Photo by Nick Fewings | Unsplash
Unlike efforts to simply cut costs, value management aims 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 Qatar and Northern Ireland. Lenox Hill Hospital, a part of the Northwell Health System in New York, is the first organization to work on value management with IHI in the United States. Northwell Health is an IHI Strategic Partner.
Many clinicians are reluctant to talk about reducing health care costs. According to Aashish Patel, DO, a neurointensivist in the 8 East mixed Surgical Intensive Care Unit/Neurological Intensive Care Unit (SICU/Neuro ICU) at Lenox Hill Hospital, “Some think that cost shouldn’t factor into patient care,” he says. “In their eyes, it’s inhumane to think that way.”
Patel disagrees. While getting his master’s degree in health care delivery science at Dartmouth College, Patel learned to see managing costs as an important component of creating high quality, patient-centered care. Witnessing extreme health disparities while growing up in India also influenced his determination to lead the delivery of sustainable, cost-efficient, and equitable patient care.
In early June of 2019, IHI started teaching the guiding framework of the value-management methodology to a team at Lenox Hill. Orientation began with an explanation of key value-management tools, including the “box score” and visual management boards. Point-of-care teams use the box score to assemble three categories of measures (quality performance, staff capacity, and financial) on a single page. A visual management board is a communication tool teams can use to see at a glance their quantitative and qualitative data to help coordinate their daily work and monitor ongoing improvement. The team also learned QI methods, including how to use Plan-Do-Study-Act (PDSA) cycles to test changes.
Within two months of orientation, the 8 East team developed a routine for their value-management improvement work. Data was flowing regularly and reliably, the visual management board was updated daily, and the team met weekly for a 10-minute huddle.
The 8 East team’s value-management work has become an important contributor to making changes around cost and value. For example, in less than two months, they saw a dramatic decrease in the cost of IV acetaminophen and increased mindfulness around the use of costly items like patient repositioning systems.
According to Patel, however, the power of the work goes deeper than what is shown in their early results and has had unexpected benefits for their team culture:
Since beginning the value-management work, 8 East has seen an increase in the collegiality of our already close community. As familiarity with the huddles increased, so did participation. More people began voicing ideas. You could see an increased sense of ownership over the various pieces of work, including the bedside nurses. It’s empowering each one of us to think critically, both individually and on a collaborative level. The autonomy is a result of feeling empowered. The value-management journey has helped us build a more cohesive, collaborative team, which has been of vital importance during the unprecedented COVID-19 pandemic.
Despite their early success, Patel knows that shifting the mindset around cost reduction in health care won’t be quick or easy. He cites the commonly held misconception that providing good care means doing as much testing as possible. “There’s this sense that if you’re doing more cancer screening, for example, more people will live longer,” Patel notes. “It’s not true, but we think this way because it’s how many of us have been taught.”
Clinicians often don’t learn to consider the potential adverse effects of the misuse or overuse of unnecessary procedures and treatments, including physical side effects and increased costs for individuals and health systems. Patel and his team are hopeful that the value-management methodology will help to turn common assumptions about cost reduction on their head. “The 8 East SICU/Neuro ICU team feels very privileged to be a part of this meaningful work,” he says. “We are excited to see how value management continues to shift priorities in health care in the post COVID-19 era.”
Emma Robinson is an IHI Project Coordinator.