How many times have we heard the answer in healthcare, “That’s the way we’ve always done it?” How many times have we recognized that answer wasn’t good enough? More importantly, how many times have we had the courage to challenge it? In value analysis, one of the greatest risks isn’t making the wrong decision, it’s accepting long standing assumptions without ever questioning whether they still make sense.
You may be familiar with the children’s book by Hans Christian Andersen, The Emperor’s New Clothes. In the story, two swindlers convince an emperor that they can create magnificent garments invisible to anyone who is incompetent or unworthy of their position. Desperate to not feel foolish, everyone pretends they can see the clothes. Advisors praise them. Townspeople admire them. The emperor proudly parades through the town wearing nothing at all. This illusion (and the delusional emperor) continues until a small voice arises up and says, “But he isn’t wearing anything!”
The power of this story isn’t that the emperor was fooled. The power lies in the fact that everyone else knew something didn’t make sense and remained SILENT.
Healthcare organizations face similar situations every day. Products, processes, and practices become so deeply rooted in organizational culture that questioning them can feel uncomfortable. Even when opportunities for improvement are visible, few people are willing to raise their hand and ask why.
Silence is rarely neutral. In many organizations, people recognize variation, inefficiency, or outdated practices long before any action is ever taken. The challenge is not identifying the opportunity; it is speaking up about it. The longer assumptions go unchallenged, the more they become accepted truth.
This is where value analysis professionals play a critical role. Like the child in the story, value analysis professionals provide the evidence, clinical rationale, and objectivity. We have the courage to ask an important question: Are we seeing real value, or are we simply accepting what everyone else believes?
The Invisible Problem
The most expensive product in healthcare is not necessarily the one with the highest price tag. Sometimes it is the product, process, or practice that no one has reevaluated in years. Many organizations continue certain practices because they have become accepted truths.
The emperor’s advisors didn’t evaluate the clothes objectively. Instead, they relied on social pressures and assumptions. In value analysis, similar dynamics are seen when decisions are driven by tradition, preference, vendor influence, or subjective experiences rather than evidence.
A product may have been introduced years ago to solve a specific problem. Clinical practices may have evolved around it, and new staff inherit the process. Eventually, few people, if any, remember why the original decision was even made. The “clothing” may look impressive, but no one has stopped to ask whether it still exists at all.
Value analysis examines these inherited decisions through the lens of clinical evidence, utilization data, patient outcomes, operational impact, and total cost. Sometimes, the review confirms that existing products, practices, and processes continue to deliver value. Other times, it reveals the naked truth. Like the story, the simple truth is that the emperor is either very well dressed, or he isn’t wearing anything at all.
The Courage to Ask Questions
The child in the story possessed something the adults lacked, the willingness to ask an honest question and to point out the obvious truths. In value analysis, progress often starts the same way. The goal is not to prove someone wrong, but to ensure decisions remain aligned with evidence, outcomes, and patient needs.
The strongest value analysis programs create environments where questions are welcomed rather than avoided. Where others feel safe to test long-held practices, improvement opportunities become easier to identify.
We should be asking and addressing the why’s. Why are we using this product? Why do utilization rates vary significantly between departments? Why does one physician use twice as much of a supply as another? Why are we paying a premium price for a feature that is rarely used? Why have we not re-evaluated this product? The questions drive the process of improvement and are directional towards an answer. They are about curiosity and not criticism.
Seeing What Others Miss
In the story, one reason the emperor’s illusion persisted was that people evaluated the situation individually, not collectively. Value analysis teams are uniquely positioned to bring together perspectives by creating a multidisciplinary approach utilizing experts from the team. Clinicians are patient care experts, supply chains bring the operational knowledge, finance contributes cost transparency, quality teams address outcome measures, and leadership steers the strategic direction.
When these viewpoints are combined, the organization develops a clearer picture of reality. What may appear valuable from one perspective may look very different when viewed through other lenses. This collaborative approach allows organizations to move beyond the assumptions and towards a shared understanding. The result is not merely lower costs or greater standardization. The result is more informed decision making with greater perspective of the whole.
Data: The Child in the Crowd
The child did not rely on politics, titles, or opinions, he simply stated what he saw. He spoke truth without question. In value analysis, data serves the same function. Even though data does not eliminate emotion or preference, it does provide a common foundation for productive discussions. When data is used to measure utilization, review clinical outcomes, compare benchmark pricing, and assess practice variation, it becomes the catalyst to help organizations cut through perceptions and evaluate what is occurring.
Data often gives organizations permission to discuss what they already suspect. Like the child in the crowd, data cuts through conventional thinking, titles, and opinions by revealing what is happening. It transforms opinion into evidence and assumptions into measurable facts. In many ways, data becomes the voice that allows teams to acknowledge what everyone can see but no one has been willing to say out loud.
When these conversations are grounded in evidence, supported by data, teams spend less time defending their positions and more time solving problems. Sometimes the data confirms existing practices, other times, it reveals opportunities that have been hiding in plain sight. Either outcome is valuable because both lead to better decisions.
Keeping the Patient in the Center
The emperor’s parade was ultimately about appearances. Value analysis must never be. The purpose of questioning assumptions is not to simply reduce spending or challenge tradition. The purpose is to ensure that every decision supports the highest possible value for the patient.
Practice that improves outcomes may justify additional expenses. A lower cost alternative may create greater value if patient outcomes remain the same. A utilization change may improve both quality and financial stewardship together. The patient remains the ultimate measure of value. If the patient benefits, the decision is valuable. If they do not, the decision deserves further examination.
Conclusion
The lesson from The Emperor’s New Clothes is not that leaders occasionally make mistakes, it is about courage. The opportunity for improvement is already visible. Like the crowd watching the emperor’s parade, people often recognize it long before they are willing to speak about it. Value analysis helps organizations find the courage to ask why.
Healthcare organizations achieve the greatest improvements when they are willing to challenge the status quo; when they challenge assumptions, evaluate long-held beliefs, and openly discuss what the evidence reveals. Value Analysis teams serve as the voice that brings evidence, transparency, and perspective to decision making. Our role is not to criticize the past, but to ensure that every product, practice, and process continues to earn its place through demonstrated value.
Because every organization eventually faces a moment when someone must raise their hand and ask difficult questions.
And sometimes, those questions change everything.
Article by:
Sarah Hobbs, MSN, RN, CCRN, CVAHP, LSSGB, Clinical Value Analysis Program Manager at OHSU
Sarah Hobbs is a Clinical Value Analysis Program Manager at Oregon Health & Science University (OHSU). She has more than 20 years of experience across critical care nursing, healthcare value analysis, supply chain optimization, and quality improvement. Her professional credentials include Certified Value Analysis Healthcare Professional (CVAHP), Critical Care Registered Nurse (CCRN), and Lean Six Sigma Green Belt (LSSGB).
Throughout her career, Sarah has led evidence-based initiatives focused on product evaluation, standardization, utilization management, and cost optimization. She has held leadership roles at University Medical Center, Lehigh Valley Health Network, and Blue.Point Supply Chain Solutions, where she partnered with clinicians, physicians, supply chain professionals, and executive leaders to improve patient care while enhancing operational and financial outcomes.
In her current role, she oversees strategic value analysis efforts aimed at advancing evidence-based decision-making, improving resource stewardship, and driving sustainable healthcare value.
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