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The implementation of change model adds value to value-based healthcare: a qualitative study

BACKGROUND: Value-based healthcare (VBHC) is a concept that focuses on outcome measurement to contribute to quality improvement. However, VBHC does not offer a systematic approach for implementing improvement as implementation science does. The aim is to, firstly, investigate the implementation of i...

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Autores principales: Zipfel, Nina, van der Nat, Paul B., Rensing, Benno J. W. M., Daeter, Edgar J., Westert, Gert P., Groenewoud, A. Stef
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728951/
https://www.ncbi.nlm.nih.gov/pubmed/31492184
http://dx.doi.org/10.1186/s12913-019-4498-y
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author Zipfel, Nina
van der Nat, Paul B.
Rensing, Benno J. W. M.
Daeter, Edgar J.
Westert, Gert P.
Groenewoud, A. Stef
author_facet Zipfel, Nina
van der Nat, Paul B.
Rensing, Benno J. W. M.
Daeter, Edgar J.
Westert, Gert P.
Groenewoud, A. Stef
author_sort Zipfel, Nina
collection PubMed
description BACKGROUND: Value-based healthcare (VBHC) is a concept that focuses on outcome measurement to contribute to quality improvement. However, VBHC does not offer a systematic approach for implementing improvement as implementation science does. The aim is to, firstly, investigate the implementation of improvement initiatives in the context of VBHC and secondly, to explore how implementation science could be of added value for VBHC and vice versa. METHODS: A case study with two cases in heart care was conducted; one without the explicit use of a systematic implementation method and the other one with the use of the Implementation of Change Model (ICM). Triangulation of data from document research, semi-structured interviews and a focus group was applied to evaluate the degree of method uptake. Interviews were held with experts involved in the implementation of Case 1 (N = 4) and Case 2 (N = 7). The focus group was held with experts also involved in the interviews (N = 4). A theory-driven qualitative analysis was conducted using the ICM as a framework. RESULTS: In both cases, outcome measures were seen as an important starting point for the implementation and for monitoring change. Several themes were identified as most important: support, personal importance, involvement, leadership, climate and continuous monitoring. Success factors included intrinsic motivation for the change, speed of implementation, complexity and continuous evaluation. CONCLUSION: Application of the ICM facilitates successful implementation of quality- improvement initiatives within VBHC. However, the practical use of the ICM shows an emphasis on processes. We recommend that monitoring of outcomes be added as an essential part of the ICM. In the discussion, we propose an implementation model that integrates ICM within VBHC. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4498-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-67289512019-09-12 The implementation of change model adds value to value-based healthcare: a qualitative study Zipfel, Nina van der Nat, Paul B. Rensing, Benno J. W. M. Daeter, Edgar J. Westert, Gert P. Groenewoud, A. Stef BMC Health Serv Res Research Article BACKGROUND: Value-based healthcare (VBHC) is a concept that focuses on outcome measurement to contribute to quality improvement. However, VBHC does not offer a systematic approach for implementing improvement as implementation science does. The aim is to, firstly, investigate the implementation of improvement initiatives in the context of VBHC and secondly, to explore how implementation science could be of added value for VBHC and vice versa. METHODS: A case study with two cases in heart care was conducted; one without the explicit use of a systematic implementation method and the other one with the use of the Implementation of Change Model (ICM). Triangulation of data from document research, semi-structured interviews and a focus group was applied to evaluate the degree of method uptake. Interviews were held with experts involved in the implementation of Case 1 (N = 4) and Case 2 (N = 7). The focus group was held with experts also involved in the interviews (N = 4). A theory-driven qualitative analysis was conducted using the ICM as a framework. RESULTS: In both cases, outcome measures were seen as an important starting point for the implementation and for monitoring change. Several themes were identified as most important: support, personal importance, involvement, leadership, climate and continuous monitoring. Success factors included intrinsic motivation for the change, speed of implementation, complexity and continuous evaluation. CONCLUSION: Application of the ICM facilitates successful implementation of quality- improvement initiatives within VBHC. However, the practical use of the ICM shows an emphasis on processes. We recommend that monitoring of outcomes be added as an essential part of the ICM. In the discussion, we propose an implementation model that integrates ICM within VBHC. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4498-y) contains supplementary material, which is available to authorized users. BioMed Central 2019-09-06 /pmc/articles/PMC6728951/ /pubmed/31492184 http://dx.doi.org/10.1186/s12913-019-4498-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zipfel, Nina
van der Nat, Paul B.
Rensing, Benno J. W. M.
Daeter, Edgar J.
Westert, Gert P.
Groenewoud, A. Stef
The implementation of change model adds value to value-based healthcare: a qualitative study
title The implementation of change model adds value to value-based healthcare: a qualitative study
title_full The implementation of change model adds value to value-based healthcare: a qualitative study
title_fullStr The implementation of change model adds value to value-based healthcare: a qualitative study
title_full_unstemmed The implementation of change model adds value to value-based healthcare: a qualitative study
title_short The implementation of change model adds value to value-based healthcare: a qualitative study
title_sort implementation of change model adds value to value-based healthcare: a qualitative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728951/
https://www.ncbi.nlm.nih.gov/pubmed/31492184
http://dx.doi.org/10.1186/s12913-019-4498-y
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