Bas Leerink: Collaboration is the new competition in healthcare

By Healthcare, News

The healthcare landscape is changing. Third parties are making their entrances, the sector is searching for more collaboration and at the same time feeling the need for specialization. How can the branch find a balance? IG&H Healthpartner Bas Leerink offers his vision with regards to five big challenges.

Leerink joined IG&H as a partner of the Health practice in January. Prior to this, he was chairman of the executive board at Medisch Spectrum Twente, where he was highly praised for helping the hospital emerge stronger from trying times and making the organization more transparent. He has also worked as a director and executive board member at health insurer Menzis.

  • The healthcare landscape is very fragmented. What needs to happen in order to create more unity?

In our healthcare system, many issues depend on each other. The government decides many things, but hospitals and insurance providers also have a big influence. I would like to see all of these parties work together more closely, deciding priorities and choosing a course based on this. At the moment this occurs far too infrequently, as far as I’m concerned.

Since the start of this year, I have been a future scout for the province of Flevoland. I was hired to formulate a vision regarding healthcare in the province starting in 2020. We at IG&H aren’t there to analyse what went wrong during the bankruptcy, but to find out how we can reach an agreement with all stakeholders to continue in the same direction. You can see that there has been much damage done to the balance between municipalities, doctors, insurance providers, and specialists. They need each other in order to be able to help patients, but they aren’t able to find each other at the moment.

I believe that IG&H’s role is to make it possible again. Together with every party involved, we look at how we can leave the past behind in order to be able to once again focus on caring for the patient. That’s what we are doing it for in the end, not in order to sustain an institution. I look for harmony and connection within organizations and enjoy being able to contribute to this.

  • In the past six years, you have been intensively involved as a hospital director in Value Based Healthcare projects. When is this method useful for healthcare institutions?

Because of the focus on regulations and costs, we sometimes lose sight of how we in healthcare can systematically improve the outcome for the patient. The Value Based Health Care method makes sure the focus is on the patient. You should not ask directors or managers to think about this subject, as patients and professionals are able to perform this task much better. As a board, you must help to facilitate and execute these improvements.

In my previous function, we used Value Based Health Care (VBHC) as an improvement tool between professionals of 7 hospitals, united in the Santeon group.  We were able to create multidisciplinary teams that improved outcomes and costs for patients in 7 hospitals for 11 medical conditions. And the improvements were significant! Not everybody is convinced that VBHC is the way formard for health care, and indeed it is not a solution for all problems. But it definitely is a very powerful way to improve outcomes for patients. At IG&H can create added value in these discussions by bringing people together,  And facilitating the creation of improvement dashboards from the diverse systems that are being used in hospitals.

  • Another current issue is the call for specialization in healthcare. What is your take on that?

In every branch of business that is currently developing, there is a call for specialization. That is now also the case in healthcare. An important question in this debate is whether it is possible as a board of directors of a healthcare organization to make sure that every part of the organization you are responsible for functions optimally. Can these specializations develop according to the latest state of the art standards?

Many directors believe that it is possible for hospitals to specialize in various fields. I think that this is not feasible in the end. Take a look, for example, at the field of pathology. You are substantively educated to do that work; it’s a profession. At the same time, this job is very much in development due to technical possibilities, such as digitalization or new molecular possibilities for ideal diagnostic performance, for example. I don’t think that it is possible for every hospital to be at the forefront of these new developments and to be able to offer these to patients.

  • At the same time, we are seeing that more and more commercial parties are taking over specialized issues in healthcare. How should hospitals deal with this?

We are already seeing that certain laboratories are working together with each other, allowing them to bundle their areas of expertise. In the future, more of these new groups will come into being, maybe even from overseas.

This development is approaching and brings a few questions with it. Hospitals are no longer owners of these organizations. That is new –and exciting- for us in the healthcare branch. How will hospitals and other companies come up with offers and in which way can collaboration be productive? It is important to expressly think about the long term and the value for patients with regards to this.

  • It is clear that e-health is going to play an increasingly large role in healthcare. How should the branch respond to this?

You can already see that hospitals are taking steps in this direction. For example, they are creating patient portals, making medical information such as blood test results available at home. In this manner, it’s possible for patients to follow their own care processes.

Big tech players also collect various data, such as the Apple watch. This information can be connected to a personal platform which allows you to see health trends.

I don’t think it will be long before these kinds of trends are represented everywhere. At the moment, hospitals are not able to respond to them. They are stuck in all kinds of ICT systems and packages that prescribe our internal processes.

If they do not respond in a timely fashion to these developments, they will be overtaken by big players and lose control. That’s why it is important that they start thinking now about ways to for the client to also occupy centre stage in the field of technology.

