Search results

Despite the unparalleled importance of value within healthcare, value-based models remain underutilised in the procurement of medical devices. Research is needed to understand what factors incentivise standard, low-priced device purchasing as opposed to value-adding devices with potentially higher overall health outcomes. Framed in agency theory, we examine the conditions under which different actors involved in purchasing decisions select premium-priced, value-adding medical devices over low-priced, standard medical devices.

We conducted 2 × 2 × 2 between-subjects scenario-based vignette experiments on three UK-based online samples of managers (n = 599), medical professionals (n = 279) and purchasing managers (n = 449) with subjects randomly assigned to three treatments: (1) cost-saving incentives, (2) risk-sharing contracts and (3) stronger (versus weaker) clinical evidence.

Our analysis demonstrates the harmful effects of intra-organisational cost-saving incentives on value-based purchasing (VBP) adoption; the positive impact of inter-organisational risk-sharing contracts, especially when medical professionals are involved in decision-making; and the challenge of leveraging clinical evidence to support value claims.

Our results demonstrate the need to align incentives in a context with multiple intra- and inter-organisational agency relationships at play, as well as the difficulty of reducing information asymmetry when information is not easily interpretable to all decision-makers. Overall, the intra-organisational agency factors strongly influenced the choices for the inter-organisational agency relationship.

We contribute to VBP in healthcare by examining the role of intra- and inter-organisational agency relationships and incentives concerning VBP (non-) adoption. We also examine how the impact of such mechanisms differs between medical and purchasing (management) professionals.

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

The purpose of this study is to capture patients' and employees' perception of quality of care in the Indian private hospitals and to find the possible perceptual gaps between both the groups.

Authors have referred to the Victorian patient satisfaction monitoring (VPSM) scale and studied the responses of 327 patients and 327 employees collected from six private Indian tertiary care hospitals. SPSS v26 software was used to conduct the data reliability test, descriptive analysis and Mann–Whitney U test.

Authors have found significant differences in perceptions of quality of care between the patients and employees in the Indian hospitals. Employees have high positive perceptions towards the provided medical care whereas the patients have less favourable perceptions for many quality indicators.

This study findings help the healthcare managers, practitioners and healthcare workers of the Indian hospitals to understand the perceptions of both the employees and the patients towards healthcare quality elements and help to reduce the existing perceptual gap in the process of providing quality healthcare services.

To the best of authors knowledge, this is one of the pioneering studies conducted in Indian healthcare industry to capture and compare the perceptions of both the employees' and the patients' perceptions of various quality of care elements. This study highlighted the existing perceptual gap between the employees and the patients on various healthcare quality elements and indicated the critical areas for improvement to provide high quality healthcare services.

Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

This article investigates how the healthcare sector can reorganize its procurement network to better balance its resilience and cost-minimization objectives.

A single case study was conducted on the procurement of personal protective equipment (PPE) during the first COVID-19 pandemic wave in the Quebec public healthcare network. Interviews were conducted with stakeholders from the supply chain management (SCM) departments at eight public healthcare institutions.

Two major challenges in the early months of the pandemic impacted the development of resilience in the healthcare network. First, peripheral actors’ decisions, which orient procurement objectives, limited the deployment of resilience measures in the supply chain (SC). Second, SC resilience included hundreds of products other than PPE that are critical to the delivery of care. The article illustrates the challenges of SCR, which will inevitably be accompanied by additional costs when purchasing in the public healthcare sector is often focused on the lowest price.

Drawing from the network perspective model, this article examines the actions of Quebec supply network stakeholders through the three phases of SCR: anticipation, response to disruption, and recovery. Finally, the article suggests that decision-makers remove the cost of resilience measures from the purchase price of products, in order to maintain these measures over the long term.

In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and mangers in developing and enhancing a culture of trust in their organizations to enable co-design, with the potential to drive innovation and change in healthcare.

