Nurses can address the economic imperative in healthcare with Value-informed Practice

Nurses can address the economic imperative in healthcare with Value-informed Practice

by Lori Wightman DNP, RN, NEA-BC, PCC, FAONL

Value-informed Nursing Practice

Are you a nurse that “grew up” in the fee-for-service era and learned we don’t mix money and nursing in the same conversation? In fact, some nurses believe it is unethical to discuss cost and care. However, with time and new knowledge the profession has come to understand the concept of value. Well, most of us....

An article by Yakusheva, Rambur, and Buerhaus (2022) defines health care value as the outcome of patient care provided, divided by the cost of the resources needed to achieve the outcome. High-value care produces an improvement in patient outcomes while using the least number of resources. Hence, nurses, as the largest of health care professions, are able to significantly impact the value of care.

Nurses are in a position to address an economic imperative. The United States (US) healthcare system is not a leader in performance as compared to other countries not only in quality, but in cost. Infant mortality, maternal mortality, and life expectancy are the worst when compared to other developed countries. (Future of Nursing: 2020-2030, 2021)

Approximately 20 cents of every dollar in the US are spent on health care. According to Shrank, Rogstad, & Parekh (2019), instances of wasteful use of health care resources add up to as much as $935 billion (about $2,900 per person in the US) annually with $286 billion being preventable through judicious use of resources.

Ten percent of the nearly trillion-dollar annual health care waste is related to over testing and over treatment. The other two main sources are administrative complexity and care delivery and coordination failures. (Shrank et al., 2019). While we need help from our physician colleagues related to testing and treatment, nurses have the ability to impact complexity, care delivery, and care coordination failures. 

To address the economic imperative, Yakusheva, Rambur, & Buerhaus (2022) call for a new practice model – Value-informed nursing practice. It is a practice model that consistently incorporates considerations of both outcomes and cost of resources required to achieve the outcomes in clinical decision making. Nurses carefully assess each care situation with an eye toward using resources effectively and judiciously.

How do we get there?

Moving toward a value-informed nursing practice will require transformational leadership and courage and curiosity of the entire profession. First, leaders need to be transparent about the cost of supplies, testing, and other services to help nurses assess the value of care delivery.

Secondly, nurses need to be equipped with basic Lean skills to be equipped to improve processes, communication, and coordination. Improvements can be organic and tested at micro levels before diffusion to the rest of the organization.

Stop “top down” strategies for improvement that do not incorporate the voice of the caregivers. More on that in a future blog!  

Call to Action

• Leaders: Provide the tools and resources needed to redesign workflows, promote collaboration, reduce non-value-added work, and distribute responsibilities that reflect appropriate scope of practice and expertise of healthcare roles.
• Leaders: Establish an environment that promotes a culture of safety.
• Nurses: Take accountability for creating value for your patients.
• Nurses: Seek to understand the cost of supplies, tests, and other expenses

Yakusheva, O., Rambur, B., & Buerhaus, P. I. Value-informed nursing practice: What is it and how to make it a reality. Nursing Outlook 70(2022) 211-214.

Shrank, W., Rogstad, T., & Parekh, N. (2019). Waste in the US Health Care System: Estimated Costs and Potential for Savings. Journal of the American Medical Association, 322(15), 1501-1509.

National Academy of Medicine (2021). The Future of Nursing 2020 – 2030: Charting a path to achieve health equity. The National Academy Press, Washington, DC.

Learn more about Washington University's online master’s of Health Care Operational Excellence degree or certificate. 

Request information