Glossary Bottom Lines
Language creates social reality, here is the new language for the new reality, namely that everyone has to feel a sense of stewardship for optimising value and minimising waste from the resources available for health and social care.
Value
Value is assessed by weighing up the benefits received by an individual or a group if people with a common need or by a population, considering the resources that have been used
Personal value - appropriate care to achieve a patient’s personal goals
Allocative value - equitable resource distribution across all patient groups
Technical value - achievement of best possible outcomes with available resources
Social value - contribution of healthcare to social participation and connectedness
Waste
Waste is the use of resources that would produce more value if used for another purpose or another subgroup of the population. There are four types of waste in healthcare:
1. Waste left after a job has been done.
2. Waste due to inefficiency.
3. Waste when the resources used do not achieve outcomes that matter to patients.
4. Waste due to opportunity costs, namely when those resources could have provided greater value when used for another purpose for people with a defined health problem or reallocated for use for people with another type of health problem.
Efficacy and Effectiveness
Efficacy is the magnitude of the benefit demonstrated in the research setting.
The effectiveness is the degree to which an intervention whose efficacy has been proven in the research setting delivers benefit in the ordinary service setting.
Cost-effectiveness, productivity, and efficiency
Productivity relates the outputs of a service to the inputs.
Efficiency relates the outcomes of care to the inputs.
Cost-effectiveness relates the outcomes of a technology or intervention to the costs.
Quality and Safety
“The quality of a service is the degree to which it conforms to pre-set standards of goodness.” Donabedian A (1980) The definition of quality: a conceptual exploration. In: Explorations in Quality Assessment and Monitoring. Volume 1: The Definition of Quality and Approaches to its Assessment. Health Administration Press, Ann Arbor.
Variation, Warranted and Unwarranted
“Unwarranted variation is Variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences”
Wennberg JE (2010) Tracking Medicine. A Researcher’s Quest to Understand Health Care. Oxford University Press.
Overuse, Underuse and, Optimality
“Overuse is the provision of medical services for no benefit or for which harms outweigh benefits.” Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S (2012) Less is more. Overuse of healthcare services in the United States. An understudied problem. Arch Intern Med 172(2): 171-179.
Appropriate, Necessary and, Futile
A treatment is:
Necessary, if everyone agrees it is essential even though there is a risk.
Appropriate, if almost everyone agrees the benefits outweigh the risks and that the intervention is justified.
Inappropriate, if almost everyone agrees that the risks outweigh the benefits and that its use is not justified.
Futile, if everyone agrees the intervention would do more harm than good.
Equity, Equality and, Health Inequalities
Inequality is an objective difference in mortality, morbidity, or service provision. Inequity is a difference in service access or use that is deemed unfair.
Structure, Process and, Outcome
The structure is the organisation which may be a bureaucracy or a market or a network.
The process is the activities, for example the number of operations done. The outcome is the result of the process.
Outcomes that matter to health and social care
These outcomes are the results of health and social care interventions that indicate that high value is being realised for individuals and populations.
Outcomes that matter to individuals
These outcomes are the results people care about most and they often differ from the outcomes regarded as important by clinicians and people who manage health services.
Culture
“Culture is the shared tacit assumptions of a group that it has learned in coping with external tasks and dealing with internal relationships.”
Schein EH (1999) The Corporate Culture Survival Guide. John Wiley & Sons. Page 186.
Stewardship and Sustainability
Stewardship is a culture in which people who do not own something are committed to ensuring its survival for future generations.
Population health, population healthcare and, population health management
Population health means the health status of a defined group of people.
Population healthcare focuses primarily on segments of the whole population defined by a common need which may be a symptom such as breathlessness, a condition such as arthritis or a common characteristic such as frailty in old age, not on institutions, or specialties or technologies.
Population health management is a method which stratifies the population by levels of risk, allowing resources to be focused on those subgroups at highest risk.
Integrated care – System, Network and, Pathway
A network is a set of organisations and individuals that deliver the system’s objectives.
A system is a set of activities with a common aim, a common set of objectives, and a set of criteria against which progress towards the outcomes that matter can be measured. A pathway is the course an individual follows as they go through the system.
Programme budgeting and marginal analysis
Programme budgeting, sometimes called service line accounting in industry, is budgeting based not on institutions but on segments of the population defined by need, for example budgets for people with respiratory problems or people in the last year of life. Within a budget for such a segment there may be budgets for sub segments, for example budgets for people with asthma and for people with COPD within the respiratory budget.
Marginal analysis is a technique for estimating the effects shifting resources from the budget for one segment or subsegment budget to another.
Precision, Personalised and, Stratified medicine
Personalised medicine considers the patient’s unique beliefs, preferences, and environment as well as clinical findings.
Precision medicine uses the patient’s genome in addition to other clinical measures.
Stratified medicine focuses on the person’s level of risk, considering their genetic profile as well as their clinical condition.
Shared decision-making
“In a shared decision, a health care provider communicates to the patient personalized information about the options, outcomes, probabilities, and scientific uncertainties of available treatment options, and the patient communicates his or her values and the relative importance he or she places on benefits and harms.”
Wennberg JE (2010) Tracking Medicine. A Researcher’s Quest to Understand Health Care. Oxford University Press.
Empathy
Empathy is different from sympathy or compassion. It is the ability to understand what another is thinking from their perspective and communicate to the other that they have managed to do this.
Leadership, Management, & Accountability Leadership creates and changes culture.
Management achieves the objectives of an organisation working within that culture.
Accountability is a relationship based on the provision of information about performance from those who have it to those who have a right to it.
