Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review

Abstract

Background We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. Methods We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost–benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed. Results We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI. Discussion and conclusion Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation’s goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.

The potential for in-patient mortality reductions to drive cost savings through decreases in hospital length of stay and intensive care unit utilization: a propensity matched cohort analysis

“…13 Such investments face scrutiny given that widespread challenges in hospital nancial performance 14 have increased pressure to demonstrate that hospital quality programs will yield a positive nancial return on investment (ROI), despite this often being a di cult measure to quantify. 15,16 Directly calculating the ROI attributable to mortality reduction initiatives ideally involves a comparison of costs between patients who expire but could have been intervened on ("potentially avoidable mortalities", sometimes termed failure to rescue 17 ) and a similar group who would have likely died without the interventions prompted by the initiative ("successfully avoided mortalities"). However, the relatively low rate of avoidable mortality 18 and the wide variation in diagnoses, medication and treatment plans, as well as non-clinical factors (e.g., patient-dictated goals of care and the in uences of administrative and insurance status considerations) confound basic analyses seeking to generalize the costs of care associated with patient mortality.…”