Harvard Case - Brigham & Women's Hospital: Using Patient Reported Outcomes to Improve Breast Cancer Care
"Brigham & Women's Hospital: Using Patient Reported Outcomes to Improve Breast Cancer Care" Harvard business case study is written by Robert S. Kaplan, Navraj S. Nagra, Syed S. Shehab. It deals with the challenges in the field of Accounting. The case study is 21 page(s) long and it was first published on : Jul 1, 2021
At Fern Fort University, we recommend Brigham & Women's Hospital (BWH) implement a comprehensive Patient Reported Outcomes (PROs) program. This program should include standardized PROs collection across all breast cancer care pathways, integration with electronic health records (EHRs), robust data analysis, and the development of actionable insights to improve patient care and outcomes. This approach will ensure BWH remains at the forefront of patient-centered care, enhances its reputation, and potentially improves financial performance by optimizing resource allocation and demonstrating value-based care.
2. Background
Brigham & Women's Hospital, a leading academic medical center, faces the challenge of improving patient care and outcomes in breast cancer treatment. While BWH excels in clinical expertise, it lacks a standardized approach to collecting and utilizing PROs. This limits their ability to understand the patient experience, identify areas for improvement, and demonstrate the value of their services. The case study highlights the potential of PROs to enhance patient engagement, improve communication, and drive better clinical decision-making.The main protagonists in this case are:
- Dr. Susan Love: A renowned breast cancer surgeon and advocate for patient-centered care, who champions the use of PROs.
- Dr. David Kent: A physician and researcher at BWH, who is leading the effort to implement PROs within the hospital.
- BWH leadership: The hospital's administration, who need to prioritize and allocate resources for the PROs program.
3. Analysis of the Case Study
This case study can be analyzed through the lens of strategic management and operational efficiency.
Strategic Analysis:
- Competitive Advantage: BWH can leverage PROs to differentiate itself from competitors by demonstrating a commitment to patient-centered care and driving better outcomes. This will enhance its reputation and attract patients seeking personalized and value-driven care.
- Value Proposition: By incorporating PROs into its care pathways, BWH can strengthen its value proposition by demonstrating the positive impact of its services on patient well-being. This will be crucial in a healthcare landscape increasingly focused on value-based care models.
- Growth Strategy: A successful PROs program can support BWH's growth strategy by attracting new patients, expanding its research portfolio, and potentially attracting partnerships with pharmaceutical companies or other healthcare providers.
Operational Analysis:
- Process Improvement: PROs can be used to identify bottlenecks and inefficiencies in the breast cancer care pathways, leading to improved workflow and resource allocation.
- Performance Measurement: PROs provide valuable data for measuring the effectiveness of treatment plans, identifying areas for improvement, and demonstrating the impact of BWH's interventions.
- Cost Optimization: By identifying and addressing areas of inefficiency, PROs can contribute to cost optimization and improved resource utilization within the breast cancer care program.
4. Recommendations
BWH should implement a comprehensive PROs program with the following key components:
- Standardized PROs Collection: Implement a standardized set of PROs questionnaires across all breast cancer care pathways. These questionnaires should be validated and culturally sensitive, covering key areas such as physical symptoms, emotional well-being, quality of life, and satisfaction with care.
- Integration with EHRs: Integrate PROs collection into the EHR system to ensure seamless data capture, analysis, and reporting. This will streamline the process, reduce administrative burden, and facilitate data-driven decision-making.
- Robust Data Analysis: Develop a robust data analysis plan to extract meaningful insights from the PROs data. This should include statistical analysis, trend identification, and the ability to link PROs data to clinical outcomes.
- Actionable Insights: Utilize the PROs data to develop actionable insights that inform clinical decision-making, improve patient care, and enhance communication between patients and providers. This includes identifying patients at risk, tailoring treatment plans, and proactively addressing patient concerns.
- Continuous Improvement: Establish a continuous improvement cycle for the PROs program, regularly evaluating its effectiveness, identifying areas for improvement, and adapting the program based on data and feedback.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core Competencies and Consistency with Mission: BWH's mission emphasizes providing patient-centered care and advancing medical knowledge. A comprehensive PROs program aligns with this mission by improving patient experience, generating valuable research data, and driving innovation in breast cancer care.
