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t m c » p u l s e | j u ly 2 0 1 4 22 The Science of Improvement A value-based health care delivery course launched at the Texas Medical Center sheds light on important issues LEFT: Michael E. Porter, Ph.D. (Credit: Jimmy Ushkurnis) RIGHT: Robert S. Kaplan, Ph.D. (Credit: Harvard Business School) FACING PAGE, LEFT TO RIGHT: Thomas W. Feely, M.D., Robert C. Robbins, M.D., Kathleen Carberry, R.N., MPH, Porter, Kaplan, Charles Fraser Jr., M.D. (Credit: Spike Johnson) B y A l e x O r l a n d o W hat is the actual cost of health care? Rising health care costs threaten the growth of the American economy. Despite the amount we spend, quality is uneven, errors con- tinue to occur and the health status of Americans, in general, is no better than many other developed countries that spend less. Health care spending in the United States currently exceeds 17 percent of our gross domestic prod- uct, according to the Commonwealth Fund. A lack of knowledge and trans- parency about costs and outcomes of delivering patient care is a prin- cipal driver of high and escalating expenditures. In an effort to counter that imbal- ance, the Texas Medical Center worked to bring a course titled Value-Based Health Care Delivery (VBHCD) to Houston, earlier this year. The course, taught by renowned Harvard Business School (HBS) professors Michael E. Porter, Ph.D., and Robert S. Kaplan, Ph.D., emphasized a simple but essen- tial idea: the fundamental purpose of any health care organization is to improve value for patients—defined as the health outcomes achieved per dollar spent. "Value for patients is the only goal that can unite the interests of all system participants, and improving value is the only real solution to the health care challenge," said Porter, Bishop William Lawrence University Professor at the Harvard Business School. "Value improvement will require major changes in the way health care is delivered, measured and reimbursed, not just incremental improvement." Porter characterizes value as the "true north" with which to navigate the major challenges in health care. Aiming to educate executives, physician leaders, practicing phy- sicians and senior administrators responsible for health care delivery within the Texas Medical Center, the curriculum was anchored in actual in-depth case studies, including a new case on Texas Children's Heart Center. The course took place in April at the Bioscience Research Collaborative. It was sponsored by a steering com- mittee that included, among others, Robert C. Robbins, M.D., president and chief executive officer of the Texas Medical Center, Charles Fraser Jr., M.D., surgeon-in-chief of Texas Children's Hospital, Thomas W. Feeley, M.D., head of The University of Texas MD Anderson Cancer Center's Institute for Cancer Care Innovation (ICCI) and Kathleen Carberry, R.N., MPH, direc- tor of the Texas Children's Hospital Outcomes & Impact Service. "The senior leaders attending quickly recognized the universal rele- vance of the issues and choices faced by the organizations highlighted in the case studies—there's a huge potential to rapidly translate those ideas into action within their own organizations," said Porter. "The course was also a good platform for those senior leaders to develop relationships with their peers in other organizations, facilitating col- laborations and ongoing discussions." Embracing an inherently optimis- tic view of health care reform, Kaplan, HBS's Marvin Bower Professor of Leadership Development, Emeritus, is adamant that sacrificing quality through harsh reduction of costs isn't a tenable, or even necessary, solution to these problems. "There's a lot of pressure on the health care system to do more with less and there's an emphasis on trying to contain costs or even reduce costs, which can be detrimental to the patients we're Solving our health care crisis begins with getting all stakehold- ers to agree on a single overarch- ing goal—improving the quality of care delivered for each dollar spent—and providing them with a common strategic framework to accomplish this goal. — MICHAEL E. PORTER, PH.D. Bishop William Lawrence University Professor at Harvard Business School