Using social science analyses, the authors argue that current co-design literature has limited focus on interactions between senior leaders and managers, and healthcare staff and service users in supporting co-designed innovation and change. The authors draw on social and health science studies of trust to highlight how the value-based co-design process needs to be supported and enhanced. We outline what co-design innovation and change involve in a health system, conceptualize trust and reflect on its importance within the health system, and finally note the role of senior leaders and managers in supporting trust and responsiveness for co-designed innovation and change.

Healthcare needs leaders and managers to embrace co-design that drives innovation now and in the future through people – leading to better healthcare for society at large. As authors we argue that it is now the time to shift our focus on the role of senior managers and leaders to embed co-design into health and social care structures, through creating and nurturing a culture of trust.

Building public trust in the health system and interpersonal trust within the health system is an ongoing process that relies upon personal behavior of managers and senior leaders, organizational practices within the system, as well as political processes that underpin these practices. By implementing managerial, leadership and individual practices on all levels, senior managers and leaders provide a mechanism to increase both trust and responsiveness for co-design that supports innovation and change in the health system.

The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.

In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.

The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.

The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.

Many countries struggled to respond to the pandemic burden; in fact, most suffer from healthcare incapacity generally. Therefore, they need to find innovative systems to compensate for their deficiencies in dealing with current and future problems. One such goes down the public-private partnership (PPP) route. It is important to note, however, that PPP is not a magic wand, and some of these projects have been criticized for overruns that exceed the value created. Aiming to promote the value created in healthcare PPP projects, this study aims to identify factors and critical points related to their implementation.

A two-stage literature review was conducted to shape semi-structured interviews. Based on this, the questions to be asked in the interviews were prepared. The interviews were conducted with twelve experts. The transcripts of the twelve semi-structured interviews were analyzed using manual thematic analysis to reveal the most critical value-creation factors (VCFs). The VFCs were validated by comparing them with the studies in the literature and by having focus group discussions (FGDs) with the experts. Finally, in an FGD, the experts discussed how these factors affect value creation in healthcare PPP projects.

The findings show that VFCs can be categorized into four dimensions: assets, partnership synergy, cooperation environment and processes. Based on the frequency of codes during the thematic analysis, the most frequently addressed VFCs in each category were identified. These were complementary skills and resources, attitude, early establishment of the operational body and effective design development, respectively.

This research contributes to both society and practice by unveiling VCFs and effective ways to achieve them in healthcare PPP projects. Thus, practitioners can generate more value and bring value to the forefront of healthcare PPPs, which can then enhance the value gained by society.

Studies to date have offered little about VCFs and how to realize value in PPP projects by considering the factors involved in them. Moreover, value creation in PPP healthcare projects has largely remained unexplored, despite PPPs being adopted and investigated quite commonly.

To remain sustainable, open source software (OSS) projects must attract new members—or newcomers—who make contributions. In this paper, the authors develop a set of hypotheses based on the knowledge barriers framework that examines how OSS communities can encourage contributions from newcomers.

Employing longitudinal data from the source code repositories of 232 OSS projects over a two-year period, the authors employ a Poisson-based mixed model to test how community characteristics, such as the main drivers of knowledge-based costs, relate to newcomers' contributions.

The results indicate that community characteristics, such as programming language choice, documentation effort and code structure instability, are the main drivers of knowledge-based contribution costs. The findings also suggest that managing these costs can result in more inclusive OSS communities, as evidenced by the number of contributing newcomers; the authors highlight the importance of maintaining documentation efforts for OSS communities.

This paper assumes that motivational factors are a necessary but insufficient condition for newcomer participation in OSS projects and that the cost to participation should be considered. Using the knowledge barriers framework, this paper identifies the main knowledge-based costs that hinder newcomer participation. To the best of the authors' knowledge, this is the first empirical study that does not limit data collection to a single hosting platform (e.g., SourceForge), which improves the generalizability of the findings.