- External Customers and Internal Clients: By incorporating PROs, BWH can better understand and address the needs of its patients, enhancing their experience and increasing satisfaction. This will also improve communication and collaboration between providers and patients, leading to better clinical decision-making.
- Competitors: Implementing a robust PROs program will differentiate BWH from competitors by demonstrating a commitment to patient-centered care and value-based medicine. This will attract patients seeking personalized and high-quality care, enhancing BWH's competitive advantage.
- Attractiveness - Quantitative Measures: While quantifying the financial benefits of a PROs program is complex, the potential for improved efficiency, resource allocation, and value-based care reimbursement makes it a worthwhile investment. The program can also generate valuable research data that can attract funding and partnerships.
6. Conclusion
By implementing a comprehensive PROs program, BWH can enhance its patient-centered care approach, improve clinical decision-making, and demonstrate the value of its services. This will strengthen its competitive advantage, enhance its reputation, and potentially improve financial performance.
7. Discussion
Alternative approaches to implementing PROs include:
- Limited PROs collection: This approach involves collecting PROs data on a smaller scale, focusing on specific areas or patient populations. This may be less resource-intensive but may not provide a comprehensive understanding of the patient experience.
- External PROs vendors: BWH could partner with external vendors to collect and analyze PROs data. This approach can provide expertise and technology but may limit control over data ownership and integration with the EHR.
Risks associated with the recommended approach include:
- Data privacy and security: Ensuring the confidentiality and security of PROs data is crucial. Implementing robust data protection measures and adhering to HIPAA regulations will be essential.
- Resistance to change: Some providers may resist the adoption of PROs due to concerns about additional workload or perceived lack of value. Effective communication, training, and demonstrating the benefits of PROs will be necessary to overcome this resistance.
- Resource allocation: Implementing a comprehensive PROs program requires significant resources, including personnel, technology, and training. BWH leadership needs to prioritize and allocate these resources effectively.
8. Next Steps
BWH should take the following steps to implement the recommended PROs program:
- Form a dedicated PROs team: Assemble a multidisciplinary team to oversee the implementation, data analysis, and utilization of PROs.
- Develop a comprehensive PROs strategy: Define the goals, objectives, and scope of the PROs program, including the selection of standardized questionnaires and integration with EHRs.
- Pilot test the program: Conduct a pilot test of the PROs program in a specific breast cancer care pathway to evaluate its effectiveness and identify areas for improvement.
- Secure necessary resources: Allocate the necessary budget, personnel, and technology to support the PROs program.
- Communicate and train staff: Develop training programs for providers and staff on the use of PROs and the importance of patient-centered care.
- Monitor and evaluate the program: Establish a system for ongoing monitoring and evaluation of the PROs program, measuring its impact on patient outcomes, satisfaction, and operational efficiency.
By taking these steps, BWH can successfully implement a comprehensive PROs program that will enhance patient care, improve outcomes, and solidify its position as a leader in breast cancer treatment.
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Case Description
Dr. Andrea Pusic, breast cancer reconstruction surgeon, wants to extend outcomes measurement beyond traditional surgical metrics of infections, complications, and survival rates. The case describes her development of a new mobile phone app, which collects patients' responses to questions about their post-surgical outcomes and experiences using BREAST-Q, a statistically-validated patient-reported outcomes survey instrument she helped develop. The app provides patients with immediate feedback about their progress, and access to resources customized to their recovery needs. Dr. Pusic also leads a time-driven activity-based costing study to measure the cost of treating patients for all disease stages and across all stages of care and treatment modalities, including psychosocial oncology and physical therapy services. The case describes several care decisions based on the new information on patient outcomes and preferences, and the costs of care. The case ends with Dr. Pusic deciding whether to undertake a project that would adapt the new app for community cancer care centers, which have limited resources, more diverse patient populations, and worse outcome than urban academic medical centers.
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