Value is a fundamental theme in healthcare. In the usual context, value is determined through the equation of cost divided by quality. If cost rises and quality does not improve or worsens, then value decreases. Conversely, if cost decreases while quality remains the same or improves, then value increases. This value equation underlies the value-based purchasing or pay-for-performance model of healthcare reimbursement. Today's leaders are challenged to constantly improve the value of their clinical services through "doing more with less."

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Few would disagree that high-quality healthcare should be the goal and that we must lower healthcare costs to have a sustainable delivery model. However, there is also a cost if institutional strategies do not account for the real needs of frontline staff that enable the delivery of high-quality healthcare. Such misalignment can produce less-than-optimal outcomes as demonstrated in multiple studies in the literature that clearly link inadequate nurse staffing to patient morbidity and mortality, for example.

At a more basic level, another aspect of value that is critical to success may be overlooked or ignored: The individual performing the work must feel valued. Value in this paradigm equates to nurses and other healthcare personnel knowing that their efforts are recognized and appreciated, and that their team and leaders "have their backs" in relation to realistic resource needs and individual life circumstances. Feeling valued goes beyond the quality of "recognition" that is typically assessed on employee engagement surveys, but it is fundamental to an engaged, high-performing workforce.

The need for the healthcare industry to transform its "business as usual" approach is compelling. Burnout, compassion fatigue, and moral distress have recently achieved national media attention as pervasive healthcare quality and safety concerns.1 Nurses are not cogs in a wheel that can be easily replaced if the business machine is not moving fast enough to meet corporate goals when systems and resources are not aligned with expectations.

Patient care is a complex art and science that requires individual dedication to professional excellence as well as sufficient team and employer support. In our challenging, value-based healthcare world, each of us has a part in conveying to our coworkers that they are valued. Moreover, healthcare leaders must fully appreciate and leverage that value as their greatest asset in achieving long-lasting success and sustainability.

Until next time,

LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN

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EDITOR-IN-CHIEF, NURSING2019

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