Part 2: Blue Ocean Medical Center

By Uncategorized

Blue Ocean Medical Center

Part three in the series of our famed fictional hospital as it tries on alternatives to the status quo in healthcare. Let it continue to inspire you to think and act a bit differently and engage with me to find a greater truth. For the extended introduction and parts one and two (‘Hospital without a Home’ and ‘Cells instead of Structures’), please follow this link. Still to come in the weeks ahead: When Prediction meets Precision, Evidence Based Only Please and the Ultimate Medical Mall.

Introduction

The mirrored-window facade of Blue Ocean Medical Center, or Blue Ocean Med, only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. The hospital aims to serve the regional community on all relevant aspects of specialist care, offering all regular diagnostics and surgical interventions as well as prevention programs, radiotherapy, e-health and research and development. A truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver, in about equal measure:

blue-ocean-medical-center-intro

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. In order to stand out, they know they must make some fundamental changes. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

BOM Two: Cells instead of Structures

Another rainy day on the coast with a sky as uniformly grey as the strategic promise of a general hospital. Blue Ocean Medical Center is  painfully aware that they, like all general hospitals the world over, basically promise that no matter what the ailment or complaint; they’ll soon find out what it is, treat it quickly and effectively with the latest in medicine and technology wielded by caring and competent staff. This concept gets in the way of delivering the promised ready-access to high quality and affordable care.  You see; in order to deliver ‘anything for anyone’ Blue Ocean Med must combine a vast array of capabilities. These include many different medical specialists, facilities and technologies. All these capabilities come with different processes, schedules, operating margins, regulations and even business models. All of this needs to work seamlessly together in a slightly different way each time someone comes through the shiny double revolving doors. Not only is this extremely ambitious and fault-prone (the organization, not the revolving doors), it also diverts attention from professionals and patients to figuring it all out and somehow making it work.

Damned complexity

Organizational complexity is a major factor in things going wrong, resilience to change and burn-out of (healthcare) professionals. It seems very efficient to have all this expert knowledge, departments and facilities organized in a single body. Unfortunately this concentration of capabilities also exponentially increases organizational complexity, outstripping the capability to effectively manage it all. As the law of requisite variety states: in order to deal properly with the diversity of problems the world throws at you, you need to have a repertoire of responses which is (at least) as nuanced as the problems you face. This repertoire of responses is not only pretty limited considering the number of states to control, it also costs tons of coordination, task division, reporting, registrations, accounting, ict, coffee machines and parking lots.  The CEO also realized that none of these are on his shopping list should a congenital heart failure catch up with him.

Why focus is not the answer

The best known alternative to the general hospital is a focused clinic. These clinics are far less complex and regularly outperform general hospitals on both quality and costs. But they also have a downside. Human beings are not a set of organs held up by bone and skin. A body works as an integrated organic whole. Therefore patients are likely to need more than a single specialism when seriously ill. And with the increase of chronic disease and comorbidity through the ageing of the population, we need more professionals to be working together in more multidisciplinary teams. Are such things not easiest organized within a single healthcare system? Besides, the complexity and interconnectedness of general hospitals are the main reasons why general hospitals cannot and will not make meaningful portfolio choices. They cannot fully foresee the consequences to the plate of spaghetti if they start pulling strings out. They are more or less cemented to their comprehensive care offering.

Organism instead of organization

blue-medical-center-01

Blue Ocean Med’s CEO realized he was long past the point where he could effectively manage the complexity of Blue Ocean Med when yet another improvement programme failed. It all started out brilliantly, but trouble started when the words ‘budget’, ‘governance’ or ‘ownership’ came to the table. They always do. He was painfully reminded that he actually does not run a single organization. He heads a federalized union of semi-independent sub-organizations, like most general hospitals. He also realized that because these units are relatively small and focused, they reduce some of the complexity and overhead for their members, but not for the whole. But more focus means better results. Lower overhead and interference means greater sense of entrepreneurship. That is why performance and change within the boundaries of a unit is usually good. Things go south when two or more units/departments/divisions need to work together. Even when working in those multidisciplinary teams we need so badly.  He remembered reading a book called ‘Eckart’s Notes’. In it, Eckart Wintzen, founder and CEO of BSO/Origin, describes how he used to split-up any organizational unit exceeding 30 members. Eckart goes on to describe how each unit was expected to function independently from a central organization. These small units did almost everything themselves, within company boundaries. Personnel, office-equipment, leasing cars. These small units act like cells in a living organism. Each cell interconnected to form a whole, but seemingly functioning independently. Governed only by the company’s DNA, not some totalitarian central organ.

Within BSO/Origin this set-up maximized agility and entrepreneurship of each unit, while reducing central HQ to a bare minimum. So why could this not work in his hospital? Never afraid to take a different tack, Blue Ocean Med started to de-compose itself into these very small independent units or cells. These are preferably not organized around medical specializations, rather on client-centred propositions. They started out with units focusing on organ specific care, disease specific diagnosis, patient-group research, technology development: you name it. As long as there is a clear value proposition, target group and a viable business model, it is a go. Because of their focus and very small size, everyone soon found that they absolutely needed other cells in order to function. That helped things move along nicely on the cooperation front. They also found they could not decentralize everything of the central HQ. The Blue Ocean Med central organization needs to offer some support in matters of compliance, knowledge transfer, ICT and finance. It also supports initiative and cooperation by providing a safe internal environment for budding initiatives and innovation.

