IMPLEMENTING VALUE-BASED CLINICAL QUALITY IMPROVEMENT IN HEALTHCARE
Bruce Ramshaw, MD, FACS
Chairman and Professor, Department of Surgery University of Tennessee - Knoxville
Given that a theme of the meeting was quality improvement, we invited Bruce Ramshaw, MD, FACS to discuss “Implementing value-based clinical quality improvement in Healthcare.“ Dr. Ramshaw had previously presented a series of podcasts on the General Surgery News website in September and October, 2015 during which he discussed patient safety and cost conservation. Dr. Ramshaw that NOW is the time for surgeons to lead the way in making value the overarching goal in healthcare (theme from Harvard Business review October 2013). In healthcare, VALUE is defined as the quality, safety, satisfaction and cost of care for each patient. In his terms, value is comprised of a reduction in complications AND cost. He explained that the concept of silos is antiquated and that we must use complex systems thinking. He advised us not to equate standardization to absolute uniformity but to strive for the optimal variety needed to perform a particular aspect of patient care. We should identify techniques that improve outcomes in terms of satisfaction and quality and use multidisciplinary teams to accomplish quality improvement goals.
In October 2015 I met with Dr. Ramshaw to discuss topics including patient safety and safety science, failure of attempts to improve patient safety, cognitive bias, and true leadership in healthcare. I asked Dr. Ramshaw how he was most successful in delivering his message. He stated “I think after years of trying to push the multi-disciplinary, team approach, including the importance of having patient care managers, I have had much more success getting people interested in exploring the complex systems concepts by just asking- ‘shouldn't we be measuring the value of care we provide?’" Dr. Ramshaw works at UT Knoxville to develop an ideal model that others can eventually use. If we can measure the value of care then that will encompass safety, complications, outcomes and patient satisfaction and can then compare to cost (overall and at each point in care). We need to work together to ensure everyone sees the same picture by developing a model that provides us with a VALUE metric we can all understand and the patients will accept. The VA is an ideal environment in which to assess a model as we have robust quality and cost data.