A shift from volume-based to value-based healthcare is viewed as a way to deliver more effective, patient-centered, and productive care based not only on the best clinical practices but also on patients’ feedback. Such an approach places customers at the center of a healthcare system, which allows for narrowing a perpetual gap between clinical realities in which healthcare providers and patients live. The given paper will discuss the executive proposal for the embedding of patient-reported outcome measures (PROMs) in routine practice.
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Purpose Statement and Proposal Objective
Even though healthcare professionals employ the best evidence-based interventions to improve patient outcomes, clinical understanding of the effect of treatment on patients is still little known. The purpose of this executive proposal is to suggest an innovation of PROMs that would enable healthcare providers to enhance care delivery. Then, an action plan for mobilizing an interprofessional team to lead this organizational change will be outlined. The objective of the proposal is to make a move from volume- to value-based healthcare.
In contrast to volume-based care, value-based one provides for the establishment of a correlative relationship between value and outcome. However, the realities of the current healthcare system are such that customers usually pay for the care services received rather than the value obtained from these services (Baumhauer & Bozic, 2016). Embedding of PROMs will allow for measuring outcomes from the customer’s perspective, which will lead to an increase in their satisfaction.
Recommended Action Plan
At the first stage, the interprofessional team should be mobilized. At the second stage, these professionals will collaborate on the development of valid and sensitive instruments to collect information about patient-reported outcomes (PROs). At the third stage, criteria will be designed to assess PROs. At the fourth stage, IT personnel will be tasked to develop a reliable and precise patient-reported outcome measurement information system. Finally, the comparative trial will be performed to evaluate the outcomes of patient’s participation in the development of the healthcare system and quality improvement.
The involvement of the interprofessional workers is the keystone of improved patient care. Therefore, the working group should consist of different healthcare professionals, such as nurses, physicians, therapists, pharmacists, and others. The collaboration of interprofessional team members on a shared mission is crucial for successful change implementation and its effective sustaining. These people will be involved in the development and testing stages, and leaders will be selected to inspire other personnel to embrace the change.
Leadership strategies utilized by the DNP practice scholar should improve team cohesion, as well as engage and encourage the personnel to support the innovation. In particular, communication strategies may be used as an effective tool to share the mission and the action plan with the team. It is through communication the leader may create such an environment that would foster the change implementation. It is also important that a leader appreciate each team member as this instills a sense of commitment.
The proposed innovation involves the development of a precise patient-reported outcome measurement information system for collecting customers’ perceptions of their general health and quantifying them. This, in turn, would allow for tailoring treatment plans to meet customers’ needs (Kingsley & Patel, 2017). Data collected from PROMs will be further used to guide quality improvement in healthcare domains and develop a more cost-effective model of care. It is worth mentioning that if appropriately executed, PROMs may be helpful in predicting recovery trajectories for certain patients.
Associated Risks and Barriers
When developing PROMs, considerable attention should be paid to the methodological issues, including reliability, sensitivity, validity, and precision of the instruments. Failure to comply with any of these requirements may lead to the risk of elaborating a tool yielding poor empirical evidence regarding customer’s health or the low generalizability of findings (Francis, McPheeters, Noud, Penson, & Feurer, 2016). Extrapolation of PROMs used in research methodology to the clinical practice use may result in inaccurate data interpretation (Foster, Croot, Brazier, Harris, & O’Cathain, 2018). Main barriers to the embedding of PROMs include the complexity of electronic systems development and physicians’ reluctance to use the tools routinely.
Ethical Issues of Concern, Relevant Opportunities, and Ethical Considerations
Ethical issues of concern that may arise include patient health information confidentiality and privacy. The use of PROs data derives ethical considerations around patient consent and information sharing. It is required that healthcare organizations should provide PROs to patients with a thorough explanation of their purpose (Gensheimer, Wu, & Snyder, 2018). Relevant opportunities for dealing with these ethical concerns depend on state and organizational ethical requirements. Thus, healthcare facilities should seek legal advice to choose the most optimal option.
Strategies to Mitigate Risks and Facilitators to Overcome Barriers
Strategies to mitigate the risks described above include the development and selection of PROMs with consideration of validity, specificity, and sensitivity. In such a case, findings obtained from these tools will be generalizable and reliable. In order to successfully develop electronic systems of patient-reported outcome measurement, it is crucial that IT specialists and interprofessional team members work collaboratively. Physicians’ unwillingness to use PROMs may imply that they lack information about the benefits of the innovation. Therefore, the DNP practice scholar should effectively utilize communication strategies to educate physicians about the importance of value-based healthcare.
The organization will benefit from the innovation as the systematic use of PROMs will result in improvements to patient outcomes due to the collection of patient-centered information. Teamwork patterns will be shifted from uni- to interprofessional, which will upgrade team unity and collaboration. Patients’ involvement in the decision-making process is likely to contribute to the establishment of more open patient-nurse and patient-physician relationships (Greenhalgh et al., 2018). As a change agent, the DNP practice scholar will build their leadership capacity while working on the proposed development.
Evaluation Strategies to Measure Success
The success of the innovation implementation will be determined based on clinical outcomes measures, such as a change in the incidence of diseases and the number of readmissions. Leadership strategies employed by the DNP practice scholar will be considered efficient if the change has been fully embraced by the staff and is sustainable. The productivity of the interprofessional team will be evaluated on the basis of cohesion which members demonstrated while working on the innovation and the validity and reliability of the measurement of PROs which the developed PROMs system should ensure.
The philosophy of value-based healthcare provides for the measurement of outcomes from a customer’s perspective. That is why the effectiveness of a shift from volume to value will mainly depend on the assessment of the extent to which services provided by healthcare organizations contributed to customer satisfaction (Kingsley & Patel, 2017). Ideally, rewards obtained by healthcare professionals should correlate with the value of the care they deliver.
The given proposal aims at establishing value-based healthcare by embedding PROMs in routine clinical practice. This innovation will be helpful in solving the practice problem of poor patient outcomes emanating from a gap between the physician’s and patient’s view of healthcare reality. Also, the development of PROMs will significantly contribute to the evaluation of care based on its value rather than volume. The expected outcomes include an increase in patient satisfaction and more patient-centered and high-quality care that takes into consideration individual experience.
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Baumhauer, J. F., & Bozic, K. J. (2016). Value-based healthcare: Patient-reported outcomes in clinical decision making. Clinical Orthopaedics and Related Research, 474(6), 1375-1378.
Foster, A., Croot, L., Brazier, J., Harris, J., & O’Cathain, A. (2018). The facilitators and barriers to implementing patient reported outcome measures in organizations delivering health related services: A systematic review of reviews. Journal of Patient-Reported Outcomes, 2(1), 46-50.
Francis, D. O., McPheeters, M. L., Noud, M., Penson, D. F., & Feurer, I. D. (2016). Checklist to operationalize measurement characteristics of patient-reported outcome measures. Systematic Reviews, 5(1), 129-140.
Gensheimer, S. G., Wu, A. W., & Snyder, C. F. (2018). Oh, the places we’ll go: Patient-reported outcomes and electronic health records. The Patient, 11(6), 591-598.
Greenhalgh, J., Gooding, K., Gibbons, E., Dalkin, S., Wright, J., Valderas, J., & Black, N. (2018). How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. Journal of Patient-Reported Outcomes, 2(1), 42-45.
Kingsley, C., & Patel, S. (2017). Patient-reported outcome measures and patient-reported experience measures. BJA Education, 17(4), 137-144.