Societies are plagued by growing healthcare expenditures and budgetary constraints. The strategy for solving the issue has been heavily debated, with proposed solutions such as Valuebased healthcare (VBHC), Public-Private Partnerships (PPP) and improved medical treatments. A novel concept that aims to improve medical treatment is strategic biobanking. Strategic biobanking is the act of saving biological samples and clinical data for future research. Access to strategic samples can speed up future clinical trials and studies, provide researchers with more useful research material, enable more thorough analyses of biomarkers, facilitate faster drug development, and increase the power of both retrospective analyses and precision medicine. This thesis studies the shared value effects of a strategic biobanking PPP by drawing on the theoretical fields of VBHC, PPP and Creating Shared Value (CSV). Specifically, the effects of hospital organisational structure, regulatory framework and public interest on strategic biobanking PPPs was studied. The research was carried out through a single holistic case study of Karolinska University Hospital in Stockholm, Sweden and multiple pharmaceutical companies, and data was collected through semi-structured interviews. Data analysis was carried out in accordance with the grounded theory framework. The researchers find that regulatory structure can limit the options when crafting the business model and the industry value proposition for a strategic biobanking PPP. Some strategies on how to deal with these restraints are outlined. Furthermore, the research highlights the importance of longitudinal data-sets and how a hospital organised according to the VBHC principles is more suitable for implementation of longitudinal sampling routines. Finally, the research shows that that the concept of CSV can act as guidance for private partner decision making to increase public interest. By adopting principles of transparency regarding financial incentives and motivations, an industry partner can garner increased trust with the general public as well as their public partner. The shared value effects are pronounced, and the study finds that a strategic biobanking PPP moves the boundary for what is scientifically possible for all stakeholders in the healthcare domain. / Samhällen plågas av skenande sjukvårdskostnader och budgetåtstramningar. Vilken strategi som kan lösa problemet har debatterats flitigt. Lösningar så som Value-based Healthcare (VBHC), Public-Private Partnerships (PPPs) och mer avancerad vård har alla föreslagits som alternativ. Ett nytt koncept som ämnar att förbättra sjukvården är strategisk biobankning. Strategisk biobankning innebär att spara biologiska prover och klinisk data inför framtiden. Detta kan snabba på framtida kliniska prövningar och studier, förse forskare med mer användbart forskningsmaterial, möjliggöra mer grundliga analyser av biomarkörer, snabbare utveckling av mediciner, samt öka potensen hos både retrospektiva studier och precision medicine. Denna uppsats studerar gemensamma värdeeffekter hos ett PPP inom strategisk biobanking genom att använda sig av de teoretiska fälten VBHC, PPP och Creating Shared Value (CSV). Mer specifikt studeras hur PPP inom strategisk biobankning påverkas av sjukhusets organisationsstruktur, rådande regelverk och allmänintresse. Forskningen utfördes genom en enkel, holistisk, fallstudie av Karolinska Universitetssjukhuset i Stockholm, Sverige. Data samlades genom semi-strukturerade intervjuer och analyserades senare enligt ramverket för Grounded Theory. Forskarna finner även att rådande regelverk begränsar möjligheten för utveckling av affärsmodell och värdeerbjudande gentemot privata partners. Några strategier för att hantera dessa begränsningar tas upp i uppsatsen. Vidare belyses vikten av longitudinella dataset, och att ett sjukhus vars organisation är strukturerad enligt VBHC-principer är mer lämpligt för implementation av longitudinell provsamling. Slutligen finner forskarna att privata CSV-conceptet utgör bra vägledning för privata partners för att skapa allmänintresse. Genom att anamma principer som premierar transparans gentemot sina ekonomiska och strategiska incitament så kan förtroende byggas gentemot allmänheten. De gemensamma värdeeffekterna är tydliga, och forskarna finner att tillgång till en strategisk biobank flyttar gränsen för vad som är vetenskapligt möjligt för alla aktörer i det sjukvårdsrelaterade ekosystemet.

