Table 2 Overview of results, illustrating the core code tree

Motivation: the extent to which professionals are willing and eager to engage in their work

Perception of making a positive impact

Increasing motivation

• Genuinely supporting individual patients

• Improving care for many patients collectively

• Advancing VBHC

Decreasing motivation

• Constraints to making a positive impact

• Doubting positive contribution of VBHC-efforts

• Slow progress in achieving VBHC and optimizing value^a

Enjoyability of tasks

Increasing motivation

• Increased richness and depth in consultations

• Increased task diversity

• Alignment of tasks with expertise and preferred challenge level

Neutral

• No changes in one’s tasks

• Work remains equally enjoyable

Decreasing motivation

• Reduced time for valued tasks

• Discontent with VBHC-related task attributes

Personal development

Increasing motivation

• Opportunities for personal development

• Personal growth

Decreasing motivation

• Limitations in feedback

Sense of community and support

Increasing motivation

• Teamwork (internal)

• Collaboration (external)

• Organizational support

Decreasing motivation

• Unengaged colleagues^a

• Limitations in organizational support^a

• Systemic limitations within national healthcare system^a

Strain: the physical, mental, and emotional exhaustion that limits professionals' ability to engage in their work

Workload

Increasing strain

• Additional, uncompensated time investment

Neutral

• Unnoticeable changes in workload

Decreasing strain

• Efficient, streamlined processes

Cognitive demands

Increasing strain

• Data overwhelm and scatteredness

Decreasing strain

• Improved oversight (processual)

• Ease from increased information availability

Confidence

Increasing strain

• Deviating from established standards

• Perceived limitations in competence

Neutral

• Feedback on performance

Decreasing strain

• Confidence from increased information availability

• Evidence of high-quality service delivery^b