Healthcare; the Value challenge
Healthcare as we have mentioned elsewhere.. is under pressure to change.
If you look at the % of GDP spent of healthcare, one of the interesting conclusions is that the % countries spend on healthcare does not directly relate to the outcomes from that spend.
So in these difficult economic times, rather than spending more money or necessarily working harder, it appears we all need to be smarter about the way we manage healthcare. That may involve more patient self-caring, more patient centred care pathways that reduce duplication and waste and/or changes in the way that we use technology in healthcare. In short we simply need to deliver better value for money in healthcare.
Currently across much of healthcare many would admit it is difficult to measure “value”. We may currently exercise our judgement or know it when we see it but there is a related challenge in how to deliver “Value for Money” within healthcare systems.
Value is a loosely defined concept, though I find value definitions commonly relate to this things that most of us believe are important in life (i.e. quality, safety, timeliness and costliness).
Ultimately if we aim towards value in terms of quality, safe, timely and not costly care, this needs to be delivered at the frontline, which requires changes.
Towards those changes we need to make iterative improvements with routine and regular audit. In addition research is needed to provide the Knowledge Base of which quality/safety/time and cost measures are most useful.
Within the UK the speciality of Emergency Medicine has used a time measure (4-hour standard from Admission to Discharge) as a proxy of quality of care and value for the patient. This thinking is now developing towards most balanced measures to get a more holistic approach to measure value from the patients perspective..
While I am not suggesting that measuring value is easy, what is clear is that if we are aiming at measuring any of those elements that contribute towards value (i.e. quality, safety, time and money) that we are providing at the point of care, we need better information systems to support attempts to increase the value offered.
So whatever health system one explores internationally, be it tax based or insurance based or a mix of something in between, all systems are converging on the realisation that better information is required to drive changes required to get better value for money within healthcare systems.
If measuring value in healthcare strikes you as complex, you will have noted that the term complexity keeps coming up in our exploration.
As complexity is such a recurrent theme across my work, I would like to now introduce you to a range of concepts from simple, to complicated, from complex to chaotic and a related framework named Cynefin that I find very useful.
We will return to healthcare to look again at related solutions in due course.
Porter, M, Teisberg E. O., (2006) “Redefining Healthcare: Creating Value Based Competition on Results”