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Value management: decision making using the value paradigm.

Health care delivery systems must address the sometimes conflicting expectations of its stakeholders. The people who pay for the service or a set of benefits are not always the people who receive the service. The challenge is to meet the expectations of the patient for high quality and to meet the expectations of the employer and/or insurance plan for low costs. We are no longer managing just quality. We are managing the total value of service from the perspective of out stakeholders. Stakeholder satisfaction is defined as achieving or exceeding the stakeholder's expectations from the resources committed. An operational definition of value is useful in helping administrators and physicians to focus on the interactions of the key management variables of cost, effectiveness, efficiency and access. The development of decision models based on these key variables is a helpful tool for quantifying the value of the decision from the perspective of each stakeholder.