Why It Matters
Cost, quality, and value are all terms you hear a lot about in health care. To be a good health care provider, you need to truly understand what these terms mean and how they interact.
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Author Perspective: An Inside Look at TA 103: Quality, Cost, and Value in Health Care

By Michael Briddon | Wednesday, August 13, 2014
In early 2014, a team from the University of Toronto approached the IHI Open School with an idea for a new online course. The team -- Professor Brian Wong and medical students Raman Srivastava and Marisa Leon-Carlyle -- loved the improvement and safety focus of our catalog, but really thought we could use some additional education on cost and value in health care.

Eight months later, the course -- TA 103: Auality, Cost, and Value in Health Care -- is ready to launch. 

The University of Toronto will use the course with its medical students this fall. And the course authors hope other universities follow suit. 

This marks the first time in Open School history when students led the creation of an online course. How did they do it? How did they find the time in between course work? What drove them to change the curriculum in their own medical school? We asked them four questions, and here's what Raman and Marisa had to say:

Open School: First off, tell us why you believe this course is important. Why should someone take some of their valuable time to complete this module? 

Raman and Marisa: Cost, quality, and value are all terms you hear a lot about in health care. To be a good health care provider, you need to truly understand what these terms mean and how they interact. For example, health care costs involve much more than money - health care decisions can impact patient, family, and the health care system, financially and non-financially.

To practice "high-value" health care, it is important to understand just what exactly value is and what factors into value. It is also important to recognize why value is important in everyday decisions and why people sometimes fall into traps that lead to low-value decisions. We believe this module provides a great foundation on all these concepts, and is part of a larger culture change in health care that recognizes the importance of making wise clinical decisions that minimize waste and maximize outcomes. 

OS: So, why did you and your colleagues decide to take the time to create this module? 

R and M: We created this module because waste in health care is a problem all over the world. We just aren't doing enough to think about the value of the care we provide. We add tests, drugs, and technologies, but don't always think about the impact of our current "more is better" philosophy. When health care professionals neglect to think about these impacts and costs, patients suffer, and we're not doing our jobs. 

People are starting to talk about value and resource stewardship, and that's fantastic, but there aren't many resources available that provide foundational stewardship knowledge to health care professionals. We wanted to make an educational tool that anyone - a student or a professional - could use. This is far from a complete encyclopedia on the topic, but it is a great place to start. 

OS: Give us a paragraph that summarizes the course. 

R and M: This module explores the concepts of value, quality, and cost, how they are interrelated, and what makes them so hard to measure. It discusses current health care spending and how resource stewardship can address these rising costs without compromising care. The module describes basic ethical principles and their relationship with stewardship, as well as some common barriers to stewardship for both the student and professional. Last, it discusses what you can do to practice and promote high-value health care. 

OS: And finally, share one important lesson you learned as you researched and wrote the course. Share one lesson that will stick with you.  

R and M: As learners ourselves, we were struck by all the barriers to stewardship that are already present in our education system, but also by the simple things that we can do to promote stewardship. For example, by taking the time to understand the reason patients ask for a test, we can address their concerns often without ordering any inappropriate or harmful procedures.

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