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Translating value-based healthcare into practice
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2017
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Abstract
In this paper, we report from an experiment into healthcare governance called
‘new governance in the patient’s perspective’ (NG) initiated by a Danish Region. The
experiment was inspired by principles of value-based health care (VBHC), and initiated to
transform governance from a productivity-regime, allegedly incentivizing clinical conduct
in ‘perverse’ and counter-productive ways, towards a new regime focusing on value for
the patient. Pursuing this ambition the Region exempted nine hospital departments from
activity-based financing based on Diagnosis-Related Groups (DRG), and asked instead
the departments to develop self-chosen indicators to measure and account for ‘value for
the patient’. Drawing on the notion of ‘translation’ (Latour, 1987) we analyse how NG was
put into practice in the departments, and how their indicators were accounted for.
Relating to literature on performance indicators, our case seemingly confirms a wellestablished
distinction between indicators for internal improvement vs. external
accountability. However, in pointing out the dialogues facilitated by the indicators
between the Region and the departments, this distinction is challenged. Our analysis
provides inspiration for healthcare governance to think of indicators as means, not for
purely data-driven governance, but for dialogical practices in which concerns with
accountability and local quality improvement conflate.