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by Meriam Soryal
Published on August 27, 2017

There have been a lot of conversations around value recently. I wanted to take this opportunity to share what value means to me in the context of health care delivery, how it impacts our role(s) today and what makes value/outcomes different than metric or key performance indicators (KPI) improvements.

Let’s look at a recent award-winning innovation from this year’s Cerner Middle East Collaboration Forum.

Hamad Medical Corporation’s Women Hospital High Dependency Unit (HDU) 4– Encouraging Breastfeeding Initiative

In 2014, the HDU 4 at Women Hospital realized that only 51 percent of the mothers giving birth in the unit were successfully breast-feeding, despite having given 80 percent of them education on why it is important and how to do it correctly to have more success. Like most health care institutions, they knew the education level was too low to be acceptable, so they set off on a quality improvement journey to improve both the education and success rate of breast-feeding. They had an end of year 2016 metric/KPI goal to educate 100 percent of the mothers of proper technique and other helpful hints and achieve 100 percent success of getting them to successfully breast-feed.

To encourage mothers to breast-feed, they developed an education program that explained the clinical benefits of breast-feeding together with the practical means of making it easier. As you can see from the graph below, the KPI for education was met just 90 days later. The job was done … or was it? The KPI goal was achieved but the value/outcome metric was not. Taken just by itself, an increase of education by the nurses, creates little value.

Like many of our value stories, this is where our story normally ends, but we need to push the client and ourselves for more data on outcomes. But getting to the real value is hard. You must talk to many people and find out what happened as a result of the change.

At HMC they were not yet satisfied, although they were encouraged. So what about the nurses? What role should they play? What is the role of the patient?

The nurses’ role is to deliver that education, but more importantly monitor and document that the mothers are breast-feeding. This is where the electronic health record’s (EHR’s) role becomes critical. By entering the data in the EHR, the nurses are essentially signing off that the breast-feeding activity has occurred. They can also document issues encountered, what works best, etc. This data can then be easily retrieved to report on progress and used to enhance the original educational materials so that continual improvement can be accomplished.

Let’s follow their journey of improvement.


Let’s dissect the graph, bearing in mind that the unit had two targets:

1. Increase patients receiving education to 100 percent by the end of 2016.
2. Increase patients breast-feeding to 100 percent by the end of 2016.

• In July 2014, only 51 percent of mothers where breast-feeding and about 80 percent of mothers received the education.
• Just 30 days later, about 88 percent of the mothers received the education, which resulted in about 73 percent of mothers breast-feeding.
• Ninety days later, 100 percent of the mothers received the education and from there on they kept a steady 100 percent on the education. The unit had met their KPI target but they still needed to increase the value to the babies.
• As all the mothers received the necessary education and as the nurses learned what worked well and what didn't, we see that the actual percentage of mothers breast-feeding is on a continuous increase.
• By December 2016, 95 percent of mothers are breast-feeding. They are close to meeting their second KPI target and this one is the one that created value.
• To be even more accurate, we would need to follow these babies around for the next 10 to 20 years to determine the true long-term value. This is where research picks it up and that is how policy gets created in health care organizations by the Ministers of Health.

All these numbers are a means of measuring output; on their own they will not guarantee the delivery of value outcomes. Similarly, the EHR in this story is an enabler; on its own it will not guarantee the delivery of value outcomes.

The moral of this story is to show that meeting the needs of the patient should be the overarching goal of health care delivery. Since value depends on results, not inputs, value in health care is measured by the value outcomes achieved and not the volume of services delivered nor by the processes of care used or the new content created or the reduction of clicks.

Each of us has a role to play. As we build relationships with our clients, walk the hospital departments and engage with end-users, we will be able to identify value creation opportunities.

The value wave is hitting the health care industry; get ready to catch the wave and let it carry you to the heights of excellence in the delivery of health care with the patient being the most important resource. Together with our clients, we can improve the quality of life in our communities.

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