Model to reduce waste in healthcare and add value

Introduction

The startling revelation that one fifth of health expenditure makes little contribution to good health outcomes is surely a call to action to tackle waste in the delivery of care. Across member countries of Organisation for Economic Co-operation and Development (OECD) a significant share of healthcare system spending and activities are wasteful at best, and harmful to our health at worst.1 By way of example OECD cites, 11.7% of visits to emergency departments (EDs) in England and 31.3% in Portugal are identified as ‘inappropriate’—resulting in the misappropriation of scarce healthcare resources and the inappropriate use of patient time (many of whom could have been more appropriately treated in primary care, without the need for a visit to an ED). Secondly, the continuation of provision of some imaging, therapeutic and surgical procedures on an inpatient as opposed to outpatient basis further contributes to the ‘wasteful’ utilisation of expensive resources and inappropriate patient admissions, when such interventions could be carried out in other settings. Combine this powerful data with the global challenge of healthcare financial constraints, ageing populations and the increasing burden of chronic disease and ‘more and faster’ is not the answer—a new approach is needed. In order to optimise health system performance, the Institute for Healthcare Improvement (IHI) offers the triple aim2—improving the experience of care and the health of our populations, at the same time as lowering per capita costs.

The term ‘waste’ is often uncomfortable to those of us in healthcare, as somehow it seems to undermine the ‘purity of purpose’—making services safer and better for patients. However, when the term is framed into meaningful components to care givers it becomes something identifiable. Work facilitated by IHI American and European Healthcare Alliances demonstrates that when the evidence of wasteful impact is well presented, it is strong motivator for change. This paper charts the journey and learning associated with the exploration of ‘adding value, reducing waste’ in healthcare as originated by the IHI US-based Leadership Alliance and more recently by the Health Improvement Alliance Europe (HIAE). At the time of commencing this work the HIAE was constituted from 10 member countries and 40 member organisations—all of whom are committed to the common aim of improving health and healthcare worldwide.