From 4 to 5 September the first Southern African conference on the importance of outcome measuring and reporting (OMR) will be held virtually. Aimed at stimulating the debate on the role of OMR in improving the quality and accessibility of healthcare to the benefit of all patients, the conference will feature a host of local and international experts from various fields in the healthcare sector. It is a must-attend conference for all role-players who are passionate about value-based care.  Another objective of the conference is to stress the key role of OMR in changing a fragmented, unsustainable healthcare system dogged by poor outcomes and high costs, to one that maximises the value for patients by achieving the best outcomes for the lowest cost.

One of the speakers is Sharon Fonn (pictured above), professor of Public Health Science at the University of the Witwatersrand in Johannesburg, and panellist of the Health Market Inquiry which found among others that the lack of OMR was a major constraint in efforts to improve healthcare delivery and adopt best practices in South Africa.

We asked Prof Fonn to give her views on the importance of OMR, its status in South Africa and the measures that should be taken to implement an outcomes measurement and reporting system that involves everyone responsible for the delivery of healthcare services.

Q: Why is health outcome measurement and reporting important?

Prof Fonn: The only real measurement of good health outcomes is whether the patient is and feels better. We should be offering and agreeing on the things that improve patients’ health. Knowing what this is, is important to both healthcare providers and the users of the healthcare system. As a provider you should constantly be comparing yourself to others who are achieving the best outcomes and ask yourself what they are doing that you are not doing.

Q: Where are we in South Africa in measuring health outcomes and reporting and why do we seem to be lagging behind other countries in this regard?

Prof Fonn: There are no outcomes measures in South Africa at all. We do have process measures such as “was this hospital clean and nice or did this doctor take longer or shorter for an operation”.  However, although it is useful data to have, it doesn’t tell you much about the quality of care patients receive, the outcomes that are achieved or how it compares with best practices. Patients may love their doctors and trust them but if the patients’ conditions are not controlled, they are not getting the care that they deserve.  

We are lagging behind some countries in terms of OMR but not all countries have systems in place to measure and assess outcomes. However, those that do seem to have better health outcomes.

Q: Why do you consider health outcome measurement important from a public health sector perspective and a private health sector perspective?

Prof Fonn: There is no difference to why it is important in the public or private sector – the benefits are the same no matter if you are a private or public provider of a private or public sector patient. All healthcare should have some benefit and the only way to know if it does, is to look at the health outcomes of patients. We should be training people in the best practice. We should be spending money on what works. All providers should be striving to achieve good outcomes no matter what sector they are in. 

Q: How important is it for clinical practitioners to be involved in OMR and what should the societies they belong to, be doing in this regard?

Prof Fonn: Health outcomes can only be improved if everyone adheres to best practice. This tells us that healthcare providers should be at the centre of the system. They should want to share their data anonymously in a registry, and they should encourage their patients to report how they feel after an intervention. Healthcare professionals should want to know on average where they are on a range and how they compare to their colleagues. This way, they can see if they can improve themselves or if they can share what they are doing with others. Health practitioners have to trust the system to enable them to collect the data properly and do their analyses in a sensible and transparent way. The only way they can do that is if they are involved in driving and developing it.

 Q: What should funders be doing with regards to OMR?

 Prof Fonn: Funders (both private and public) should be interested in getting value for the money that is spent on health. To know if they are getting value, they need to combine two things the cost and outcome. So, funders should be creating an environment where outcomes reporting is possible. They may want to contribute money to make sure it happens.

 Q: How should national policies and protocols with regards to the management of health conditions (including the prevailing practice in public hospitals) link into outcome measurement?

 Prof Fonn: We should spend money on things that make people better. Every healthcare provider should ultimately be obliged to report to the relevant outcomes monitoring authority. But this cannot be done overnight. You start slowly and over time more and more people volunteer to do it. In Sweden, at a certain point in time when only some providers were not reporting, the providers themselves asked for it to be made a legal requirement. You start slowly in a voluntary way with a few selected outcomes and people get to understand the system and how to use it and then to trust it so that over time it becomes the norm. That is what you really want to achieve. It is good for patients.

Q: Is health outcome measurement and reporting only necessary if we move to a single NHI fund model or is it important irrespective of the funding model a country uses?

Prof Fonn: No matter what the funding model is, outcomes measurement and reporting is important to make sure that money we spend money on healthcare wisely and to assist providers to continually improve their practice. 

Q: How positive are you that South Africa can implement an OMR system in the long term? Please explain what leads you to your answer.

Prof Fonn: There is no reason why this cannot be done in SA. We have the technology and the know-how, and there are proven tested international systems like ICOM that we can learn from. We are already measuring, and reporting process quality measures and we should move on in starting to measure outcomes.