IHI 2018: How to demonstrate the ROI on quality improvement projects 

A bar chart showing positive business growth
Highlighting the ROI for quality initiatives is a major challenge for improvement teams. (Getty/NicoElNino)

ORLANDO, Fla.—A significant challenge in quality improvement is demonstrating the return on investment. 

But a team working in London as part of the country’s National Health Service has developed a framework they say can help quantify the benefits from such efforts, both in patient outcomes and in financial perks, that they say providers stateside could adapt. 

The framework divides potential returns into categories, allowing a health system's quality team to better articulate the perks, said Amar Shah, M.D., consultant forensic psychiatrist and chief quality officer for the East London NHS Foundation (ELFT).


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“If you provide teams with tools to improve productivity and efficiency, they’ll be better equipped to adapt,” said Shah, one of dozens of speakers at the Institute for Healthcare Improvement’s National Forum this week. 

RELATED: Getting health system boards engaged in quality improvement is tricky. IHI releases new framework to help 

Cost avoidance and cost savings are two sides of the same coin, Shah said. Achieving either will require teaching finance workers to be able to measure and estimate potential cost instead of tracking existing numbers, he said. 

Initiatives that may not be initially based around cost may be beneficial from an avoidance perspective, and that can get leadership excited about these projects, he said. An example would be reducing pressure ulcers, which improves patient care and experience but can also avoid the unneeded cost of treating these injuries. 

The revenue benefits, Shah said, may come from unexpected sources. Providers that truly lead the charge on quality improvement may be able to monetize those efforts by teaching their peers how to follow in their footsteps. 

However, while it’s great to have a guideline for highlighting the perks of these programs, that’s far less useful without a way to effectively determine which projects should be a priority, said James Innes, pharmacist and associate director for quality improvement at ELFT. 

RELATED: These 6 healthcare leaders say quality improvement is an organization-wide effort and a cultural imperative 

So ELFT also designed a framework for that. In it, quality improvement teams map the drivers behind different issues they might like to tackle, and then divide those into a two-by-two grid based on whether they're high-value programs that are familiar or unfamiliar to the organization or low-value programs that are either familiar or unfamiliar. In that process, a health system can identify the projects that would offer the greatest return on investment, Innes said—namely, those in the high-value but low-knowledge segment. 

Innes said most quality improvement teams understand that low-value projects should also be low-priority, but they may gravitate toward high-value opportunities that they have a strong understanding of. These initiatives, he said, have a lower opportunity for improvement as they’re often areas where a health system is already doing well. 

“It’s not that one is higher-value than the other, but where are you going to get the biggest bang for your buck,” Innes said. 

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