Small rules Big

Without centralizing structures getting in the way or to hide behind, each cell needs to actively work together and show vitality. Entrepreneurship, ownership and local responsibility also makes cells look for superior offerings both inside as outside the organization. That meant that Blue Ocean Med lost some non-viable units and functions to the market. They did not choose to, but things sorted themselves out. The end-result is a focused general hospital based on healthy cells, interconnected both inside and outside the organization, with minimal central rule. The market and network doing the pruning of unviable functions, combinations and cells. A truly vital organism. Most general hospitals however are turning to growth through mergers, geographical expansion, broadening of portfolios and innovation. All of these adding complexity, increasing cost and further outstretching the already limited grasp on running things smoothly. Blue Ocean Med’s energy is aimed at actually improving health the way they know best instead of managing ever increasing and redundant complexity.

Master data management in retail – brake or accelerator for growth?

By News

Legacy systems, inconsistent processes, not knowing who is responsible for data entry and who exactly is using the data… does that sound familiar?

Probably data processes, systems and governance are not sexy topics within your organization. However, without master data no core business process works properly. Definitely in our world where retailers want to transform to digital and omni-channel organizations, masterdata management is a prerequisite. Data and 100% ‘right’ is not part of the core DNA of traditional retailers, they are used to deliver hands-on results. On the contrary, new pure online players have it in their core DNA. So, traditional retailers have to catch up…

With poor data quality, your organization cannot serve its customers to their required service-levels, back-office processes become inconsistent and data is unreliable to steer your organization correctly.

So imagine master data management as a core competence within your company – meaning that the foundation of your core activities is rock solid. So let’s compare it to your house: with the right foundation, it is easy to put in new heating, new plumbing or a new kitchen. You can save yourself a lot of trouble and inconsistencies by setting up master data management properly. This is often seen as ‘not worthwhile the trouble’ or ‘overdone’, but master data management can absolutely be an accelerator instead of a brake for your growth ambitions. In order to do so, consider ticking at least the following five check boxes:

1) Gain top-level commitment
Since master data runs through all core business processes, it is not just a ‘single-unit-party’. This means that changing your processes, the way of working, the way your company looks at data requires a wide range of (long-term) commitment at the highest levels. Top-down support ensures your company will be able to make data-related decisions and get required guidance at the right level.

2) Set up your data governance across all relevant business units
Data governance serves an important role in your company, Set the ‘rules of the data game’ by enabling data ownership, resolving data issues and making business decisions on high-quality data. As long as the ‘data rules’ are not embraced by all relevant business units, it will be an uphill battle for the data management team. Developing a successful data governance strategy requires careful planning, alignment with the right people, and the right tools (e.g. business glossary). Three key lessons here:

A) keep it realistic and align your governance with the maturity of the organization
B) build a triangular partnership between data-business-IT with clear roles, responsibilities and a steering model
C) balance your top-level commitment (see point 1) with bottom up business unit needs.

3) Deliver quick wins
Often forgotten when your company wants to do ‘the right thing’ is to deliver short-term results via an agile way of working. Small master data process changes that generate value create buy-in from business units, to also embrace larger changes. Always make sure you put the small changes in perspective of your guiding principles and your end-goal. Here the rule applies ‘just don’t make a regret move’.

4) Build the foundation (long-term perspective)
Think about your data management roadmap. First, do you know what the ‘reason of existence’ is for your master data management capability? Hence, develop your master data vision. Once you translate this into your roadmap, make sure you balance your ambition with the maturity and pace of your organization. Second, ensure your fundament is there before you start or make sure that you’re willing to make changes in your IT-landscape on short-term.

5) Build awareness for the relevance of data
Master data is not always sexy. So try to come up with a charm-offensive to make it a bit more attractive for the majority of the users. Use your communication department to emphasize the value of high quality data in relation to the business/commercial objectives. Certainly in our digital world we can easily see the benefits of high data quality.

All these five check boxes require careful planning and change management capabilities to some extent. If you tick off all the check boxes, master data can be one of your key accelerators for your future growth.

About IG&H
Specializing in retail, we apply our proven Make Strategy Work method to radically improve organizations’ customer focus. Behind us we leave permanent change, embedded at every level. What can we change for you?

Use our Impuls approach to get more out of your teams for even better results

By News

At IG&H we have seen how companies’ focus in the crisis years lay primarily on restructuring and reorganization. In the past two years, a break has at last become apparent in this trend and there is again some room to develop. Does this apply to your organization too and would you like to build on your success again? In that case, we have something important to tell you!

Ambitions are again shifting towards improving performance and increasing client and employee satisfaction. And we are seeing more and more that companies want to become more flexible and agile, and are ready to invest in that. Flexibility is, moreover, crucial for the digital transformation that many companies are going through at the moment. For these sharper ambitions, sustainable behaviour change is the crucial condition for success, in addition to having excellent processes, superior digital infrastructure, online skills and a logical organization structure.

