Managing processes of inpatient care and treatment: Swedish healthcare process managers' descriptions

The need to succeed - learning experiences resulting from the implementation of value-based healthcare

Purpose The aim of this study has been to explore learning experiences from the two first years of the implementation of value-based healthcare (VBHC) at a large Swedish University Hospital. Design/methodology/approach An explorative design was used in this study. Individual open-ended interviews were carried out with 19 members from four teams implementing VBHC. Qualitative analysis was used to analyse the verbatim transcripts of the interviews. Findings Three main themes pinpointing learning experiences emerged through the analysis: resource allocation to support implementation, anchoring to create engagement and dedicated, development-oriented leadership with power of decision. Resource allocation included the need to set aside time and administrative resources and also the need to adjust essential IT-systems. The work of anchoring to create engagement involved both patients and staff and was found to be a never-ending task calling for deep commitment. The hospital top management's explicit decision to implement VBHC facilitated the implementation process, but the team leaders' lack of explicit management mandate was experienced as obstructing the process. The development process contributed not only to single-loop learning but also to double-loop learning. Originality/value Learning experiences drawn from implementing VBHC have not been studied before, and thus the results of this study could be of importance to managers and administrators wanting to implement this concept in their respective organizations.

Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study

Background

Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013.

Methods

An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis.

Results

Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical.

Conclusions

Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

How staff experience teamwork challenges in a new organizational structure

Purpose

This study aims to explore challenges arising from the development of teamwork in a new organizational structure, based on the experiences of the staff involved.

Design/methodology/approach

An explorative and qualitative approach was used, with individual interviews as the data collection method. These interviews were analyzed using qualitative and interpretative analysis with a modified editing style.

Findings

The results describe how the lack of essential organizational prerequisites for teamwork and the absence of the leadership qualities needed to facilitate teamwork contribute to difficulties in working in a team-orientated way. Shortage of information among the team members and few scheduled meetings signify insufficient coordination within the working team. Without a team leader who can keep things together, read the team members’ needs and support and guide them, team work is difficult to uphold because the members will need to seek support elsewhere. Assumed synergies from working together as team member experts will be thwarted.

Originality/value

This study contributes knowledge about the difficulties in creating team-orientated cooperation in a new organizational structure when leadership as well as structures and processes supporting team work are absent. The challenges described are drawn from the experiences of the staff concerned, providing insights to form a basis for theoretical and practical discussion.