The values of Value Based Healthcare

King’s Health Partners is working with clinicians to develop the capability to deliver value based healthcare. Our aim is to maximise value by focusing both on outcomes that matter to patients and understanding the costs of care across complete pathways. In this blog, Joseph Casey, Deputy Director of Programme Delivery, sets out the core principles that are shaping our work.

In our recent blogs and videos, Prof John Moxham has set out the critical importance of focusing on outcomes that matter to patients and carers to drive value in healthcare. To do this successfully, we believe there are some core principles which must sit at the heart of any value based healthcare approach. These include listening to – and learning from – others.

This is why we are sharing our approach, please get in touch by email, share your feedback on Twitter using the #valuebasedcare hashtag or join one of our upcoming events. We are talking with patients and staff to get their views and will continue to share back.

Our priorities for improving value:

1. Focus on outcomes that matter to patients and carers: This involves going beyond the clinical or process outcomes that are routinely measured in the NHS to include a wider focus on quality of life, including
   
   both physical and mental health and wellbeing. 
   
   
   
   Patient reported outcomes have been regularly collected nationally by the NHS for some conditions for nearly a decade, but have not often been systematically and rigorously built into delivery of care or quality improvement efforts. They should, as recent research suggests that integrating patient-reported outcomes into routine care is associated with increased survival rates.
   
   
   
   Patients have a critical role not only in reporting their outcomes, but also in developing meaningful measures that drive improvement in outcomes (which is why this is one of our core principles). 
   
   
   
   
2. Work with patients and carers to develop outcomes that matter to them: This is reflected in work across King’s Health Partners. For example, colleagues at the Cicely Saunders Institute have worked with patients and carers to develop a set of valid and reliable patient-centred outcome measures for palliative care. In palliative care, standard clinical measures such as mortality and health status are often not relevant and measures for less tangible aspects of quality of life are needed (see our value case study for further details). And for Parkinson’s disease, non-motor symptoms are a key determinant of quality of life. Working with patients our researchers have developed the first patient-centred questionnaires that allow the documenting of non-motor symptoms to drive direct care and support quality improvement (see our value case study for more details). 
   
   
   
   
3. Enable clinical teams to lead improvements based on understanding outcomes and costs across pathways of care: We believe that change in health services needs to be driven by the people who provide care to patients on a day-to-day basis. The evidence overwhelmingly supports this belief. This means understanding, in detail, the care provision as well as the costs along the entire patient journey through different care settings including in primary care, outpatient clinics, inpatient wards, community, social care and mental health services. Our clinical teams are working with the Healthcare Financial Management Association (HFMA) Costing for Value Institute to draw on costing expertise developed nationally and internationally into this multidisciplinary approach. 
   
   
   
   
4. Embed mind and body throughout everything we do: We know that joining up physical and mental healthcare can help improve patient outcomes, and that not doing so has significant costs for both individuals and healthcare services. As Kate Lillywhite, Programme Director of the Mind & Body programme, recently argued, focusing on mind and body is potentially the greatest value proposition of all. At King’s Health Partners, our Mind & Body programme aims to do just that, by joining up mental and physical healthcare, research and education. We recently appointed Dr Rumina Taylor as our Value Based Healthcare Mind & Body lead who will help drive forward this ambition. Read Rumina’s blog on Pushing the value agenda. 
   
   
   
   
5. Be inclusive and ask questions: So that we draw on the expertise and experience available within our Academic Health Sciences Centre and across our local health and care partners. This includes health and social care commissioners, third sector organisations and charities as well as the academic expertise within public health, health economics, improvement science and data science. In Lambeth for example, Black Thrive has been working with the local community to develop a series of outcome measures. Researchers and clinical teams should be continually challenging themselves to learn from community-developed expertise. 
   
   
   
   
6. Keep on sharing outcomes that matter to patients and carers: We firmly believe “a value driven NHS can only be achieved through the sharing and use of high quality data in an open and transparent way”, with patients, with health and care teams, with commissioners, and with policy makers. Our approach is evolving as we test our ideas, and we will continue to share as our pilot pathway projects progress further. Our team has a mantra – keep on keeping on – and we intend to do just that. 

It is a privilege to be working with so many people across King’s Health Partners and beyond who are passionate about improving outcomes that matter to patients and carers. We hope that by sticking to the values above that we will improve value in the services we deliver and improve the outcomes for patients. 

The next Value Based Healthcare learning event will be hosted by King’s College Hospital NHS Foundation Trust on Monday 2 July (1.00 – 2.00pm) at the Foetal Medicine Research Institute. Register now. 

Dr Irem Patel will be presenting, followed by a discussion session. For background, see our value case study on developing integrated practice units to improve value in chronic obstructive pulmonary disease.