Table 2 The description of each phase with their goal, tasks and support

1

Preparation phase

• Ready to start with the VBHC design phase with a multidisciplinary team including patient representatives

• Select a specific patient population and delineate it

• Create a multidisciplinary value team around a specific patient group

• Make a draft care structure

• Select patient representatives who can participate in the design sessions

• Schedule sessions (5) for preparation design phase

1. Coordination of tasks

1. Internal consultant of VBHC expert team, together with clinical lead

2

Design phase

• Common short- and long-term ambition of VBHC with the multidisciplinary value team

• Patient representatives are involved in team and focus group are conducted for expressing their wishes and needs

• An established plan for how the outcomes set will be used in the clinical care process

• Jointly defined key elements and actions of VBHC for the specific patient group to start improving the value of care for the specific patient group

• Use a BHAG for forming a common goal

• Design the final care pathways

• Map the patients’ experiences with the care process and their wishes and needs

• Select an appropriate clinical and patient-reported outcome set

• Ensure an action agenda; existing of short- and long term actions that will improve the value of care

1. Facilitation of workshop sessions (5)

2. Moderation of patient focus group

Tools

• Format BHAG

• Format final care pathway

• Format questions focus group

• Format action agenda

• PREM dashboard

1. Internal consultant(s), optionally with consultant of PROM expertise point

2. Experienced moderator

3

Building phase

• Proactive multidisciplinary value team working with defined actions

• The outcome set is ready to be used in practice, so that they can be filled in for & by every patient

• New registration rules are embedded in the care process

• The selected outcomes for the patient and the care givers are visualised in dashboards

• Integrate the outcome set in the electronic health record by the principles of unambiguous documentation

• Ensure a uniform and clear registration process by multidisciplinary team

• Build an improvement dashboard at population level

• Build a dashboard for improving personalised care at patient level

• Select process outcomes to use for continuous improvement daily care process

1. Advice on process

2. Advice on content and outcome selection

3. Support for building clinical outcome set in the electronic health record and for visualizing PROMS in a dashboard at patient level

4. Support for visualising data in improvement dashboard

5. Training for using PREM dashboard in practice

1. Internal consultant of VBHC expert team

2. Consultant of PROM expertise point

3. Data-IT expert of EHR department

4. Data-IT expert of Business Intelligence department

5. Clinical lead together with internal consultant of PREM team

4

Implementation in daily practice

• The implementation of various elements of value-based working have been incorporated in the care process of the specific patient group

• Proactive multidisciplinary team, improving outcomes and working towards VBHC

• Shared decision-making in the consultation room

• Formulate improvement actions based on PREM results

• Train the healthcare team how to use the outcome registration forms in practice

• Prepare the healthcare team for shared decision-making in practice through training

1. Training how to use the outcome registration forms in practice

2. Training shared decision-making by PROM expertise point

3. Training for using the dashboard, at patient level, in practice

1. Consultant of PROM expertise point

2. Consultant of PROM expertise point

3. Consultant of EHR department and PROM expertise point

5

Continuous improvement cycle

• Continuous improvement of care by multidisciplinary value team

• Follow-up steps towards value-driven working are determined

• Monitor the implementation process and improvements in daily practice

• Organise feedback sessions with multidisciplinary value team

1. Training for using the population dashboard in practice

2. Feedback sessions to discuss actions, results and the implementation process

1. Data-IT expert / internal consultant

2. Clinical lead (option: together with internal consultant)