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Reframe value-based purchasing to improve experience

June 6th, 2012

by Jason A. Wolf

Value-based purchasing (VBP) is upon us. This new era of pay for performance on both core measures and consumer scores--via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)--has generated great energy in many healthcare organizations and panic in others.

Some have used this as a catalyst for action charging forward on areas critical to quality care and exceptional experience. Others have worked the numbers and chosen to invest in other ways to offset the pending potential losses due to performance flaws.

Examining the activity caused by this policy change has been eye opening and in some ways disconcerting. There are plenty of organizations that have been and remain committed to experience (quality, safety, service and centeredness) before any incentive (or punishment) was placed in their path. Yet, with VBP that which has been part of the healthcare ideology for so long--the provision of quality healing and a human experience grounded in service, dignity and respect--has now gained increased attention as a critical part of healthcare action.


Why is it that this one acronym--VBP--and its associated financial implications have spurred action? In exploring this "why," I believe we have great opportunity to reframe our perspective, revisit our commitments and reset our plans. I suggest we look at VBP in a much different way, not as a reward or punishment, a catalyst or a curse, but rather approach these letters in a way they can make a difference for our patients and families and for healthcare overall. Perhaps we can reconsider VBP in this manner:

V represents Vision, Definition and Purpose
In my previous Hospital Impact blog posts I stressed the importance of clarity of purpose for healthcare organizations. For me, this comes in defining what patient experience is for you. You can call this your vision or your purpose statement, but I would much rather you have clarity of direction than worry that you have your standard management checklist punched.

When asked what I see as key to success in experience efforts around the world, it is having clarity about where you are trying to go. Without definition, you have no basis for action. What is your organization’s definition for the experience you are trying to provide? Can your staff and your doctors restate it with confidence? Do your patients and your community feel it the minute they walk in your door? With only 27 percent of all U.S. hospitals having a definition for experience, the potential for even greater outcomes is significant.

B represents Bottom Line Perspective
We are no longer in an era where patients are the passive recipients of care. We still may be the experts, but it is their experience. Some in healthcare see "bottom line" as a driver of financial success and others view it as a "dirty word" impeding quality of care. I challenge individuals at each of these extremes to realize that whether you like it or not, patients now have choice and are making big choices every day that impact the bottom line. They evaluate and share much more about their encounters, while making an increasing number of healthcare decisions based on consumer data. Engaging patients in ownership and choice and finding lean, quality processes drives better outcomes. In fact research has shown lower-cost care can lead to higher quality.

P is for Patient and Family Focus
Sometimes stating the obvious is not obvious at all. All too often I have heard hospital leaders and caregivers say a focus on patients is "a given." With that statement I know they have already missed the mark. Focusing on patients and families must be an intention. They are and should be our one true focal point, whether you are providing care or supporting those who do. Our patients and families are having an experience at every instance of their encounter within our organizations. Our focus needs to be on these individuals, not the surveys they may ultimately complete.

This has been highlighted in central contributions to healthcare performance such as the Institute of Medicine's "Crossing the Quality Chasm" and the Institute for Healthcare Improvement's Triple Aim. If we focus on the people versus the paper, the scores we look to achieve will come much easier than we could ever imagine.

I do not intend to diminish the reality of VBP. But, I do challenge you to reconsider VBP and not see it as something you are "required" to do to gain financial reward. Instead I encourage you to focus on the key ideas that will drive a quality patient experience from the start. In building a framework for achievement in your organization you will not only reap the rewards from required processes but you also will create organizational success by creating lasting and lifetime customers, fostering community respect, fortifying a strong and committed workforce, and delivering unparalleled quality and experience.

We have an opportunity to do much more in impacting the patients and families we serve. The choice is significant and the result will be much greater than success on a survey or the reimbursement dollars we receive. Choose wisely.

Jason A. Wolf, Ph.D., is executive director of The Beryl Institute, where he specializes in organizational effectiveness, service excellence and high performance in healthcare. Follow Jason @jasonawolf and The Beryl Institute @berylinstitute on Twitter.


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