Traditionally healthcare organisations have measured their effectiveness in terms of outputs. For example, was an operation carried out successfully? This is obviously vitally important, particularly in life and death situations, but it misses out the perspective of the person at the heart of the treatment – the patient, and can lead to fragmented care.
Their point of view can be radically different to that of the doctors and surgeons treating them, and therefore needs to be taken into account. Carrying out an operation could fix a particular problem (and therefore be judged a clinical success), but cause a known, secondary issue that impacts their quality of life. We’ve all heard the medical saying, “The operation was a complete success, but the patient died.”
At the same time the NHS, and other healthcare providers, are under enormous resource pressure. The population is living longer, and the cost of treatment is rising at a much faster rate than budgets are increasing. This is equally true in insurance-based healthcare systems such as the US, leading to a growing focus on payment by results approaches.
Introducing value-based healthcare
Both of these factors are driving the move to value-based healthcare, which looks at the actual value to the patient from particular operations and treatments, and therefore allows an informed choice on how care should be structured and given. This puts the patient at the centre of their own treatment, judging success through the outcomes that are important to them, rather than technical metrics. Increasingly more and more organisations are now adopting outcomes-based commissioning and outcomes-based/value-based contracting models. This means that funding is focused on the impact of treatment on the patient, based on their own views, rather than simply looking at the technical success of an operation. This shift to value-based healthcare benefits both patients and healthcare organisations:
- Patients have an ongoing dialogue throughout their journey, helping ensure they are informed, engaged and empowered.
- Clinicians and Trusts receive a much more detailed, patient-focused insight into the success of treatments.
Measuring these Patient Reported Outcome Measures (PROMS) is obviously central to value-based healthcare. However, it requires a radical change from traditional ways of measuring success – healthcare organisations now need to listen to the patient and gather much more detailed, qualitative feedback rather than relying on recording outputs and information gathered from standardised questionnaires. Patient dialogue is at the heart of delivering this high quality healthcare.
This brings three challenges – what to measure, how to actually collect feedback, and how to ensure that feedback is acted upon.
1. Measurement standards
To overcome the measurement challenge, the International Consortium for Health Outcomes Measurement (ICHOM) was created in 2012. It aims to support the move to value-based healthcare by providing standard sets of the outcomes that matter most to patients for particular conditions. This framework allows healthcare providers to collect relevant, in-depth patient feedback that can be used to judge the ultimate success of a treatment.
2. Collecting feedback
While ICHOM is defining what needs to be measured, it is vital that healthcare organisations are effectively and efficiently collecting feedback evidence directly from patients. Opportunities to give both quantitative and qualitative feedback have to be embedded within the patient journey, so that information is as accurate, high quality and in-depth as possible. Additionally, patients want the ability to respond through different channels – from paper-based questionnaires to PCs, online communities and mobile devices. What is needed is a single system that can collect all of this feedback safely and securely, automating the process as much as possible to minimise costs while giving patients a clear voice.
3. Acting on feedback
For feedback to deliver real benefits, it needs to be analysed and acted upon quickly. For example, PROMs have to be visible in real-time to healthcare managers so that they can see exactly how their organisation is performing, and any areas that require improvement. Linking feedback to business metrics (such as costs of treatment) provides a powerful method of demonstrating the benefits of value-based healthcare to providers, and the efficiencies it delivers.
As part of its commitment to value-based healthcare Questback has become an ICHOM Technology Affiliate, with our technology making it simple to capture Patient Reported Outcome Measures, alongside staff and patient experience feedback, and combine this with financial metrics. Questback’s flexible platform facilitates greater dialogue with patients through their channel of choice, across the entire patient journey. Once collected, our MySight dashboard solution makes it simple to create beautiful, interactive presentations of the metrics that matter, and share this amongst clinical staff, helping ensure that the value-based healthcare approach benefits both patients and the wider NHS.