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Value-based healthcare: the pragmatic start

Despite the many initiatives, few value-based healthcare programs at institutional level have been launched. What is the reason? IG&H lists the three main causes (and solutions).

Healthcare organisations are often organised around specialisms. Breaking through this structure requires leadership. In order to set up ‘integrated practice units’, walls must be broken and existing interests (including budgets) must be abandoned. Few healthcare institutions in the world are given the opportunity to implement value-based healthcare completely, including organisational changes, in one go.

The Karolinska Institute in Sweden has gone down this road. The university hospital made this decision after careful deliberation. Within the Swedish system of registries, the organisation first gained years of experience in managing the outcomes of care.

After the institute decided to tilt the organisation, it turned out to be even more difficult in practice than had previously been estimated. A ‘big bang’ was chosen in which all divisions and departments were abolished. The introduction of the extensive new structure with hundreds of patient groups and new management methods met a great deal of resistance from medical specialists and nurses.

If you want to roll out value-based healthcare programs in a broad sense, you need to be pragmatic.

Make sure that it is clear in advance what the scope of the project will be. Take into account the feasibility, impact and make the right decision.

For example, do you join an existing initiative or start a new one? Both have advantages and disadvantages that need to be weighed against each other. In this way, you can build on the lessons learned from an existing initiative, but your own contribution will be smaller.

Do you start your own initiative or do you start working together immediately? An important question that needs to be asked is whether the benefits outweigh the complexity of starting together. Examples are the added value of being able to benchmark externally and sharing investments in information management.

Finally, there are many hard and soft criteria that need to be considered: for example, what is the size of the care areas you start with? What data is already available? What is the support base among healthcare professionals?

2. Organise for success at program level

Perhaps the most important precondition for success is that the leadership of an institution is committed to the implementation of an institution-wide program. It is essential that the (care) professionals feel supported by the top of the organisation.

A value-based healthcare program as a change process that requires a lot of time, energy and perseverance is the right approach. It must be a priority on the long-term policy agenda and should be guided for a longer period by means of tight program management.

Finally, a prominent place on the investment agenda is also necessary; value-based healthcare requires investments in both people and systems, which pays off later.

3. Organise for success per care area

Another decisive precondition for a successful implementation within a healthcare area is that the healthcare professionals involved support the initiative. This goes hand in hand with the need for strong leadership at institutional level.

The professionals involved are the driving force in setting up the multidisciplinary team. This group then determines which indicators should be used as a basis for steering and how the continuous improvement cycle should be set up. All this, of course, with the support of the program that is set up at institutional level.

Conclusion and follow-up

Starting small and pragmatic is important to create momentum. However, for a successful roll-out at institution level, more is needed. A well thought out delineation of the scope and organising for success at institution level and per care area are essential. The above questions can help. Do you want to know more? Please contact us, we will be happy to help you.

This series of blogs on value-based healthcare will soon be followed up with the topic “data-driven performance dialogue”. What type of conversation should be conducted between professionals? How do you do so? And what do you need for this?


Interested in what IG&H can do for you? Contact us!


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