Value in Healthcare and the Role of the Patient Voice.

A prevailing feature of recent healthcare delivery and reform initiatives is a focus on increasing the value provided by investment in services, alongside a more nuanced understanding of how such value should be considered. Effective measurement of this value remains an elusive goal for most health system performance assessment (HSPA) systems. A more prominent role for the patient voice can enable a better understanding of value at both patient and population levels. The Tuscan HSPA model has evolved over the past several years by adopting the perspective of service users, including multiple dimensions of performance, and illustrating the interactions of these elements. For the heart failure pathway, this approach has now been further developed to combine these dimensions with the systematic electronic collection of patient-reported outcome measures and patient-reported experience measures - initially in a specialist hospital. This enables a richer understanding of the value delivered by professionals as they operate in reality, as opposed to by organizational boundaries, and more timely and actionable insights into the drivers of that value. This commentary sets out the latest developments in the Tuscan HSPA and the lessons from implementation.