Is return on investment the appropriate tool for healthcare quality improvement governance?
Abstract
Purpose
In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.
Design/methodology/approach
Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.
Findings
ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.
Practical implications
This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.
Originality/value
The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.
Keywords
Acknowledgements
Funding: This work is supported by the Economic and Social Research Council (grant number: ES/P000703/1). Infrastructure support for this research for TS was provided by the NIHR London MedTech and In Vitro Diagnostic Co-operative.
Conflicting interests: TS received funding from Cancer Alliance and NHS England for training cancer multidisciplinary teams (MDTs) in assessment and quality improvement methods in the United Kingdom. TS received consultancy fees from Roche Diagnostics, Parsek and Salutare. The other authors declare that they have no competing interests.
Authors’ contributions: As part of her Ph.D. project, ST performed the studies discussed in paper under the supervision of co-authors TS and CH. ST wrote the manuscript and compiled all the figures in this manuscript. All authors advised, reviewed and approved the development of this manuscript and figures.
Citation
Thusini, S., Soukup, T. and Henderson, C. (2024), "Is return on investment the appropriate tool for healthcare quality improvement governance?", International Journal of Health Governance, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJHG-06-2024-0067
Publisher
:Emerald Publishing Limited
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