24 October 2019

Karin Nilsson, Project Manager at King’s Health Partners, looks back on ten years of working with Value Based Healthcare and shares some of the lessons learnt on our journey so far.

Value is subjective

When working with Value Based Healthcare the question always arises: ‘what is value in healthcare?’ At King’s Health Partners, Value Based Healthcare is centred around outcomes that matter to patients. Only our patients can define the outcomes that matter to them. This makes value a topic which can be highly subjective and efforts to agree fixed definitions can be unhelpful. The meaning of value will evolve with time as patients’ views and beliefs change. For King’s Health Partners this has led us to no longer ask what value is, but what value means to us.

It takes a community

Value and outcomes that matter to patients cannot be contained within organisational boundaries. At King’s Health Partners we are always keen to listen, learn and share with all involved in the health and care system. This is particularly true when it comes to value. Over the years, King’s Health Partners has collaborated locally, regionally and globally, teaming up with organisations that, like us, want to learn more about value and understand how focusing on value will improve the health and care system. One of the most important partnerships we are building is with our patients. Drawing on the old proverb ‘it takes a village to raise a child’, it takes a community to improve value.

Switching the conversation - resource use is more relevant than cost

Value based healthcare traditionally relates outcomes that matter to patients to the costs required to deliver those outcomes. Costs are often based on various accounting models, require financial understanding to make sense, and are difficult to compare across organisations. As such, discussions on costs can be unhelpful when working with value. Instead, at King’s Health Partners we have begun to think about the use of resources as a more useful measure. Resources such as staff, materials and equipment are more meaningful when assessing value. Switching the conversation from cost to resource also allows for traditionally non-costed items to be included, for example waiting times and an individual’s wellbeing. A member of staff that is stressed and one that is not may cost the same, but they do not necessarily create an outcome of the same value for a patient.

Communication is key

There are no right or wrong answers to questions raised around value. Instead, the more nuanced the picture of value can be the better. Successful collaboration requires bringing people together in open dialogue and ongoing communication and engagement. It is also necessary to have a common language to ensure we understand each other and can build on each other’s experiences. Value is subjective and dependent on personal experiences and beliefs. Assumptions about what we mean when we talk about outcomes that matter must be discussed openly and made explicit. 

Part of this is the work we do at King’s Health Partners to be open and transparent about the care and outcomes we deliver by publishing outcomes books. By publishing outcomes, we can help to foster a culture of improvement across our partnership and help patients, service users, carers, referring clinicians and commissioners to make better-informed decisions, and, most importantly our staff, to drive up the quality of the care we provide.

All staff have a role to play

Value in health care is generated on a system level and everyone who participates has a unique role in its creation. We need to enable everyone at King’s Health Partners to work with value. No set of skills is more important than another. At King’s Health Partners we benefit from a diverse workforce from many different backgrounds and variety of expertise. We need to bring all our staff together and enable everyone to work on value.

It is my hope that by working together through shared conversations with our staff and patients, we can provide the inspiration and ideas to improve value and outcomes. To explore how these ideas could shape the narrative of what value means to us, to all of us, and that through this work we can fully realise the power of our collective resources, diversity and skills to shape the future of a value based healthcare system.

To learn more about the value based healthcare team or explore how we can work together please email khp-programmesupport AT kcl.ac.uk

Read more about our case studies that have used value based healthcare methodology to improve care for our patients and service users.

To learn more about Value Based Healthcare, please see our website for: