Oxford Healthcare Value Briefing – No. 3

This online monthly briefing from Better Value Healthcare in Oxford will provide the latest information on value, based on work in; Oxford, NHS Right Care, and the International literature, because the paradigm shift can be seen in many countries.

Between the two documents on the NHS England Five Year Forward View there was no increase in the use of term quality but the term value had four mentions in the original document and sixteen in the Next Steps. See here where the word Value was mentioned in the new 2017 document, like the example below:







Book of the Month: ‘Creating public value: Strategic management in government’ Moore, M. (1997) Harvard University Press.

Distilled message: “Politics is the answer that a liberal democratic society has given to the (analytically unresolvable) question of what things should be produced for collective purposes with public resource. “

Why is this book important? This book is a summation of 15 years of research on what public-sector executives should do to improve the performance of public enterprises. Cases are used to illuminate their broader lessons for government managers. Mark Moore writes very clearly about the relationship between politicians and officials. While his work relates to American cities, police departments and planning and housing departments, his discussion focuses not only on what constitutes public value but also on the relationship between politicians and officials.

For other descriptions of this relationship, including the third group of scientifically trained officials (such as physicians), read Herbert Simon’s ‘Administrative Behaviour’. Don’t forget the books of CP Snow, quite old now but still very fresh. Try ‘The New Men’ and, of course, ‘Corridors of Power.’ Yes Minister is also as fresh as when first produced.

Word of the Month: Value

Value is a very difficult word with different meanings in the singular and the plural. In the plural, it has a moral meaning as in “this hospital’s values are diversity and openness”. In the singular, the meaning is more economic.

There are three types of Value – Allocative, Technical and Personal

  • Allocative value, called allocative efficiency by economists, determined by how well the assets are distributed to different sub groups in the population
  • Technical value, determined by how well the allocated resources are used for all the people in need in the population, measured by the relationship between outcomes and costs, and costs are not only financial they may be carbon costs, or the time of clinicians and patients. Technical value includes but is broader than productivity and efficiency. Also, it is not quite the same as in the way in which the term value is used in the USA because services in the USA are not, with rare exceptions, responsible for whole populations. Thus, a hospital could be highly efficient in joint replacement but if there are much lower rates of replacement in the most deprived parts of the population, as is the case, then the service is not delivering value for that population. Technical value considers opportunity cost as well as the direct cost of the service. Also, to stick to the musculoskeletal example, if the orthopaedic service is doing high numbers of knee ligament operations very efficiently but the need of the population is for more knee replacement then the value of that service is not as high as it could be if resources were switched from knee ligament surgery to knee replacement surgery. It is also important to distinguish productivity from efficiency. Productivity is measured by the number of outputs related to the resources, whereas efficiency is measured by the outcomes related to the resources used.
  • Personalised value, determined by how well the decisions relate to the values of each individual
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Radio Value – Soundcloud 

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