Opening Keynote: Charting Your Course to Success – Financial Wins through Value-Based Performance

Editor's Note

Although the central tenets of value-based healthcare have not changed, in many cases implementation has been reduced to little more than reducing costs, to the detriment of clinicians and patients. In a session at the 2025 OR Business Management Conference in February, economist Susanna Gallani, PhD, examined this problem from an economic perspective. Leveraging extensive research on motivation, she dove into how realigning physician incentives with performance outcomes can help reduce burnout, boost retention, improve outcomes for patients, and accelerate the transition to truly value-based care.

To that end, Dr Gallani urged perioperative leaders to reclaim control over their organizations' strategic goals by aligning performance metrics, incentives, and motivation to drive value. This requires defining value at the organizational level, then reverse-engineering operations to ensure incentives align. Rather than relying solely on external payment models, hospitals and surgical centers should develop internal strategies that reflect their specific objectives.

One major challenge is the disconnect between performance measurement and actual value creation, Dr Gallani said. Many healthcare organizations track metrics that don’t fully capture desired behaviors. The speaker warned against optimizing for the wrong indicators, as staff will naturally adjust their actions to meet defined targets, even if those metrics don’t improve patient care. Instead, leaders should ensure performance measures accurately reflect and reinforce strategic priorities.

Team dynamics, especially in the operating room, present another obstacle to efficiency. Research suggests teams with greater familiarity achieve better outcomes than fluid teams, in which members frequently change and struggle to develop cohesion. However, stabilizing surgical teams isn’t always feasible. In one study, a hospital improved OR turnover times by 14% by using small financial incentives, such as gift cards, rather than structural changes. This approach yielded results equivalent to significantly increasing team familiarity—without the cost of hiring additional staff.

Recognizing and motivating employees is essential for retention and engagement, particularly in knowledge-intensive fields like perioperative care, Gallani continued. Even simple, creative incentive programs can drive significant behavioral change. She offered the example of a hospital that was unable to pay physicians directly, so instead rewarded nurses for improving physicians’ hand hygiene compliance. This led to sustained improvements, as positive reinforcement reshaped physician habits long after the program ended.