their effects are mixed and the programmes can motivate behaviour that goes against professional values. Value-based reimbursement programmes may better align professional values with financial incentives. The aim of this study is to analyse if and how healthcare providers adapt their practices to a value-based reimbursement programme that combines bundled payment with performance-based payment. Forty-one semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden. Data were analysed using thematic analysis with an abductive approach and a conceptual framework based on neo-institutional theory. Healthcare providers were positive to the idea of a value-based reimbursement programme. However, during its introduction it became evident that some aspects were easier to adapt to than others. The bundled payment provided a more comprehensive picture of the patients' needs but to an increased administrative burden. Due to the financial impact of the bundled payment, healthcare providers tried to decrease the amount of post-discharge care. The performance-based payment was appreciated. However, the lack of financial impact and transparency in how the payment was calculated caused providers to neglect it. Healthcare providers adapted their practices to, but also resisted aspects of the value-based reimbursement programme. Resistance was mainly caused by lack of understanding of how to interpret and act on new information. Providers had to face unfamiliar situations, which they did not know how to handle. Better IT-facilitation and clearer definition of related care is needed to strengthen the value-based reimbursement programme among healthcare providers. A value-based reimbursement programme seems to better align professional values with financial incentives.
... H ealth care is in the midst of a global transformation toward value-based care in which better health outcomes and patient experience are prioritized above quantity and efficiency of clinical procedures. 1 Besides, care is increasingly moving out of the hospital toward remote care settings and e-health strategies. This process of reshaping health care also affects the field of metabolic and bariatric surgery. ...
... We also believe that patient and families have a key role in building patient trust and creating public awareness and education campaigns to convey the power of meaningful data to better manage cancer care [84]. Policymakers and decision-makers should support the definition of evidence-based quality-ofcare indicators [25] as well as seek a way to pay for healthcare that aligns all interests, fosters the delivery of superior value to patients and empowers providers to coordinate and integrate J o u r n a l P r e -p r o o f care [62]. Implementing these interventions include many of the tenets of implementation science and the inclusion of all relevant stakeholders [50]. ...
Efficiency in healthcare is crucial since available resources are scarce, and the opportunity cost of an inefficient allocation is measured in health outcomes foregone. This is particularly relevant for cancer. The aim of this paper was to gain a comprehensive overview of how efficiency in cancer care is defined, and what the indicators, different methods, perspectives, and areas of evaluation are, to provide recommendations on the areas and dimensions where efficiency can be improved.
Methods
A comprehensive scoping literature review was performed searching four databases. Studies published between 2000-2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide their insights and comments to deliberate policy recommendations.
Results
46 papers met the inclusion criteria. Based on the papers retrieved we have identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we have categorized the methods and outcome used to measure efficiency gain
Conclusion
This is the first attempt to systematize a scattered body of literature on how to improve efficiency in cancer care and identify key areas to improve it. Based on the findings of the literature review and on the opinion of the experts involved in the consultation, we propose seven recommendations that are intended to improve efficiency in cancer care throughout the care pathway.
... 2 Strategic agenda for value transformation In 2013, a strategic agenda was published, consisting of six agenda items for implementing a high-value healthcare delivery system (box 1). 3 The agenda items were intended to support healthcare providers in the transition from a focus on volume, that is, being organised around functionally ...
Objectives
We aimed to systematically map the extent, range and nature of research activity on value-based healthcare (VBHC), and to identify research gaps.
Design
A scoping review with an additional cited reference search was conducted, guided by the Joanna Briggs Institute methodology.
Data sources
The search was undertaken in PubMed, Embase and Web of Science.
Eligibility criteria
Eligible articles mentioned VBHC or value with reference to the work of Porter or provided a definition of VBHC or value.
Data extraction and synthesis
Data were independently extracted using a data extraction form. Two independent reviewers double extracted data from 10% of the articles. Data of the remaining articles (90%) were extracted by one reviewer and checked by a second. The strategic agenda of Porter and Lee was used to categorise the included articles.
Results
The searches yielded a total of 27,931 articles, of which 1,242 were analysed. Most articles were published in North America. Most articles described an application of VBHC by measuring outcomes and costs (agenda item 2). The other agenda items were far less frequently described or implemented. Most of these articles were conceptual, meaning that nothing was actually changed or implemented.
