Assessing the Return on Investment (ROI) Through Appreciative Inquiry (AI) of Hospital Improvement Programmes

Abstract

Across the globe hospitals are struggling financially as they are in a transition to change and support the development of new integrated models of health and social care. The vision and insights of W. Edwards Deming’s process management theory argues that the best way to reduce costs is to improve quality. While Deming’s principles have been successfully applied in the manufacturing and service sector, it is more challenging to apply these principles to the context of healthcare. Rauh et al (2011) argue that the management and organisation of a typical healthcare setting creates a rigid cost structure that is relativly insensitive to small changes in patient volume, resource use or even in the severity of the patients’ health condition. Rauh et al, (2011) argue that while fixed costs in healthcare remain relatively unaffected by clinical quality improvements, typically such quality improvements can create additional capacity rather than bottom line savings. Successful healthcare organisations will create the correct balance between Capacity, Demand and Actvity in order to provide a positive quality experience for patients. This chapter sets out how the metrics to determine a Return on Investment (ROI) calculation can determine the additional capacity that results from a clinical quality improvement project. Due to the complex nature of collective working between a number of stakeholder groups including patients in a hospital setting, it is recommended that determining the ROI should be a collective activity undertaken within a model of Appreciative Inquiry (AI).