The Value Transformation

January 17, 2018

The Value Transformation

Tremendous progress has been made over the last forty years due to the second healthcare revolution; the first having been the public health revolution of the nineteenth century. Hip replacement, transplantation, and chemotherapy are examples of the high-tech revolution funded by increased investment and, in the last twenty years, optimised by improvements in quality, safety, and evidence-based decision making.

However, there are still three outstanding problems which are found in every health service no matter how they are structured and funded: One of these problems is huge and unwarranted variation in access, quality, cost and outcome, and this reveals the other two.

  • Overuse which leads to:
    • waste, that is anything that does not add value to the outcome for patients or uses resources that could give greater value if used for another group of patients
    • patient harm, even when the quality of care is high
  • Underuse which leads to:
    • failure to prevent the diseases that healthcare can prevent,
    • inequity

In addition, the services will have to cope with rising need and demand without additional resources. We need to continue with the four activities that have transformed healthcare in the last twenty years:

  1. Preventing disease, disability, dementia and frailty to reduce need
  2. Improving outcome by providing interventions strong evidence of effectiveness
  3. Improving outcome by increasing quality and safety of process
  4. Increasing productivity by reducing cost

These are necessary but not sufficient and what is needed is to focus on value which has three aspects:

  • Allocative value, determined by how well the assets are distributed to different subgroups in the population
  • Technical or utilisation value, determined by how well resources are used for outcomes for all the people in need in the population
  • Personalised value, determined by how well the outcome relates to the values of each individual

The focus has to be on value, on better value for individuals and populations. To achieve this we need three new activities:

  • Increase personal value by ensuring that by providing people with full information about the risks and benefits of the intervention being offered
  • Increase value for the population by shifting resource from budgets where there is evidence of overuse or lower value to budgets for populations in which there is evidence of underuse and inequity
  • Developing population-based systems that
    • Address the needs of all the people in need, with the specialist service seeing those who would benefit most
    • Increase rates of higher value intervention (underuse) funded by reduced spending on lower value intervention (overuse) e.g. shift resources from treatment to prevention or polypharmacy to district nursing
    • Implement high-value innovation (underuse) funded by reduced spending on lower value intervention (overuse)

This, in turn, requires a new set of skills and concepts to help people answer questions such as:

  1. What do you understand by the term complexity?
  2. What is meant by the term system and how does it differ from a network?
  3. What is meant by population-based healthcare rather than bureaucracy based care?
  4. What is the relationship between value and quality?
  5. What is the relationship between value and efficiency?

In addition, there is a need for a new set of skills such as:

  • The introduction of shared decision making
  • The explicit, evidence-based and ethical allocation of resources to different subgroups of the population in need
  • The appraisal of innovations not only in terms of their cost-effectiveness but also in terms of their opportunity cost

These skills and concepts are all covered in our new course for Healthcare Value.


Professor Sir Muir Gray

Scholarships are available for this Accredited Short Course for applicants wishing to take the course for credit. The Scholarship will cover the full cost of tuition fees (£2,110) but excludes the cost of travel, accommodation, and subsistence. The student is expected to cover these costs.

To apply please download the Application form for a Healthcare Value Scholarship and complete this on your computer. Save and email us this form along with your Short Course Application, your CV, and a Reference.

All applicants are asked to write a short paragraph (max 1000 words) about themselves. The Scholarship will be awarded to the applicants who show the greatest ability in terms of a) their existing experience to apply the new learning and b) their ability to influence and improve their local practice.

The deadline for scholarship applications for this accredited short course is Monday 29 May 2017.

The successful applicant will be selected by the EBHC Standing Committee and will be notified of the outcome by Friday 2 June 2017. It is a requirement of the Scholarship that the successful applicant completes and submits the assignment and is willing to share their story. There will be an interview with each scholar after one year to identify the impact of the course on them and their work.

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