PhD V.P.M. (Veerle) van Engen

Below is a brief summary of the dissertation:

Hospitals are implementing Value-Based Healthcare (VBHC). VBHC focuses on optimizing patient value by reshaping how care is delivered, organized, measured, and reimbursed. This thesis, six published articles, addresses three knowledge gaps hindering progress:

Gap 1: insufficient implementation knowledge for hospitals 
Through mixed-methods research, we examined the decade-long (2012–2023) change towards VBHC at Erasmus Medical Center, a Dutch university hospital pioneering VBHC. This research investigated: (1) the evolution of the hospital's VBHC implementation strategy over the decade and its outcomes, analyzed through a complexity-lens; (2) patient response rates to Patient Reported Outcome Measures (PROMs) and healthcare professionals' use of these responses; (3) strategies to improve PROMs use by patients and clinicians, including identifying patient and consultation characteristics associated with response behavior.

Gap 2: no consensus on VBHC in outpatient practice
In a Delphi study, clinicians identified 63 key activities essential for a value-based outpatient consultation, emphasizing person-centered care, care optimization, and resource stewardship.

Gap 3: limited attention to healthcare professionals within VBHC
Through a systematic literature review and interview study, we examined the experiences of healthcare professionals in various (inter)national hospitals with VBHC. Both positive and negative perceived impacts on their motivation and job strain were found, alongside mechanisms behind these ‘gains’ and ‘pains.’

Highlighting the importance of optimizing the dynamic between implementation strategy and healthcare professionals for implementing and sustaining VBHC, key contributions of this thesis include: applying insights from complexity theory to navigate the value movement, framing VBHC as a goal-means hierarchy, and addressing the motivation, well-being and (re)professionalization of healthcare professionals.