There are various ways to make this possible. At IG&H, we are big supporters of platform technology. That makes it possible to create a flexible shell around the pre-existing ICT structure, allowing fast and effective applications to be developed. This allows you to control the costs and maintain control as an organization. 

Tech companies take giant steps in healthcare

By Healthcare, News, Technology

Tech giants, such as Google and Apple, have had their sights set on the health market for years. They have a good reason: the health sector ticks every box that technology companies are interested in. They are suffering from problems such as affordability and scarcity, it is a relatively non-transparent market and there is a lot of money in it.

In the past, competitive forces proved they were able to shape and dominate other sectors. Apple, Google, Amazon and Microsoft have completely changed the way we communicate, shop and work. These tech companies have the same similar ambitions in healthcare, although each concern has its own approach based on its own strengths. Apple focuses on consumer electronics, Google on data and Microsoft on online services and analytics. Which steps did they take recently during last year?

Apple

Apple has offered the ‘health, care and research kit’ for years in order to be able to build healthcare apps quickly, and to gather and share information. In 2018, Apple launched Health Records on iOS, allowing customers to see and change their medical dossier, as well as share them with healthcare providers. This can also consist of data from electronic patient records belonging to hospitals or other healthcare providers.

By mid-2018, more than 500 hospitals were connected to Health Records. Apple also further developed their personal metrics programs, such as cardiac monitoring (ECG) via the newest Apple Watch. They are also forging partnerships to work towards digital eye tests and revalidation programs for those recuperating from knee and hip operations.

Alphabet

Google’s parent company Alphabet was possibly the most active in the healthcare branch in 2018. Most noteworthy was the launch of the new Google Fit platform and their new partnership with Fitbit. Their goal is to make data more easily accessible for doctors. They are now in direct competition with Apple in the e-health market.

Alphabet also showed strong support for the American company Oscar Health. The online health insurance company gained almost 400 million dollars in investment capital last year. Oscar Health customers can save for discounts on their health insurance premium by exercising. On top of this, Alphabet also has two subsidiary companies which are focused on healthcare. Verily develops possibilities for medical machine learning, whilst Calico is focused on genome research.

Amazon

Amazon shook up the healthcare market last year in their quest for growth. Firstly, they announced that they are going to set up their own health care providers for staff. This will be done in partnership with business bank J.P. Morgan Chase and Warren Buffett’s megacorporation Berkshire Hathaway.

Amazon’s CEO Jeff Bezos wants to start his own healthcare company that will offer smarter, cheaper, and better care. After this announcement, Amazon bought online pharmacy Pillpack for 1 billion dollars. Through smart use of data, Pillpack improves service for patients. The client receives precisely measured doses, is reminded when it’s time to take medication, and no longer has to take care of declaring costs to insurance companies, as Pillpack takes care of that as well.

On top of all this, Amazon has started developing products to gather and process medical data via the cloud service Amazon Web Service, with digital assistant Alexa fulfilling the role of digital doctor.

Microsoft

Microsoft is mainly focusing on researchers, doctors, and biotech. The company is developing various AI and cloud computing projects through the NExT program. In 2018, Microsoft launched diagnostic support of images and tooling for doctors and scientists in the field of genomics.

Both projects are AI-driven and are saved in the cloud. Microsoft emphasises the latter. The company offers cyber security by saving healthcare data safely in the cloud following strict compliance and confidentiality regulations.

Alibaba/Tencent

Large Asian tech companies are also active in the healthcare sector. Alibaba is predominantly known as a cheap web shop, but in Asia they are leading the application of Artificial Intelligence in healthcare. CEO Jack Ma rapidly developed a platform for the interpretation of diagnostics like CAT scans. The tech giant also has a virtual assistant that supports doctors when selecting treatments.

It’s even less well-known that Tencent- Asia’s number one tech company- is also extremely interested in healthcare. Customers can get medical advice and make appointments via the app WeChat. The company has an online and offline ecosystem at their disposal in order to provide healthcare through partnership with Trusted Doctors. Moreover, Tencent has developed diagnostic programs in order to help doctors diagnose cancer early. They’ve also started initiatives to utilise their AI platform in order to help diagnose other diseases, including Parkinson’s disease.

