Caring About Value: A grounded theory of the quest to move towards higher value care in hospitals

Abstract

Caring About Value: A grounded theory of the quest for higher value care in hospitals. The global pursuit of ‘value’ in hospitals continues amid rising healthcare costs. Traditionally, value in this context has focused on costs and benefits. Extending constructivist grounded theory using a therapeutic landscape lens, we explore value in hospitals not only as places of caring but also as workplaces where professional hierarchies and specialisation dictate what is considered to be ‘of value’. Through this approach, we develop a grounded theory of Caring About Value. Drawing on interviews with 47 staff and patients, 24 field visits, and 14 documents from three large metropolitan public hospitals in Australia, findings depict a three-stage dynamic social process through which people in hospitals move towards higher value care. These stages are: (1) Triggering consciousness; (2) Balancing competing priorities and values; and (3) Keeping up with the changing landscape. Two core concerns, caring about value and attending to power, shape value judgements about the spectrum of care from low to high value and underpin the theory. The Caring About Value theory can be used to transcend entrenched value judgements in hospital structures and systems, reduce inequities, and guide the redesign of hospitals and therapeutic landscapes. The theory may be useful for recruiting, supporting, retaining and elevating the status of individuals and teams best placed to do this, recognising that system transformation requires multifaceted actions beyond individual efforts.