Language creates social reality, here is the new language for the new reality, namely that everyone has to feel a sense of stewardship for optimising value and minimising waste from the resources available for health and social care.
Value
Value is assessed by weighing up the benefits received by an individual or a group if people with a common need or by a population, considering the resources that have been used
Personal value - appropriate care to achieve a patient’s personal goals
Allocative value - equitable resource distribution across all patient groups
Technical value - achievement of best possible outcomes with available resources
Social value - contribution of healthcare to social participation and connectedness
Waste
Waste is the use of resources that would produce more value if used for another purpose or another subgroup of the population. There are four types of waste in healthcare:
1. Waste left after a job has been done.
2. Waste due to inefficiency.
3. Waste when the resources used do not achieve outcomes that matter to patients.
4. Waste due to opportunity costs, namely when those resources could have provided greater value when used for another purpose for people with a defined health problem or reallocated for use for people with another type of health problem.
Efficacy and Effectiveness
Efficacy is the magnitude of the benefit demonstrated in the research setting.
The effectiveness is the degree to which an intervention whose efficacy has been proven in the research setting delivers benefit in the ordinary service setting.
Cost-effectiveness, productivity, and efficiency
Productivity relates the outputs of a service to the inputs.
Efficiency relates the outcomes of care to the inputs.
Cost-effectiveness relates the outcomes of a technology or intervention to the costs.
Quality and Safety
“The quality of a service is the degree to which it conforms to pre-set standards of goodness.” Donabedian A (1980) The definition of quality: a conceptual exploration. In: Explorations in Quality Assessment and Monitoring. Volume 1: The Definition of Quality and Approaches to its Assessment. Health Administration Press, Ann Arbor.
Variation, Warranted and Unwarranted
“Unwarranted variation is Variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences”
Wennberg JE (2010) Tracking Medicine. A Researcher’s Quest to Understand Health Care. Oxford University Press.
Overuse, Underuse and, Optimality
“Overuse is the provision of medical services for no benefit or for which harms outweigh benefits.” Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S (2012) Less is more. Overuse of healthcare services in the United States. An understudied problem. Arch Intern Med 172(2): 171-179.
Appropriate, Necessary and, Futile
A treatment is:
Necessary, if everyone agrees it is essential even though there is a risk.
Appropriate, if almost everyone agrees the benefits outweigh the risks and that the intervention is justified.
Inappropriate, if almost everyone agrees that the risks outweigh the benefits and that its use is not justified.
Futile, if everyone agrees the intervention would do more harm than good.
Equity, Equality and, Health Inequalities
Inequality is an objective difference in mortality, morbidity, or service provision. Inequity is a difference in service access or use that is deemed unfair.
Structure, Process and, Outcome
The structure is the organisation which may be a bureaucracy or a market or a network.
The process is the activities, for example the number of operations done. The outcome is the result of the process.
Outcomes that matter to health and social care
These outcomes are the results of health and social care interventions that indicate that high value is being realised for individuals and populations.
Outcomes that matter to individuals
These outcomes are the results people care about most and they often differ from the outcomes regarded as important by clinicians and people who manage health services.
Culture
“Culture is the shared tacit assumptions of a group that it has learned in coping with external tasks and dealing with internal relationships.”
Schein EH (1999) The Corporate Culture Survival Guide. John Wiley & Sons. Page 186.
Stewardship and Sustainability
Stewardship is a culture in which people who do not own something are committed to ensuring its survival for future generations.
Population health, population healthcare and, population health management
Population health means the health status of a defined group of people.
Population healthcare focuses primarily on segments of the whole population defined by a common need which may be a symptom such as breathlessness, a condition such as arthritis or a common characteristic such as frailty in old age, not on institutions, or specialties or technologies.
Population health management is a method which stratifies the population by levels of risk, allowing resources to be focused on those subgroups at highest risk.
Integrated care – System, Network and, Pathway
A network is a set of organisations and individuals that deliver the system’s objectives.
A system is a set of activities with a common aim, a common set of objectives, and a set of criteria against which progress towards the outcomes that matter can be measured. A pathway is the course an individual follows as they go through the system.
Programme budgeting and marginal analysis
Programme budgeting, sometimes called service line accounting in industry, is budgeting based not on institutions but on segments of the population defined by need, for example budgets for people with respiratory problems or people in the last year of life. Within a budget for such a segment there may be budgets for sub segments, for example budgets for people with asthma and for people with COPD within the respiratory budget.
Marginal analysis is a technique for estimating the effects shifting resources from the budget for one segment or subsegment budget to another.
Precision, Personalised and, Stratified medicine
Personalised medicine considers the patient’s unique beliefs, preferences, and environment as well as clinical findings.
Precision medicine uses the patient’s genome in addition to other clinical measures.
Stratified medicine focuses on the person’s level of risk, considering their genetic profile as well as their clinical condition.
Shared decision-making
“In a shared decision, a health care provider communicates to the patient personalized information about the options, outcomes, probabilities, and scientific uncertainties of available treatment options, and the patient communicates his or her values and the relative importance he or she places on benefits and harms.”
Wennberg JE (2010) Tracking Medicine. A Researcher’s Quest to Understand Health Care. Oxford University Press.
Empathy
Empathy is different from sympathy or compassion. It is the ability to understand what another is thinking from their perspective and communicate to the other that they have managed to do this.
Leadership, Management, & Accountability Leadership creates and changes culture.
Management achieves the objectives of an organisation working within that culture.
Accountability is a relationship based on the provision of information about performance from those who have it to those who have a right to it.
