DEVELOPING VALUE BASED HEALTHCARE AND A CULTURE OF STEWARDSHIP

THROUGH THE OXFORD VALUE AND STEWARDSHIP PROGRAMME

The NHS in England had hoped for a reduction in pressure after the COVID-19 pandemic but it is instead being challenged with growing pressure stemming from:

• Significant backlog of patients waiting for care; 
• Increasing need and demand;
• Limited resources
• Workforce challenges
• Financial constraints
• Space limitations
• Carbon

Many of these pressures are rooted in commons problems including: unrecognised variation in spend and outcomes, overuse of interventions that do not deliver good outcomes, underuse of interventions that deliver good outcomes and, most importantly, a lack of a culture of stewardship. 

Historic solutions focused on providing better quality and safer care will be necessary not sufficient to effectively tackle these problems and avert the crisis the NHS is facing.  

Founded by Sir Muir Gray, the Oxford Value and Stewardship Programme (OVSP) builds on pioneering work on healthcare systems in NHS England, NHS Scotland, NHS Wales, the European Commission, the US, Singapore, the Middle East and Canada. OVSP’s mission is aligned with One Finance’s EVO (Engagement Value Outcome) initiative to realise a new paradigm for 21st Century Healthcare that delivers value with a culture of stewardship: 

Personal value can be increased by focusing on what is really bothering the person and not just on their diagnosis.  

Allocative value forces us to review variation in spend on different segments of the population which is not the result of allocative decision making but of years of drift and reactive spending. By reviewing spend and outcome a 2-fold variation is often seen between populations, giving the ICB the opportunity to switch resources from lower value to higher value interventions. 

Technical value is much broader than efficiency and clinicians given budget responsibility can be asked to identify overuse and waste to free resources to shift to services or subgroups of the population where there is underuse or inequity. 

Social value includes the carbon footprint of the service and the broader impacts healthcare services can have.

OVSP’s Value Improvement Programme (VIP) was designed to build capacity rather than build dependency and focuses on:

• Reducing wait lists and backlogs including addressing health inequalities
• Disinvesting from wasteful activities
• Tackling a toxic healthcare culture
  

Your ICS or ICB VIP begins with a leadership and management agenda for a core group of multidisciplinary professionals (clinicians, public health professionals, analysts, commissioners, finance) that focuses on five interrelated themes: 

Population: define population sub-groups with a common need and allocate resources optimally to them

Systems: Design the outcomes-based system for each population sub-group

Value: deliver value for the population and all the individuals in need equitably through networks

Stewardship: create the culture of stewardship with a governance process that promotes collective responsibility and reduces waste

Personal Value: ensure each individual makes decisions to optimise personal value

The core group collaborates closely with a cohort of professionals with whom they design and implement value improvement projects for specific areas that they define – the goal being to improve patient and population outcomes while optimising resource utilisaiton. 

Introduction to Value Based Healthcare

This online course introduces busy healthcare professionals to value based healthcare and will empower them with practical approaches to deliver value for their patients, populations and their services.

The Learning Objectives include: 

• To analyse the reasons for the increasing need and demand for healthcare
• To explore the major paradigm shifts of healthcare
• To highlight why value based healthcare with a culture of stewardship will need to be the driving healthcare paradigm of the 21st century
• To outline the role of that tackling underuse, overuse and waste can play in increasing value 
• To outline how personal, technical and allocative can be increased in practice 
  
  

The Oxford Value and Stewardship Programme supports individuals and organisations to understand and adopt the new paradigm and there are five activities that are needed to create the new paradigm

• Define population sub-groups with a common need and allocate resources optimally
• Design the system for each population sub-group
• Ensure each individual makes decisions to optimise personal value
• Deliver value for the population and all the individuals in need equitably through networks
• Create the culture of stewardship, with a governance process that promotes collective responsibility

These are relevant to everyone formally involved in leadership and management, many of whom are also clinicians, but all of them, particularly the need for a culture of stewardship should be felt by everyone in a health service.

This requires a new set of skills and we provide the learning required in five modules. At the end of the five modules, participants will:

• Understand the concepts and practical actions necessary for value-based population health and care.
• Know how to establish and lead new culture of stewardship.