Conclusion
The number of publications increased steadily after the introduction of VBHC in 2006. Almost one-fifth of the articles could not be categorised in one of the items of the strategic agenda, which may lead to the conclusion that the current strategic agenda could be extended. In addition, a practical roadmap or guideline to implement VBHC is still lacking. Future research could fill this gap by specifically studying the effectiveness of VBHC in day-to-day clinical practice.
... TDABC and process mapping allow for a selection of the most appropriate time to perform outcome measurement. Moreover, where TDABC is being applied, it is helping providers find numerous ways to substantially reduce costs without negatively affecting outcomes (and sometimes even improving them) [5]. ...
Value-based healthcare (VBHC) is a service improvement approach developed at Harvard Business School (HBS) that explores the best practices for reorganizing and coordinating healthcare that aim to achieve the outcomes that are important to patients. An implementation of value-added services for patients diagnosed with age-related macular degeneration (AMD) and macular edema using value-based healthcare (VBHC) was introduced in a Bulgarian ophthalmic clinic. Human resources were freed using time-driven activity-based costing (TDABC) methodology and were then reinvested in patient-related outcome measurement activity. A change in the way health-related outcomes are administrated was necessary to make an appropriate outcome analysis and to reduce additional administrative burden to medical staff. Processes should be included as a part of the routine clinical practice, which will also ensure their execution. It is important to build a clearly defined strategy for structuring the process. Objectives and steps should be outlined clearly, starting with a specific indication and gradually expanding the scope. The choice of standard sets and periodisation for data collection is important. There is a need for constant communication between team members, who will be responsible for the measuring, collecting, analyzing, and processing data, regular meetings of all members, and ongoing training.
The clinical use of patient-reported outcome measures (PROMs) in musculoskeletal care is expanding, encompassing both individual patient management and population-level applications. However, without thoughtful implementation, we risk introducing or exacerbating disparities in care processes or outcomes. We outline examples of opportunities, challenges, and priorities throughout PROM implementation to equitably advance value-based care at both the patient and population level. Balancing standardization with tailored strategies can enable the large-scale implementation of PROMs while optimizing care processes and outcomes for all patients.
Background: The rising healthcare costs demand a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. This requires all future doctors to understand VBHC. We aimed to evaluate VBHC awareness-level among Brazilian medical students and to identify the associated intrinsic/extrinsic factors. Methods: This was a survey based, cross-sectional study, conducted through an online survey applied to students from Brazilian medical schools. A descriptive analysis based on participants' level of awareness about VBHC was performed. The categorical variables included were absolute and relative frequencies using chi square tests. A multivariate binary logistic regression analysis was performed by calculating the odds ratio (OR) and 95% confidence intervals (95%CI), to compare each response according to VBHC awareness. Results: We collected 3030 responses, from 148 Medical Schools across all Brazilian states. Medical students were compared in 2 groups; 1 was familiar with VBHC (14%; 426); 2 was not (86%; 2575). The univariate analysis showed that group 1 was more willing to share clinical outcomes/costs data related to their practice (57.04%) compared to 2 (48.12%). The multivariate analysis showed that internship experience was the most relevant factor associated with VBHC exposure (OR 4.32 [CI 95% 1.82 - 10.24]). Conclusion: We found that few medical students understand VBHC concepts, and that exposure was due to self-education efforts. Our results suggest that medical schools have the potential to reinforce both intrinsic and extrinsic factors related to VBHC knowledge to prepare future doctors to practice in a value-driven context.
Background
Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs).Methods
This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution.ResultsThe mean new patients per year in 2006–2011 versus 2012–2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299).Conclusions
The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
Value-based healthcare (VBHC; delivering the best possible health outcomes for patients in a cost-efficient manner) has been a strategic priority among healthcare stakeholders for years. Pioneering providers embrace VBHC principles (such as organising care delivery around medical conditions, monitoring health outcomes and costs per patient group along the clinical pathway, and using those metrics to drive organisational improvements). Still, widespread adoption has been slow due to multiple factors, one of which is the sheer complexity of such a transformation. However, because of the urgent need for infection control during the COVID-19 pandemic, providers made unprecedented strides towards VBHC and achieved VBHC goals that were unattainable before. This article considers the barriers to adopting VBHC and shares best practices from an extensive knowledge base to advise providers on capitalising on the pandemic's momentum to implement value improvement quickly and efficiently.