Behaviour determines the result
Culture change is an essential condition for gaining return on digital and other investments. The behaviour of all staff together always determines a company’s result. In practice, the behaviour component is often forgotten unfortunately, which means that nearly none of the changes will be sustainable.

IG&H has experienced how teams do not use their full potential without culture change and we have therefore developed a proof-of-concept approach called Impuls©: giving an impulse to skilled employees and a push towards improvements in Key Performance Indicators (KPIs).

Defining the overall competition sharply (the company’s ambition) is essential for a good start. It’s important to get each team’s contribution to the overall competition clear right at the start: what do we need to do as a team in order to push the KPIs up at company level and what can we improve directly within our own sphere of influence?

Our Impuls approach comprises two building blocks, which we call Hard and Heart:
• Hard: we help teams to sharpen their ambition and KPIs and teach them to steer towards them time and again, by means of holding an effective performance dialogue in which goals are really achieved;
• Heart: we ensure that each team pays attention to how each employee is placed in the competition, how they can be facilitated, and that they get help if they have a question. And we teach them how to give feedback to each other, with the goal of continuously improving the team and the individual. At the same time, we also encourage teams to celebrate their successes together.

How do we set about this?
In a ‘wave’ of 10 weeks we guide the selected teams intensively. In these waves we facilitate the work sessions, make daily observations and give constant coaching-on-the-job. Our Impuls approach is special because we combine both our coaching and consulting skills. In this way we are in an excellent position to train teams and to coach them daily on the work content, the process and the people. Consequences can thus be linked to their behaviour, partly by using concrete tools which are employed in various situations.

Our IG&H colleagues are present on the work floor every day to give on-the-spot feedback to managers and their staff. This enables us to relate to the starting point and the needs of each team, which leads to tailored advice being given within a standard approach.

Our approach has already led to many sustainable hard and soft results for big clients, for example:
• Hard results:
– Higher client satisfaction (e.g. NPS up from -12 to +17 and Customer Effort Score down from 2.4 to 2.0)
– Significant reduction in mistakes made (percentage mistakes in Operations down from 11% to 1.5%)
• Soft results:
– A safe environment for feedback created
– More intensive cooperation and targeted action
– More transparency and focus within teams

Our Impuls projects are highly appreciated and have an average Net Promotor Score of +70; this is also apparent from our clients’ feedback on our efforts:

  1. “The programme ensures that people can now really enter discussions on the basis of trust and content.”
  2. “IG&H is sharp, on the ball, persistent … with the goal of bringing the organization to a higher structural level.”
  3. “IG&H is very involved up to the last moment. They aim at making continuous improvements towards a long-term goal.”

We would like to share our approach and best practices with you. Because it’s the employees’ behaviour together that determines your company’s result!

Would you like to know more about our tried and tested Impuls approach?
Jorien Weerdenburg (j.weerdenburg@igh.nl, 06-22203632), or
Robin van Wankum (r.vanwankum@igh.nl, 06-53313969).

Jorien and Robin both work as senior managers at IG&H and are active in the domain of changing culture and behaviour every day.

Part 1: Blue Ocean Medical Center

By News

Introduction
The mirrored-windowed facade of Blue Ocean Medical Center (or Blue Ocean Med) only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. Like most hospitals it is also among the biggest employers of the region. In the particular case of Blue Ocean Med, they are only outmatched by the local tinning plant. As an organization, however Blue Ocean Med has no match for complexity. The hospital aims to serve the regional community on all relevant aspects of specialist care. They offer all regular diagnostics and surgical interventions, but also prevention programs, radiotherapy, e-health and research and development. For anyone familiar with hospitals: a truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver (in about equal measure):

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. Focused clinics are taking more of their market, insurers are tearing down tariffs, real-estate cost is through the roof and the media are just waiting for anyone to slip up. In order to stand up to all this while delivering ready access to high quality yet affordable care, they know they must make some fundamental changes. They need to move from marginal improvement to far better ways of doing things. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

Follow Blue Ocean Medical in a series of blogs as it tries on alternatives on the above characteristics. Each article will feature one characteristic, yielding one alternative Blue Ocean Medical. There are three reasons for following these thought experiments. First; the dramatic changes Blue Ocean Med goes through may inspire those of you in healthcare to start doing things a little differently too. Second; I hope you will challenge and build on the presented ideas, working toward a greater truth and having fun while at it. Third I hope that some of you may one day join me in actually building Blue Ocean Med.

BOM One: Hospital without a home
It is hard to imagine Blue Ocean Med without its mirrored-windowed facade, the hum of the analyzers, MRI’s and the air conditioning. We are all familiar with the single-bed rooms, the professional men and women in white hurrying along grey-green corridors and the understated waiting rooms. Most of us are also familiar with limited access to physicians and their high-tech equipment and facilities. Here’s a fun fact: most of those facilities stand idle most of the time (except for the air conditioning). A large amount of Blue Ocean Med’s real-estate is also actually quite general. It comprises of thousands of square meters of office space, bedrooms (low-complexity care wards), bathrooms, kitchens and parking lots. And facilities only seem to grow.  All these facilities need management, scheduling, servicing and regulating. But surely this is a prerequisite for high quality care? Well; it’s not. Many aspects of hospital care do not need specialized facilities or high-tech equipment on site at all. Then there are the really expensive specialized facilities like high-field MRI’s and radiology bunkers. Almost all general hospitals have these things nowadays. But…why? Is it not far more efficient to share such expensive resources?