The future

Tech companies are on a roll and are going to have an increasingly large impact on the healthcare sector. The degree to which this occurs depends on a number of developments:

  • Tech companies are wrestling with a lack of information standards in health care, which hinders the exchange of data. In 2019, Google, Amazon, Microsoft, and IBM are working on further developing a new standard, FHIR, in order to enable unhindered connection.
  • Medical professionals are critical of tech companies’ developments, and they are the ones who decide in the end if these developments are implemented. There are, for example, doubts about the reliability of these developments, such as the ECG of the Apple Watch. Moreover, the sector is suffering from ‘not invented here’ syndrome.
  • Tech companies are not always as careful with data as they should be. Facebook is the most recent example of this. Many consumers don’t let this stop them. However, it remains to be seen how long they will accept this when dealing with sensitive information such as illnesses and treatment.
  • Everything is different in healthcare. A patient can act differently than a consumer. The healthcare branch is also much more strictly regulated than other sectors.
  • In closing, the healthcare sector- depending on the country- is often publicly financed.

The answer

In the Netherlands, many healthcare facilities will say that they aren’t noticing the influence of large tech companies very much. That is true. That is the very reason why now is the correct time to take action. Ask yourself if you, as a healthcare provider, know enough about the digital needs of your patients. Research how tech companies can contribute to affordability, accessibility, and staff choice within your healthcare facility. Broaden your horizons and don’t be surprised by the development speed of tech companies.

By: Walter Kien (manager Healthcare IG&H) en Arvid Glerum (consultant Healthcare IG&H).

Are we in the Dutch healthcare market looking forward to Amazon?

By Health, Healthcare, News

Last year, Amazon entered into a partnership with Berkshire Hathaway and JPMorgan Chase & Co. The company also bought Pillpack, an online pharmacy. Both initiatives aim to offer good care at a low price. This step arouses unrest: the share prices of several companies in the med tech and pharmaceutical industries fell. Has a new disruptive healthcare player emerged? And what will the effect be on the Netherlands?

By entering into a partnership with Berkshire Hathaway and JPMorgan Chase, Amazon is circumventing the health insurer. The purchase of Pillpack and the plans to open clinics indicate that the ambitions of the web giant go beyond just financing care. If Amazon interferes with technological developments in the healthcare market, the impact will be vast. It fits in with the strength and motivation with which the company has also entered the supermarket sector, for example.

Opportunities for digital platforms in the Netherlands

In other markets, we see tech parties that bring supply and demand together on a single digital platform emerge. This excludes intermediaries, as Airbnb and Netflix are already doing.

Does Amazon have this healthcare role in mind and is their plan to take it outside the US? There are many intermediaries active in the Dutch healthcare sector, for example in health insurance, pharmacy or medical devices. For Amazon and other online disruptive players, there are plenty of opportunities to integrate and digitise the role of these intermediaries.

Exciting, because they will significantly increase the competitive pressure in the healthcare market. A platform offers many advantages in terms of ease of use and experience. It also makes the offer transparent, which lowers prices. And that is the – so far only – goal communicated by Amazon, Berkshire Hathaway and JPMorgan Chase.

Getting a foothold is difficult

Before a digital player like Amazon gets a foothold in the Netherlands, it will have to overcome many hurdles. Our complex financing structure leaves little space for new business models. The patient is not or hardly willing to pay extra for new services, on top of the premium. This is a major entry barrier for new initiatives.

Health care systems across the globe vary considerably, making it more difficult for platforms to scale up across borders. Crucial to the success of digital platforms is the low cost of an additional user. With different systems, this success factor does not seem to work. Truly successful digital players need a minimum scale that is larger than the Dutch market alone.

To be successful, digital disruptive parties use data and algorithms. In Dutch healthcare, mass data and especially medical data are well protected by laws and regulations. Previously, the national EPD had already failed in the Senate for privacy reasons. Technological innovations in data exchange offer a solution, but are still in pilot phase and not widely implemented.

Finally, healthcare is a service par excellence for which human contact is essential. There is a relationship of trust between doctors, pharmacists and their patients. This can be supported, but it is difficult to replace it entirely by a digital platform of an American tech giant.

Pressure on these barriers is increasing: breakthroughs are imminent

However, we cannot assume that a party like Amazon will be held back by this. Health insurers are increasingly looking for innovative ways to reduce healthcare costs. This may change the payment culture among patients, making them more sensitive to the supply of new parties. Progress is also being made on digital data exchange. This will hopefully be further accelerated by the obligation to share patient data digitally, recently announced by Minister Bruins.

As a result of these developments, the aforementioned stumbling blocks for tech players are becoming less threatening. The current healthcare market can see this as an opportunity for further development. Tech players are successful because in their business operations, they put their customers first. They offer more convenience and excellent service. Ask yourself whether your organisation still meets the needs of the patient or customer to the maximum. Identify the steps you can take to match this level, perhaps in collaboration with successful tech players.

Wondering how (digital) disruptions can take your organization to the next level? At IG&H we are happy to think along with you.

