Navigating ethical landscapes and resolving grievances: cornerstones of value-based healthcare

Value-based healthcare (VBHC) has been described as a key driver in prioritising patient outcomes and experiences relative to the resources expended on care – yet there is no consensus in what value means. Sturmberg and Taher¹ suggested that, to determine value, the value movement has adopted the formula: V (Value) = Q (Quality) + S (Service)/Cost ($). At its core lies a commitment to align healthcare delivery with the health needs of consumers, providers, and the broader healthcare system.² This policy reflection argues that a robust ethical framework as well as transparent, effective complaints resolution mechanisms are not supplementary features of VBHC – they are essential for its successful and sustainable implementation.

Ethics is fundamental to clinical practice, guiding decisions at all levels. The four main ethical principles – namely, beneficence, nonmaleficence, autonomy, and justice – are the essence of care. An ethical approach within VBHC necessitates that care decisions are informed by an understanding of what matters to the individual consumer. This includes shared decision-making processes, where patients are actively involved in choosing treatment options that align with their personal values and goals. Furthermore, ethical considerations extend to resource allocation, demanding transparency and fairness in how healthcare resources are distributed to maximise value for the entire patient population. Principles of justice and equity must be carefully considered to avoid exacerbating existing health disparities.³

The integration of patient values into clinical practice raises complex ethical dilemmas. For instance, conflicts might arise between a patient’s desire for a particular treatment and the provider’s assessment of its clinical effectiveness or cost-effectiveness – this is particularly the case when communicating complex concepts in emotionally charged situations.⁴

Effective complaints resolution mechanisms are vital for fostering trust and accountability within a VBHC system. The establishment of statutory complaints resolution bodies in each state and territory, commencing in 1984 with New South Wales, occurred because of medical scandals and diminishing public trust in clinical self-regulation.⁵ Consumer complaints reveal where the delivery of care might not align with patient values or expectations. A fair, transparent, and timely process to address grievances demonstrates a genuine commitment to patient-centredness and provides opportunities to learn and improve.

An effective complaints resolution system should be easily accessible to consumers, offering multiple avenues for lodging concerns. In South Australia, this includes telephone, email, webform, in writing, and in person opportunities. In all states and territories, Health Complaints Entities (HCE), such as the Office of the Health and Community Services Complaints Commissioner (HCSCC) in South Australia, offer a variety of complaints resolution mechanisms, including mediation, conciliation, and investigation. The HCEs are impartial and independent and offer a cost effective mechanism to resolve disputes without recourse to the courts.

The intersection of ethics and complaints resolution is particularly significant. Since the health system emerged from the COVID-19 pandemic, the complexity and seriousness of complaints appears to be increasing. The HCSCC has seen situations involving death because of sepsis, secondary to necrotic pressure injury and other fundamental care issues, which have become more common. While it is unclear why this has occurred, it is indicative of a system under pressure, where compassion becomes less of a priority. Without compassion at the centre of healthcare, VBHC will fail.

While VBHC holds immense promise for improving patient outcomes, it requires the robust integration of ethical principles into all aspects of care and the use of complaints resolution mechanisms. By prioritising patient values, fostering ethical decision-making, and actively learning from patient grievances, healthcare systems can embody the principles of VBHC and create a more patient-centred, compassionate, and sustainable future for healthcare.