Nilsson Kerstin, Bååthe Fredrik, Erichsen Andersson Annette, Sandoff Mette
Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg , Göteborg, Sweden.
Sahlgrenska University Hospital , Göteborg, Sweden and Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg , Göteborg, Sweden.
Leadersh Health Serv (Bradf Engl). 2018 Feb 5;31(1):2-16. doi: 10.1108/LHS-08-2016-0039. Epub 2017 Oct 25.
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.
目的 本研究旨在探索瑞典一家大型大学医院在实施基于价值的医疗保健（VBHC）的头两年中的学习经验。 设计/方法/途径 本研究采用探索性设计。对实施VBHC的四个团队的19名成员进行了个人开放式访谈。采用定性分析方法对访谈的逐字记录进行分析。 结果 通过分析得出了三个确定学习经验的主要主题：为支持实施而进行资源分配、为建立参与度而进行定位以及具有决策权的专注于发展的领导力。资源分配包括留出时间和行政资源的必要性，以及调整基本信息系统的必要性。为建立参与度而进行的定位工作涉及患者和工作人员，并且被认为是一项需要深度投入的永无止境的任务。医院高层管理人员实施VBHC的明确决定促进了实施过程，但团队领导缺乏明确的管理授权被认为阻碍了这一过程。发展过程不仅促成了单环学习，也促成了双环学习。 原创性/价值 此前尚未对实施VBHC的学习经验进行过研究，因此本研究结果可能对希望在各自组织中实施这一理念的管理人员和行政人员具有重要意义。