In typical style, Blue Ocean Med’s CEO started wondering what would happen if he’d sell the real-estate on the edge of town and go nomad. First of all he figured he would make a killing by transforming it into luxury ocean-view condos. Second he would be out of business. There is just no organizing the complexity of hospital care without some physical and managerial structures. Instead of selling off everything, he did three things.

First he determined which facilities were generic and which were specialized medical facilities. He also analyzed the utilization of all facilities and asked himself: ‘Do I really need to own and operate this facility myself? Are there better or more cost effective options outside our organization?’ and ‘Can we optimize utilization and the cultivation of skill and knowledge that comes with focus and volume?’. The generic facilities proved to be little more than very expensive office space. They soon found out that the city had thousands of square meters of vacant office-space. They rented half the building across the street at half the cost of their own facilities. That building now houses management, support, e-health and knowledge transfer workers. Most of the outpatient care is also organized there. They also found the utilization of their labs to be just as poor as that of the nearest other hospital. They downsized the lab to a stat-lab only, subcontracting bulk testing from the other hospital. Next the kitchen and facility management weregrafiek-bom-igh-gezondheidszorg-v2outsourced completely. In one move freeing up space, saving money and maximizing service to patients. Negotiations with two other hospitals have started on swapping specialized functions (like high sensitive imaging and radiotherapy) in order to maximize utilization and specialization in the wider region. These are always tough processes and will take some more time to complete.

 

 

Second, he de-concentrated low-complexity specialist care. The idea of transforming these practices into ambulatory care units actually came from a Dutch entrepreneur. Meet Ivo Knotnerus (www.Beterinjebuurt.nl). He offers and organizes low-complexity specialist care in GP’s offices and local care centers in the Netherlands. A hospital without a home! This organization not only halves (!) the cost of care, it also literally brings physicians and patients closer together. It works a charm for Blue Ocean Med increasing trust, lowering barriers and greatly improving efficiency.

But the bricks were still there eating up space, money and time. Blue Ocean Med started to sublet space to private partners. The hospital now features a pretty comprehensive medical mall, guesthouses for families of patients and they actually did put in some condos, gratefully occupied by staff members and their families. The rest of the facilities are to be written off and torn down in time. If CEO’s are measuring success in the number of cranes going up, this Blue Ocean Med measures it by the number of wrecking balls going in.

Part 5: Blue Ocean Medical Center

By News

Introduction

The mirrored-windowed facade of Blue Ocean Medical Center (or Blue Ocean Med) only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. Like most hospitals it is also among the biggest employers of the region. In the particular case of Blue Ocean Med, they are only outmatched by the local tinning plant. As an organization, however Blue Ocean Med has no match for complexity. The hospital aims to serve the regional community on all relevant aspects of specialist care. They offer all regular diagnostics and surgical interventions, but also prevention programs, radiotherapy, e-health and research and development. For anyone familiar with hospitals: a truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver (in about equal measure):

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. Focused clinics are taking more of their market, insurers are tearing down tariffs, real-estate cost is through the roof and the media are just waiting for anyone to slip up. In order to stand up to all this while delivering ready access to high quality yet affordable care, they know they must make some fundamental changes.
They need to move from marginal improvement to far better ways of doing things. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

Follow Blue Ocean Medical in a series of blogs as it tries on alternatives on the above characteristics. Each article will feature one characteristic, yielding one alternative Blue Ocean Medical. There are three reasons for following these thought experiments. First; the dramatic changes Blue Ocean Med goes through may inspire those of you in healthcare to start doing things a little differently too. Second; I hope you will challenge and build on the presented ideas, working toward a greater truth and having fun while at it. Third I hope that some of you may one day join me in actually building Blue Ocean Med.

BOM Five: Evidence based only please

We really don’t know’ and ‘There is no way we can know for sure, but…’ are two messages we dread and hardly ever hear in the doctor’s office. These are rare moments of clarity and honesty. Because in many cases doctors simply don’t know if or why certain treatments will be effective. A 2012 study showed that of a whopping 50% of healthcare services offered, the impact on health is either negligible or unknown. It is difficult to say which whopping half, because the actual list of ineffective interventions has only recently been drafted and the first 1300 were published this month. And with or without a complete list we are all very dependent on specialists in determining healthcare, often by choice. In healthcare supply has always been a better predictor of consumption than demand.

Now take into account the fact that this supply shows enormous variance between specialists, institutions and regions. In some cases it seems like everybody is doing something different when faced with the same question or complaint. Even within the same hospital. And about half of what’s been done has little to no positive impact on health?! Research also shows that the greater the regional variance in activities, the weaker the evidence base for effectiveness.

