The Value Proposition of Standardized Care Processes

James C. Etheridge, M.D. 

Resident in General Surgery 

Brigham and Women's Hospital 

PGY 3

06/02/2021

James C. Etheridge, M.D. 

The benefits of standardized care processes are well-established.  Clinical pathways and protocols, when properly implemented, have been shown to improve adherence to evidence-based practices, efficiency of healthcare, and patient outcomes.  Enhanced recovery pathways, for example, have been enormously successful in surgery.  However, the benefits of these approaches are seldom explored from a value perspective.  As such, the Value Based Healthcare Delivery Course helped me to see these approaches in a new light.

Standardized care processes tend to be discussed from a “high-reliability” perspective.  The argument is logical and reasonable: if we can ensure timely adherence to evidence-based practices, patients will do better and leave the hospital sooner.  There is a tacit emphasis on process measures from this perspective – outcomes are frequently presumed to follow improved process adherence.  The only element of value routinely explored is the denominator, most commonly in terms of length of stay.

Certainly, there is a benefit to improving best-practice adherence and streamlining care.  From a value perspective, however, these process-oriented advantages are secondary.  Standardized care practices are, rather, a prerequisite to value-based healthcare delivery.  A health system has no way to assess the costs of care processes and the return on investment for these processes without standardization.

Consider a patient with uncomplicated appendicitis.  A system with a systematic approach to care delivery will be able to predict the choice of antibiotics, operative or non-operative management, surgical devices used, and postoperative care provided.  With this data, the system can anticipate costs and likely outcomes.  Process improvements to reduce costs or improve outcomes can be made and studied with confidence.  A system comprising a conglomeration of individual providers, lacking standardized approaches to patient care, can do none of these things.  Failure to standardize thus does not simply promote errors – it prohibits the functions necessary to a well-designed, value-based healthcare delivery system.

This realization was one of many insights I gleaned from the Value-Based Healthcare Delivery Course.  Sessions on costing methods, organization of care around common conditions or organ systems, and rationalization of increasingly consolidated healthcare systems were thought provoking and stimulating.  Nonetheless, as an implementation researcher with an interest in care standardization, I found this realization profound.  I am thankful for this opportunity to refocus my efforts from processes and outcomes to value.