Why It Matters
Value management is unlike other efforts to cut health care costs. Its aim is to reduce costs of care while improving quality. This approach was developed by IHI in partnership with the NHS Highland Raigmore Hospital in Scotland in 2015. It has since spread to Northern Ireland, the US, and Qatar through some of IHI’s Strategic Partners.
Every health care improvement professional has their reasons for devoting themselves to quality. Poonam Gupta, MBBS, MPH, CPHQ, CMQ, is no exception. She is a physician and head of Quality Improvement who directs the value improvement program at the Heart Hospital, Hamad Medical Corporation (HMC) in Doha, Qatar. Dr. Gupta and her colleague, Dr. Salah Arafa, a senior consultant interventional cardiologist and HMC Director of Performance Improvement, are strong proponents of value management (also called value improvement), a methodology used to decrease costs while simultaneously increasing value. Dr. Arafa and Dr. Gupta supervise the Heart Hospital value management program.
Studying for her master’s degree in public health introduced Dr. Gupta to Lean, the foundation of value management. “I’ve always been passionate about figuring out how to apply lean thinking to the health care system because I see it as a resolution to many of our longest-standing institutional problems,” Dr. Gupta says. “I’ve been in quality improvement for 10 years now, and value improvement is the closest I’ve come to an actual answer.”
In tandem with the Hamad Healthcare Quality Institute (HHQI), the Heart Hospital undertook three months of intensive planning before officially launching the value management work in 2018. Once the program found success in their pilot unit, Heart Hospital decided to spread the work throughout their system, with Dr. Gupta serving in one of the key planning roles. Ultimately, HMC decided to spread the value management work throughout their entire health system which is led by HHQI.
Discussing costs in relation to patient care can be challenging in any health care system. Many health care providers associate such talk as too closely aligned with a profit-driven business mentality that prioritizes dollars over lives. Dr. Arafa maintains that health care can provide high-value care to patients while maintaining or lowering costs by reducing waste or increasing efficiency in the system.
Prior to the introduction of the value management methodology, there weren’t many conversations about cost at the Heart Hospital. “We used to be so focused on performance measures,” says Dr. Gupta. “We never thought about reducing cost by improving the quality of services or reducing waste.”
Like teams in other organizations that have done work on value management, Dr. Arafa and Dr. Gupta have seen an increase in communication, cooperation, and systems thinking throughout organization. “We saw some great results in one of our labs where we reduced wasted by decreasing the amount of rejected blood samples sent for analysis,” they explains. “Using the value management system-wide lens, our frontline staffs were empowered to view and address the issue from a whole-system perspective.” Instead of teaching themselves to work around the problem and allowing the waste to grow, or having several teams tackle the issue separately, those involved banded together to effectively resolve the issue without creating unnecessary conflict with the lab.
Dr. Gupta says she wouldn’t change anything about value management and had one key piece of advice about implementation. “Involve all the stakeholders from the beginning, especially in finance,” she says. Staff on the front line, she explains, need help learning how to tangibly correlate performance results with cost savings.
Dr. Arafa believes the Heart Hospital’s work on value management had the unexpected benefit of helping to prepare their teams for the current pandemic. “COVID-19 has affected every one of us, especially the frontline clinicians,” he says. “The value improvement work provided the teams with fundamental improvement capabilities they wouldn’t have had otherwise, giving them a strong skillset with which to face the pandemic.”
A visual management board at Heart Hospital
Dr. Nidal Asaad, the Heart Hospital’s Medical Director added, “We are committed to providing the safest, most effective, most compassionate, and highest value care to our patients. In addition, we work hard to make sure that our staff is working in a safe environment, which is paramount during this time.”
Emma Robinson is an IHI Project Coordinator.
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