Identifying consensus on activities that underpin value-based healthcare in outpatient specialty consultations, among clinicians.

OBJECTIVE: To find a consensus on clinicians' and patients' activities that underpin an ideal value-based outpatient specialty consultation, among clinicians. METHODS: A three-round online Delphi study was conducted. A purposive sample of nineteen clinicians from a Dutch university hospital judged activities on importance. Consensus was defined at 80% agreement. Activities were thematically analyzed to derive conceptual themes. RESULTS: The expert panel agreed on 63 activities as being important for an ideal value-based outpatient specialty consultation and two activities as being unimportant. They failed to reach a consensus on 11 activities. Conceptual themes for activities that were considered important regard: 1) empowerment, 2) patient-reported biopsychosocial outcomes, 3) the patient as a person, 4) the patient's kin, 5) shared power and responsibility, 6) optimization, 7) coordination, 8) therapeutic relationships, and 9) resource-consciousness. CONCLUSION: A value-based outpatient specialty consultation requires contextual decision-making, is person-centered, and focusses attention on care optimization and intelligent resource allocation. No importance is attributed to healthcare's societal burden and climate footprint. Disparities existed in various areas including the role of patient reported experience measures, "patient-like-me" data, and healthcare costs. PRACTICE IMPLICATIONS: This study contributes a toolbox to guide and evaluate clinicians' and patients' behaviors in value-based outpatient specialty consultations and reveals opportunities to enhance facilitation.

Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review.

Introduction: Healthcare systems increasingly move toward "value-based healthcare" (VBHC), aiming to further improve quality and performance of care as well as the sustainable use of resources. Evidence about healthcare professionals' contributions to VBHC, experienced job demands and resources as well as employee well-being in VBHC is scattered. This systematic review synthesizes this evidence by exploring how VBHC relates to the healthcare professional, and vice versa. Method: Seven databases were systematically searched for relevant studies. The search yielded 3,782 records, of which 45 were eligible for inclusion based on a two-step screening process using exclusion criteria performed by two authors independently. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Based on inductive thematic analysis, the Job Demands-Resources (JD-R) model was modified. Subsequently, this modified model was applied deductively for a second round of thematic analysis. Results: Ten behaviors of healthcare professionals to enhance value in care were identified. These behaviors and associated changes in professionals' work content and work environment impacted the experienced job demands and resources and, in turn, employee well-being and job strain. This review revealed 16 constructs as job demand and/or job resource. Examples of these include role strain, workload and meaning in work. Four constructs related to employee well-being, including engagement and job satisfaction, and five constructs related to job strain, including exhaustion and concerns, were identified. A distinction was made between job demands and resources that were a pure characteristic of VBHC, and job demands and resources that resulted from environmental factors such as how care organizations shaped VBHC. Conclusion and Discussion: This review shows that professionals experience substantial job demands and resources resulting from the move toward VBHC and their active role therein. Several job demands are triggered by an unsupportive organizational environment. Hence, increased organizational support may contribute to mitigating or avoiding adverse psychosocial factors and enhance positive psychosocial factors in a VBHC context. Further research to estimate the effects of VBHC on healthcare professionals is warranted.