"The Right Thing for Patients": Pioneering Outcomes Measurement in Wales | ICHOM – International Consortium for Health Outcomes Measurement

“The Right Thing for Patients”: Pioneering Outcomes Measurement in Wales

“The Right Thing for Patients”: Pioneering Outcomes Measurement in Wales

Aneurin Bevan


In 2013, Alan Brace, Deputy Chief Executive of the Aneurin Bevan Health Board in Wales, participated in Professor Michael Porter’s value-based health care course at Harvard Business School. In his coursework, Brace was struck by how neatly the value-based approach could link financial and clinical aims in a common vision. Returning to Wales, he vowed to champion the approach at his home institution.


“In an environment of economic austerity, it was sobering to think that the more traditional cost reduction measures being used without regard to the outcomes achieved could actually limit the effectiveness of the care being provided to our population,” Mr. Brace explained. “It was difficult to argue against the basic thrust of value-based care—doing the right thing for patients.”


The message was especially salient in light of the 2009 restructuring of the Welsh health care system. An aging population, surge in chronic diseases, and challenging financial environment had prompted government leaders to call for a more streamlined health care system capable of delivering better health outcomes. In response, in October 2009, Wales’ 22 Local Health Boards and seven NHS Trusts were reorganized into seven integrated Local Health Boards, each responsible for delivering all-encompassing primary and secondary care within a geographic region. The goal? To simplify management structures, channel more money to patient services, and improve collaboration between hospitals all while focusing on health outcome improvement.


The Aneurin Bevan Health Board was formed as a part of this restructuring, and as a result, patient-centered care, value, and outcomes have always been pillars of the institution. Forming a Strategic Alliance with ICHOM was therefore a way of publicly restating their commitment to these ideas. More importantly, the Alliance is a key step on the path to achieving these aims.


“This is why partnering with ICHOM has been so hugely helpful for us,” said Sally Lewis, Assistant Medical Director at Aneurin Bevan. “The structure and the rigor that ICHOM brings to the process gives some real seriousness to the commitment that we as a health board have given to this project. It demonstrates internally and externally that we’re invested in this, we’re serious about it, and we’re going to provide the tools and resources necessary to commit to this project in the long term.”


As part of the Strategic Alliance, Aneurin Bevan has committed to implementing the Parkinson’s Disease Standard Set. Clinicians are expected to begin data collection at the end of October using an internally-developed data capture solution. The process has progressed more quickly than expected, at least partially due to an enthusiastic physician response to the project. “Because of the emphasis on PROMs—real outcomes, not just process measures—clinicians are really engaged and excited by the project,” Dr. Lewis said. “I’ve never seen that before, so that, to me, is a really powerful thing.”


After the Parkinson’s Disease Standard Set, Aneurin Bevan plans to implement the Low Back Pain and Cataracts Standard Sets. In the long term, they aim to measure as many Standard Sets as possible with the ultimate goal of initiating a trend within the broader Wales health care community. Currently, awareness of value-based health care is high and growing; however, the other local health boards are looking to Aneurin Bevan to set the example before diving in themselves.


“Our long-term outlook is that we would like this to be an all-Wales approach. Wales is small enough to do that,” explained Dr. Lewis. “Our aspiration is to go the whole way, and I would hope that the community in Wales will have a similar aspiration. It would be great if we could have one unified ICHOM approach.”