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Penny Dash: Facing the hospital challenge
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Penny Dash: Facing the hospital challenge

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  • 1. Future of Hospitals 9 June, 2014 Penelope Dash Senior Partner McKinsey & Co Nuffield Trust
  • 2. 1 What I will talk about today Where have we come from? Where are we today? Where to next?
  • 3. 2 Spot the hospital
  • 4. 3 What does it feel like to be a hospital today? 24x7 healthcare needs …. 120 babies …… New technologies arriving almost daily …. Major tariff pressures …. The “incontinence” challenge ……. Confused old ladies who shouldn’t be there ……….. Ever increasing standards….
  • 5. 4 No wonder hospitals are on the edge
  • 6. 5 So what could we do? Drive productivity1. Tackle quality2. Tier and manage3. Reframe the hospital4.
  • 7. 6 Compared to other industries, healthcare is still lagging behind in efficiency gain Optimise estates Support self service/self care Innovate the workforce Standardise processes Drive productivity1.
  • 8. 7 Standardized processes and routine monitoring Trackable RFID chip Transmitter for equipment localization Transmitter for staff localization Intelligent room surveillance for status Maintenance status by remote hand held
  • 9. 8 Look at Aravind? SOURCE: Rockefeller Foundation; Interviews; 2010/11 National Schedule of Reference Costs; 2010/11 Aravind Eye Care System Activity Report; Global Insight; Conversation with Dr. Sathya Ravilla at Aravind; Team Analysis UK-NHS $PPP 1,400 Aravind $PPP 250 UK-NHS 6% Aravind 4% Unit cost of cataract surgery in 2010/11 Infection rate per 10,000 patients … at ~1/6th the cost… … and with better outcomes 10%
  • 10. 9 Innovate the workforce – what can technology do? Say hello to intelligent pills – digital system tracks patients from the inside out Nature The doctor is out, but new patient monitoring and robotics technology is in Scientific American
  • 11. 10 Lots of technology but slow adoption
  • 12. 11 Innovate the workforce? GP obstetricians in Australia Midwives administer epidurals in Canada Primary care paediatrics in the US
  • 13. 12 Optimise the estate ……… it is 20% of costs
  • 14. 13 Support self care – changing the paradigm?
  • 15. 14 Tackle quality2. ▪ How much experience does she have? How many cases a year does she do? Is that enough? ▪ How up to date is she in the latest thinking/knowledge? ▪ What are best practice protocols for the conditions she is managing? ▪ How good are her results? What are the main complications in her speciality and how do her results compare to colleagues in your hospital, the one down the road, the leading edge centre, the best in class globally? ▪ How well are patients’ symptoms resolved? How often does she publish her results? ▪ What do her patients think of her? ▪ How much research has she done this year? How many articles were published? ▪ What do her medical colleagues think of her? Is she in top 10% of all doctors they work with or bottom 30%? ▪ What do other staff think? ▪ What do juniors think of her? How well do they assess her teaching style, knowledge, impact? ▪ How efficiently does she care for and manage patients? ▪ Do you measure this every month? Every year? ▪ How often do you publish it?
  • 16. 15 Tier3. Complexity of care summary for maternity service levels Service level 1 2 3 4 5 6 Emergency Care Resuscitation, stabilisation and retrieval       Complexity of Care needs Normal       Moderate complexity    High complexity  Antenatal Care Outpatient care       Inpatient care      Maternal fetal medicine service 1 Planned Birthing Care Gestation >37 wks      Gestation 34 wks    Gestation >32 wks   Less than 32 wks  Elective caesarean section > 39 wks gestation     Unplanned Birthing Care Access to or onsite facilities for emergency caesarean section      Intrapartum EFM + fetal blood sampling (scalp pH I lactate)    Postnatal Care Outpatient care       Inpatient care      1 Access to Source: Standing Council on Health (2012) National maternity services capability framework (http://www.qcmb.org.au/media/pdf/The%20National%20Maternity%20Services%20Capability%20Framework.pdf)
  • 17. 16 A single campus where patients can access high quality integrated care and diagnostics Primary care GP surgeries Community care Full range of community services Fast response teams Re-ablement and day-care unit Physiotherapy, SALT, OT Wellbeing services Health advice, weight watchers Smoking cessation Information centre Social care Co-located social care services to create sense of place focused in the centre of the community Acute services 24x7 urgent/ emergency care MLU GP OOH Short stay acute medical unit Day cases Outpatients Diagnostics ISCAT Reframe the hospital4.
  • 18. 17 101 GP practices 50 community care centres 39 Sure Start centres 5miles 0miles Reframe the hospital?4. And four major hospitals ………………..
  • 19. Abingdon Community Hospital Catchment - 5 market towns in SW - 140,000 Co-located services - Minor Injuries Unit - Diagnostics (X-ray) - Mental Health base - Outpatients - Primary Care - GP practice - out-of-hours base - Inpatient wards - 45 beds - stroke, hip fracture, ‘generic subacute’ - close relationship with ‘acute Trust’ Reframe the hospital4.
  • 20. PRELIMINARY DRAFT 19SOURCE: Rochdale EUCC Operational Policy 2012 Care Model: Rochdale ‘EUCC’ onsite MAU Patients/conditions treated Key goals and achievements • Minor nose bleeds (not on Warfarin) • Minor cuts, bites and stings • Burns and scalds • Infections (including abscesses) • Foreign bodies in wounds, ears and noses • Muscular sprains and strains to shoulders, arms and legs • Fractures to shoulders, arms, legs & ribs • Dislocations of fingers, thumbs and toes • Minor eye conditions including conjunctivitis and foreign bodies • Minor chest, neck and back injuries • Minor head injuries with no loss of consciousness or alcohol- related • Minor allergic reactions • Minor ailments such as coughs, colds, flu symptoms, sore throat, earache, urinary tract infections and sinusitis • Diarrhoea / Constipation • Emergency contraception Support services provided • Basic Laboratory services • X-ray diagnostics 08:00 – 24:00, 7 days a week • Ante-Natal Ultrasound 08:00 – 17:00, Monday – Friday • CT when coverage is available, 09-17, Monday – Friday • MRI 08:00 – 20:00 Monday - Friday • Step-up/ Resuscitation room • Pharmacy support 7 days a week • Retains 80% of old A&E activity and growing • Patients assessed within 20 minutes of arriving • Patients will be seen by a Clinical Decision Maker within an hour of presenting Reframe the hospital4.
  • 21. COMMERCIAL IN CONFIDENCE – DRAFT FOR DISCUSSION Urgent care centre (24x7) • GPs work in minor injury unit to ensure maximum number of patients can be safely cared for • GP out of hours services co-located and fully integrated • Diagnostics co-located and x ray open 7 days a week Outpatient clinics • GP run fracture clinic Therapy services • Occupational therapy • Physiotherapy • Rehabilitation • Podiatry Maternity services • 400 women managed ante-natally per year • 200 deliveries Inpatient care • 12 bedded older people mental health unit • 2 wards for 40 medical and surgical patients (one male, one female) GP services • One practice (~14 doctors) based on site • Other practice on other side of town but plans to relocate Base for community teams • Community mental health teams • Health visitors, school nurses, district nurses • Public health Day case surgery unit • Two theatres Reframe the hospital4.
  • 22. COMMERCIAL IN CONFIDENCE – DRAFT FOR DISCUSSION But …. Here’s what the doctors think …. ` 21
  • 23. 22 So …….. What could a future look like? 100 major emergency centres 300 local hospitals 600 health centres

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