So Blue Ocean Medical Center’s CEO summed up the sorry state of affairs sketched in these reports in  his own words: ‘I am running an integrated healthcare company in a market where;

  • supply is a better predictor of consumption than demand,
  • practices show great variance and little effectiveness,
  • we are reimbursed for quantity of services, not effectiveness
  • half of those reimbursed services are ineffective and may well be detrimental to our clients
  • not even counting missed diagnoses, re-admissions, failure, complications or negative side-effects…”

As much as he believes in his hospital, loves his organization and trusts his staff, the CEO felt an uneasy guilt crawling up his spine. What would happen, he wondered, if he would put his foot down and forced the issue? What if Blue Ocean was to only provide services, treatments and medication that have a clear evidence based positive impact on the health of its’s patients? Would they be cheered as a beacon of sense in a field gone coco? Would they take the market by storm? Nope. They would be out of business. For three clear reasons there would be a massive pushback:

Delusion of manipulability

The first push-back would come from patients and their families. They don’t want to hear that the best way to go is doing nothing! In this day and age we live under the misguided notion that all health is manageable, life is makeable and death is to be fought off. Read the obituaries: ‘He fought this terrible disease bravely until the end’, is a common enough line. And in that fighting spirit we are overconfident in what medication, doctors or lifestyle management can do. Hell, we think that data analytics, digital watches and goji berries prevent cancer. Patients, the CEO fears, want the comfort of the idea that –however ill they are- something can be done and is being done. Patients want hope more than they want truth.

Propensity to fight

This fighting spirit is actually stimulated by the medical profession. Professionals are trained to observe, listen, investigate and act to improve health. To be cool and collected under pressure and never jeopardize a patients’ health. The latter being difficult when there is no evidence base. ‘It doesn’t hurt to try’ is a common enough outcome when considering courses of action. That’s an admirable trait and we love our doctors for it. But oftentimes it does hurt to try. Treatments and medications may very well be detrimental to quality of life. Or have long-term side-effects which are more damaging than the actual disease or complaint. We need to stick to what we know will work. We need to know what the net-impact is of services, drugs and interventions before unleashing them on ourselves. As Sun-Tsu wrote: only fight those battles in which victory is certain.

Losing money and patients

When Blue Ocean cancelled all reimbursement of ineffective services and medication, they started to lose money fast. Doing nothing may be the best option for some patients, it certainly is not for the P&L. And as long as reimbursement is based on fee-for-service and Blue Ocean stands alone in this practice, they will lose both money and patients. People will go to providers who will do something, anything to help them (or their child) fight disease. Whether this choice is detrimental to health or not. A warning to all who claim that direction of healthcare delivery is to be put squarely into the hands of patients. Yes, we want treatments to have evidence based positive impact. But all parties involved need to come together on this subject to make this work: professionals, patients, management, government and healthcare insurers.

The R&D to deliver the evidence base is the subject of next edition of Blue Ocean Medical Center. To be continued…

Employee satisfaction and NPS increased within 10 weeks

By News, Pensions

Daily performance dialogue on customer goals leads to unprecedented collaboration.

The IG&H ‘IMPULS’ approach has enhanced employees’ ownership and mutual collaboration. As a result, both the service provision and the working atmosphere have improved strongly in a short period of time. This development has continued autonomously after the initial 10 weeks, thus laying the foundation for a continuous improvement culture at Loyalis. The balance between the ‘Hard’ and ‘Heart’ building blocks of the IG&H ‘IMPULS’ approach distinguishes ‘IMPULS’ from other methodologies.

Challenge
Loyalis aimed to realize higher customer satisfaction (NPS). Analysis showed that internal collaboration and customer service needed to be improved to achieve this goal. Service provision to employers posed a challenge: substantial improvements had to be made in all areas. Their stalled execution resulted from the limited preliminary translation of the organizational strategy, which was due to a lack of ownership at several levels and due to insufficient operational control.

Solution
A successful transformation of the internal organization has been a crucial part of the solution. The ‘IMPULS’ method, used by and characteristic to IG&H, is based on the aforementioned ‘Hard’ and ‘Heart’ building blocks. Through our ‘Hard approach,’ we stated perspicuous overall objectives, set clear KPIs in collaboration with Loyalis, and provided a methodology that clarifies performances. The ‘Heart approach’ has allowed Loyalis to measure behavior that supports performance, encourage desired behavior, and discourage undesired behavior. As a result, the internal organization is back on track.

Way of working
The bottom-up approach used by IG&H has immediately resulted in better performances – by allowing employees to take more ownership and by contributing positive energy and inspiration, but also through better collaboration and a focus on customer service. The performance dialogue has become key to continuous improvement at Loyalis. Teams are now learning to analyze and solve challenges in an 8- to 10-week time period, in addition to acquiring and encouraging feedback (skills).

“Extremely professional and results-oriented. I am a warm and active supporter of IG&H’s working methodology.” Mario Bakker, Marketing & Sales Manager, Loyalis

Footprint
In ten weeks, an initial IMPULS wave was performed within Loyalis. Employees were provided with assistance and guidance to enter into a performance dialogue by collaborating in a different way based on sharp objectives. After these ten weeks, measurements have shown a strong increase in both customer satisfaction (NPS) and employee satisfaction (ENPS).

Gamma A future-proof DIY formula

By Casestudys, Clientcases

Gamma
A future-proof DIY formula

Challenge
Gamma is on difficult terrain nowadays with increasingly strong competition and customers demanding increasingly higher standards. Aggressive pricing, online players and various international parties are entering the Dutch DIY market. GAMMA is therefore facing the question of how to build a future-proof DIY formula.

