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Quality/Cost/Disparities

Management research to provide operational advice on improving quality, reducing costs and eliminating disparities.

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High Value and Efficiency Culture Surveys

Maximizing value within the American health care system is an important priority. Value is often viewed as a combination of high quality, high efficiency, and low cost care. Value must link efforts to improve care quality with efforts to reduce unnecessary costs. Ignoring the financial implications of quality improvement efforts will fail in the real world where many providers face acute financial challenges and where costs are leading to consumer bankruptcies, increased insurance costs, and significant shortfalls in Medicaid and Medicare programs. Many of the root causes of inefficiencies that drive up costs are closely linked to root causes of inefficiencies that lead to poor quality, uncoordinated care where redundancies and system failures place patients at risk.

Adding value within healthcare requires understanding the contribution that organizational culture makes to value and working to foster a culture where high value is a cultural norm. The development of the Patient Safety Climate in Healthcare Organizations (PSCHO) tool and AHRQ's Hospital Survey on Patient Safety Culture (HSOPS) survey have contributed greatly to efforts to promote the important role culture plays in providing safe care. HSOPS is used extensively in national improvement campaigns and many hospitals and health systems now regularly assess their safety cultures and use culture scores on organizational dashboards and as parts of variable compensation programs. The decision to create a culture of value survey is a logical extension of these two assumptions. If organizations lack cultures committed to value then discrete efforts to raise dimensions of value are likely to yield limited and unsustainable results. And if organizational leaders have no plausible way to know whether their organizational culture is committed to value, then their ability to make value a higher organizational priority will be very limited. Thus, developing culture of value survey instruments for hospitals and medical offices as well as a checklist for providers seeking to discuss value with patients fills an important need for many ongoing and planned efforts to foster greater value within American health care.

HRET, under a contract from AHRQ, will develop surveys for hospitals and medical group practices that will measure an organization's culture pertaining to how it cultivates a climate of efficiency and value in health care.

This project will provide HRET with an opportunity to help shape how the concept of “value” is understood and measured. HRET will also create a “communicating about value” checklist to help guide clinicians in incorporating discussions about value in their patient communications.

If you have any additional questions or comments, please contact Kevin Kenward at: kkenward@aha.org (312) 422-2634.

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