Why Value In Healthcare Is A Matter Of Life And Death

Dear Colleague

This is part four in a series of letters about our strategy. In previous weeks I’ve looked at our strategy from three perspectives:

Today I look at how our strategy will deliver better value for patients and HMC. 

Let’s define value.

Value is the specific healthcare outcome we achieve, divided by the cost of securing that outcome 

Value matters for two reasons.

  1. Although we certainly don’t have the same financial constraints in Qatar that some other countries have, nonetheless there are not unlimited financial resources. This means that what we choose to spend delivering an outcome for one patient, is not available for the next patient.
  2. Outcomes (the specific, measurable benefit to a patient of the treatment and care we provide), must be the best that the evidence tells us is possible for that patient. Delivering outcomes for patients that are as good as possible is the real reason we are all here.

Some people believe that good outcomes are always the consequence of spending more resources. This is not true.

It is entirely possible to spend a vast amount of resources and still achieve a very poor outcome.

Here are some examples of what can happen if we approach outcomes without careful thought.

  • Patients can be over-investigated. As an example, exposing patients to more radiological tests than necessary is potentially harmful. Conducting more invasive investigations than necessary carries a risk that a complication could occur.
  • Patients can wait too long for a procedure, a test or an examination. When that happens their disease or illness can deteriorate, making their recovery more difficult.
  • Patients can have the wrong medication, treatment or investigation. This can happen when doctors and other clinical staff are under pressure to make quick decisions. Without standardised ways of working this risk increases and problems are more likely to occur, which can lead to poorer outcomes.
  • Patients can be offered a treatment for which the evidence of its effectiveness is lacking. This can happen when patients are very demanding or when doctors or other clinicians are unclear about what the evidence says.
  • Patients can develop an avoidable complication of their treatment. This can happen when a patient acquires a healthcare related infection. Patient can develop a clot which could cause a stroke or another complication if they are not given the right preventative treatment. Patients undergoing long surgeries in the OR can develop complications if they are not kept warm enough or if they are not given the right preventative antibiotic treatment.

There is a long list of ways in which well intentioned efforts to give patients the best treatment can go wrong.

Every time something like this happens, two consequences occur. 

  • First and most importantly the patient suffers a less positive outcome.
  • Second, the resources which are then used to “put right” the consequences of the poorer (or potentially poorer) outcome are resources that cannot be used to treat another patient.

For all of these reasons, we want our clinical teams to begin to identify the outcomes they believe they should be offering their patients. We would then like to measure how well we are doing against these outcomes and to assess how much resource we are using to secure them.

Value is not something we should shy away from. It is one of the most important indicators of a good hospital. When we can demonstrate to our patients that we deliver good outcomes we will build our reputation as a good hospital. 

If we can deliver these outcomes without wasting resources we can increase the amount of treatment we offer. By no longer wasting resources we can further strengthen quality by investing these resources to secure even better outcomes.

I hope that these last four letters have helped to explain the different ways we can think about what we do together and how we can move closer to our goals.

Next time I will talk about what we are doing to organise ourselves as a hospital to start making our strategy happen.

For now, let me as usual wish you and your family good health and happiness for the week ahead.

Best wishes

Adam