Solution
We helped GAMMA to recalibrate their compass and to set a focus for their positioning in order to create sustainable and distinctive assets. This served as the starting point to determine a strategic course for the long term and make tactical choices for the shorter term. Deep dives were made into the target group, range of products, range of services and shop image, for instance. Based on the recalibrated formula and strategy, we helped GAMMA define a plan of action and start rolling out the strategy.

Way of working
The key is that we made a difference by working closely with GAMMA, together we formed one team. That was seen in daily stand-up sessions with the team and in nearly weekly co-creation workshops with the MT to reach a well-supported vision. We ensure that the client has the required background information in good time so that they can get the most out of their discussions in the working sessions and work towards making decisions.

Footprint

Together with GAMMA, we laid the basis for sustainable and distinctive assets for the long term.

Quote from Ron Kloos, GAMMA director: “IG&H makes it really human and personal. It’s not “us” and “them”, but we truly formed one team on all levels, which I find exceptional.”

Bringing master data management capability and awareness to the next level

By News

Client:

Dutch food service and food retail company with revenues of  €2.7 billion (around 23% market share in the Netherlands) with an ambitious international and online growth strategy.

Challenge: 

To implement master data management as an enabler and key value driver for business

  • New online platform: close gap between the need for product data and data availability
  • Overcome data quality issues and create end-to-end control processes
  • Make ‘value of data’ a relevant topic in the commercial business lines and programmes

Solution:

To create a breakthrough by building a solid foundation
for data processes and increasing awareness of  ‘data
value’ in the business lines

  • Design and implement processes to ensure product
    data availability and quality for the online platform
  • Implement a data governance structure across the
    business lines (roles & responsibilities)
  • Push cultural change regarding importance and value
    of product data in Marketing and Procurement, and in
    other areas

Way of working:

  • Two-phase approach: building the foundation and business ownership, while delivering short-term impact at the same time
  • Programme set-up around four ‘must-win battles’ with high client involvement (~50 fte involved)
  • Encouraging business with a hands-on, supportive approach, creating a good, constructive atmosphere
  • Agile approach for delivering ICT foundation, focusing on prioritized deliverables in sprints; along with the realization of quick wins (process improvements)

Footprint: 

  • Data processes live and product data 100% ready for online platform (with revenues of around €1 billion)
  • Four key processes redesigned and implemented; yielding a uniform way of working
  • Reports and reporting governance: using both operational- and data quality KPIs to steer operations
  • Clear cultural change towards ‘data is relevant for us all’

Client’s comments: 

  • “IG&H added structure in the approach and hence increased throughput significantly”
  • “IG&H contributed significantly to the cultural change and necessary attitude towards using data and data quality”

Part 4: Blue Ocean Medical Center

By News

Introduction

The mirrored-windowed facade of Blue Ocean Medical Center (or Blue Ocean Med) only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. Like most hospitals it is also among the biggest employers of the region. In the particular case of Blue Ocean Med, they are only outmatched by the local tinning plant. As an organization, however Blue Ocean Med has no match for complexity. The hospital aims to serve the regional community on all relevant aspects of specialist care. They offer all regular diagnostics and surgical interventions, but also prevention programs, radiotherapy, e-health and research and development. For anyone familiar with hospitals: a truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver (in about equal measure):

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. Focused clinics are taking more of their market, insurers are tearing down tariffs, real-estate cost is through the roof and the media are just waiting for anyone to slip up. In order to stand up to all this while delivering ready access to high quality yet affordable care, they know they must make some fundamental changes.
They need to move from marginal improvement to far better ways of doing things. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

Follow Blue Ocean Medical in a series of blogs as it tries on alternatives on the above characteristics. Each article will feature one characteristic, yielding one alternative Blue Ocean Medical. There are three reasons for following these thought experiments. First; the dramatic changes Blue Ocean Med goes through may inspire those of you in healthcare to start doing things a little differently too. Second; I hope you will challenge and build on the presented ideas, working toward a greater truth and having fun while at it. Third I hope that some of you may one day join me in actually building Blue Ocean Med.

BOM Four: When Prediction meets Precision

Many people will agree that E-health is doing wonderful things for healthcare. Mostly through the application of distance monitoring, wearables, PHRs and other internet-connected devices and applications. We are talking about information gathered by a huge number of people over long periods of time, combined with all the available knowledge and empirical expertise of medicine, applied to people personally. But isn’t that exactly what doctors have been doing to the day?  In this perspective, current E-Health practices and development do no more and no less than boost current abilities of doctors and patients. And for a good part the applications are long overdue repairs, like digitized health records and sharing crucial information.

As he wanders the grey-green corridors of the (still fictional) Blue Ocean Medical Center this cold November morning, Blue Med’s CEO sees patients in wards and waiting rooms and the regular bustle of doctors and nurses going about their business of comforting, caring, co-operating and curing <insert appropriate verb beginning with ‘c’>. To him the ‘E’s’ in E-Health should stand for efficacy, efficiency, expertise, empathy < insert appropriate noun beginning with ‘E’>.  What he realizes is that healthcare actually has little to do with mobiles, wearables, sites, records and apps. These are just things. Soon to be outdated and rather cold stuff. By definition of dr. Clay Christensen, these are sustaining innovations. Novelty boosting current offerings and existing business models. Disruption will come when two other developments in healthcare connect: advanced analytics and precision medicine.

