Networked health care: Rethinking value creation in learning health care systems

Abstract

Creating better value in health care service today is very challenging. The social pressure to do so is real for every health care system and its leadership. Real benefit has been achieved in manufacturing sector work by the use of "value-chain" thinking, which assumes that the work is a series of linked processes necessary to make a product. For those activities in health care systems that are similar, this model may be very helpful. Attempts to "install" the value chain widely in health care systems have, however, been frustrating. As a result, well-meaning leaders seeking better value have resorted to programs of cost reduction, rather than service redesign. Professionals have not been very happy or willing participants. The work of health care service invites an expanded model of value creation, one that better matches the work. This paper proposes a networked architecture that can mobilize and integrate the resources of health care professionals, interested patients, family, and other community members in the delivery and improvement of health care systems. It also suggests how this value-creation architecture might contribute to research and the development of new knowledge. Two cases illustrate the proposed architecture and its implications for system design and practice, technology development, and roles and responsibilities of all actors involved in health care systems. We believe that this model better fits the need of making and improving health care services. This expanded understanding of how value is created invites attention by senior leaders, by those attempting to facilitate the improvement of current systems, by patients and clinicians involved in the daily work of health care service coproduction, by those charged with the preparation and formation of future professionals, by those who measure and conduct research in health care services, and by those leading policy, payment, and reimbursement systems. K E Y W O R D S learning health systems, organizational architecture, value in health care

A science of collaborative learning health systems

“…36 Healthcare services take various organizational configurations to produce value for patients. 36 The dominant organizational form in healthcare is a consultative model known as a F I G U R E 1 Schematic illustrating a CLHS. Changing the system, rather than people, unleashes inherent motivation toward a shared purpose.…”

“…39 The value shop logic can be enhanced via a "value network" in which value is created by facilitating connections among actors as well as resources. 36,37 This organizational configuration is ubiquitous in other industries (eg, Wikipedia, Facebook, Travelocity, Lyft, Monster.com). In a value shop, doctors and patients can bring only their own resources to solve the matching problem.…”

COproduction VALUE creation in healthcare service (CO-VALUE): an international multicentre protocol to describe the application of a model of value creation for use in systems of coproduced healthcare services and to evaluate the initial feasibility, utility and acceptability of associated system-level value creation assessment approaches

“…25 26 Value creation: a five-part model Fjeldstad et al describe a three-component model (value chain, value shop and facilitated value network) for value configuration in business, which offers a flexible approach to value creation and, potentially, a good fit with the diverse realities of healthcare services. [18][19][20] A 'value configuration analysis' provides a way to assess and design better-value operations. The first component of Fjeldstad's value configuration model is the value chain, which closely aligns with the product-dominant logic historically employed in healthcare.…”

“…This renal haemodialysis service organically demonstrates coproduction characteristics and the three components of Fjeldstad's model in a chronic illness population. 20 These coproduction value creation elements are: (1) a value chain element, in which people work with nurses who administer dialysis procedures via standardised algorithm; (2) a value shop element, in which people consult with a staff nephrologist located on-site to manage complex and unique service needs and (3) a facilitated value network element, where people trained and approved by clinic nurses as able to self-administer dialysis, manage their own dialysis care independently. Peer facilitators function within the network structure to help support, guide and connect people to needed resources and to help navigate among elements.…”

“…These frameworks include coproduction, 15 16 coproduction learning healthcare systems (CLHS) 17 and multilevel interactive collaboration and value configuration models. [18][19][20][21][22] Building on the historical foundations of systems-based healthcare improvement approaches and these new conceptual models, we herein propose a novel five-part, coproduction value creation model for healthcare service improvement and a mixed-methods approach for iteratively assessing coproduction value creation. We aim to refine the model and assessment approach through a 3-year, three-phase study (CO-VALUE) employing principles of coproduction, a community of practice (CoP) and discovery learning cycles (DLCs).…”