It’s all too easy for clinicians and managers to get wrapped up in the detail of structures and processes of care delivery, only to find that patients’ problems aren’t going away and problems like long waiting times and frequent trips to the emergency room just get more troublesome. But, as described by Professor Sir Muir Gray in our value-based care (VBC) report, the core business of healthcare ‘‘is not running primary care or secondary care. It’s dealing with individuals and populations”. So, designing VBC calls for a change in perspective, away from hierarchies of care and towards delivering what matters to patients. But how do you organise care around patients?
In our experience of helping clients establish and provide VBC, it boils down to four steps.
First, understand what matters to your patients. How can they best be supported to help themselves? How does being cared for with dignity feel to them? And what does good health mean to them? Talk to them purposefully – use focus groups to understand how these factors might vary with age or geography. Use a few detailed case studies to create a picture of their lives, in which healthcare should support, not dominate.
Second, find out what matters to your staff – after all, they’re people too. In the UK, the country’s annual National Health Service staff survey provides a broad benchmark with which to assess how your workforce are feeling. But what specifically is it they want to get out of their time at work? Are they working to the top of their licence and feeling valued? Are they able to trust their colleagues so they don’t have to take the job home with them? Do they have what they need to improve clinical outcomes? Don’t forget your staff includes groups like receptionists, housekeeping and porters – often the eyes and ears of the organisation, providing valuable insight into how patients and other staff are feeling.
Third, walk through the patient journey and note what actually happens at each step. Is the right thing happening when it should? Are some processes unnecessary or mistimed? Do patients have enough information to make decisions? What innovations could save time and improve outcomes? For example, when a mental health client looked at how they managed their intensive care inpatients, they realised their review processes were time-consuming and their patients’ care required review more frequently. So, the ward team moved to daily board huddles, providing quicker updates and faster decision-making. As a result of this agile way of working, patients’ progress accelerated and their ‘time to first leave’ from the ward fell significantly.
Finally, decide how you’re going to know that things are improving. Rather than drowning in a sea of detailed process and outcome measures, find the few tools that provide the ongoing feedback you need on how much value your service is providing. Rather than being an administrative add-on, this information should be incorporated into routine patient care. For example, the MSK HQ tool allows patients to think through their musculoskeletal health before visiting their specialist, so they can tailor the conversation in their consultation to cover the issues that matter to them. At the same time, the MSK HQ results show the clinician their patient’s current health status, so they can recommend the most appropriate clinical interventions to improve clinical outcomes.
These four steps can unlock significant opportunity and potential to improve outcomes and reduce waste in healthcare. If they seem time-consuming and daunting, start small and see how effective they can be. In our experience, when the benefits become apparent, others will soon want to follow.