Novel quality improvement method to reduce cost while improving the quality of patient care: retrospective observational study

Abstract

BackgroundHealthcare cost management strategies are limited in number and resource intensive. Budget constraints in the National Health Service Scotland (NHS Scotland) apply pressure on regional health boards to improve efficiency while preserving quality.MethodsWe developed a technical method to assist health systems to reduce operating costs, called continuous value management (CVM). Derived from lean accounting and employing quality improvement (QI) methods, the approach allows for management to reduce or repurpose resources to improve efficiency. The primary outcome measure was the cost per patient admitted to the ward in British pounds (£).InterventionsThe first step of CVM is developing a standard care model. Teams then track system performance weekly using a tool called the ‘box score’, and improve performance using QI methods with results displayed on a visual management board. A 29-bed inpatient respiratory ward in a mid-sized hospital in NHS Scotland pilot tested the method.ResultsWe included 5806 patients between October 2016 and May 2018. During the 18-month pilot, the ward realised a 21.8% reduction in cost per patient admitted to the ward (from an initial average level of £807.70 to £631.50 as a new average applying Shewhart control chart rules, p<0.0001), and agency nursing spend decreased by 30.8%. The ward realised a 28.9% increase in the number of patients admitted to the ward per week. Other quality measures (eg, staff satisfaction) were sustained or improved.ConclusionCVM methods reduced the cost of care while improving quality. Most of the reduction came by way of reduced bank nursing spend. Work is under way to further test CVM and understand leadership behaviours supporting scale-up.

Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

“…Nevertheless, this discipline has shown how beneficial it is for all parties involved in healthcare (from the patient to the funding organization) to have a clear framework to continuously improve value by reducing cost and improving quality. 120 There are many ways to approach quality improvement, and indeed, training in this field will be an essential part of the MDT. In fact, as an example, a recent article by Mate et al 120 applied Lean management tools (an approach to eliminating waste and optimizing workflows) at an inpatient respiratory ward in a mid-sized hospital in NHS Scotland.…”

Lean accounting: a structured literature review

“…For the Organizational Focus criterion (B), it was used six different attributes: B1: Publicly listed organizations; B2: Private -SME; B3: Private -Others; B4: Public sector; B5: Not-forprofit and for organizations not falling into any of these categories or that authors kept confidentiality regarding company's information as B6: General/Other. Apart from General/Other (69%) (e.g., Allawi et al, 2019;Myrelid and Olhager, 2019), the most common type of organization researched was Private -Others (8%) with 3 articles ( Åhlström and Karlsson, 1996;Mate et al, 2020), followed by Private -SMEs (13%) (e.g., Chiarini, 2012), Publicly listed (5%) (e.g., Schonberger, 2020), Not-for-profit (3%) (e.g., Fortsch and Liao, 2019) and Public Sector (2%) (e.g., Holmgren Caicedo et al, 2018), with one paper each.…”

Value improvement at the point of care: engaging and empowering front-line teams with a new quality improvement methodology

“…To address value, the IHI innovation group developed the value management approach. At another institution (Raigmore Hospital, Inverness, Scotland), this approach was shown to improve outcomes and reduce costs specifically in the context of respiratory care 5 …”

“…To address value, the IHI innovation group developed the value management approach. At another institution (Raigmore Hospital, Inverness, Scotland), this approach was shown to improve outcomes and reduce costs specifically in the context of respiratory care 5 To improve value at the unit level, we at Heart Hospital (HH) began working with the IHI and Hamad Healthcare Quality Institute (HHQI) to further develop the value management approach. Emphasising on the improvement aspect, we have rebranded it as Open access value improvement (VI).…”

“…Emphasising on the improvement aspect, we have rebranded it as Open access value improvement (VI). This approach described elsewhere in detail, 5 uses improvement science and three new concepts, a 'box score' of measures, a 'visual management board' and weekly staff 'huddles' to drive rapid cycle improvement.…”