By: Roos Blankena (r.blankena@igh.nl) and Linda de Jong (l.dejong@igh.nl).

Value-based healthcare: the road to success

By Healthcare, News

It has been more than a decade since the book Redefining Health Care by Prof. Michael E. Porter was published. Since then, the attention of the Dutch healthcare sector for value-based healthcare (VBHC) has increased every year.

We know that value-based healthcare is about maximizing the value of patient care and reducing healthcare costs. Porter describes the transformation of care into value-based healthcare using six sub agendas:

Last year, during a working session with Michael Porter, 25 decision-makers from the Dutch health care sector identified the first two sub-agenda’s as most relevant and urgent: the design of the IPUs and the measurement of the results.

We do see a number of themes that need attention:

  • Healthcare organisations are often organised around specialisms and it requires leadership to break through this. In order to set up integrated practice units, walls must be broken and existing interests (including budgets) must be abandoned.
  • The lack of funding is an often heard excuse. Reforming the DOT-system is the only way to make Value-based Healthcare possible. Fortunately, practical examples show many opportunities within the current system.
  • The required (outcome) indicators are not or only available to a limited extent. Although the available control information in care institutions is often not yet at the desired level, however this does not mean that you can’t do anything with it.

Although these are complex themes, they are already being tackled by a number of Dutch healthcare organisations. For example, we are seeing the emergence of integrated practices units more and more often. For example, in Diabeter for type 1 diabetes care and within the Dutch Obesity Clinic (NOK) for patients with morbid obesity. The number of cases in which value is purchased has also increased in recent years in terms of funding. Menzis is the leader in this field and applies this for a large number of providers of cataract operations and hip and knee osteoarthritis treatments. As a hospital, Santeon has taken a leading role in the value-based healthcare philosophy. For example, by starting with what is already measured, instead of waiting until the entire set of indicators is available. With a manageable scope and a pragmatic approach, Santeon hospitals are able to achieve their first successes. We believe that these are the crucial factors for a successful implementation of value-based healthcare.

How do you increase the chance of success?

A limited scope and organisation at program level and in the care area are important success factors for a successful start. The focus of many organizations is mainly on the, often ambitious, final goal and not on the road to it. Some examples to start pragmatically:

  • The entire organisation does not have to change, you can start per medical condition.
  • Develop a roadmap and systematically do one or few medical conditions at a time. Start with the information that is available and expand these indicators step by step.
  • Introduce activity-based costing step by step, starting with the largest cost items. Also take a good look at what’s in-house. It does not have to be extremely accurate. Estimates are also just fine.

Good leadership is essential

To start small, there must be room to change, to make mistakes and to learn from them. Good leadership is essential. Give employees a safe environment to experiment in by radiating ambition and believing in the ultimate goal. But how do we ensure good leadership, a healthy ambition and a safe culture of improvement? And how can we make optimal use of this to make value-based healthcare really work? It is our ambition to help the healthcare sector by sharing our vision and experiences with you. In the coming period we will discuss the following topics in a series of blogs.

Blog 1: The Pragmatic Start

Starting small and pragmatic is important to create momentum. Give the enthusiastic healthcare professionals and existing initiatives a platform. We describe three steps to start with, to organize for success. What makes this start pragmatic and therefore feasible?

Blog 2: The Data driven Performance Dialogue

How do you get from insight to action? What type of conversation should be held between professionals in value-based healthcare? How do you do so? And what is needed for this?

Blog 3: Data and Insight

Data and insight: an important factor in value-based healthcare. Not for nothing one of the most important strategic sub-agenda’s and at the same time a big threshold. What is needed to unlock the necessary data? And how do we present the data in an intelligent way so that it facilitates the performance dialogue? How can data-analytics support this to the maximum?

Blog 4: Our vision for the future

How beautiful it would be …

… if the patient can take part in the care process and is in control of his own health?

… if technology is used to the maximum and doctors and managers are supported by predictive (or even prescriptive) analytics?

… if knowledge sharing is the norm, among doctors, among care providers and between research and the clinic?

Value-based healthcare: the pragmatic start

By Healthcare, News

Despite the many initiatives, few value-based healthcare programs at institutional level have been launched. What is the reason? IG&H lists the three main causes (and solutions).

Healthcare organisations are often organised around specialisms. Breaking through this structure requires leadership. In order to set up ‘integrated practice units’, walls must be broken and existing interests (including budgets) must be abandoned. Few healthcare institutions in the world are given the opportunity to implement value-based healthcare completely, including organisational changes, in one go.

The Karolinska Institute in Sweden has gone down this road. The university hospital made this decision after careful deliberation. Within the Swedish system of registries, the organisation first gained years of experience in managing the outcomes of care.

