| The institutional logic’s impact on value |
| We work so much more with outcomes than with costs. That is the brutal truth | If you try to get the health-care professionals to produce more, then you will not get much attention or they won’t agree with you. But if you have a clear target for what value you want to achieve, you have a higher chance of success. |
| At the hospital, of course we see the cost and how it impacts our operation. But, of course, there is a cost to the patient and society that we do not acknowledge, and if you want to deliver value to the patient, you need to see the entire picture | You can’t separate clinical outcomes and cost. If you work with the numerator (outcome) then you should let the denominator (cost) be unchanged, and vice versa |
| For me, value is something personal; I think you should ask the patient so they can express what’s important to them, and that differs, of course, depending on their condition, age, education and so forth, so it’s important to get the patients’ perspective | The objective is to deliver as much health care as possible for every Swedish crown spent, as there are limited resources available to deliver quality care to the patient using less or the same measure of resource |
| The challenge of working with cost |
| … we haven’t done that, only the economists know what the cost is | We don’t measure the patient pathway or the cost per patient. Although, in this case that would be preferable. So, the systems are not tuned to this way of working… |
| The concept of cost is extremely difficult. It isn’t that outcomes are easier, but they are easier to understand, more like a process measurement | Because we lack a perfect per patient cost system, we use a resource-based system instead. In many cases, the length of the hospital stay is the single most important cost driver, so it’s a good proxy for cost |