Objective: To examine the success rate of limb salvage in patients with acute lower extremity ischemia of Rutherford class IIb who presented early vs late and were receiving revascularization Study Design: Comparative/observational study Place and Duration: This study was conducted in multi centers at Mardan Medical Complex and Teaching Hospital and DHQ Battagram during the period from January, 2021 to June, 2022 Methods: 60 patients with acute lower limb ischemia of Rutherford class IIB, ranging in age from 18 to 65, were recruited in this research. Two groups of patients were formed. 35 patients make up Group I (delayed presentation >6 hours), while 25 patients make up Group II (early presentation 6 hours). Embolectomy was performed on each patient. At the third month following surgery, the limb salvage rate in the two groups was compared. P-value 0.05 was considered significant when the data were analyzed using SPSS 22.0. Results: Regarding age and gender, there was no discernible difference between the two groups (p-value >0.05). A substantial difference was seen in the limb salvage rate between the two groups (p-value 0.05), with group I having 22 (62.9%) patients with limb salvage and group II having 21 (84%) patients with limb salvage. When compared to group II, mortality was higher in group I (delayed presentation) (17.1% Vs 0%) with a p-value <0.05. Conclusion: The limb salvage rate was found to be much higher in early-presented patients than in delayed-presented patients. Patients who were presented later than those who were presented earlier had substantially higher 30-day death rates and amputation rates. Keywords: Early Presented, Acute Lower Limb Ischemia, Late Presented, Limb Salvage, Revascularization
Background
Porter's value-based healthcare (VBHC) idea has gained immense popularity in literature and practice in the past decade. While the value agenda clearly articulates the goal and content of VBHC, it provides no advice on an implementation strategy. This is problematic as, without an appropriate implementation strategy, even the most significant improvement initiatives are bound to fail. In this research, we adopt a change management perspective to understand better the critical principles that determine an effective implementation of VBHC. Furthermore, we provide guidelines to increase the likelihood of implementation success.
Methods
We performed a scoping review of the literature published in English on the topic of VBHC initiatives using Scopus and Web of Science. The studies were included if they offered empirical evidence on care providers' implementation of VBHC.
Results
The findings from the scoping review are based on 24 studies and underline that VBHC implementation is a complex concept. Implementing all ideas related to VBHC in practice appears to be challenging, and frequently, projects fail to measure or make progress in reducing costs and improving patient-centric outcomes. The findings also indicate that specific change management elements increased the likelihood of the VBHC implementation's success. The findings show the importance of 1) establishing the need and vision for change throughout the organization, 2) managing stakeholders' responses to change, 3) combining a supportive top-down and participative approach to change, and 4) using data on patient-centric outcomes and costs.
Conclusion
The implementation of VBHC is a complex endeavor, demanding that the reason (why), content (what), and process (how) of the change to VBHC is well-developed. With no approach to VBHC implementation, there is little knowledge about the shift to VBHC from a change management perspective. By conducting a scoping study, this research aimed to systematically investigate the concept of VBHC implementation in the literature from a change management perspective by identifying and mapping the available empirical evidence on care providers' implementation of VBHC.
Background: An earlier evaluation (Fox et al., 2014) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted.
Aims: To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service.
Method: Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes.
Results: Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period.
Conclusions: Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients’ perceptions of recovery.
Background
Value-based oral healthcare (VBOHC) has two fundamental components, the assessment of patients’ dental outcomes and the measurement of the costs to achieve those outcomes. The aim of this article is to describe challenges and opportunities of implementing dental patient-reported outcomes (dPROs) in clinical care at the University Clinic of Dentistry, Medical University of Vienna, in Austria, to determine lessons learned and describe next steps forward to VBOHC implementation.