After the institute decided to tilt the organisation, it turned out to be even more difficult in practice than had previously been estimated. A ‘big bang’ was chosen in which all divisions and departments were abolished. The introduction of the extensive new structure with hundreds of patient groups and new management methods met a great deal of resistance from medical specialists and nurses.

If you want to roll out value-based healthcare programs in a broad sense, you need to be pragmatic.

1. Scope determination

Make sure that it is clear in advance what the scope of the project will be. Take into account the feasibility, impact and make the right decision.

For example, do you join an existing initiative or start a new one? Both have advantages and disadvantages that need to be weighed against each other. In this way, you can build on the lessons learned from an existing initiative, but your own contribution will be smaller.

Do you start your own initiative or do you start working together immediately? An important question that needs to be asked is whether the benefits outweigh the complexity of starting together. Examples are the added value of being able to benchmark externally and sharing investments in information management.

Finally, there are many hard and soft criteria that need to be considered: for example, what is the size of the care areas you start with? What data is already available? What is the support base among healthcare professionals?

2. Organise for success at program level

Perhaps the most important precondition for success is that the leadership of an institution is committed to the implementation of an institution-wide program. It is essential that the (care) professionals feel supported by the top of the organisation.

A value-based healthcare program as a change process that requires a lot of time, energy and perseverance is the right approach. It must be a priority on the long-term policy agenda and should be guided for a longer period by means of tight program management.

Finally, a prominent place on the investment agenda is also necessary; value-based healthcare requires investments in both people and systems, which pays off later.

3. Organise for success per care area

Another decisive precondition for a successful implementation within a healthcare area is that the healthcare professionals involved support the initiative. This goes hand in hand with the need for strong leadership at institutional level.

The professionals involved are the driving force in setting up the multidisciplinary team. This group then determines which indicators should be used as a basis for steering and how the continuous improvement cycle should be set up. All this, of course, with the support of the program that is set up at institutional level.

Conclusion and follow-up

Starting small and pragmatic is important to create momentum. However, for a successful roll-out at institution level, more is needed. A well thought out delineation of the scope and organising for success at institution level and per care area are essential. The above questions can help. Do you want to know more? Please contact us, we will be happy to help you.

This series of blogs on value-based healthcare will soon be followed up with the topic “data-driven performance dialogue”. What type of conversation should be conducted between professionals? How do you do so? And what do you need for this?

Setting up the organization of the Princess Máxima Center: “Streamlining countless structures”

By Healthcare, News

“It’s a good thing you don’t know what you’re getting yourself into, that’s a pro”, Dieneke Mandema says facetiously looking back on the last year and a half. As President of the Organization and HR, she was one of the people responsible for setting up the Princess Maxima Center.

The center, that is specialized in care, research and education in the field of pediatric oncology, opened its doors for the first time on 18 May. When Mandema took the job, there was no building, and hardly any staff or structure. Unheard of in the current market and a challenge, especially due to the staff shortages in the healthcare sector. “And what is better than being able to work on the mission to cure all kids with cancer while maintaining their quality of life?”

“We started with a blank piece of paper in November 2016. We needed new staff, nurses for example. At the same time, we didn’t have an existing company structure to fall back on. There wasn’t even a building. We were faced with the challenge of starting a center within one year and developing the foundation of the organization at the same time. We also had the opportunity to reinvent the wheel quite often thanks to the innovative character of the brand-new center and adapt it to the needs of kids and their parents”, Mandema says.

Marketing campaign to attract staff

Healthcare professionals are a rare commodity these days. To still be able to fill all positions, we deployed a so-called ‘recruitment factory’, linked to a labor market campaign. “We sold the vacancies like they were products.” The hospital played into the experience of nurses and put children at the center of the campaign. These were then brought to people’s attention via social media. It turned out to be a huge success. “When the campaign went live on Christmas Eve, we had hundreds, thousands of replies within several hours. We definitely didn’t count on that, so we all had to jump in to answer all the questions.”

‘This hospital has a unique company structure’

Hiring people is one thing but having them land in the organization is another. “The biggest groups started on 1 and 18 May. Until then, we were working for the Princess Maxima Center in five different locations. We had a construction trailer, a floor at the UMC Utrecht (Wilhelmina Children’s Hospital) and worked from an office building in Zeist”, Mandema says.

Basing the hospital’s structure entirely on an existing organization wasn’t an option, she explains. “Our basic organization is completely different. With us, the kids don’t go to the doctors, the doctors come to the kids. The entire logistical process of the hospital revolves around the child. That is unique.”