Syftet med denna studie är att undersöka hur införandet av managementkonceptet värdebaserad vård upplevs av vårdgivare respektive patienter. Vi vill även undersöka hur arbetet med värdebaserad vård påverkar kvaliteten av vården. I samband med detta vill vi dessutom studera vad införandet av kundbegreppet har haft för konsekvenser för vårdgivare och vårdtagare. Vi har genomfört en kvalitativ forskningsmetod och genom semistrukturerade intervjuer och genomgång av tidigare forskning, har vi kunnat besvara studiens frågeställningar och uppnått dess syfte. Respondenterna av intervjuerna bestod av fem vårdgivare (läkare) och fyra vårdtagare (patienter). Dessa intervjuer utgör, i kombination med tidigare forskning, datainsamlingen. Vårdgivare drabbas och begränsas dagligen i hur de vårdar sina patienter.  Resultatet visar även att implementeringen av värdebaserad vård är problematisk då konceptet är välbekant, men kan inte alltid tillämpas i praktiken. Både vårdgivare och vårdtagare talar om bristen i värde och kvaliteten av vård, till följd av bland annat personal- och platsbristen som råder. Dessutom har det kunnat slås fast att politiken har en avgörande roll i hur sjukvården styrs, och att politikerna har ett inflytande på sjukvården, utifrån inkorrekta ändamål, det vill säga med ekonomi och siffror i centrum. Slutligen har det likaså påvisats att kundbegreppet inom sjukvården inte nödvändigtvis har påverkat vårdgivarnas synsätt på patienter, däremot har det haft en inverkan på styrsättet. Detta i form av att sjukvården mer likt styrs som en affär i syfte att behålla sina kunder, snarare än en plats för vård av sjuka. / The purpose of this study is to investigate how the introduction of the management concept value-based healthcare is experienced by care providers and patients respectively. We also want to investigate how the implementation of value-based healthcare has affected the quality of care. In connection with this, we also want to study what consequences the introduction of the concept of customer has had for care providers and care recipients. We have implemented a qualitative research method and through semi-structured interviews and a review of previous research, we have been able to answer the study's questions and achieved its purpose. The respondents of the interviews consisted of five care providers (doctors) and four care recipients (patients). These interviews, combined with previous research, forms the basis of the data collection.  Caregivers face limitations in their daily care for patients. The implementation of value-based healthcare has been problematic, as it is talked about much more than it is actually applied. Both caregivers and care recipients have reported a lack of value and quality of care, which can be attributed to staff and space shortages. It was also established that politics plays a decisive role in healthcare governance, with politicians focusing on incorrect objectives such as economics and numbers. Finally, the concept of a customer in healthcare has affected the management approach, but not necessarily the caregivers' approach to patients. Healthcare is now governed more like a business with the aim of retaining customers, rather than a place for the care of the sick.

Fragmentation in healthcare has led to a desire to align and integrate care processes horizontally. The concept of value-based healthcare has been introduced, suggesting a maximized value creation to occur when optimal conditions are created for selected patient segments, integrating all activities that jointly determine the success in meeting a set of patient needs. While targeting specialized segments has been shown to be beneficial, theories of diversification suggests that an increased scope may be an even more efficient approach to improve performance. By sharing resources and capabilities across several specialized units, coordination and knowledge sharing of a hospital’s ancillary services becomes important.   In this study, we examine how an ancillary service function, providing resources and capabilities that are shared across specialized units, can be organized to ensure contribution to the overarching goal of maximizing value for patients. This is done through a qualitative case study of the Karolinska University Laboratory – an ancillary service function of the Karolinska University Hospital. It is concluded that an ancillary service function can, in a diversified context, facilitate and support the value creation around medical conditions by developing a comprehensive structure for knowledge management and sharing, both externally towards medical conditions and internally within the ancillary service function. If structured properly, clear benefits, such as economies of scale, scope and knowledge spillovers, can be achieved by separating sharable resources from the patient flows.

La tesi vuole porre l’attenzione su uno dei dilemmi dei moderni sistemi sanitari: garantire buoni servizi di cura a costi contenuti. La tesi affronta tale questione attraverso l’implementazione del modello value-based (cfr. medicina basata sul valore), dove per “valore” si intende il risultato di salute conseguito per risorse impiegate. L’obiettivo della tesi è quello di dedurre, attraverso tre differenti punti di analisi, le condizioni e i fattori che stanno inducendo le aziende sanitarie a migliorare i loro modelli di erogazione di cura al fine di incrementare il valore per i pazienti. Nello specifico, la tesi focalizza l’attenzione sui processi sanitari (cfr. operations management) mettendo in risalto le modalità con cui le aziende sanitarie tendono a ridisegnare i processi sanitari per rispondere meglio ai bisogni dei pazienti.La tesi tocca diverse prospettive del modello teorico del value-based. I primi due capitoli analizzano la creazione di valore e le condizioni di implementazione analizzando il fenomeno dalla prospettiva aziendale. Al contrario, l’ultimo capitolo punta ad analizzare tale questione dalla prospettiva del paziente. La tesi da spunti su come le aziende sanitarie debbano intraprendere tali cambiamenti operativi e supportare l’implementazione del modello value-based attraverso tre differenti prospettive: percorsi clinici, efficienza operativa, prospettiva del paziente. / The current thesis tries to shed a light on one of the dilemmas concerning healthcare systems: delivering good care at affordable costs. Therefore, this thesis addresses the issues related to the implementation of the value-based healthcare theory, where “value” is the clinical outcome achieved per resources used. The scope of the thesis is to deduce, through three different viewpoints of analysis, the conditions and drivers that are leading healthcare organizations to enhance their healthcare delivery system in order to create more value for patients. In particular, the thesis stresses the perspective of healthcare operations highlighting how providers tend to redesign healthcare processes to better meet patients’ needs. The thesis touches on different perspectives with regard to the value-based theoretical model. The first two chapters analyze value creation and the conditions of its implementation, looking at these phenomena from the provider’s point of view. In contrast, the last chapter aims to analyze this issue from the patient’s perspective. The thesis makes suggestions on how healthcare organizations should undertake operational changes and deals with value-based healthcare implementation through three different fronts: clinical pathways, operational efficiency, patient’s perspective.