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This metric you've never heard of wins partner buy-in

October 31, 2019

    We are in business to make and keep people healthy. But when we discuss digital solutions, we often frame performance in terms of return on investment (ROI), the amount of financial return generated relative to the initial cost. The use of ROI in isolation is a shortcoming in our industry because ROI measures how the investment improves the business but falls short of measuring how the investment improves outcomes.

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    We are not advocating to stop using ROI, but I want to propose that investments should be looked at through an additional lens: return on outcomes (ROO). ROO is the measurement of how the investment improved patient outcomes and health. Essentially, ROO anchors us in care transformation, the process of improving the way that care is delivered for the betterment of the patient.

    As we discussed in our chief executive sessions, digital investments should NOT be made on the basis of transforming the hospital into a high-tech masterpiece, but rather on the principle of transforming care. For that reason, we must expand our performance expectations to include ROO.

    ROI alone not fit-for-purpose

    Over the past few years, University Hospital Southampton NHS Foundation Trust (UHS), a 1,100-bed teaching hospital in England, UK, realised pregnant women often get treated like they're sick patients. But because most of them are healthy, pregnant women don't necessarily need to be kept under the doctor's supervision and care directions like a child with a high fever. So UHS wanted to give pregnant women more autonomy over their health care.

    In England, pregnant women often seek out care at multiple sites because each site offers different services (antenatal, post-natal, obstetrics and gynaecology, etc.). Each of these sites operates on different electronic medical records, so in order for doctors to have up-to-date patient health information, patients must bring hand-held notes with them to each visit. As you can imagine, this can result in disjointed and duplicative care. As a solution, UHS developed a cloud-based personal health record (PHR) so that information could travel seamlessly with patients to each visit, regardless of the site.

    While this solution is good in theory, it's useless if other sites don't adopt the same system—and UHS's four partner hospitals were not initially receptive to spending more money on another digital initiative. To win them over, UHS prepared a business case to present their solid financial projections. Due to the centralisation of information from the PHR, they expected to save about seven midwives worth of work (and, consequently, money), typical ROI metrics that UHS felt sure would win buy-in.

    But after UHS presented the projected ROI, its partners decided not to move forward with the PHR; there wasn't a business need to cut midwives' work, making the PHR an unnecessary investment. However, because it's at the core of every hospital's value proposition, there is always a need to improve the way they make and keep people healthy. UHS simply had to show how its PHR did just that.

    ROO proves investment is about patients

    UHS went back to its analysis determined to get the other sites to adopt the personal health record. What UHS found is that the targeted outcomes, in fact, had been improved. There were increases in the number of patients using the PHR, patients proactively initiating self-referrals through the PHR, and patient satisfaction. The women had indeed taken control over their health care by inputting comprehensive notes into the PHR and visiting their specialist when they saw fit. In other words, the PHR boosted patient engagement and enabled pregnant women to better manage their own care.

    Framed this way, the emphasis was no longer on dollars and midwives saved, but instead on patients becoming active owners of their care, which keeps people healthy. Presenting these ROO metrics alongside ROI metrics, UHS got its four partner hospitals to adopt the PHR.

    Making the best use of our health care dollars is absolutely critical. But focusing on only the financial benefit rarely drives the kind of support you need for these digital change initiatives. The combination of ROI and ROO paints a more comprehensive picture of digital platforms as an enabler for improving business operations and delivery of care.

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