As the transformation to value-based healthcare (VBHC) has just recently started in Saudi Arabia, limited literature is available on the challenges to its implementation. This study aims to assess the barriers to measuring and using health outcomes for VBHC in Saudi Arabia and to propose strategies for their improvement in order to promote the implementation of VBHC. This explorative qualitative study was conducted between March and April 2023 using in-depth semi-structured interviews with hospital administrators. The identified barriers were thematically analysed following two complementary theoretical frameworks: the behavioural change wheel (BCW) and the theoretical domains framework (TDF). We interviewed 16 hospital administrators. A total of 30 themes were generated and mapped into the 14 TDF domains and the three BCW components. The common barriers included a lack of knowledge and skills, competing clinical and business demands, gaps in plans and strategies to implement VBHC, time constraints, disrupted workflows, inadequate information technology and automation and an immature culture of VBHC. To enhance the implementation of VBHC in the vibrant healthcare system in Saudi Arabia, it is important to recognise and address the potential barriers to this transformation. Hospital leaders should consider robust strategies to overcome these barriers to ensure the successful implementation and integration of health outcomes in routine patient care.
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