The Joint Commission Annual Conference on Quality and Patient Safety:

• 4/30/2010
• Author: Steven Berman
• Category: The Journal Blog
• 11691 Views
• 0 Comments
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A Preview of "Evidence-Informed Value Improvement"

As you may know, The Joint Commission Annual Conference on Quality and Patient Safety will be held June 23–25 in Chicago. This conference will focus on organizational greatness and decisions and actions for health care executives seeking to improve quality, reduce errors, contain costs, increase productivity, sharpen execution, and to build leaders throughout their organization.   Participants will hear practical application of improvements from successful organizations that have driven change to sustain organizational greatness. Headline speakers include Joint Commission President Mark Chassin, M.D., M.P.P, M.P.H.; John J. Nance, J.D., a world-renown broadcast analyst and advocate for safety in aviation and health care; and John Øvretveit, Ph.D., M.H.S.M., a member of the Journal’s Editorial Advisory Board who has devoted much of his career to studying how health care organizations improve. Click here for registration information: http://www.jcrinc.com/Conferences-and-Seminars/The-Joint-Commission-Annual-Conference-on-Quality-and-Patient-Safety/1979/

I was curious about Dr. Øvretveit’s talk, "Leading Evidence-Informed Value Improvement," and so I recently “chatted” with him (by e-mail). He and I welcome your comments—and hope to see you at the conference.

What is Evidence-Informed Value Improvement?
When an organization makes a value improvement, it makes changes that increase the quality of a service relative to the costs of providing the service. For example, antibiotic prophylaxis before surgery reduces postsurgical infections and improves clinical outcomes. But it also reduces costs because treatment of postsurgical complications such as infections takes time and resources and is not reimbursed.

Most value improvements reduce patient suffering and reduce waste. But there are some that add quality at a small cost—not to realize future savings, but to generate more revenue—for example, by remote monitoring of patients at home that is made possible by investments already made in the information technology system for other purposes.
 
The “evidence-informed” part comes from experience reported elsewhere, such as in the Journal and other published research, conference presentations, or listserve discussions. This experiential evidence helps us to make improvements in a more effective way as we draw on the “lessons learned” by others. Reports that describe the setting and the steps taken also help us to determine whether the same improvement might or might not be feasible to implement in our own setting.

We hear a lot about value these days. Like value-based purchasing, is this a way to arrive at a "value" measuring stick so organizations can determine how to allocate their resources for improvement?
For me the most important aspect of the “value” idea is to connect quality and finance for both health care providers and purchasers. At present, buying and selling is done mostly on the basis of cost and volume, with very iittle attention paid to quality, which often is not measured and made part of the contract. Evidence-based value improvement can help purchasers move from volume-based purchasing—where lowest price/highest volume is the only consideration and quality is either assumed or ignored—to value-based purchasing, which relates price to quality. Now, the challenge is to develop valid, service-specific measures of quality that efficiently capture and report data. Evidence-based value improvement approaches also helps providers prioritize their quality and safety improvement activities on the basis of the anticipated return on their investment, thereby aligning the clinical operations with strategic goals.

What is to guard against organizations simply devoting improvement resources that are already measured by the Centers for Medicare & Medicaid Services (CMS) clinical performance measures?
No pay for never events and other pay-for-performance initiatives are already moving organizations in the direction of value-based purchasing. Organizations will focus resources on avoiding these events and work to improve quality for those items that are measured and linked to payments, which is what those schemes are designed to do. The problem is, as you say, that some organizations may divert resources from other quality activities that are more effective and do more good for other patients. This is why a broad range of measures are needed, and why we need to further assess the ultimate impact of these schemes on quality. You have to start somewhere.
 
How would evidence-informed value improvement affect continuity and coordination of care, which go beyond patient conditions or procedures?
You have hit on a subject dear to my heart and that I am working on now—the tremendous waste in systems due poor communications and coordination between providers. I am sure that some of the greatest value improvements can be made in improving connections between organizations and between clinical services and shifts within organizations.

As you know, patient handoffs are very problematic, in terms of the costs of inefficiency and the risk of adverse events. Improvements in communication and coordination in general, and specifically in handoffs, can usually be carried out at low cost and reduce considerable waste—for the next stage down the line. The problem, then, is that the people making the improvement often do not always realize the savings. Evidence-informed value improvement should help make the costs and savings associated with improvements plain for all to see.

For more on this subject, read Dr. Øvretveit’s “Does Improving Quality Save Money?”