Value for Money

Chapter 4Introducing the ROI Methodology

A group of hospitals in the Birmingham, Alabama, metro area were seeking an innovative approach to reduce bloodstream infections in the intensive care unit. Participating hospitals comprised a mix of religious-affiliated, government-owned (city, county, and state), university-affiliated, and private-sector organizations. These hospitals were concerned about the excessive number of central line blood infections that were occurring as a result of a central vascular catheter, inserted into a large vein in the chest, introducing infection.

As the group developed and implemented a new set of procedures for reducing the number of infections, they realized that the procedures represented a cultural shift in the way they operated. This comprehensive, unit-based safety program required participants to use checklists, gain knowledge, double-check, and speak up. For the new procedures to be successful, various levels of data were needed beyond the traditional monitoring of infections, length of stay, and costs associated with these infections. Successive sets of data were needed that would examine the team’s reaction to the new procedures, the extent of learning of new processes and procedures, and correct application of new procedures and tools, all of which are aimed at the impact: infections, mortality rates, length of stay, and operating costs. This group envisioned sets of data that represented a chain of impact that must be present for the ...