Framing Value Based Healthcare for the Complex Case

Student thesis: Doctor of Business Administration


Abstract The aim of this thesis is to progress the question of how to frame value based complex case management by grounding an empirical exploration in a series of case examples, in order to elicit a complex case management framework. Three investigations, as papers intended for publication, are undertaken framed by an overarching pragmatic stance. A series of care programme approach (CPA) case management reviews are used as a meta-theoretical sample and as the focus for each study. Each investigation uses a thematic template analysis to explore the range of practices within the case series. Further analysis is supported by set theoretic methods. The first investigation explores the process of forming the service participant context. The second investigation explores the process of value making within complex case management. The third investigation appropriates and revises the widely used Wagner’s Chronic Care Model (CCM) for use in complex case level management. This proposed Complex Case Management Framework (Complex CMF) is tested against practices within the case series and further revisions made. Finally, the themes and insights developed across the three studies are collated and synthesised as a platform to develop value-based complex case management. The key finding is that the diversity of practices relating to value realisation underlines the need to develop suitable service platforms for case management. Five principles are developed. First, the individual complex care project should be the focus of interest for value based healthcare. Second, the care project is formed at the intersection of direct participant networks (i.e patient, clinician and commissioner networks), as represented by a unique service delivery network (SDN). Third, each case review within the care process functions as an opportunity for a service valuation, within a style of co-valuation that is determined by the nature of the collaboration. Fourthly, the valued outcome that emerges from such reviews can be seen as a meaningful construction of what matters to the participants, as well as an element that can be aggregated across case reviews in a way that has currency for wider service management. Finally, the proposed Complex CMF integrates these components into an accessible format as a basis both for supporting development of local platforms for service and as a foundation for further research.
Date of Award1 Aug 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorNathan Proudlove (Supervisor) & Luis Araujo (Supervisor)


  • Platforms for Service
  • Pragmatic Stance
  • Valuation Practices
  • Complex Case Management
  • Value Based Healthcare
  • Service Delivery Networks

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