Michael Porter’s book "Redefining Healthcare" provides the basis of the value chain of a clinical trial. He says: don’t worry so much about the clinical practice guidelines, focus, instead, in sharing with the patient the health goals that you reasonably expect to obtain, clarify either how much of the outcome depends on the patient or how much depends on the professionals involved. Then focus on measuring the achievements in order to know at what cost you achieved them and compete in the healthcare market with these values in hand.
The clinical process’ difficulties should not cause you to lose focus: the clinical effectiveness is the only objective.
According to the methodology Care Delivery Value Channel (CDVC), the creators of a clinical trial should be able to define how to address each of the stages of a clinical trial: prevention, diagnosis, preparation, response, recovery and follow-up or monitoring. At the same time it must be ensured that the patient flows through the process smoothly, without any surprises or poor coordination, but with assurances and being kept well informed.
To help you better understand the Porterian theory, I have invented an example case. Imagine a service of orthopaedic surgery in which there is a surgeon (and a team) performing well on the spine. The word spreads and the pull effect appears then the team becomes a "machine" operating on spines with excellent results in terms of efficiency and quality. But the surgeon, on a day visits a "Back Clinic", and realizes that these people are selling a different message from "we are the best in operating on spines”. Instead, what is being said is "if you have a back problem trust us, we take care of everything" and stunned, our surgeon notes that in the centre’s service portfolio they even have a "Back School" and that the hosts like to state that, thanks to multidisciplinary work, they are achieving lower rates of intervention, and thus are fighting the therapeutic overacting in this field. And by the way, they say that if ultimately there’s no other choice but to operate, the "Back Clinic" has an excellent team of surgeons and rehabilitation professionals.
Now, I don’t quite know how to end the tale of the orthopaedic surgeon, but it would be nice that he’d buy a copy of "Redefining Health Care", that he would read on his trip back, he then returns to work and meets his team with some copies of CDVC on the table.
The philosophy pervading the value chain (Porterian) of a clinical process is: we are committed to getting the results that we agree with you, trust us, we will take care of everything.
Jordi Varela
Editor
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