Table 1

Taxonomy of selected VBM projects

DomainOpportunityProject(s)Status
Supply chain managementNon-standardised OR suppliesPreference card standardisation, rationalisationIn progress
Inconsistent naming taxonomy for surgical procedures
Preference cards listed items as ‘open for procedure’ that were rarely used
Operational efficiencyDelayed discharge because of waits for postdischarge bedsRevision of inpatient rehabilitation assessments; increased use of long-term acute careIn progress
Delays for weekend dischargesWeekend discharge coordination staffing increase; warm handoff Friday rounds; weekend rounding initiativesIn progress
Intrainstitutional transfers delayed careRight place, right time bed management; ICU admission criteria; ICU transfer projectComplete
Prolonged dwell time in ICU, step-down and PACUPrioritise transfers out of those units to facilitate high-cost bed availabilityComplete
Wide variability in individual physician practiceValue opportunity tool: analytics to identify specific areas of cost/quality that are outliers per physicianIn progress
Lack of postdischarge coordinationDedicated personnel assigned to medicine units to make postdischarge follow-up appointments consistent with patient preferencesComplete
OutliersNon-standardised care promoted development of outlier casesEpic-based clinical pathways for heart failure, pneumonia and colorectal surgery, GI bleed, paper-based lap sleeve pathwayComplete
End-of-life patients account for disproportionate share of quality, cost, readmission and outliersSupportive care initiative aimed at improving value of care delivered at end of life both in the outpatient and inpatient settingIn progress
Surgical patients with medical comorbidities had disproportionately length of stay outliersHospitalist comanagement programme on acute care surgery, general surgery, neurosurgery servicesIn progress
Resource utilisationExcessive duplication of studies that did not generate new findingsEHR best practice alert to reduce ordering of repeat echocardiograms within 2 months of last examComplete
Above benchmark use of intravenous medicationsPharmacists review dashboard of adult inpatients with enteral access receiving one of 18 target intravenous medications with equivalent oral bioavailability who met criteria for oral conversationComplete
Corporate services cost disproportionately highCorporate services challenge to generate ideas for cost reductionOngoing
Multidose medication vials were being wastedOpen drugs only as needed rather than in advance in cardiac catheterisation labComplete
Excessive use of reference lab testingAlert created in EHR to display turnaround time and cost for 42 reference labs that accounted for 80% of cost. Required attestation when ordering lab that the test was required for inpatient management. Created just-in-time learning for six reference labs to improve ordering practices. Created mechanisms for monthly reporting and real-time feedback.Complete
Excessively high rate of blood transfusion benchmarked to peer institutions17 Packed red blood cell and platelet transfusion order set revised, clinical decision support applied in the EHR, hospital-wide educational campaign deployedComplete
Excessive testing of serial troponins in postoperative patientsCreated guidelines for obtaining postoperative troponin levelsComplete
  • EHR, electronic health record; GI, gastrointestinal; ICU, intensive care unit; PACU, postanaesthesia care unit; VBM, value-based management; delete, please delete this footnote.