Delivering High Value Healthcare

I attended an interesting conference recently jointly hosted by the OECD and the King’s Fund on, “Delivering High Value Healthcare” on the 10th January 2017 which followed on from the, “Tackling Wasteful Spending on Health” report. The backdrop to both the report and conference is the increasing cost of healthcare across the globe and how approximately a fifth of health expenditure around the globe makes limited, if any, improvements to people’s health. The report and conference defined waste and detailed strategies to reduce it, whilst maintaining health outcomes and health system performance.

Waste, apparently high on the policy agenda in the UK, was defined as services and processes which are harmful/ non-beneficial and excess costs which could be avoided by replacing them with cheaper alternatives. Environmental reasons for cutting waste were not specifically mentioned in the discussions.

Three areas of waste were defined:

• Clinical (e.g. avoidable adverse events, unwarranted variation in care, antibiotic overuse)
• Operational (e.g. avoidable attendances, delays in discharge)
• Governance (e.g. administrative costs, fraud)

Levers to be used to avoid such waste were outlined:

• information systems- used to identify low value care
• behaviour change- clinical guidelines or campaigns (e.g. Choosing Wisely; antimicrobial stewardship programmes; safety campaigns)
• Financial incentives- don’t pay for readmissions/ never events/promote day-surgery/bundled population-based payments
• Alternative services- OOH/community services 

The importance of clinician and patient involvement in efforts to reduce waste was emphasised in the conference. An excellent report from the Academy of Medical Royal Colleges details how clinicians can get involved in cutting waste by focussing on patient care, outcomes and reducing resource use,“Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care”.

Sustainability, though not a part of the conversation at the conference, has much to offer any efforts to deal with waste. The benefits of seeing waste reduction from a resource stewardship/sustainability perspective (in addition to a financial one) while focussing on patient outcomes and care can be manyfold. A sustainability lens can motivate a different group of people to engage with efforts to reduce waste, it can enable a broader understanding of waste and highlight areas that may not have been previously considered. It can also lead to a reduction in carbon emissions and the AoMRC report (see above) details one such example in, “a project that provided specialist geriatric services within nursing and residential homes, which led to a reduction in unplanned admissions. This initiative improved care and saved the Trust £65,000 and 23 tonnes of carbon in one year”.