Improving Health Care, Part 1: The Clinical Value Compass

The Clinical Value Compass, named to reflect its similarity in layout to a directional compass, has at its four cardinal points (1) functional status, risk status, and well-being; (2) costs; (3) satisfaction with health care and perceived benefit; and (4) clinical outcomes. To manage and improve the value of health care services, providers will need to measure the value of care for similar patient populations, analyze the internal delivery processes, run tests of changed delivery processes, and determine if these changes lead to better outcomes and lower costs. In the case example, the team’s aim is “to find ways to continually improve the quality and value of care for AMI (acute myocardial infection) patients.” Four to 12 outcome and cost measures are sufficient to get started. In the case example, the team chose 1 or more measures for each quadrant of the value compass. An operational definition is a clearly specified method explaining how to measure a variable. Measures in the case example were based on information from the medical record, administrative and financial records, and patient reports and ratings at eight weeks postdischarge. Measurement systems that quantify the quality of processes and results of care are often add-ons to routine care delivery. However, the process of measurement should be intertwined with the process of care delivery so that front-line providers are involved in both managing the patient and measuring the process and related outcomes and costs. This article begins a planned four-part series, Improving Health Care, which is designed to provide practical, user-friendly tutorials that busy clinicians can use to improve the value of health care quickly and successfully. Real improvement will only occur when the measurement of outcomes is linked to the understanding and change of the processes and systems related to the production of those results. Each of the three remaining tutorials, planned for publication in the late summer and fall, will include a worksheet to guide the clinician or clinical team through a particular aspect of clinical improvement work, plus case examples to illustrate the application of the concepts.