Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

A conceptual framework to support hospitals to measure and realise financial benefits from process improvement programs: perspectives from Australia, USA and UK

Jane Evans https://orcid.org/0000-0002-4079-7339 A * , Sandra G. Leggat B C and Daniel Samson D
+ Author Affiliations
- Author Affiliations

A St Vincent’s Health Australia, East Melbourne, Vic., Australia.

B School of Psychology and Public Health, La Trobe University, Bundoora, Vic., Australia.

C Public Health & Tropical Medicine, James Cook University, Townsville, Qld, Australia.

D Department of Management and Marketing, University of Melbourne, Carlton, Vic., Australia.

* Correspondence to: Jane.evans@svha.org.au

Australian Health Review 47(6) 700-706 https://doi.org/10.1071/AH23113
Submitted: 4 June 2023  Accepted: 7 November 2023  Published: 23 November 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

The objective of this research is to appraise current practice in hospitals against the ‘Framework to achieve value in healthcare’ (the Framework) and to identify additional contributory factors that support or hinder its application.

Methods

A multi-site case study was undertaken with five hospitals in Australia, the USA and UK using purposeful sampling to identify hospitals to participate. Data collection took place between September and November 2022. The hospitals included in the study had Process Improvement (PI) programs of more than 5 years duration, with strong executive engagement and broad outcomes measurement, including financial benefits. All hospitals were acute public hospitals or private, not for profit.

Results

All hospitals indicated current practice according to Steps 1–5 for some part of their PI programs. All hospitals indicated that they were more likely to include financial benefits measurement for activities aimed specifically at improving cost rather than reducing non-value adding activities or improving the value of clinical care. Step 5 (reinvestment of cost savings) of the Framework is dependent on the accomplishment of Step 4 (measurement and realisation of financial benefits) and the contributory elements are important in supporting hospitals to utilise the Framework.

Conclusions

The ‘Framework to achieve value in healthcare’ provides a practical guide for hospitals to reduce non-value adding activities, improve the value of clinical care and reduce costs. Further research is indicated to establish its reliability in hospitals in other countries and hospitals that do not have an established PI program.

Keywords: health economics, health funding and financing, health policy, health services management, health services research, lean, process improvement, quality improvement.

References

OECD. Tackling Wasteful Spending on Health. 2017. Available at https://www.oecd.org/health/tackling-wasteful-spending-on-health-9789264266414-en.htm

Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012; 307: 1513-1516.
| Crossref | Google Scholar |

Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Med 2020; 18: 102.
| Crossref | Google Scholar | PubMed |

Duckett S, Breadon P, Weidemann B, Nicola I. Controlling costly care: a billion-dollar hospital opportunity. Melbourne: Grattan Institute; 2014.

Marshall M, Øvretveit J. Can we save money by improving quality? BMJ Qual Saf 2011; 20: 293-296.
| Crossref | Google Scholar | PubMed |

Marsilio M, Pisarra M. Lean management in health care: a review of reviews of socio-technical components for effective impact. J Health Organ Manag 2021; 35: 475-491.
| Crossref | Google Scholar | PubMed |

Bueno BLJ, Macfie H. Trillion Dollar Checkbook: Reduce Waste and Cost in the US Health Care System. Boston: Institute for Healthcare Improvement; 2019.

James BC, Savitz LA. How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts. Health Aff 2011; 30: 1185-1191.
| Crossref | Google Scholar | PubMed |

Kenney C. Transforming Health Care; Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. New York: Productivity Press; 2011.

10  Meyer H. Life In The ‘Lean’ Lane: Performance Improvement At Denver Health. Health Aff 2010; 29: 2054-2060.
| Crossref | Google Scholar | PubMed |

11  Evans J, Leggat SG, Samson D. A systematic review of the evidence of how hospitals capture financial benefits of process improvement and the impact on hospital financial performance. BMC Health Serv Res 2023; 23: 237.
| Crossref | Google Scholar | PubMed |

12  Wemmerlöv U. The retrospective determination of process improvement’s economic value at the individual manufacturing firm level: Literature review and proposed measurement framework. J Oper Manage 2021; 67: 182-211.
| Crossref | Google Scholar |

13  Evans J, Leggat S, Samson D. A practical framework for achieving value creation and capture in healthcare through process improvement. J Health Organ Manag 2022; 36: 561-576.
| Crossref | Google Scholar |

14  Nolan T, Bisognano M. Finding the balance between quality and cost. Healthc Financ Manage 2006; 60: 67-72.
| Google Scholar | PubMed |

15  Martin LA, Neumann CW, Mountford J, et al. Increasing Efficiency and Enhancing Value in Health Care White Paper 2009. Cambridge, MA: Institute for Healthcare Improvement; 2009.

16  Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Harvard Business Press; 2006.

17  Vijverberg JRG, Daniels K, Steinmann G, et al. Mapping the extent, range and nature of research activity on value-based healthcare in the 15 years following its introduction (2006–2021): a scoping review. BMJ Open 2022; 12: e064983.
| Crossref | Google Scholar | PubMed |

18  Hallam CRA, Contreras C. Lean healthcare: scale, scope and sustainability. Int J Health Care Qual Assur 2018; 31: 684-696.
| Crossref | Google Scholar |

19  Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-357.
| Crossref | Google Scholar | PubMed |

20  Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health 2015; 42: 533-544.
| Crossref | Google Scholar | PubMed |

21  Burgess N, Radnor Z. Evaluating Lean in healthcare. Int J Health Care Qual Assur 2013; 26: 220-235.
| Crossref | Google Scholar | PubMed |

22  Shah R, Ward PT. Defining and developing measures of lean production. J Oper Manage 2007; 25: 785-805.
| Crossref | Google Scholar |

23  Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev 2011; 89: 46-52.
| Google Scholar | PubMed |