Building the business case for quality improvement: a framework for evaluating return on investment

Abstract

There is increasing interest and belief in applying quality improvement (QI) to help solve our most complex challenges in healthcare, yet little published literature to help leaders develop a business case and evaluate return on investment from QI. This is even more pronounced in fi elds such as mental health and community health services. This paper presents a framework to help identify, understand and evaluate return on investment from large-scale application of QI in healthcare providers. The framework has been developed at East London NHS Foundation Trust (ELFT), a provider of predominantly mental health and community health services to a population of 1.5 million people, which has been undertaking QI at scale since 2014. This paper presents case studies and examples from ELFT to illustrate return on investment from QI at multiple levels: improving outcomes for patients and service users, improving the experience of staff, improving productivity and effi ciency, avoiding costs, reducing costs and increasing revenue.

Evaluating quality improvement at scale: routine reporting for executive board governance in a UK National Health Service organisation

“…Swensen, Dilling, Mc Carty, Bolton, and Harper (2013) focused on four domains: patient needs, reputation, esprit de corps, and financial return. Along similar lines, Shah and Course (2018) identified six domains: patient, carer and family experience; staff experience; productivity and efficiency; cost avoidance; cost reduction and revenue. While both attempted to address the task of defining impact at scale, return on investment in one form or another was demonstrated using case studies (rather than organisation-wide QI implementations).…”

Quality improvement made simple

“…As well as focusing on cost avoidance and reduction, it includes a domain on staff experience, highlighting evidence suggesting that providers with happier, more engaged staff have better patient outcomes and improved financial performance. 50 The trust proposes that by giving front-line teams the autonomy to address the challenges that matter most to them and their patients, quality improvement plays a critical role in improving staff engagement and, in turn, the organisation's overall performance.…”

Value-based healthcare in mental health services

“…There is considerable evidence that organisations that pursue systematic quality improvement and the concepts of value-based medicine provide better and safer care. Both the East London (Shah 2018)…”

“…There is considerable evidence that organisations that pursue systematic quality improvement and the concepts of value-based medicine provide better and safer care. Both the East London (Shah 2018) and the South London and Maudsley NHS Foundation Trusts have embarked on such an approach (both in partnership with the Institute of Healthcare Improvement) and have demonstrated early benefits. The experience of organisations in the USA such as the Cleveland Clinic and Intermountain Healthcare (Porter 2006) shows that this is a long-term endeavour and the real benefits are achieved several years into the programme.…”