Ever since NHS forward plans and long term plans have been a thing A&E has always been a consistent part of them. Whether it is reducing pressure on A&E, diverting people to alternatives to A&E or talking people out of going to A&E it is seen as a problem that needs solving.

The focus on A&E provides a really good opportunity to look at how value in healthcare practically works. Recently I wrote a post for the Q Community on value in healthcare, this post follows on from that, looking at one example of how we can understand how value works.

I think the first thing to say is that I don’t believe the title of this post. There isn’t a problem with A&E. Of all of the NHS it is the one element that is clearly working better than intended. This is evidenced by how many people choose to use it.

The value proposition model typically asks us some key questions about the people we expect to use a service or product. The most important being, “what are the customer’s jobs?” In healthcare, we frequently focus on need but to understand the true value created we have to understand what it is that people are trying to achieve. This doesn’t necessarily relate to the services itself but to the value the person expects to generate through accessing the service.

This leads us to the first challenge in understanding the value of A&E. In looking at the value proposition for A&E the first conclusion many would come to is that it is working. It’s working really well. So what are the elements of the A&E value proposition that can teach us about how we design alternatives?

In terms of A&E the only way to find out what the individual is trying to achieve, by going there, is to ask them. This doesn’t mean asking people to diagnose themselves or even what they think the service can provide, but what is it they are trying to achieve?

The sort of things that people tell us about a visit to A&E is not going to be a surprise. They want relief from pain, they want reassurance or they want an answer today.

Once we understand the things that A&E is obviously solving we are in a much better position to create alternative services that also help people do these jobs. Or more importantly, we can look at why the alternatives are not doing helping people do these jobs.

The NHS has invested large amounts of money in alternatives to A&E but still seems to perceive that these are not sufficiently reducing the number of people using it. There are a number of reasons why alternatives might not be working as intended. These breakdown into three categories.

  • People don’t know about the alternatives
  • People do not believe the alternative will help them achieve what they want
  • People know the alternative will not help them achieve what they want

Which of these three is the most relevant is the key to how you design alternative A&E models. This explains whether or not it is a fundamental design problem or a communication problem.

The process of setting out the value proposition of any health service should be one of the key steps in its creation. It is not enough to see a service as solving a clinical problem without understanding what it is the patient themselves wants to achieve.

The daunting part of creating such a value proposition is the point where you realise that the people who use services are not homogeneous. The range of things that people want to achieve will be determined by individuals and local communities. There is unlikely to be a nationally dictated alternative model to A&E. Which is why it is important to work with the people currently in A&E to try and create a new version.

That means the people that have gone there to achieve something and the people that are delivering the service. After all, we know that A&E is already creating value. Taking the elements that work and transferring them into a new is key.

You can access Value Proposition canvasses at www.strategyzer.com.