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The Costs of Implementation

Posted on November 15, 2011

John A. Øvretveit advises conducting a comprehensive analysis of costs associated with implementing an intervention.


A lot of the work that I do is in quality and safety improvement, and in this particular movement, a lot of the thinking is only about "Does it improve quality?" and the first thing those kinds of decision makers that we also work with are concerned about is, well not the first thing, but it's certainly high up on the list about whether they commit to something, is the cost and possible savings or higher cost of putting that improvement into place.

We have to start having the numbers for those sorts of discussions with decision makers, and for me, that would be one of the top priorities for research, and in fact I wouldn't fund research unless it added a costing component of it if I was a research funder because I would say, "Where have you people been for the last three years? Haven't you noticed what's going on out there?"

I wouldn't necessarily want researchers and certainly health economists as part of my team when we do the costings of an implementation program. I'd just want someone who knows how to do accountancy or just is good with numbers, and to say, "I just want you to track the amount of time that different people have given to this program and any other computer or materials, resources that we've had to spend money on to make this change.

"And I want you to find out if other people were to reproduce it what they'd be letting themselves in for in terms of the time for different people and the equipment and data collection, and other things that they will need. And I want you to attach a money figure to that, so that we can warn people to say, 'Now it's going to cost to do this.' But also I want you to track any savings that might be made in the provider services or for anyone else and also to be sensitive to the fact that if they make this change, someone else might have to bear the cost of it. It may have other effects for other parties that need to figure into our estimates."

We're taking it for granted that the intervention we're looking at will result in improved quality of benefits for people, but we need to now start talking about the resources that will be needed to make that thing happen and to give some sort of ballpark figure about what that is.

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Excerpted from interview with Dr. Øvretveit at the 2011 Global Implementation Conference in Washington, DC. Dr. Øvretveit is a professor of implementation, improvement, and evaluation at the Karolinska Institutet in Sweden.


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