Abstract
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.
Highlights
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
This review reveals that healthcare professionals in VBHC may experience 16 job resources and/or job demands, four constructs related to their well-being, and five constructs related to job strain
This review reveals that increased job resources resulting from the adoption of VBHC may increase professionals’ engagement, energy, joy in practice, and job satisfaction, which corresponds to findings from research on clinician engagement during organizational change (80)
Summary
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. Healthcare systems increasingly move toward “value-based healthcare” (VBHC) (1), aiming to further improve quality and performance of care as well as the equitable, sustainable, and transparent use of resources (1–3). A characteristic shared by most VBHC programs is the multifaceted approach that, on top of clinical outcomes, provides a prominent place to patientreported quality and performance indicators Examples of these include “Patient Reported Outcome Measures” (PROMs) and “Patient Reported Experience Measures” (PREMs) (2). In comparison to traditional care practices, VBHC may change professionals’ work by introducing new, or shifting emphasis toward, valuepromoting care activities and team-based care (6) Such activities include discussing value with patients, making a shared decision, learning, and improving based on quality and performance indicators and providing care in pathways (7–9). We may expect changes in professionals’ well-being with VBHC currently gaining traction
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