16 Apr 2021
On April 2, the Sasin Research Seminar series continued with Assistant Professor Yupin Patarapongsant, Ph.D. and Pattarawan Prasarnphanich, Ph.D. presenting their research topic: The Case of Sustainable Healthcare at Siriraj Integrated Center of Excellence. Their action research began with an explanation of ‘Value-based’ healthcare as a delivery model where providers, including physicians, healthcare professionals, and hospitals, focus on patient well-being and health outcomes. For the project, healthcare marketing literature was incorporated and applied at the Siriraj Hospital, Bangkok, Thailand. The result is the Sustainable Healthcare Model of Siriraj Integrated Center of Excellence (SiCOE). To discuss value-based healthcare, some of the terminologies needed explaining. In healthcare, value can be calculated by the outcomes divided by cost, with outcomes relating to patient experiences and the quality of clinical care. The costs include resource utilization and the price of clinical treatment. Value-based healthcare is not a new idea. It began in the U.S. and has also been established in places like Singapore. The researchers discussed some of the literature behind it, such as ‘Value-Based Healthcare Agenda’ written by Harvard Professor Michael E. Porter in 2013. To create a value-based health care system that significantly improves value, a fundamental restructuring of healthcare delivery is required. This is not something that can be achieved through incremental improvements. Many problems stem from the fact that 21st-century technology is being used, but the healthcare is often delivered with 19th-century management practices, organizational structures, measurement methods, and payment models. If the system is to be overhauled, the overarching goal must be value for patients. The outcomes are the health results over the entire care cycle for each patient. To create a value-based healthcare delivery system, the researchers presented a strategic agenda. The first step is organizing care into Integrated Practice Units (IPUs) around patients’ medical conditions. The current model is organized by specialty and discrete services, but under the new model, IPUs lead to multidisciplinary teams, not specialty silos. To lower prices, it is necessary to measure outcomes and costs for every patient. The cost is the actual expense of patient care, including resources, facilities, personnel and time. There are also benefits of a single bundled price covering the entire care cycle for an acute medical condition. To enhance value, it is necessary to integrate care delivery across system facilities with sister hospitals and outpatient units, expand areas of excellence, and have patient care outside the immediate area. The final point was building an information technology platform to restructure care delivery and measure results, rather than treating it as a solution itself. This would require standard data definitions, combining multiple sets of ‘structured’ patient data, templates, and an architecture that allows for easy extraction of information. The researchers then looked at the Care Delivery Value Chain and the importance of mapping what was delivered over the care cycle to provide a systematic approach to analyze and improve care delivery. These findings and strategies lend themselves better to public hospitals than private ones. So, they were able to provide a roadmap for the Siriraj Integrated Center of Excellent (SiCOE), which is government-run. After a process of diagnosis, intervention and evaluation, as an action research, Dr. Yupin and Dr. Pattarawan helped SiCOE apply the framework working alongside with Siriraj Hospital team. Aspects such as costs were measured and analyzed – something that tends not to happen at government hospitals. They focused on seven strategic areas: patient experience, clinical quality and safety, cost-effectiveness, workforce, research, education, and market expansion/extension. These frameworks and strategies allow them to look end to end and see where services could improve to provide consistent quality. Additional digital content would help with the ‘patient journey’ – admission, observation/treatment, and survey. By improving digital literacy and technology, more analysis of a patient’s journey can be undertaken. The researchers looked at factors that were most important for outcomes, such as communication with doctors and nurses, staff responsiveness, pain management, discharge, care management, and more. Moving forward, it will be essential to standardize bodies of knowledge, tools, services, processes, and roles. One of the attendees, Dr. Amornpun Sareemaspun, Director of Chula Medical Innovation Center, Faculty of Medicine at Chulalongkorn University said: “Besides incorporating Value-Based Healthcare in healthcare services delivery, medical innovations in Thailand need to get developed progressively in this transformation of medical services and healthcare innovations. There are new services and medical innovations from the major medical schools and medical institutions across the country creating leapfrog research and innovations foundation in order to have cost-effective and efficiency in the healthcare delivery outcomes – such as adoptions of Tele-Medicine, Robotics, and Nanotechnology. This action research was fascinating. It will be fascinating to see how the Sustainable Healthcare Model of Siriraj Integrated Center of Excellence works when fully implemented in the near future.