Hospital care goes far beyond strict medical activity. Of course, it is essential that patients receive the best possible clinical care, but that alone is not enough. Other parameters must be considered, such as the patient’s experience during a time when they may be very vulnerable, as well as the perceptions of healthcare professionals as they perform their work.

For this reason, the Vall d’Hebron University Hospital (HUVH), Barcelona, Spain, began a care reorganization 5 years ago aimed at a more coordinated, interdisciplinary approach aligned with the principles of value-based care. “Value-based care means not only focused on healthcare activity but also taking into account what really matters to the patient and the health outcomes achieved,” María Àngels Barba , director of Nursing at the hospital, told Univadis Spain, part of Medscape’s Professional network. These principles translate into identifying and eliminating common inefficiencies in a health center, optimizing care processes, adding value, and promoting continuous improvement.

This new organization grouped specialties under the umbrella of “Knowledge Areas.” The pioneering area was the Heart Area, whose first results were recently published in the journal Medicina Clínica.

The Origin

It is hard to find beneficial consequences from the pandemic that shook the foundations of society, especially in healthcare: hospitals and health workers were overwhelmed caring for thousands of patients with COVID while racing to find solutions, inevitably putting other conditions on the back burner. However, “the hospital being nearly full of COVID-19 patients at the end of the first pandemic wave 5 years ago made us see the opportunity to implement an organizational change,” Barba said.

Organization by Knowledge Areas

The goal of organizing care by knowledge areas is to concentrate professional expertise and competencies on the most prevalent health problems. This improves the entire patient care process — before, during, and after admission — because all clinical decisions and actions are taken in a coordinated, consensus-driven way by specialized multidisciplinary teams focused on the person and their condition. HUVH is currently structured into 35 knowledge areas: 29 specific areas (heart, solid-organ transplant, general postsurgical care, frail trauma patients, pediatric specialties, pediatric onco-hematology, and others) and six cross-cutting areas (critical care, emergency care, surgery, clinical laboratories, diagnostic imaging, and treatment). These areas “were defined based on medical specialties, existing care units, the different care processes a patient goes through, and their interactions when a patient has a health problem,” Barba said.

A key element that sets HUVH model apart from other hospital management models is that clinical teams lead the transformation and share responsibility for outcomes, with strategic support from the executive team. “This is important because one reason a reorganization attempt at Karolinska University Hospital , Stockholm, Sweden, which had some similarities with ours, failed was the large increase in managerial positions,” Barba continued.

“The role of these clinical leaders has greatly helped to bring together and improve communication between the different disciplines and professional groups (doctors, nurses, physiotherapists, social workers, healthcare technicians, administrative staff, orderlies, and others) to work together on the diagnosis, treatment, and monitoring of the disease, thus offering comprehensive patient care,” said María José Abadías , healthcare director at HUVH and a predoctoral researcher at Vall d’Hebron Institut de Recerca, in a press statement. 

Another distinctive feature of HUVH model is that evaluation considers not only clinical indicators but also patient-reported outcome measures, patient-reported experience measures, and staff surveys.

All this was done without increasing annual budgets. “We prioritized within the existing budget the adjustment of staff and resources deemed necessary,” Barba said.

The Heart Area

The Heart Area encompasses cardiology, cardiac surgery, and related units: coronary unit, hemodynamics unit, arrhythmia unit, inpatient cardiology and cardiac surgery wards, cardiology day hospitals, and outpatient clinics. “The reason we chose these specialties and units for the first area was that, initially, they were the ones that worked most similarly,” Barba explained.

The 2021-24 experience, published in Medicina Clínica, is so far satisfactory. The data show a reduced average length of stay and fewer readmissions — findings we view positively because they suggest improved follow-up and continuity of care after discharge. The model has enabled more efficient, higher-quality care, particularly for patients with chronic, complex conditions such as cardiovascular disease; patient surveys also report high satisfaction. Nevertheless, it remains early, and we must wait to assess the model’s long-term impact, Mercè Andorra, nursing supervisor of the coronary and arrhythmia units at HUVH until December 2025, told Univadis Spain.

Specifically, health outcomes showed an 18% reduction in average length of stay, greater hospital management efficiency without compromising care quality, a 12% decrease in 30-day readmission rates, and a 48% reduction in in-hospital mortality — one of the most notable findings.

Regarding patient experience, data analysis revealed improved engagement and satisfaction. Response rates to surveys rose from 7% in 2021 to 16% in 2024, suggesting greater patient engagement in providing feedback. Patient satisfaction trends favorably, with increased perceptions of coordination among professionals and quality of care, which supports better interdisciplinary communication and more patient-centered care. To improve patient-hospital communication, “We have created committees with citizen participation to listen to patient needs and keep the patient at the center of our objectives,” Andorra said.

Staff perceptions also showed improved survey participation, reflecting greater commitment to the evaluation process. Professionals reported better accessibility and use of health outcome indicators; perceptions of interdisciplinary coordination improved significantly, showing the model has facilitated collaborative work and reduced fragmentation. “Listening to professionals is important because these changes often depend on them to succeed,” the nursing supervisor added.

Care Intensity Classification

Another goal of the current HUVH management model is to develop and apply a nursing care model based on patient complexity and intensity of care because “organizing by nurse-to-patient ratios does not reflect patient needs according to their complexity,” Barba said.

Early results from this new classification system, published in the Journal of Nursing Management, showed that reorganizing patients by nursing care needs (acute, intensified, or intermediate) has led to a significant improvement in the optimal nurse-to-patient ratio. “There is now better allocation of nursing care hours to patients who require it based on their complexity,” the hospital’s director of nursing said.

Overall Assessment and Future Plans

After 5 years, current data support continuing the model. “The results are beginning to be satisfactory and the assessment is very positive, but this is an innovative model that needs consolidation. Cultural changes of this magnitude require at least 10 years to take hold,” Barba said. For now, there are no plans to create additional specific or cross-cutting knowledge areas.

To consolidate the model, “we must work on continuous improvement in all aspects, both short- and medium-term, always seeking where there is potential for improvement. Each knowledge area has a dashboard that helps decision-making,” Barba said.

Transferable Care Model

HUVH new hospital care management system is attracting national attention: “Many hospitals have contacted us and shown interest in learning about the change we made and how we implemented it operationally,” Barba said.

For this reason, on March 26 the hospital will host an open day for professionals and managers from across Spain to share the keys to the model and the results from these 5 years. “We believe our system can be implemented in other hospitals, provided they make the necessary adaptations to fit their reality and develop a sound deployment strategy. Choosing the right moment to implement it is also very important,” Barba concluded.

The authors declared having no conflicts of interest.

This story was translated from Univadis Spain.