Best Possible Value
Organisational enablers
DRAFT
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State of “value” today in the NHS
STRENGTHS TO BUILD ON
• The NHS is one of the best value health care
systems in the world
- Ranks highly on effective, safe, coordinated and
patient-centred care at a cost per patient that is far
lower than in other developed countries
AREAS OF DEVELOPMENT
• Variation in outcomes across organisations
within the NHS
• No single definition of value
• Quality Adjusted Life Years is used as a
measure of value in certain circumstances
• No “common currency” of outcomes and metrics
that is understood by Finance and Clinicians
• Tools and guides are available for particular
types of decisions
• Use of existing tools is patchy and driven by
individual initiative
- e.g. RightCare approach, STAR tool,
Commissioning for Value packs, Capital Investment
Manual
• Data is insufficiently granular, coverage and
access is inconsistent
• Data and metrics are captured that are relevant
for the value calculation
Source: The Commonwealth Fund; Delivery Group member interviews
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Making effective decisions that deliver value relies on a set of
organisational enablers
Organisational enablers
Decision
effectiveness
Critical
decisions
Value
• Quality
• Speed
• Yield
Tools &
technology
• Effort
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System wide enablers can also be important but are not part of our
focus
System wide enablers
e.g. cross-organisation structures, regulation,
Political environment
Organisational enablers
Decision
effectiveness
Critical
decisions
Value
• Quality
• Speed
• Yield
Tools &
technology
• Effort
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
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High-value healthcare organisations have a common set of
organisational enablers, independent of delivery model
Clarity and
alignment
Clear mission, values and outcome objectives with tightly defined criteria and
processes for decision-making
Roles and
structure
Decision-making structures organised around patient outcomes that connect people
across and within finance and clinical
Processes
and
information
Self-measurement over time that generates publicly available outcome data and
supports patient involvement in decision-making
Technology
and tools
Technology that puts information in the hands of those that need it, when they
need it and enables decision-makers to benefit from collective experience
People and
incentives
Investment in developing people to be able to make value-based decisions and
alignment of incentives to outcomes
Leadership
and culture
Culture centred on patient outcomes and continuous self-improvement that is
embodied by the leadership and maintained by systematic engagement with
employees
Source: Richard Bohmer; Michael Porter; Cleveland Clinic; Mayo Clinic; Dartmouth Spine Centre; Ribera Salud; Delivery Group member interviews
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Case study: Ribera Salud (Spain) uses patient involvement to help
deliver value in a public-private collaboration system
INSTITUTION OVERVIEW
RESULTS
• Healthcare Management Company established 1997
National Best in Class awards for Orthopaedics,
Digestive Surgery, Nervous System Areas, Clinical
Security and Best Hospital
• Operates four privately run public hospitals in Spain
• Captive payment model where provider receives fixed
annual sum per inhabitant
Torrevieja
Denia
Elche
ORG ENABLER EXAMPLES
Roles and
structure
• Structure centres around patient using an
integrated primary and secondary care model to
ensure work carried out in most appropriate place
Processes • Local population informed of changing
and
processes, health outcomes and associated costs
informaand involved in decision-making and
tion
governance
• Patients self-route themselves to most
Techappropriate location based on health website and
nology
text messages with waiting times in different
and tools
locations depending on their condition
Source: Company website; Kings Fund; NHS Confederation
Patient experience
Alzira
Clinical outcomes
Quality indicator
Ribera Salud
Valencia region
hospitals
Average hospital
stay
4.5 days
5.8 days
Readmission within
three days (per
1,000 discharges)
4.05
6.1
Outpatient surgery
rate
79%
52%
Patients’
satisfaction
9.1
7.2
External
consultation delay
25 days
51 days
Average surgery
delay
34 days
60-90 days
CAT delay
12 days
90-120 days
Emergency waiting
time
< 60 mins
131 mins
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Case study: Mayo Clinic (US) aligns employees around a
Model of Care with a culture of continuous improvement
INSTITUTION OVERVIEW
RESULTS
• Largest integrated non-profit medical group practice in the
world and also runs research and education divisions
• Best Hospital in the US 2014-15 (Mayo Minnesota) – U.S.
News and World Rankings
• Based in the US employing ~4K physicians and ~54K allied
health staff
• #1 in 8 of 16 specialities nationally out of ~5,000 hospitals
• Operates across 4 campuses in Arizona, Minnesota and
Florida and treats ~1.2M patients annually
ORG ENABLER EXAMPLES
Clarity and
alignment
• Mayo Clinic Model of Care is a public covenant
with patients that explicitly describes the care
experience patients should expect
People and
incentives
• Quality Academy is part of a comprehensive
multi-level career and leadership development
programme that equips leaders to deliver the best
outcomes for the population
Leadership
and
culture
• Culture of learning and improvement supported
by the See-Plan-Act-Refine-Communicate
(SPARC) programme that encourages new
“dissenting” innovations
Source: Company website; Academic Medicine
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Case study: Cleveland clinic (US) was a pioneer in the
capture and publication of outcomes data
INSTITUTION OVERVIEW
• Non-profit multi-speciality medical centre that provides
clinical and hospital care alongside research and education in
the US
RESULTS
• Consistently among top U.S. hospitals for several decades
• The Clinic’s Heart and Vascular Institute has ranked
number one continuously for 16 straight years
• $6.2B revenue (2012), 5.1M patient visits per year, 42K
employees
• Main Ohio campus plus 8 community hospitals, 16 family health
and ambulatory surgeries and 50 specialty centres
ORG ENABLER EXAMPLES
• Transitioned from profession-oriented
Roles and
organisation, designed around physician
structure
competencies (e.g. surgery), to patient needsoriented e.g. Heart and Vascular Institute
Processes • Pioneered publication of data with 16 different
and
“outcomes” books each containing
informacomprehensive data on procedures, volumes,
tion
mortality, complications and innovations
Leadership
and
culture
• Chief Experience Officer is guardian of the
“patient outcome” culture, proving leadership
within the organisation on how to instil a culture of
service and improvement
Source: Company website; Cleveland Clinical Hear and Vascular Institute Outcomes 2010
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Case study: Dartmouth Spine Centre uses involves patients in
decision-making tracks data along patient journey
INSTITUTION OVERVIEW
RESULTS
• Dartmouth Spine Centre is part of the Dartmouth-Hitchcock
Medical Centre (DHMC)
• Blue Distinction Centre for Spine Surgery based on
commitment to quality care and improved patient outcomes
• DHMC is a teaching hospital with 1,500 primary care
doctors and specialists
• Orthopaedic Research and Education Foundation’s (OREF)
Clinical Research Award for spine patient outcomes
research trial
• The Spine Centre provides care for patients with complex
spine conditions
ORG ENABLER EXAMPLES
Clarity
• Collaborative multi-disciplinary approach
and
aligned around the patient and supported by an
alignment
explicit culture of delivering value
Processes
• Data management staff included on each team
and
focused on measuring patient progress and
informacreating most effective modes for data presentation
tion
Technology
and tools
• Shared decision-making website for those
faced with surgical decisions; 95% of patients
find it valuable for their decision and 25% change
their minds in both directions.
Source: Company website; *Lebanon (New Hampshire) Hospital Referral Region includes the D-H Spine Centre and is used as a proxy for the centre’s figure
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Case study: HCAHPS (“H-Caps”) is a national, standardised,
publicly reported survey of patients’ hospital care experience in US
PATIENTS INVITED TO
COMPLETE SURVEY
PUBLIC CAN COMPARE ORGANISATIONS ONLINE OR USING A MOBILE APP
Source: Company website
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