To make sure this ambitious plan wouldn’t strand in chaos, Mandema also decided to hire IG&H. “I really see them as a business partner that thinks along with us and is great at developing processes. They have a pleasant way of looking at what is necessary; they’re action-oriented, but with a human dimension. A business consultant merely making decisions, isn’t going to make it. That doesn’t fit with our center.”

Mapping out structures so processes run smoothly

Mapping out processes, which had an extra layer of complexity due to all the different locations and help systems, was a challenge. “I can still see Anouk standing there with an overview of all the HR and recruitment milestones: ‘No, no wait! I have something else! Guys, be quiet for a minute'”, recalls Mandema. It didn’t take long until several rooms were covered in post-its.

“It also didn’t take long before the document was meters long”, adds Anouk Baars, Health consultant at IG&H. “The starting hospital was using several technical systems, amongst which that of the UMCU. But we also had to reinvent the wheel for ourselves a few times. There was no insight into these processes yet, so we wrote everything down first. Then it became clear that about thirty things had to be in place before someone could start providing healthcare for some jobs.”

That way we figured out which members of staff were trained where, what the team structure looked like and where they could take their questions. “Everyone wants everything to run smoothly, but there needs to be a system for that first. The IT department was recruiting people themselves, for example. The same went for the medical teams. To make sure everyone has the right training, there needs to be someone taking the lead and overlooking all of this”, she says.

Trial and Error

Every week, Baars and Mandema sat around the table with a team to structure. What are we running into, how are we going to take this on and who is responsible for this process?, were the main questions Mandema asked. “It was a challenge for everyone, because no one had experience with a similar project.”

“Sometimes we had to do things the old-fashioned way. I regularly had to walk to and from the UMC Utrecht 5 or 6 times a day to sort out IT- or HR-related cases”, Baars says. The team had an issue with digital authorizations, for example. Which doctors have access to which files? It turned out no one had taken responsibility and it had to be sorted out fast. In this case we had to take care of the problem right away. Definitely important, because children would come to our hospital at the same time as their doctors. Nothing was allowed to go wrong.”

Practical solutions for complicated problems

To prevent any issues, Mandema and Baars ran around like headless chicken the last few months before the opening. “In May, our list of priorities was huge. We realized how complex the situation really was. The fastest way to make sure all new staff could start working right away, was to implement everything they needed into an excel sheet manually. That is why I did that once. I locked myself up for an entire week to make an inventory of things every employee needed and whether they had received it or not. After the opening, we turned this into a structural process”, Baars says.

This challenging time also caused some tension between the teams. “IG&H was definitely a good mediator. They brought people together, especially if something wasn’t taken care of right away. To prevent these situations to become worse, they only looked at the content. Who needs what and how do we arrange that as quickly as possible? Afterwards we looked at how the teams involved could take their responsibilities, so these structures matched the practical applications”, says Mandema .

‘To do lists are getting shorter and shorter’

By now, the center has been open for half a year already. Dozens of children are treated and supported by doctors, nurses and pediatricians daily. They come by for a day treatment or stay at the hospital longer for the more difficult parts of the treatment. For each room the kids stay in, there is an adjoining room to for the parents, a parent-child-unit.

Baars’ and Mandema’s to do lists are getting shorter and shorter. “We are currently determining how the organizations can pick up things themselves. We are past the real hurdles; everyone is helped by the right team and are able to ask their questions to the right person. The hospital has its own routine now.”

Three opportunities for more chemistry between hospital and MSB

By Healthcare, News

Now that the participation model does not seem to take hold, the following question arises: what can we as hospital and MSB do to join forces? “To date, the introduction of integrated funding has not meant that the hospital and MSB jointly manage healthcare in a smarter and more efficient manner”, is one of the conclusions from the ‘Integrated Fidelity Monitor’ recently published by the NZa. Three concrete opportunities in this article.

Why is it so difficult? An important reason why this objective does not get off the ground is the calculation system between hospital and MSB, which in many cases is primarily driven by volume. In some cases there are additional agreements about quality outcomes that are included in the settlement. Whatever the case, doctors who work for the MSB, are not affected by the incurring costs related to their choices – for example medicines, length of stay and diagnosis. The smart and efficient organization of healthcare in times of staff shortages remains the main concern of the managers and directors of the hospital organization.

Professional interlocutor. With the arrival of the MSB, a single point of contact has arisen for the hospital management, in which there is a joint sense of responsibility and a certain alignment of interests. This offers potential when it comes to joint performance management. How to redeem this potential as a hospital organization?

