# Understanding Value-Based Healthcare: Qualitative Insights From Nurses and Nursing Managers in Hospital Settings

## TL;DR

This study explores how nurses and managers in Barcelona understand and implement value-based healthcare, highlighting challenges and opportunities.

## Contribution

Provides qualitative insights into VBHC from nursing perspectives, identifying practical challenges and opportunities for implementation.

## Key findings

- Nurses and managers understand VBHC through patient-centered care models but face challenges like unclear strategies and training needs.
- Nurses focus on personal and allocative value, with less emphasis on cost and societal value.
- Nursing managers play a key role in fostering a culture that prioritizes patient outcomes over volume-based metrics.

## Abstract

To explore nurses' and nursing managers' perceptions regarding Value-Based Healthcare (VBHC) and the implementation of patient-reported measures in hospital settings in Barcelona, Spain.

VBHC aims to improve patient outcomes while optimizing resource allocation. Patient-reported measures are essential components of this approach, yet their implementation in clinical practice remains challenging. Understanding nurses' perspectives is crucial for successful integration of VBHC principles into nursing practice.

A qualitative thematic analysis approach was used. Semistructured interviews were conducted with a total of 19 participants (nurses and nursing managers) from tertiary public hospitals in Barcelona between December 2022 and June 2023. Data were analyzed using Braun and Clarke's six-phase thematic analysis framework. The study adhered to the SRQR guidelines for reporting qualitative research.

Four themes were identified: key elements of value in healthcare, conceptualization of VBHC through established healthcare models, practical aspects of implementing VBHC, and opportunities and systemic challenges in VBHC.

Nurses and nursing managers in hospital settings showed a good understanding of VBHC principles, often conceptualizing them through familiar patient-centered care models. They acknowledged VBHC's potential to enhance care quality and patient outcomes but identified significant implementation challenges such as unclear strategies, need for interdisciplinary collaboration, and comprehensive training. Nurses focused mainly on personal and allocative value, with less emphasis on cost considerations and societal value.

Nursing managers are crucial to implementing VBHC by fostering a culture that prioritizes outcomes that matter to patients over traditional volume-based metrics. Addressing identified practical challenges and broadening the understanding of VBHC components are key steps for nurses to effectively contribute to VBHC implementation, enhance their professional recognition, and improve healthcare outcomes and value.