Methods
A case study determining lessons learned based on an implementation process to incorporate a dental patient-reported outcome measure (dPROM) in routine clinical care was conducted. The German version of the five items Oral Health Impact Profile (OHIP-5), a dPROM was selected and integrated into the general anamnesis including dental and medical history for patients aged ≥16 years. The anamnesis is paper based and is to be completed by each new patient during the registration process. Thereafter, it is uploaded to the patients’ dental record via scan by the main central admission. However, it is then the treating dentist's task to transfer the data into the digital system. Data accuracy between digital and paper forms was investigated, and lessons learned regarding the first steps of implementing VBOHC were summarized based on the implementation process findings.
Results
To date, 8,147 patients were approached to fill in OHIP-5. However, only 266 patients´ OHIP- 5 files were transferred into the digital system by the dentist. To explore the accuracy between the manual transfer of data from paper forms to digital format, the data of 89 randomly selected patients was compared. Of this sample, 74 (83.1%) patient's data sets were found to be identical. Lessons learned included the importance of institutional dedication, stakeholders’ engagement, dPROMs integration in follow up visits, the significance of digital solutions, and the continuous monitoring and evaluation.
Conclusion
Integrating dPROMs in clinical settings is achievable and is the first important step to move forward with VBOHC implementation.
The medical cost trend had been increasing faster than the global inflation rate. Higher costs posed a significant problem for healthcare providers, payers, and eventually patients. The concept of value-based healthcare (VBHC), which emphasized the importance of measuring outcomes relative to the costs, was introduced to mitigate the impact of these medical trends. This research used a scoping review methodology to describe the factors that affect the shift from the conventional volume-based healthcare to value-based healthcare. Data of research based on article search was conducted using online Scopus and Embase databases, resulting in 800 articles describing value-based healthcare. Duplication removal excluded 76 articles, screening excluded 295 articles, eligibility assessment excluded 76 articles, and the remaining 30 articles were included. The results of study show that VBHC was proposed as a shift in healthcare management entailing six reinforcing elements, but most hospitals have implemented only one VBHC element. The most common implemented elements are “the measurement of outcome and cost” and “the reorganization to integrated practice units.” The key success for the implementation of these elements are: (1) strong data collection to measure clinical outcomes that matter to patients, (2) clear governance of this data management, and (3) strong support from the high leadership to encourage multidisciplinary teamwork. Thus, the true VBHC system can only be reached when all the six elements are achieved. However, no single study describes a success in implementing all elements of VBHC. Hospital leaders need to be cautious when interpreting VBHC as not to think that the VBHC can be reached by cherry-picking only selected elements of VBHC.
Objective
Capitation is a healthcare reimbursement scheme in which a healthcare provider equitable access to funding for services and greater flexibility and budgeting. The objectives of the study are to investigate the effect of capitation signaling on patients’ perceived value and trust and on their use intention.
Methods
This study was a scenario-based survey to examine interaction design, including capitation policy information and value-added health services information, which act as a combination of to test the hypotheses using signaling theory. Subject may receive the information about health services, information about a capitation policy, both of these two signals, or neither of them.
Results
The results of this study show that signal capitation policy and value-added health service information positively affects patients’ perceived value, but not patients’ trust. When a patient receives a signal either capitation policy information or value-added health service information, their perceived value, trust, and use intention are significantly higher than those who receive neither signal.
Conclusion
We suggest that high-quality healthcare institutions should consider distinguishing themselves from other low-quality providers by signaling information and allocate resources on value-added health services to enhance patients’ awareness of healthy behavior and benefit from implementing a capitation payment scheme. This research contributes to healthcare stakeholders, especially policymakers and service providers, in terms of how best to engage with patients.
Motivated by the increasing demand for integrated, value-based healthcare, this study proposes a valid measurement scale for sustainability in the healthcare sector. The model focuses on implementation strategies to foster social, environmental and broader economic value-based sustainability in healthcare. This unique holistic approach aligns with the UN SDGs agenda, focusing on environmental considerations and societal health and wellbeing through a multidimensional mix of leading economic, social and environmental performance indicators. Exploratory factor analysis revealed seven dimensions of the measurement scale for sustainability measured by 39 items. Confirmatory factor analysis has been used to confirm the factor structure of the study and the results indicate that the proposed measurement is valid. This measurement scale serves as the basis of a comprehensive benchmark, developed to assess sustainability-related performance in the healthcare industry. The study also explains the theoretical and practical implications of the findings, followed by the limitations and agenda for future research.
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