King's College London, London, UK. s'
Imperial College London, London, UK.
BMC Health Serv Res. 2023 Sep 19;23(1):1009. doi: 10.1186/s12913-023-09911-9.
Return on Investment (ROI), whereby the ratio of costs to benefits is assessed, is encouraged in-order to justify the value of Quality Improvement (QI) programmes. We previously performed a literature review to develop a ROI conceptual framework for QI programmes. We concluded that, QI-ROI is conceptualised as any monetary and non-monetary benefit. In the current study, we explored if this finding is shared by mental healthcare leaders. We also investigated the stability of this conceptualisation against influencing factors and potential for disinvestment.
We performed qualitative interviews with leaders in an NHS mental health organisation. There were 16 participants: nine board members and seven senior leaders. The interviews were held online via Microsoft Teams and lasted an hour on average. We performed deductive-inductive analysis to seek data from our initial ROI framework and any new data.
We found that in mental healthcare, QI-ROI is also conceptualised as any valued monetary and non-monetary benefits. There was a strong emphasis on benefits to external partners and a de-emphasis of benefit monetisation. This conceptualisation was influenced by the 1) perceived mandates to improve quality and manage scarce resources, 2) expectations from QI, 3) health and social care values, 4) ambiguity over expectations, and 5) uncertainty over outcomes. Uncertainty, ambiguity, and potential for disinvestment posed a threat to the stability of this conceptualisation but did not ultimately change it. Health and social care values supported maintaining the QI-ROI as any benefit, with a focus on patients and staff outcomes. Socio-political desires to improve quality were strong drivers for QI investment.
Mental healthcare leaders primarily conceptualise QI-ROI as any valued benefit. The inclusion of externalised outcomes which are hard to attribute may be challenging. However, mental healthcare services do collaborate with external partners. The de-emphases of benefit monetisation may also be controversial due to the need for financial accountability. Mental healthcare leaders recognise the importance of efficiency savings. However, they raised concerns over the legitimacy and utility of traditional ROI as a tool for assessing QI value. Further research is needed to bring more clarity on these aspects of the QI-ROI concept.
为了证明质量改进 (QI) 计划的价值，鼓励使用投资回报率 (ROI)，即评估成本与收益的比率。我们之前进行了文献综述，以制定 QI 计划的 ROI 概念框架。我们的结论是，QI-ROI 被概念化为任何货币和非货币收益。在当前的研究中，我们探讨了这一发现是否得到精神卫生保健领导者的认可。我们还研究了这种概念化在面对影响因素和潜在撤资时的稳定性。
我们对 NHS 精神卫生组织的领导者进行了定性访谈。共有 16 名参与者：9 名董事会成员和 7 名高级领导。访谈通过 Microsoft Teams 在线进行，平均持续一个小时。我们采用演绎-归纳分析，从我们最初的 ROI 框架和任何新数据中寻找数据。
我们发现，在精神卫生保健领域，QI-ROI 也被概念化为任何有价值的货币和非货币收益。非常强调对外部合作伙伴的收益，而对收益货币化的重视程度较低。这种概念化受到以下因素的影响：1）提高质量和管理稀缺资源的感知任务，2）对 QI 的期望，3）健康和社会保健价值观，4）期望的模糊性，以及 5）结果的不确定性。不确定性、模糊性和潜在的撤资对这种概念化的稳定性构成威胁，但并未最终改变它。健康和社会保健价值观支持将 QI-ROI 视为任何收益，重点关注患者和员工的结果。提高质量的社会政治愿望是 QI 投资的强大动力。
精神卫生保健领导者主要将 QI-ROI 概念化为任何有价值的收益。纳入难以归因的外部化结果可能具有挑战性。然而，精神卫生保健服务确实与外部合作伙伴合作。对收益货币化的轻视也可能具有争议性，因为需要财务问责制。精神卫生保健领导者认识到提高效率节省的重要性。然而，他们对传统 ROI 作为评估 QI 价值的工具的合法性和实用性提出了担忧。需要进一步研究，以更清楚地了解 QI-ROI 概念的这些方面。
