A wealth of opportunities: an ethnographic study on learning to deliver high-value, cost-conscious care.

ObjectiveSince physicians behaviour determines up to 80% of total healthcare expenditures, training residents to deliver high-value, cost-conscious care is essential. Residents acknowledge the importance of high-value, cost-conscious care-delivery, yet perceive training to be insufficient. We designed an observational study to gain insight into how the workplace setting relates to residents high-value, cost-conscious care-delivery. DesignThis ethnographic study builds on 175 hours of non-participant observations including informal interviews, 9 semi-structured interviews and document analysis. SettingDepartment of obstetrics and gynaecology in an academic hospital in the Netherlands. Population or sample: 21 gynaecology residents. MethodsIterative analysis process of fieldnotes, interview transcripts and documents, including open-coding, thematic analysis and axial analysis by a multidisciplinary research team. ResultsResidents rarely consider health care costs, and knowledge regarding costs is often absent. Senior consultants guide residents while balancing benefits, risks and costs, with or without explicating their decision-making process. Identified learning opportunities are elaboration on questions raised concerning high-value, cost-conscious care, checking information about costs that are used in discussions about high-value, cost-conscious care, and having a more open and explicit discussion about high-value, cost-conscious care. ConclusionOur study emphasizes that the opportunities and potential to train residents to deliver high-value, cost-conscious care in the workplace are present. The challenge resides in capitalizing on these opportunities. We suggest departments to consult external experts to facilitate discussions regarding high-value, cost-conscious care to contribute to informal learning and to create a workplace setting in which high-value, cost-conscious care-delivery is prioritized. Fundingnone