Nyenrode Business Universiteit, Breukelen, The Netherlands.
Health Services Administration Department, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
Int J Health Policy Manag. 2023;12:7366. doi: 10.34172/ijhpm.2023.7366. Epub 2023 May 31.
Value-based healthcare (VBHC), which can be viewed as a strategy to organize and improve healthcare services, has far-reaching organizational and managerial consequences. It is common managerial practice to support the execution of a strategy by monitoring the ensuing activities. Such monitoring provides feedback and guidance on the execution of these activities to the management of an organization and helps to realize organizational strategies. Monitoring of activities is commonly done by performance management systems. Given the rising attention in the literature and in practice for VBHC, we ask to what extent VBHC is supported by performance management systems in practice, and how we can explain what we find to support further successful implementation of VBHC.
In our scoping review of financial and performance management at the organization or unit-level of healthcare organizations that apply value-based approaches, we identified 1267 unique papers in Embase, Medline, OVID, and Web of Science. After the (double-blinded) title and abstract screening, 398 full-text articles were assessed for further analysis.
Our review reveals only eleven original papers discussing specifically the integration of VBHC and performance management systems. Almost all the featured applications in these papers focus on a specific project or medical specialty. Only one paper exemplifies how VBHC has been integrated with the performance management systems of a medical institution, and no paper provides a clear link with strategy execution. We ask why this is the case and propose several explanations by studying the extant performance management literature. We see these explanations as issues for further reflection for VBHC practitioners and researchers.
We conclude that one of the reasons for the absence of papers integrating VBHC and performance management systems is formed by the tensions that exist between striving for "the best care" or even for providing "all care that is viably possible" and pursuing greater (financial) efficiency. Implementing VBHC as an important organizational strategy and explicating this strategy in the performance management systems requires that these tensions need to be brought into the fore. When this is not done, we believe that VBHC adoptions that are fully integrated with performance management systems will remain limited in practice.
基于价值的医疗保健（VBHC）可以被视为组织和改善医疗服务的策略，具有深远的组织和管理意义。为了支持战略的执行，常见的管理实践是通过监测随之而来的活动来提供反馈和指导。这种监测为组织的管理层提供了关于这些活动执行情况的反馈和指导，有助于实现组织的战略。活动监测通常通过绩效管理系统来完成。鉴于 VBHC 在文献和实践中受到越来越多的关注，我们想知道 VBHC 在实践中在多大程度上得到了绩效管理系统的支持，以及我们如何解释我们的发现，以支持 VBHC 的进一步成功实施。
在我们对应用基于价值方法的医疗保健组织的组织或单位级别的财务和绩效管理的范围综述中，我们在 Embase、Medline、OVID 和 Web of Science 中确定了 1267 篇独特的论文。经过（双盲）标题和摘要筛选后，对 398 篇全文文章进行了进一步分析。
我们的综述仅发现了 11 篇专门讨论 VBHC 与绩效管理系统集成的原始论文。几乎所有在这些论文中展示的应用都集中在一个特定的项目或医疗专业上。只有一篇论文举例说明了 VBHC 是如何与医疗机构的绩效管理系统集成的，没有一篇论文提供了与战略执行的明确联系。我们想知道为什么会这样，并通过研究现有的绩效管理文献提出了一些解释。我们将这些解释视为 VBHC 从业者和研究人员进一步反思的问题。
我们的结论是，缺乏将 VBHC 与绩效管理系统集成的论文的原因之一是，在追求“最佳护理”甚至提供“可行的所有护理”与追求更高（财务）效率之间存在紧张关系。将 VBHC 作为一项重要的组织战略来实施，并在绩效管理系统中阐明这一战略，需要将这些紧张关系提上日程。如果不这样做，我们认为与绩效管理系统完全集成的 VBHC 采用在实践中仍将受到限制。
