van Engen Veerle, Bonfrer Igna, Mieris Fabio, Ensink Malou, Stiggelbout Anne, Ahaus Kees, Buljac-Samardzic Martina
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
Hum Resour Health. 2025 Jan 14;23(1):3. doi: 10.1186/s12960-025-00972-x.
While aiming to optimize patient value, the shift towards Value-Based Health Care (VBHC) in hospitals worldwide has been argued to benefit healthcare professionals as well. However, robust evidence regarding VBHC's workforce implications is lacking. This gap is problematic, as the motivation and health of healthcare professionals are central to the quality of care and crucial amidst contemporary workforce challenges. This study aims to qualitatively examine the implications of VBHC for healthcare professionals' motivation, job strain, and ongoing participation in VBHC. In addition, it explores how these outcomes are regulated at both the individual and organizational levels.
Semi-structured interviews were conducted with 26 healthcare professionals across six Dutch hospitals. Interviewees engaged in three VBHC activities: (1) value-based outpatient consultations and/or; (2) value-based quality improvement activities; as well as in; (3) VBHC implementation. Interview questions and data analysis were guided by the Job Demands-Resources model.
VBHC interacts with four themes perceived to affect professional's motivation (perception of making a positive impact, enjoyability of job activities, personal development, and sense of community and support) and three themes perceived to affect job strain (workload, cognitive demands, and confidence). VBHC creates both gains (primarily increasing motivation; occasionally reducing strain) and pains (primarily increasing strain; sometimes reducing motivation). The perceived impact of VBHC depends on the fit between the individual, one's activities in VBHC, the working conditions, and the pace of VBHC implementation. An observation that warrants attention is that healthcare professionals with a 'do-er' mentality and high ambitions to optimize patient value can become demotivated to continue advancing VBHC with the same intensity, particularly due to perceived slow progress.
While VBHC is centered around patients, this study emphasizes that the needs, experiences and changing role identities of healthcare professionals cannot be overlooked in this transition. VBHC currently presents as a double-edged sword for healthcare professionals: resulting in both gains and pains. In the move to VBHC, it is crucial to maintain alignment between the individual, their job activities, the work environment, and the pace at which VBHC unfolds. This is essential for fostering and retaining motivated individuals, who are not only vital to the workforce but also pivotal in advancing VBHC.
在致力于优化患者价值的同时，全球医院向基于价值的医疗保健（VBHC）转变也被认为对医疗保健专业人员有益。然而，关于VBHC对劳动力影响的有力证据却很缺乏。这一差距存在问题，因为医疗保健专业人员的积极性和健康状况对于护理质量至关重要，且在当代劳动力挑战中至关重要。本研究旨在定性研究VBHC对医疗保健专业人员的积极性、工作压力以及持续参与VBHC的影响。此外，还探讨了这些结果在个人和组织层面是如何受到调节的。
对荷兰六家医院的26名医疗保健专业人员进行了半结构化访谈。受访者参与了三项VBHC活动：（1）基于价值的门诊咨询和/或；（2）基于价值的质量改进活动；以及（3）VBHC实施。访谈问题和数据分析以工作需求-资源模型为指导。
VBHC与被认为影响专业人员积极性的四个主题（对产生积极影响的认知、工作活动的趣味性、个人发展以及社区感和支持感）以及被认为影响工作压力的三个主题（工作量、认知需求和信心）相互作用。VBHC既带来收益（主要是提高积极性；偶尔减轻压力），也带来痛苦（主要是增加压力；有时降低积极性）。VBHC的感知影响取决于个人、其在VBHC中的活动、工作条件以及VBHC实施的速度之间的契合度。一个值得关注的观察结果是，具有“实干家”心态且有很高优化患者价值抱负的医疗保健专业人员可能会失去继续以同样强度推进VBHC的动力，特别是由于进展缓慢。
虽然VBHC以患者为中心，但本研究强调，在这一转变过程中，医疗保健专业人员的需求、经历和不断变化的角色身份不能被忽视。VBHC目前对医疗保健专业人员来说是一把双刃剑：既带来收益，也带来痛苦。在向VBHC的转变中，保持个人、其工作活动、工作环境以及VBHC展开的速度之间的一致性至关重要。这对于培养和留住有积极性的人员至关重要，这些人员不仅对劳动力至关重要，而且对推进VBHC也至关重要。
