1. HCQI Health Care Quality Improvement
QUALITY
AND
VALUE-BASED
HEALTH CARE
Joseph Britto MD, MRCPCH (UK)
www.hcqi.org

2. HCQI Health Care Quality Improvement
Two stories related to my own health care journey !
Improving outcomes of critically ill children by
mobile pediatric intensive care
Improving the quality of point-of-care clinical
decision making by decreasing decision error with
data driven decision making and intelligent
information processing
www.hcqi.org

3. HCQI Health Care Quality Improvement
ELEMENTS
OF
QUALITY
OF HEALTHCARE
www.hcqi.org

4. HCQI Health Care Quality Improvement
ELEMENTS
OF
QUALITY
OF HEALTHCARE
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
www.hcqi.org

5. HCQI Health Care Quality Improvement
ELEMENTS
OF
QUALITY
OF HEALTHCARE
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
OUTCOMES
COST
www.hcqi.org

6. HCQI Health Care Quality Improvement
Quality and value-based healthcare
Six short cases
 MM: medical device burns during angioplasty
PS : severe respiratory failure waiting for an hour
for a consultant before being put on a ventilator
SM: Global myocardial ischemia, 60 mins in ER not
seen by consultant – charged Rs. 4,00,000
www.hcqi.org

7. HCQI Health Care Quality Improvement
Quality and value-based healthcare
Six short cases
 JJ – 10 hours waiting on oxygen in MICU for
550ml pleural fluid to be tapped by radiologist
No oxygen in physiotherapy department
TW – fresh myocardial infarction in pulmonary
edema transferred from HDU to MICU via lift
without oxygen
www.hcqi.org

8. HCQI Health Care Quality Improvement
QUALITY VALUE-BASED
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
OUTCOMES OUTCOMES
COST COST
www.hcqi.org

9. HCQI Health Care Quality Improvement
QUALITY & VALUE IN HEALTH CARE
PROVIDER
PAYE PURCHASER
R
PATIENT
POLICY PHARMA
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10. HCQI Health Care Quality Improvement
A New Redesigned Healthcare are System – Why ?
 Little regulation of inputs
 No regulation of outputs
 Undefined standards and standardization
 No product specifications
 No outcomes data
 Little effective patient participation
 Non-alignment of incentives
 Competition on price not value
 Little effective watchdog, remediation, litigation
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11. HCQI Health Care Quality Improvement
A New Redesigned Healthcare System – How ?
How do we improve quality of care and lower costs ?
How do we manage chronic disease and achieve better outcomes ?
How do we standardize excellent care and control costs ?
How do we leverage buying power of purchasers to improve
quality, reduce waste and drive down costs ?
Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI.
www.hcqi.org

12. HCQI Health Care Quality Improvement
A New Redesigned Healthcare System – How ?
How do we pay for care under an innovative contract that
compensates quality rather than quantity ?
How do we build capacity to innovate, spread innovations
and ideas for improvement throughout an organization
and to sustain those improvements ?
How do we develop leaders – men and women with vision,
leaders with an obsession for improvement, fearless in
their pursuit of better healthcare ?
Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI.
www.hcqi.org

13. HCQI Health Care Quality Improvement
A New Redesigned Healthcare System – What ?
Current Approach New Way
Professional autonomy drives variability. Care is customized according to patient
needs and values.
Professionals control care. The patient is the source of control.
Decision making is based on training and Decision making is evidence based.
experience.
Preference is given to professional roles Cooperation among clinicians is a
over the system. priority.
Do no harm is an individual responsibility. Safety is a system property.
Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000,
Table 3-1.
www.hcqi.org

14. HCQI Health Care Quality Improvement
A New Redesigned Healthcare System – What ?
Current Approach New Way
Secrecy is necessary. Transparency is necessary.
The system reacts to needs. Needs are anticipated.
Cost reduction is sought. Waste is continuously decreased.
Information is a record. Knowledge is shared and information
flows freely.
Care is based on continuous healing
Care is based primarily on visits.
relationships.
Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000,
Table 3-1.
www.hcqi.org

15. HCQI Health Care Quality Improvement
FROM
NON-SYSTEM
TO
SYSTEM
Any time the majority of the people behave a
particular way the majority of the time, the
people are not the problem. The problem is
inherent in the system.
W. Edwards Deming - the father of the quality movement
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16. HCQI Health Care Quality Improvement
EFFORT
TO
OUTCOME
O
CULTURE
U
BEHAVIOUR T
C
SYSTEMS O
PROCESSES
M
E
DECISIONS
S
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17. HCQI Health Care Quality Improvement
QUALITY
AND
VALUE-BASED
HEALTH CARE
“The journey of a thousand miles begins with one step.”
Lao Tzu, Chinese philosopher and father of Taoism
www.hcqi.org