The Challenge of Defining ‘Value’ in Health Services Innovation

In healthcare, ‘value’ is often framed as an objective concept, yet in reality, it is deeply complex, subjective, and frequently misaligned across different stakeholders. The IHI’s Sextuple Aim provides a structured framework for defining value, encompassing better patient outcomes, improved patient experience, enhanced provider experience, equity, sustainability, and value for money. However, achieving all six aims simultaneously is rarely straightforward.

A new innovation that enhances patient experience—for example, by reducing waiting times or improving service navigation—may come at the cost of increased expenditure. This raises an important question: when different points of value conflict, which one takes precedence? Should value for money, often equated with cost reduction, outweigh improved experiences for patients? Conversely, should patient-centred innovations take priority, even if they require additional funding - necessitating an increased healthcare budget or the potential diversion of resources from other clinical areas in an already constrained system?

It is crucial to emphasise that improved patient experience does not necessarily equate to increased costs. In fact, well-designed, patient-centred services can lead to better clinical outcomes, reducing long-term healthcare utilisation and expenditure. The OECD recently published their Patient-Reported Indicator Surveys report (PaRIS) which presents the results from the first international survey of primary care patients aged 45 years and older, living with chronic conditions. Their research shows that people who receive care that is truly tailored to their needs report better physical and mental health, as well as improved overall well-being. Given that chronic disease prevention and management and improved mental health services are two key priorities within our health system, does this present an opportunity for us to reframe how we conceptualise effective care for patients and service users through the lens of good design? The findings of the report certainly appear to support an argument for investing in human-centred design in healthcare, which prioritises patient experience, patient engagement and the development of effective, meaningful services. According to the OECD report, healthcare systems that are designed around the needs and preferences of users, can result in value that extends far beyond ‘satisfaction’—patients can actually achieve better health outcomes.

However, the reality remains that most healthcare decisions inevitably favour some aspects of ‘value’ while disadvantaging others. Rather than assuming that value-based decisions can be consistently and successfully balanced, we must critically examine who is defining ‘value’, from what perspective, and at what point in time? Are key decisions disproportionately shaped by financial pressures, clinical priorities, or policy mandates? If so, are we comfortable with the trade-offs being made? Defining value in healthcare requires ongoing dialogue—one that acknowledges complexity, embraces nuance, facilitates diverse view points and challenges us to interrogate how and why certain priorities prevail over others.