title: Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden. kerstin.nilsson@sahlgrenska.gu.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
authors.affiliation: Sahlgrenska University Hospital, Göteborg, Sweden/Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bååthe
authors.affiliation: Sahlgrenska University Hospital, Göteborg, Sweden/Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Annette Erichsen
authors.initials: AE
authors.lastname: Andersson
authors.affiliation: Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Göteborg, Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wikström
authors.affiliation: Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Göteborg, Sweden.
authors.forename: Mette
authors.initials: M
authors.lastname: Sandoff
mesh_terms: D003695:Delivery of Health Care; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D036301:Qualitative Research; D012051:Reimbursement Mechanisms; D013548:Sweden
keywords: Health outcome measurement; Implementation process; Patient value; Qualitative study; Value-based healthcare