At the End of the Funnel: Translation of Improvement Approaches in Healthcare

Abstract: Myriad approaches aimed to improve different aspects of healthcare organizations, such as Lean healthcare and patient-centered care, are presented to managers in pursuit of operational improvements. At the same time, the focus of healthcare improvement is shifting from quality to value, and value-based healthcare has become one of the more bespoken contemporary improvement approaches (IA). However, many attempts to implement such IAs have failed. One vital factor for the successful application of IAs is the process of implementation, for which several guiding frameworks have been presented. However, other scholars have challenged the often instrumental view applied in implementation science by proposing that IAs – which are more ambiguous than more technical care interventions – are translated into a context, implying a greater acceptance for transformations of the original concepts. This thesis builds on a participative, longitudinal single-case study of implementation of value-based healthcare to the context of psychiatry, using qualitative methods and elements of action research. Focusing on the aspects of content, context, and process of the implementation, a model is proposed for how IAs can be viewed and handled as moldable concepts that are translated into a context-dependent local management model in the target organization. The thesis suggests that both practitioners and scholars could benefit from actively considering the contexts in which IAs are applied, including preexisting IAs and attitudes among organization members, to better grasp the complexity of healthcare management.