Advanced Analytics

The local tinning plant near Blue Ocean Med is using advanced analytics. Not only do they monitor production and evaluate performance. They are actually combining all kinds of data to predict both the demand for tinned fish as the supply of fresh product. And these predictions are over 90% accurate to the day. They even linked data from social media to their production schedule to predict absenteeism and break downs in the production line. In most cases they are in time to prevent a break down and if not, they are always in time to take effective countermeasures. This always seemed as something which could impossibly be applicable to such a complex world as healthcare. But it is not. There are apps on the market that combine all kinds of data, including GPS positioning and local weather conditions to accurately predict an asthmatic seizure. This year market leaders in Health-Tech launch analyzers that use big data to accurately predict performance loss and even break downs in time for labs to do the necessary maintenance.  Using massive cohorts and the data trail we all leave behind have become far more important than scrutinizing small experimental set-ups and control groups.

Knowledge unused is useless knowledge

The importance to Blue Ocean Med, or any general hospital for that matter, for such monitoring and prediction is self-evident. Sure: through the advanced analysis of multiple ‘big data’-sources, capacity use and efficiency of the hospital’s facilities can be optimized.  But the real gain is in applying the power of prediction to the primary processes. Unfortunately that also means that Blue Ocean needs more than significant statistical results. They need clinically relevant questions and accurately interpreted results. John Halama, information officer at Beth Israel Deaconess Medical Center: “To me, the bigness of data is not its (..) size, but the task of transforming it into wisdom.” Blue Ocean Meds CEO couldn’t agree more. People generate and own data. But that’s just numbers. Information is produced when numbers are combined in a meaningful (and significant) way. When this information is analyzed in context by knowledgeable people, we are creating knowledge. Wisdom comes when that knowledge is actually used to enhance health. Because what is the use of accurate prediction if you can do nothing about the predicted outcome? What hospitals need are both wisdom and science to turn knowledge into effective action. That requires the artificial intelligence and accuracy of IBM’s Watson but also a new breed of medical specialists and new healthcare professions. How can the stereotypical TV- Dr. House stand to be outwitted and outperformed by artificial intelligence like IBM’s Watson? He cannot. And patients rather have an emphatic and knowledgeable specialist wielding a very accurate Watson than Dr. House wielding educated guesses, sarcasm and a massive God syndrome. Blue Ocean Med therefore offers educational programs and degrees for Bioinformatics, Medical AI Design and Healthcare Navigators. What Blue Ocean Med needs next are the tools to effectively intervene on predicted outcomes or complications.

Making it personal

That’s where precision medicine comes in. Diagnosis and treatments are now becoming available which are custom-tailored to the uniqueness of a person’s body, maximizing outcomes and minimizing side-effects. These treatments range from tailored biomarkers to personalized medication to 3D-printed bone and tissue. This level of precision is also needed to keep healthcare affordable. Doing the right things right first time, every time is the most cost effective way of doing things. Than this is what we need. And as with analytics Blue Ocean Med needs both the technology as the specialists to wield it. Patients are extremely diverse in nature, yet unbelievably similar in symptoms. Same goes for diagnoses and treatments. We need people who can connect the dots between the expressed and observed symptoms and complaints, diagnosis and proposed treatment (boosted by AI), and the precision medicine on a genetic level. Not making the mistake of adding to the tasks of already stretched medical professionals, Blue Ocean Med has started offering programs and positions for Custom Implant Design (3D printing) and invests in pharmacogenetics to minimize side effects of clinical genetics and maximize treatment outcomes.

Conservative innovators

The question is how long it will take the ever conservative healthcare community to really dive into all of this. Well; Blue Ocean’s CEO has a feeling that it will not take long at all. As soon as technology becomes available that actually lifts medical expertise and the efficacy of healthcare professionals, it will take off like nothing. He bets that anyone in healthcare who can envision what being able to accurately predict or prevent, precision medicine and having more time for patients will do to healthcare, will want to start right away. Whether they are healthcare professionals, boardmembers, patients, insurers or working in government.

Part 2: Blue Ocean Medical Center

By News

Blue Ocean Medical Center

Part three in the series of our famed fictional hospital as it tries on alternatives to the status quo in healthcare. Let it continue to inspire you to think and act a bit differently and engage with me to find a greater truth. For the extended introduction and parts one and two (‘Hospital without a Home’ and ‘Cells instead of Structures’), please follow this link. Still to come in the weeks ahead: When Prediction meets Precision, Evidence Based Only Please and the Ultimate Medical Mall.

