What does it take to raise the quality of health care?

What does it take to raise the quality of health care?

PPO Serve was created to help clinicians work in a rewarding environment where providing consistently great care is routine.

It’s an uncomfortable truth that there’s a wide variation in the quality provided by the health care sector. While clinicians believe they are providing the best level of care possible, health economists and large funders see real differences and patients experience it differently.  Care provision varies significantly between individual clinicians, whole systems and geographic regions. In fact, there is more variation in healthcare outcomes than in most other industries. Most industries routinely apply standard operating procedures and measure quality standards, so that, as a consumer, you expect and reliably get high quality food from restaurant chains and franchises. Similarly, we happily pay ‘top dollar’ for a top car brands because of the reputation for quality it carries….

Atul Gawande, in his 2012 article BIG MED poses that question and answers it – we need to learn from other industries.

Gawande proposes that our sector could learn a great deal from restaurant chains that routinely provide complex, high quality products at prices affordable for the mass market. Also, value as the basis for competition between branded healthcare systems is in the best interests of consumers and patients.  

The ‘Cheesecake Factory’ is a very successful national US restaurant chain that provides food and service of a type and quality usually associated with ‘up market’ restaurants. They have a huge and complex menu and are able to provide this at prices affordable to the mass market. He contrast this with the healthcare sector with our high costs, mediocre service and unreliable quality….

Gawande identifies key factors in the success in consistently providing these quality services.

  • Scale is critical, the single or small practice (mom and pop restaurant) vs. large organised teams in a sophisticated chain; and branded systems that compete on
    Big Med
    their reputation for quality and reliability. In our hospital systems, in the absence of meaningful measures, public speculation about questionable practice do occasionally harm hospitals but typically patients can judge quality only by appearances. In the US, large chains are increasingly competing on for patients and being paid by insurers based on their clinical production.
  • Process re-engineering is crucial. The Cheesecake Factory is a process reengineered restaurant chain, with an approach remarkably similar to that taken by the most progressive and successful integrated healthcare systems. Tasks are carefully designed and assigned, electronic systems provide support, record performance measures and enable the monitoring of quality. Also, while standardisation is key (95%), customisation is fine (5%) and individual professional autonomy determines how results are achieved.
  • Reduce waste. A dynamic capacity planning model matches the demand for products and the supply of staff and consumables (food or drugs…) so waste is reduced to under 2.5%. Planning includes a forecasting element, predicting high utilisation by season, weather or large events.

The article explores the application of these principles in the setting of the ICU – our most complex clinical system and where patients typically experience highly variable outcomes.

The intervention described is of an ‘off site’ technology support centre that provides a package of back up services to many ICUs, including monitoring and compliance. Interventions are based on aspirational standards of care, with related reference lists and alerts.       

The conclusion acknowledges that change is hard to navigate and is a deliberate process needing time and careful support.

PPO Serve exists to help you navigate this change.  We can help you create the teams, the brand, the planning model and the processes. 


Read Big Med and then engage with us.

Can value-based health care be turned into a real business model in South Africa?

Can value-based health care be turned into a real business model in South Africa?

At PPO Serve we believe the shift from service based to value based health care is inevitable because it is the answer the question of achieving the Triple Aim – improving the patient experience of care (including quality and satisfaction); improving the health of populations; and. reducing the per capita cost of health care. It is being rapidly adopted by many countries and in particular the USA market. Locally, though, there has been just a few and very tentative steps. We would like to change that.

The biggest impediment to change invariably is the shift from fee for service to value based reimbursement because performing and billing less services has the potential to erode short term revenue of providers. Nonetheless, there is a great need for innovators embracing this change are greatly needed in our sector. In fact, there are many major and well know innovators in the USA and other markets that embrace the model of value not as an act of charity but as a strategic imperative, and gain clear advantages for taking these steps.

According to an article in the Harvard Business Review, the rationale for their innovative strategies:Sustainability for all; Experience in Managing Risk; and long term Relationship Building. They see no real alternative.

These major healthcare innovators share specific strategic elements:

 “The provider organization(s) used process improvements to boost quality of care for patients: better outcomes, an enhanced care experience, lower anxiety, less wasted time, and fewer health risks. When the results became clear, each effort also fostered pride and teamwork, thereby reducing employee turnover.


Second, the organizations decided that improving value was more important than short-term fee-for-service profit. They made investments — and often disrupted the habits of their staff — because they recognized that a business plan based on value was the right kind for their patients.


Third, they decided not to game the system by targeting only patients in contracts that would yield financial rewards. Instead, they understood that care redesign had to be of value for all patients, or it wouldn’t happen reliably for any. They traded losses in some contracts for potential defection of some patients to other providers, greater professional pride, and a forward-looking strategy.”


We believe that value based market competition will reward early adopters with recognition and discerning patient choice.

In South Africa, we need supply side innovators in our sector that embrace value contracting and start designing care delivery for all the patients who they serve.  Are you one of them?




America’s epidemic of unnecessary care rings true in South Africa

America’s epidemic of unnecessary care rings true in South Africa

Important follow up to the Cost Conundrum in 2009, Atul Gawande’s Overkill has enormous relevance for the SA private healthcare sector which shares these issues and needs similar solutions.

The crux is the overall well-being that patients value (‘patient centered care’) gets lost under a tidal wave of services, many not needed or even harmful.  The anxieties, structures and incentives that cause this is well explored. The successful reform stories with better quality, less costs and improved doctors working lives, all rely on integrated teamwork and outcome measures and are very straight forward. Financial rewards must fund value for populations, not services for individuals.


Clinical Director

Clinical Director in the

Integrated Clinical Consortium

Reporting to the Local Governance Structure and the Clinical Projects Executive Lead in PPO Serve