What does value mean in healthcare?
Sifa Porter joined the On Purpose Associate Programme in October 2017 and is currently in her first placement at King’s Health Partners. In this blog she explores what she has learned over the past few months about the meaning of value in healthcare.
I joined King’s Health Partners about four months ago with little knowledge of what they do and zero experience in the healthcare sector. Coming from a social enterprise background I was initially sceptical that the public sector, especially health, could deliver the kind of transformative change and social impact that the private and third sectors do. This belief was challenged when I met with King’s Health Partners at an impact event organised by my workplace, and when the opportunity arose to work with them for a while later, I jumped at it.
I’m lucky enough to be young and relatively healthy with no chronic conditions, and as such have very cursory and sporadic interactions with the NHS or other healthcare providers. Nonetheless, I was tasked with helping the Value Based Healthcare (VBHC) team with their work on outcomes measurement and communications.
Value is defined as outcomes (that matter to patients) divided by the cost of delivering them throughout a patient’s complete journey within healthcare provision. It is championed by Michael Porter, Harvard Business School, whose research and tireless campaigning has led to the gradual take-up of the VBHC agenda, and when outcome measurement is done well, such as the Cleveland Clinic, the results have been impressive. For a more in-depth explanation, see Professor Johns Moxham’s introductory video.
But what exactly is an outcome? It depends on who you ask. The World Health Organisation (WHO) defines it as: the change in the health status of someone as a direct consequence of the treatment or intervention that they received. The International Consortium for Health Outcomes Measurement (ICHOM) gives this fuller explanation: outcomes are the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives.
I had initially assumed the NHS uses the second definition as a guiding principle when considering the various treatments they could offer, and that it’s these assessments that were included in both patient care plans and their internal measures.
This is not the case, and there is a marked difference between what is measured and what we the patients actually care about. Generally, in General Practice, and especially at hospital, some of things that tend to be tracked are clinical and structural processes such as waiting times, tests performed, drugs prescribed, operations carried out, and length of stay at the hospital.
However, measures of the clinical process often do not matter as much to patients as measures of quality of life do, namely functional ability, and emotional wellbeing.
When we get sick, nearly all of us seek the same outcomes, to be self-sufficient, symptom free, and capable of pursuing the normal activities that give us a sense of satisfaction without interference by our illness or condition. For example, if you had a stroke, what you might care most about is how quickly you’ll get better, whether it will affect your ability to drive or work, and for how long or how severely your speech or limb function might be affected.
Identifying and measuring the right outcomes is hard, frustrating, and requires work, and in my opinion reporting them is even harder. My project with the VBHC team is to collect and report findings in a ‘scorecard’. At first I had assumed scorecards were those large placards they use to judge sporting events and dog shows, but in the medical context it’s essentially a “simple” document that gives an overview of how well a particular institution is performing in terms of patient-centred care. They are fairly brief, informative, and are used for benchmarking purposes both within and across hospitals/institutions. However, I keep on running into the problem that while there is a lot of data, it’s nearly all clinical activity and process-based as described above.
However, Kings Health Partners has put itself at the forefront of designing and delivering VBHC and is actively trying to imbed the capability of providing meaningful and holistic healthcare to all patients.
We can’t do it alone and for this project to grow and thrive it must be collaborative. We need help, yours included, in your roles as patients or carers, through direct reporting on the status of our own health which can help determine whether treatment culminates in outcomes that we care about. For this purpose, we rely upon patient-reported outcomes measures (PROMs). A key example where this has worked to inform our understanding of patient outcomes is the Patient Experience Data Intelligence Centre (PEDIC) feedback survey at South London and Maudsley. PEDIC allows us to assess service users’ experience of care and feedback the scores into our Clinical Academic Group Outcome Books, enabling a full reflection of how the trust is performing on issues that matter to patients.
These are usually collected through surveys or questionnaires, sometimes months after treatment, and at the moment there aren’t enough people filling them out to offer a reliable evidence base, which in necessary for change and new practices to be adopted. I ask that next time you visit the hospital you take time to fill out those short forms as it might just result in better health and wellbeing for all of us (as well as giving the next round of scorecards more data to work with).
Find out more about what we’re doing to deliver excellent and consistent health outcomes whilst protecting our NHS resources on the King’s Health Partners Value Based Healthcare page.
