Working to Improve the Value of Health Care

What if healthcare focused less on healing in the hospital and more on keeping you healthy at home? And what if everyone in the healthcare system were aligned to provide the greatest value for your healthcare dollar – the best health outcome, the best patient experience at the lowest possible annual cost?

That’s the ambitious project under way at University Hospitals, under the guidance of Peter Pronovost, MD, PhD, the health system’s new Chief Clinical Transformation Officer.

“Health care performs miracles every day, but the same system is estimated to waste 30 cents out of every dollar on things that don’t get people well or that could be used more effectively,” Dr. Pronovost says. “Health systems have to take the lead in finding out how to provide a better value, and that is what we are embarking on here at UH.”

Dr. Pronovost is best-known as the MacArthur “genius grant” winner who saved thousands of lives nationwide with a simple but ingenious checklist for preventing bloodstream infections. Now he’s teaming up with leaders and employees across all of UH to implement a new checklist – one that helps patients stay well, get well or manage an acute condition – all in the most high-value way.

The Stay Well checklist focuses on proactively scheduling UH patients for annual wellness exams, immunizations and cancer screenings – the cornerstones of preventive medicine. Get Well targets the needs of patients with chronic disease like asthma, high blood pressure or diabetes, making sure patients can comply with the recommended therapy and that socioeconomic barriers to effective treatment have been addressed.

To help patients better Manage an Acute Condition, Dr. Pronovost and team are applying a checklist to UH processes and administration. Efforts are under way within the Department of Clinical Integration, for example, to make sure UH patients always have coordinated care, so that primary care providers and specialists are always working in tandem. At the same time, there’s increased focus within Ambulatory Operations and Digital Health on directing patients to the best site of care, whether it’s one of UH’s 50 ambulatory health centers or in a patient’s home through UH Home Care or UH Virtual Visit. Teams are also working to reduce unnecessary variation in the way care is delivered across the UH system. A successful, multi-hospital project to standardize total joint replacement surgeries is evidence that it can indeed work.

A key part of the effort? The belief that every member of the UH team has a part to play in delivering high-value care to patients.

“Take our environmental services workers,” Dr. Pronovost says. “They don’t just clean the hospital rooms; they prevent infections. They’re infection control specialists with an important role to play in driving value.”

For Dr. Pronovost, it comes down to telling a new story.

“In some of my prior work to reduce infections, what really facilitated the reduction was that clinicians adopted a new narrative,” he says. “They used to say these infections are inevitable and they just happen when you care for sick patients. What led to zero was when clinicians started saying they are preventable and I am capable of doing something about it. The UH approach to eliminate all defects in value will provide a new narrative that healthcare can optimize value.”