  1. Starting point: shared and concrete future vision.
    The healthcare landscape is changing, it’s clear that the role and position of the hospital is changing too. What the healthcare landscape looks like and what this actually means for the hospital and the different departments within the MSB, is to be agreed upon. It’s easy to see that directors are already on a different planet, while the MSB are occupied with production ceilings, internal calculation models and distribution of medical specialist capacity. By jointly exploring the strategic scenarios, a shared view of the urgency arises: the considerations and the opportunities that this offers.For example, in some regional hospitals together with the MSB we have experienced in practice what the different scenarios mean, also for the departments in the MSB: which healthcare do we no longer provide, which partnerships are important and which investments in technology and (ICT) infrastructure are needed? And which form of healthcare is being shifted internally to a specialist nurse?
  2. Maintaining a uniform working method: the right steering information.
    Medical and business manager form a crucial team in realizing the strategy and the clever organization of healthcare. In addition to formal authority for the medical manager, it is important that both maintain a uniform working method when it comes to steering. ‘Are we seeing the right patients? Do we provide healthcare in line with our chosen healthcare model (eg, do/do not perform surgery, e-consult versus screening, hospital stay)? Do we use our critical resources properly and how happy is our scarce staff actually?”In order to reach the right steering information, we are able to point out three success factors in practice: – Conducting the conversation about “when are you doing it right” and what do you want to know to get there, or even better; what do you want to know to stay there. – Developing together with the person in charge: making a semi-finished product better through good consultation. Only then does responsibility arise to also improve the quality of source information, after all ‘garbage in = garbage out’. – Transparency and the ability to down drill information to patient or employee level.
  3. From volume incentive to risk sharing and creating space to invest.
    It is not fair to jump to conclusions by saying that medical specialists at the MSB with the current incentives are only driven to make revenue and to monitor their own trade. However, in the current cooperation model, the MSB hardly bears any entrepreneurial risk. In the field of management accounting, sufficient research has been done to state that steering the performance is less effective without the right incentives.The path that has been taken to outcome steering offers opportunities. Let the medical and business manager themselves make a proposal for the results on which performance agreements can be made and which remuneration structure fits. Thus, with the space that has been created, a buffer for investments needed in technology and innovation can be supplied. So that the focus is no longer on distributing the proceeds, but on the transition to the right healthcare in the right place.

Princess Máxima Centre: from 11 workflows to 1 opening

By Healthcare, News

On May 18th, 2018, the Princess Máxima Centre opened its doors. The run-up to this opening was a rather particular period of time that did not go without its struggles. Today, the second blog of a series, in which we discuss the following question with the experts involved: how did the centre move from dream to reality in just over 8 months?

“No concessions regarding the opening date and patient safety”

“The first thing I did was create urgency”, says Ben van Miltenburg, the all-round transition manager who was involved in the project at the end of the summer of 2017. “At the administrative level, the need was already felt, but this was not yet the case in every branch of the organisation. The message to everyone was therefore twofold: we have to open on May 18th, and then everything has to be assured for the patients.”

Then an alarm went off: with our plan of action at that time it was not going to be feasible. Two things were needed: overview and coordination. On basis of this, it would be possible to set priorities. The question was: where do we start? Van Miltenburg: “That was the moment IG & H came into the picture.”

“A border collie that kept the herd together”

“You have to consider that the building was still an empty concrete box at that time”, says Van Miltenburg. “Everything was needed at every business unit and there was nothing available.” Once the urgency of this had been felt, everyone started to roll up their sleeves: “One thing was clear: we would not postpone the opening date. I kept track each week of how many people said that it must be postponed. Eventually I ended up with 206 tick marks. And yet we have achieved our goal.”

The 11 workflows that have been drawn up – including ‘HR and recruitment’, ‘care processes’, ‘compliance’, ‘finance & BI’ and ‘ICT’ – played a major role in this. “These were perceived as sort of little factories that all had to deliver at the right time”, says Bart van Sambeek, consultant at IG & H. “In the beginning, we took a thorough inventory of what was needed for a sure opening. We then translated this information into milestones, which we packaged into the 11 workflows. This way, everyone knew who was going to pick up what and when.” A hospital business only works if all cogs fit well together, but naturally everyone is more concerned with themselves – with their own cogs – than with the interaction. What we have therefore in essence created is an exoskeleton that kept the organisation-in-the-making of the Princess Máxima Centre together.

“The model of the workflows also meant that we had 1 language and 1 central steering mechanism”, adds Van Miltenburg. “In the workflows, people did what they were responsible for.” The intention was deliberately chosen to designate MT members as leaders of the workflows: “After all, they also lead the regular organisation.”

