Quality of care is about patient experience, decisions made with an impact on quality need to consider the views of patients
The Economist’s “Value-based Healthcare in Europe” summit held in London last week provided an excellent opportunity to discuss potential benefits and challenges posed by the value-based approach with international stakeholders.
This holistic approach – which is rapidly gaining traction across the continent as a desired path forward in improving health systems – critically intertwines wider patient and societal outcomes with spending. Its main promise is of a more sustainable framework for payers and improved care for citizens. Despite growing acceptance of such an approach, there are practical challenges to its full implementation.
At the core of value-based healthcare is maximising value for patients: that is, achieving the best outcomes at the lowest cost. According to Michael Porter, the healthcare system should move away from a supply-driven health care system organised around what physicians do and toward a person-centred system organised around what patients need. Similarly, and as highlighted by several stakeholders taking part in the summit, a cultural shift is needed for health care providers internationally: a shift from focusing on the volume and profitability of services provided to what matters to patients.
A focus on the needs and preferences of patients is welcome – and consistent with Picker Principles of Patient Centred Care. Making this real requires that patients and the public are meaningfully involved in the quality agenda. And despite the rhetoric about considering what really matters to patient when devising and implementing strategies for maximising value and healthcare outcomes, very little or no attention was paid to defining what patients really value the most in their experience of care, and how to get patients involved in this debate.
In the Mid-Staff public inquiry in England, Sir Robert Francis was unequivocal in his report that patients, not numbers, are what count and he commented that it is not the system but the people delivering care that would ensure patients are put first day in, day out. Quality of care is about patient experience as well as outcomes, and decisions made with an impact on quality need to consider the views of patients to understand this. Evidence shows that patients who have been able to develop care in partnership with clinicians have better outcomes and lowered costs of treatment. Patients also offer a non-institutional perspective that can test the assumptions of NHS organisations to see if they really are more convenient and better for patients. This is one reason why the NHS recognises the need for greater patient engagement in decision-making, as demonstrated by 92% of NHS leaders stating patient engagement as either very or fairly important for achieving change.
NHS organisations are getting better at including patient views in their decision-making but more can be done to recognise the value of greater patient involvement. For instance, in order to understand what really matters to patients, a better use of PROMs (Patient Reported Outcome Measurement) and patient experience data would help guide decisions and understand the effectiveness of current services. This is why any policy aiming at facilitating a value-based approach in healthcare should consider patient-reported feedback and complaints as invaluable resources to promote and implement the benefits of the care provided and obtain efficiency gains as a result. As one of the speakers briefly pointed out during the summit, patient satisfaction with the health service and evidence-based data reflecting the wider experience of patients should be key drivers for change.
We firmly agree with both ideas. However, as suggested by Michael Porter – who first coined the term “value-based healthcare” – we also believe that decision-makers need to prioritise patients’ needs and patient’s values: we urge them to embed patients’ voice and feedback in the process. By doing so, trusts and organisations – whether large or small, community or academic – will be rewarded with financial viability and the public reputation gained by excellence in outcomes and value delivered.