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Developing outcome-based models within a healthcare context
Chidavaenzi, G. T. 2025. Developing Outcome-based Models within a Healthcare Context. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/2b7f7796-ddb5-48bf-90f4-f911909a67d1
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613798236422144 |
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| access_status_str | Open Access |
| author | Chidavaenzi, Grace Tariro |
| author2 | Grobbelaar, Sara S. |
| author_browse | Chidavaenzi, Grace Tariro Grobbelaar, Sara S. |
| author_facet | Grobbelaar, Sara S. Chidavaenzi, Grace Tariro |
| author_sort | Chidavaenzi, Grace Tariro |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Chidavaenzi, G. T. 2025. Developing Outcome-based Models within a Healthcare Context. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/2b7f7796-ddb5-48bf-90f4-f911909a67d1 |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/132098 |
| institution | Stellenbosch University (South Africa) |
| last_indexed | 2026-06-10T12:41:51.674Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/132098 Developing outcome-based models within a healthcare context Chidavaenzi, Grace Tariro Grobbelaar, Sara S. Salie, Faatiema Stellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering. Outcome assessment (Medical care) Health services administration -- Decision making Evidence-based medicine UCTD Chidavaenzi, G. T. 2025. Developing Outcome-based Models within a Healthcare Context. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/2b7f7796-ddb5-48bf-90f4-f911909a67d1 Thesis (PhD)--Stellenbosch University, 2025. ENGLISH ABSTRACT: The global shift towards Universal Health Coverage (UHC) has driven the need for healthcare systems to deliver quality outcomes while managing increasing costs. A significant portion of the world population cannot receive adequate healthcare services due to high costs. A persistent challenge in healthcare is, therefore, sustaining rising healthcare costs while maintaining good outcomes. In the African context, health investment will be pivotal in building robust and equitable health systems, however, securing healthcare investment is often challenging. Outcome-based models (OBMs), which link payments to outcomes rather than service volume, offer a promising approach to address these challenges. Despite the potential of OBMs, their implementation is complex, and there is limited literature on their design and development. This study aimed to develop a framework to guide the development of OBMs within a health context. The OBM development framework developed through this study contributes to determining how such models can be developed and effectively implemented. This study employed the Design Science Research (DSR) methodology, which supports the development of a relevant solution to a particular problem identified in a specific environment. Furthermore, DSR improves the subject area by generating new knowledge or expanding existing knowledge. The DSR methodology guided the research process and facilitated the development of the OBM development framework and management tool. From a theoretical perspective, a comprehensive review of the literature culminated in an understanding of why OBMs have been implemented, their challenges, and a set of health OBM concepts that are deemed to be critical in developing health OBMs. The review also revealed different types and forms of health OBMs, which showed different ways in which outcomes may be linked to incentives and served as a basis for establishing how risk can be shared amongst the different stakeholders. Empirically, through validations and multiple design iterations from expert interviews, framework ranking activities, case studies and practical demonstrations, the framework was validated and adapted to be suitable for a real-world environment. The final OBM development management tool supports a shift from the traditional fee-for-service models to OBMs emphasising outcomes, not volume. Therefore, the tool aims to improve health outcomes, reduce health costs and improve accountability among stakeholders, leading to a more effective way to manage stakeholders. The framework and management tool are built on two perspectives: 1) the structural perspective, which influences the entire process from defining outcomes to delivering them and paying for outcomes and 2) the relational perspective, which influences stakeholder interactions and how they co-create value. These perspectives are developed into 3 phases and their respective activities. Through the lens of structural perspective, Phase 1 defines the value proposition and Phase 2 designs the value architecture. From the relational perspective, Phase 3 develops the governance structure by which the stakeholder interactions will be managed. From Phases 1, 2, and 3, the contract is developed and signed, upon which implementation may begin. This study, therefore, advances the