“If the transition team wanted something, it happened”

“In the end, we had about thirty to forty external experts in various fields – such as personnel & organisation, ICT, construction & design and planning – delivering extra capacity and crucial knowledge”, says Van Miltenburg. “In addition to substantive knowledge and experience, IG & H also provided the people necessary to help coordinate and make everything happen.” According to Van Miltenburg, this helped enormously in achieving objectives: “When we called something together with the IG & H consultants, it happened. This was also because I was able to act with the mandate of the board of directors. Everyone within the organisation honoured this, because nobody wanted the centre to not open on time because of them.” Repeating the core message proved to be a key element to success: “we had to open on May 18th and at that time it also it had to be assured for the patients. That core message gave a focus amidst the multitude of things that screamed for attention and energy. We have always looked at and emphasised what was necessary to be able to open on May 18th. That is what we have done together.”

“No pressure or control, but support”

“I knew for sure that it would work”, says Van Miltenburg. “I never doubted that. It was, however, crucial that patient assurance was guaranteed. We have looked at the processes meticulously for that.”

Within the overall plan of action, there were 2 methods. On the one hand, IG & H took care of the milestones planning and reporting, so that people could see exactly when targets were achieved or not. On the other hand, the transition team explicitly chose not to place control or performance pressure at the centre. We did not ask people why objectives had not been achieved, but what they needed to achieve the goals. They saw this as having been given support. What you notice is that people are used to performing within set limitations. But we were dealing with a very special – and temporary – situation in which that was not enough. We therefore did not say what had to be done to do something faster or better. We provided the means to accomplish what had to happen, regardless of the limitations. That could be manpower, information, alternatives, or decisions. By doing this, we were able to set things right again.

“When you work with so much external knowledge and experience, there is always a solution”, says Van Miltenburg. “Within their own domain, people do not always see the whole picture. When we asked why something had not been delivered on time, for example, they often thought it was because it was too expensive, even though the board was prepared to make extra funds available if needed. In addition, the transition team also exerted pressure on the suppliers: “We flew in some of the apparatuses months earlier than usual. This requires a certain level of creativity that you do not need in normal business situations.”

“We would have never made it without the voting mechanism”

A final element that was essential in the coordination was the voter system. Van Sambeek explains this clearly: “The workflows and components of a hospital organisation are all interlocked. When a workflow wanted to pass on a decision or milestone that had an impact outside its own workflow, it had to be submitted to all of the other workflows for voting. So everyone could indicate whether they agreed or not, with which we could ensure that all cogs continued to connect. This meant that people had to think and co-decide on matters outside their own domain. In view of the short period, it was necessary to do this.”

“We would not have made it without that mechanism”, says Van Miltenburg. “Because everyone had to see and approve almost any final decision, we were able to avoid many unpleasant surprises and gaps. In addition, no one could ‘duck away’ at a later stage. When you make decisions together on everything, you also bear the responsibility of delivering in accordance with the agreements. The voting mechanism has therefore really been invaluable!”

UMC: performance-driven care administration

By Clientcases, Healthcare

What they wanted
Solid business operations start with a well-performing care administration. Like many healthcare institutions, the UMC struggled with burdens: there were many correcting tasks for the care administration, registration tasks for specialists, control tasks required by the insurer, and change implementation tasks imposed by the government. To depart from all this, the care administration had to switch from stopgap solutions to improvement. The goal: timely, correct, and complete registration at the source. This would allow the institution to get in control and lay a foundation for horizontal monitoring, which means that the insurer performs checks beforehand instead of afterwards.

What we did
Together, we conducted a data analysis to identify the main sore points. Subsequently, we set up an audit program for improvement projects, which we rolled out to the departments. Then, we created a process design – new in terms of content – and set up the Lines of Defense model. Management information was organized using correct and supported performance indicators. Finally, we established a program organization with stand-up and day start meetings, as well as training courses.

What we achieved
With our help, the UMC has taken a major step towards departing from correcting tasks and creating an optimal chain of registration. We created a supported Lines of Defense model and ensured commitment to registration securities. Furthermore, we introduced a new way of working, tightening priorities, project activities, and the allocation of tasks. Also, the focus has shifted to transparent communications on processes and substantive matters. Moreover, openness and feedback have improved collaboration.

What they said
The Ministry of Health, Welfare, and Sport has made this project an exemplary case for other care administrations. At the Congres Horizontaal Toezicht Zorg (congress for horizontal monitoring in healthcare), the case was highlighted as an example of success. The client’s feedback: “In terms of quality, IG&H has done an excellent job providing methods that we can apply in practice. IG&H made a difference. It has been tangible in the solution they offered, but also in its reception and the way it works in practice. The organization has noticed a positive energy boost.”