Introduction

The mirrored-window facade of Blue Ocean Medical Center, or Blue Ocean Med, only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. The hospital aims to serve the regional community on all relevant aspects of specialist care, offering all regular diagnostics and surgical interventions as well as prevention programs, radiotherapy, e-health and research and development. A truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver, in about equal measure:

blue-ocean-medical-center-intro

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. In order to stand out, they know they must make some fundamental changes. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

BOM Two: Cells instead of Structures

Another rainy day on the coast with a sky as uniformly grey as the strategic promise of a general hospital. Blue Ocean Medical Center is  painfully aware that they, like all general hospitals the world over, basically promise that no matter what the ailment or complaint; they’ll soon find out what it is, treat it quickly and effectively with the latest in medicine and technology wielded by caring and competent staff. This concept gets in the way of delivering the promised ready-access to high quality and affordable care.  You see; in order to deliver ‘anything for anyone’ Blue Ocean Med must combine a vast array of capabilities. These include many different medical specialists, facilities and technologies. All these capabilities come with different processes, schedules, operating margins, regulations and even business models. All of this needs to work seamlessly together in a slightly different way each time someone comes through the shiny double revolving doors. Not only is this extremely ambitious and fault-prone (the organization, not the revolving doors), it also diverts attention from professionals and patients to figuring it all out and somehow making it work.

Damned complexity

Organizational complexity is a major factor in things going wrong, resilience to change and burn-out of (healthcare) professionals. It seems very efficient to have all this expert knowledge, departments and facilities organized in a single body. Unfortunately this concentration of capabilities also exponentially increases organizational complexity, outstripping the capability to effectively manage it all. As the law of requisite variety states: in order to deal properly with the diversity of problems the world throws at you, you need to have a repertoire of responses which is (at least) as nuanced as the problems you face. This repertoire of responses is not only pretty limited considering the number of states to control, it also costs tons of coordination, task division, reporting, registrations, accounting, ict, coffee machines and parking lots.  The CEO also realized that none of these are on his shopping list should a congenital heart failure catch up with him.

Why focus is not the answer

The best known alternative to the general hospital is a focused clinic. These clinics are far less complex and regularly outperform general hospitals on both quality and costs. But they also have a downside. Human beings are not a set of organs held up by bone and skin. A body works as an integrated organic whole. Therefore patients are likely to need more than a single specialism when seriously ill. And with the increase of chronic disease and comorbidity through the ageing of the population, we need more professionals to be working together in more multidisciplinary teams. Are such things not easiest organized within a single healthcare system? Besides, the complexity and interconnectedness of general hospitals are the main reasons why general hospitals cannot and will not make meaningful portfolio choices. They cannot fully foresee the consequences to the plate of spaghetti if they start pulling strings out. They are more or less cemented to their comprehensive care offering.

Organism instead of organization

blue-medical-center-01

Blue Ocean Med’s CEO realized he was long past the point where he could effectively manage the complexity of Blue Ocean Med when yet another improvement programme failed. It all started out brilliantly, but trouble started when the words ‘budget’, ‘governance’ or ‘ownership’ came to the table. They always do. He was painfully reminded that he actually does not run a single organization. He heads a federalized union of semi-independent sub-organizations, like most general hospitals. He also realized that because these units are relatively small and focused, they reduce some of the complexity and overhead for their members, but not for the whole. But more focus means better results. Lower overhead and interference means greater sense of entrepreneurship. That is why performance and change within the boundaries of a unit is usually good. Things go south when two or more units/departments/divisions need to work together. Even when working in those multidisciplinary teams we need so badly.  He remembered reading a book called ‘Eckart’s Notes’. In it, Eckart Wintzen, founder and CEO of BSO/Origin, describes how he used to split-up any organizational unit exceeding 30 members. Eckart goes on to describe how each unit was expected to function independently from a central organization. These small units did almost everything themselves, within company boundaries. Personnel, office-equipment, leasing cars. These small units act like cells in a living organism. Each cell interconnected to form a whole, but seemingly functioning independently. Governed only by the company’s DNA, not some totalitarian central organ.

Within BSO/Origin this set-up maximized agility and entrepreneurship of each unit, while reducing central HQ to a bare minimum. So why could this not work in his hospital? Never afraid to take a different tack, Blue Ocean Med started to de-compose itself into these very small independent units or cells. These are preferably not organized around medical specializations, rather on client-centred propositions. They started out with units focusing on organ specific care, disease specific diagnosis, patient-group research, technology development: you name it. As long as there is a clear value proposition, target group and a viable business model, it is a go. Because of their focus and very small size, everyone soon found that they absolutely needed other cells in order to function. That helped things move along nicely on the cooperation front. They also found they could not decentralize everything of the central HQ. The Blue Ocean Med central organization needs to offer some support in matters of compliance, knowledge transfer, ICT and finance. It also supports initiative and cooperation by providing a safe internal environment for budding initiatives and innovation.

Small rules Big

Without centralizing structures getting in the way or to hide behind, each cell needs to actively work together and show vitality. Entrepreneurship, ownership and local responsibility also makes cells look for superior offerings both inside as outside the organization. That meant that Blue Ocean Med lost some non-viable units and functions to the market. They did not choose to, but things sorted themselves out. The end-result is a focused general hospital based on healthy cells, interconnected both inside and outside the organization, with minimal central rule. The market and network doing the pruning of unviable functions, combinations and cells. A truly vital organism. Most general hospitals however are turning to growth through mergers, geographical expansion, broadening of portfolios and innovation. All of these adding complexity, increasing cost and further outstretching the already limited grasp on running things smoothly. Blue Ocean Med’s energy is aimed at actually improving health the way they know best instead of managing ever increasing and redundant complexity.