Table 2.
Important factors in the implementation of value-based quality improvement in hospital care
| Domain | Main factor | Sub factors | Experience§ |
|---|---|---|---|
| Organization of VBQI | 1. Practical organization of value-based quality improvement teams | a. Available time of health professionals | - |
| b. Planning and attendance of meetings | - | ||
| c. Availability of VBHC support staff (data analysts/project leaders) | + | ||
| 2. Organizational structure | a. Organization of care around the patient | +/- | |
| b. Volume versus value for patients | - | ||
| c. Shared workspace | +/- | ||
| d. Health professionals dedicated to medical condition | + | ||
| e. Financial benefits of adopting VBHC concept | + | ||
| f. Formal responsibility for quality of care | +/- | ||
| g. Mandate of value-based quality improvement team | +/- | ||
| 3. Integration of VBHC with existing QI approaches and research | a. Shared Decision Making | + | |
| b. Lean-philosophy | + | ||
| c. Use of Patient Reported Outcome Measures (PROMs) | + | ||
| d. Scientific Research | + | ||
| e. one central group for quality improvement | +/- | ||
| Culture of VBQI | 4. Adoption and knowledge of the VBHC concept in the hospital | a. Knowledge of VBHC concept | +/- |
| b. Belief in added value VBHC | +/- | ||
| c. Reputation of VBHC concept | +/- | ||
| d. Impact of seeing VBHC results | +/- | ||
| 5. Multidisciplinary engagement | a. Engagement of multiple disciplines in improvement team | +/- | |
| b. Small efficient teams | + | ||
| c. Equal input from team members | + | ||
| d. Outcome data that is relevant and adjustable for all team members | - | ||
| e. Patient involvement | - | ||
| f. Engagement of health professionals outside improvement team | - | ||
| g. Readiness to change | - | ||
| h. Engagement of colleagues from other participating hospitals | +/- | ||
| 6. Medical leadership | a. Inspirational medical leadership | + | |
| b. Medical leader’s ability to engage others | + | ||
| c. Involvement/accessibility of medical leader | +/- | ||
| Practice of VBQI | 7. Goal setting and selecting quality improvement initiatives | a. Purpose of value-based quality improvement team meetings | - |
| b. Setting clear goals for outcome improvement | - | ||
| c. Selection of improvement initiative; need for clear methodology | - | ||
| d. Improving without clear improvement potential | - | ||
| e. Improving quality of care without outcome data | - | ||
| f. Evaluation of improvement initiatives | - | ||
| 8. Long-cycle benchmarking and short-cycle feedback | a. Long-cycle benchmarking between networking hospitals | +/- | |
| b. Short-cycle continuous improvement through electronic care pathways | + | ||
| 9. Availability of outcome data | a. Data collection and data analysis | - | |
| b. Access to data not directly related to an intervention | - | ||
| c. (national) Data registry | + | ||
| d. Support of information technology (IT) | + |
§Factors were experienced by participants as hindering (-), as supporting (+), or both (+/-), depending on the poor/proper implementation of the factor