Hôpital de La Tour is one of the few hospitals today pioneering value-based healthcare (VBHC), an approach that focuses on patient outcomes and sustainable healthcare costs. Rodolphe Eurin, CEO of Hôpital de La Tour, explains why VBHC’s success depends more than anything on a shift in mindsets.

What’s the one thing you’d like people to understand about VBHC?

People rarely think of hospitals as entities that sell products, yet the comparison is useful in the context of VBHC. I often ask the teams at Hôpital de La Tour, ‘What are we selling as a hospital?’ The answer is quality of life. Regardless of why a patient comes into the hospital, our aim is always to improve their quality of life.

Take any successful company that sells a product or service. How do they make sure they remain competitive? They measure their product. Since a hospital’s product is quality of life, this is what we need to measure to offer better care. We do this by asking customers – the patients – for feedback to drive continuous improvement. This feedback gives medical professionals actionable data so they can address gaps and improve patient care.

It’s very difficult to improve what you don’t measure. Understanding this is key, as it’s the basis on which the whole VBHC system is built.

 What needs to be put in place in a hospital for a VBHC approach to work?

As the system is based on getting feedback from patients, you need infrastructure and tools to do this efficiently. At Hôpital de La Tour, we have a team that has conversations with doctors to work this out. For instance, what do we want to measure? What questions should we ask patients? We also need a coordinator to call patients and make sure they’re engaging with the questionnaires. And an IT backbone – including digital tools and apps – to make the system work efficiently.

Yet when we get caught up in how to put in place a system, it’s easy to forget the why, and we mustn’t lose sight of this.VBHC is not an IT project. It’s a fundamentally different way of defining the mission of a hospital. If we keep in our minds that we are selling quality of life, we see that the measuring, feedback and IT systems are simply tools to help us achieve this aim. This is extremely important because if medical professionals don’t understand this, they won’t be motivated to keep moving towards VBHC.

In this sense, VBHC is as much about changing mindsets as it is about putting in place robust tools that will make the system work. And it makes sense: if you understand why you’re doing something, you’ll be motivated to push the approach forward.

Doctors and nurses often go into medicine because they want to improve outcomes for patients. So aren’t hospitals and their staff already working towards improving quality of life?

I absolutely believe this is what they are doing, but it’s often a less conscious approach. The difference with VBHC is that it’s a strategic mindset that comes from the management team and is applied at all levels. That’s extremely important. It’s also based firmly on data, so medical staff can move towards this mission with the tools and information they need to make informed decisions.

Still, today, hospitals using the VBHC system are few and far between. Why is this?

More work needs to be done to engage medical practitioners. The doctors who are measuring patient-related outcomes say it’s much more efficient and precise. But many don’t engage with the topic. They have been doing things a certain way and are reluctant to change. I’ve spoken at conferences on VBHC and asked any doctors in the room to raise their hands. And out of 150 people, there are usually only a couple of doctors who attend these talks. There are lots of enthusiastic people in hospital management, medtech and pharma, but to drive VBHC forward we need more doctors to embrace this approach.

An obvious solution is to include VBHC in doctors’ education and training. Aspiring doctors today are aware that healthcare costs are a huge challenge worldwide – and they are keen to find sustainable solutions. In Switzerland and beyond, educational institutions and the healthcare sector need to work together to leverage the enthusiasm of doctors and instil the VBHC mindset early on.

But although doctors are seen as the central figures in implementing VBHC, it’s equally important to further engage nurses. There are many more nurses than doctors working in hospitals today, and they are present in the patient journey from start to finish. If more work is done to engage nurses, they could also play a key role in driving VBHC forward.

Is anything else holding back the implementation of VBHC?

Beyond engagement in the medical world, the referral system in the Swiss healthcare system needs to change for VBHC to thrive. One of the advantages of VBHC is that it shows outcomes broken down by care provider and area of care, with providers ranked according to the outcomes they’ve achieved for patients.

Let’s take knee replacement surgery as an example. The data tells us that if a patient has surgery with the lowest-ranked provider, they are more than ten times more likely to have complications than with the top-ranking provider. The answer, which should be obvious, is to refer patients to the hospital that will result in the best outcomes.

Yet today, neither doctors nor patients are thinking in this way. Instead, doctors refer patients to the hospital that’s closest to their home, because it’s convenient. Or they might refer them to a particular hospital because they’ve always referred patients there. Patients tend to trust their doctor and follow their advice, but by doing so, they’re not choosing a provider that will result in the best outcome for their condition.

This thought process is slowing down the deployment of VBHC. We need to change mentalities so that decisions are driven by data, not long-held assumptions.

Can budget be an obstacle to embracing VBHC?

Prof. Christoph Meier is a pioneer of VBHC here in Switzerland. He implemented VBHC in Basel and said it was very easy to find the budget. How? You stop doing and measuring what’s unnecessary – and instead you measure things that matter to patients.

Would you say VBHC is an innovative approach?

 Absolutely. Often when we think of innovation, we think of technology, but this is restrictive: there are so many ways to innovate. In VBHC, we see innovation in the processes for integrating feedback into our system, in feedback loops and in the cooperation between teams to give better care. VBHC brings together people from very different areas: we’ll often have an insurance company, doctors and caregivers in the same room. Diverse perspectives come together to work out a way forward. This in itself is innovation.