Search results

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

The purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT).

A corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants’ responses to the question “please tell us about the impact of your overall experience”, which culminated in a combined corpus of 75,053 words.

Findings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact.

This in-depth qualitative evaluation of participants’ feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice.

Previous research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments.

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

The instrument measures both leadership and management performance and can be used to continually measure managers’ performances as perceived by staff to identify areas for development.

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.

This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors’ leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings.

This study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants’ knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick’s model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis.

The workshop yielded positive results, as evidenced by participants’ increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program.

The intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms.

While digital transformation holds immense promise, organizations often fail to realize its benefits. This study aims to address how policies for digital transformation benefits realization are translated into practice.

The authors apply a qualitative, comparative case study of two large, public-sector health care organizations in Sweden. Through document and interview data, the authors analyze the process of translation.

The study finds that practice variation is primarily caused by two types of decoupling: policy-practice and means-ends. Contrary to previous studies, coercion in policy compliance is not found to decrease practice variation.

The limitations primarily stem from the empirical selection of two large public health-care organizations in Sweden, affecting the study’s generalizability. Reducing practice variation is more effectively achieved through goal alignment than coercion, leading to implications for the design of governance and control.

Policymakers should, instead of focusing on control-related compliance, work to align organizational objectives and policies to decrease practice variation for successful benefits realization.

The study contributes to better benefits realization of digital transformation initiatives in health care. As such, the authors contribute to a better functioning and more transformative health care in times of increased demand and decreased supply of health-care services.

The study challenges conventional wisdom by identifying that coercion is less effective than goal alignment in reducing practice variation, thereby enhancing the understanding of policy implementation dynamics in health-care settings.