PhD defence M. (Maura) Leusder

Below is a brief summary of the dissertation:

Healthcare costs keep rising, staff shortages are worsening, and demand for care continues to grow. Still, little is known about how costs and resources can best be managed, particularly in personalized care.
This thesis brings together eight studies that examine both the technical and social sides of cost management in relation to value-based healthcare. The insights were translated into a dashboard and cost management system.
A review of the literature identified good practices in cost management. A long-term study in a Dutch fertility clinic showed how major cost differences arise, even when staff follow protocols, because care is personalized. For example, “In-vitro Fertilization” treatments ranged from €2,740 to €4,089, which reimbursements don’t cover. A new method was developed: time-driven activity-based costing with process mining (TDABC-PM). It tracks patient-level differences in workload, resource use, and costs. Using TDABC-PM, data from 4,190 patient pathways (18,445 treatments) were analysed. This led to three pathway redesigns, which reduced staff burden and saved €322–€1,998 per patient. Patients achieved pregnancy faster, generating savings for the Dutch healthcare system (€1.3 million). Yet, because reimbursements do not cover costs, clinics now face financial losses. Focussing on this setting is socially relevant, as 1 in 6 adults face fertility problems during their lifetime. Lastly, a survey across a variety of medical domains (n=217) showed that when staff use such enabling cost data, their psychological wellbeing, motivation, and cost management behaviour improve. 
Overall, the thesis shows how cost management systems can improve value, reduce waste, and improve workforce wellbeing.