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. 2025 Jan 14;23(1):3.
doi: 10.1186/s12960-025-00972-x.

Gains and pains: a qualitative study on the implications of value-based health care for professionals

Veerle van Engen  1 , Igna Bonfrer  2 , Fabio Mieris  2 , Malou Ensink  2 , Anne Stiggelbout  2   3 , Kees Ahaus  2 , Martina Buljac-Samardzic  2
Affiliations

Gains and pains: a qualitative study on the implications of value-based health care for professionals

Veerle van Engen et al. Hum Resour Health. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Demands; Experience; Healthcare professional; Motivation; Netherlands; Patient reported outcome measure; Qualitative; Resources; Strain; Value-based health care.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and exempted from formal approval under the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethics Committee of the Erasmus School of Health Policy & Management (ETH2223-0195). All interview participants consented to participate and agreed to the publication of their quotes. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Adaptation from the extended JD–R model [32]
See this image and copyright information in PMC

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