literature on designing sustainable payment models that improve healthcare quality by exploring the intersection of financial incentives and improved health outcomes. AFRIKAANSE OPSOMMING: Die wêreldwye verskuiwing na Universele Gesondheidsdekking het die behoefte aan gesondheidsorgstelsels gedryf om kwaliteit uitkomste te lewer terwyl toenemende koste bestuur word. ’n Beduidende deel van die wêreldbevolking kan weens hoë kostes nie voldoende gesondheidsorgdienste ontvang nie. ’n Volgehoue uitdaging in gesondheidsorg is dus om stygende gesondheidsorgkoste te handhaaf terwyl goeie uitkomste gehandhaaf word. In die Afrika-konteks sal gesondheidsbelegging deurslaggewend wees in die bou van robuuste en billike gesondheidstelsels, maar die versekering van gesondheidsorginvestering is egter dikwels 'n uitdaging. Uitkomsgebaseerde modelle (UBM'e), wat betalings aan uitkomste eerder as diensvolume koppel, bied 'n belowende benadering om hierdie uitdagings aan te spreek. Die implementering van UBM’e is egter kompleks, en daar is beperkte literatuur oor hul ontwerp en ontwikkeling. Hierdie studie het ten doel gehad om 'n raamwerk te ontwikkel om die ontwikkeling van UBM'e binne 'n esondheidskonteks te lei. Die OBM-ontwikkelingsraamwerk wat deur hierdie studie ontwikkel is, dra by om te bepaal hoe sulke modelle ontwikkel en effektief geïmplementeer kan word. Hierdie studie het die ontwerpswetenskap metodiek (OWM) gebruik, wat die ontwikkeling van 'n relevante oplossing vir 'n spesifieke probleem wat in 'n spesifieke omgewing geïdentifiseer is, ondersteun. Verder verbeter OWM die vakgebied deur nuwe kennis te genereer of bestaande kennis uit te brei. Die OWM het die navorsingsproses gelei en die ontwikkeling van die OBM-ontwikkelingsraamwerk en bestuursinstrument gefasiliteer. 'n Omvattende oorsig van die literatuur het uitgeloop op 'n begrip van waarom UBM'e geïmplementeer is, hul uitdagings, en 'n stel gesondheids-OBM-konsepte wat as krities geag word in die ontwikkeling van gesondheid-UBM'e. Die oorsig het ook verskillende tipes en vorme van gesondheid-UBM'e uitgewys, wat verskillende maniere getoon het waarop uitkomste aan aansporings gekoppel kan word en gedien het as 'n basis om vas te stel hoe risiko tussen die belanghebbendes gedeel kan word. Die raamwerk is empiries bekragtig en aangepas om geskik te wees vir ‘n werklike omgewing deur ontwerp-iterasies met deskundiges, raamwerkrangordeaktiwiteite, gevallestudies en praktiese demonstrasies. Die finale OBM-ontwikkelingsbestuursinstrument ondersteun 'n verskuiwing van die tradisionele fooi-vir-diens-modelle na UBM'e wat uitkomste beklemtoon, nie volume nie. Daarom is die instrument daarop gemik om gesondheidsuitkomste te verbeter, gesondheidskoste te verminder en aanspreeklikheid tussen belanghebbendes te verbeter, wat lei tot 'n meer effektiewe manier om belanghebbendes te bestuur. Die raamwerk en bestuursinstrument is gebou op twee perspektiewe: 1) die strukturele perspektief, wat die hele proses beïnvloed vanaf die definisie van uitkomste tot die lewering daarvan en die betaling vir uitkomste en 2) die relasionele perspektief, wat interaksies met belanghebbendes beïnvloed en hoe dit saam waarde skep. Hierdie perspektiewe word in drie fases en hul onderskeie aktiwiteite ontwikkel. Deur die lens van strukturele perspektief, definieer Fase 1 die waardeproposisie en Fase 2 ontwerp die waarde-argitektuur. Vanuit die relasionele perspektief ontwikkel Fase 3 die bestuurstruktuur waardeur die interaksies met belanghebbendes bestuur sal word. Vanaf Fase 1, 2 en 3 word die kontrak ontwikkel en onderteken, waarna implementering kan begin. Hierdie studie bevorder dus die literatuur oor die ontwerp van volhoubare betalingsmodelle wat gesondheidsorggehalte verbeter deur die kruising van finansiële aansporings en verbeterde gesondheidsuitkomste te ondersoek. Doctoral 2025-05-23T10:42:39Z 2025-05-23T10:42:39Z 2025-03 Thesis https://scholar.sun.ac.za/handle/10019.1/132098 Stellenbosch University xviii, 339 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Outcome assessment (Medical care) Health services administration -- Decision making Evidence-based medicine UCTD Chidavaenzi, Grace Tariro Developing outcome-based models within a healthcare context |
| title | Developing outcome-based models within a healthcare context |
| title_full | Developing outcome-based models within a healthcare context |
| title_fullStr | Developing outcome-based models within a healthcare context |
| title_full_unstemmed | Developing outcome-based models within a healthcare context |
| title_short | Developing outcome-based models within a healthcare context |
| title_sort | developing outcome based models within a healthcare context |
| topic | Outcome assessment (Medical care) Health services administration -- Decision making Evidence-based medicine UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/132098 |
| work_keys_str_mv | AT chidavaenzigracetariro developingoutcomebasedmodelswithinahealthcarecontext |