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Reshaping Healthcare
Enterprises By Design
John Gøtze, QualiWare
Milan Guenther, Enterprise
Design Associates
Joining in today and beyond
• Please use the chat box to contribute
continuously during the web seminar
• Please tweet usi...
The Team Today
Presenter
John Gøtze, QualiWare
@gotze
Presenter
Milan Guenther, EDA
@ent_des
Session Chair
Janet Wildman
@...
Thank you
Dennis Middeke, Berlin
Benjamin Falke, Düsseldorf
Philip Hellyer, London
Tomomi Sasaki, Paris
Kuno Brodersen, Co...
Enterprise Design Associates helps
organizations of all shapes and sizes
to innovate and transform.
We work with a global ...
intersectionbook.com intersectionconf.com
enterprisedesign.io
Coherency
ConsensusConsistency
Design Thinking
Agile, lean,
UX, SD, DT...
Christopher Webb
Deloitte
2016
Enterprise
From Old French via Middle English and Middle French
“entreprise”, feminine past participle of entreprendre (“t...
Where do we fit?
Michael Porter
Where do we fit?
Michael Porter
#entarch
#entawk
@entawk retweets #entawk
#entawk
your call
is important
to us!
Reshaping Healthcare Enterprises
by Design
1
Challenges worth tackling
2
Working with systems at scale
3
Rapid innovation ...
1
Challenges worth
tackling
The elephant in the room
A space of intermingled concerns
Enterprise Design Framework: Stack
Creating links
Enterprise Design Framework: Assessment
Take Action Scores
Top Tasks: Norwegian Hospitals
Tiny Tasks: Norwegian Hospitals
A patient story
When I got sick, I had to orient myself in a whole new
day. I wondered what was wrong, what kind of
treatm...
Fra mosaikkkaos til kjernestruktur
Fra mosaikkkaos til kjernestruktur
Fra mosaikkkaos til kjernestruktur
“...part of the solution”
Utredning
Preoperativfase
Behandling
Mobiliering
Rehabilitering
Hjemreise
Kontroll
TREATMENT
INF...
Pasienter Pårørende
Forskere Media AndreJobbsøkereHelsepersonell
2
Working with
systems at scale
PAGE 39
Programs and
Services
Customer
Relationship
Care Delivery Operations Revenue
Management
Business
Administration
Re...
PAGE 40
Programs and
Services
Customer
Relationship
Care Delivery Operations Revenue
Management
Business
Administration
Re...
Digital Hospital
http://www.himss.org/2015-leadership-survey
digital-innovation.dk
http://cimt.dk/
HIMSS Analytics Continuity of
Care Maturity Model
Stage 7
Knowledge driven engagement for a dynamic, multi-vendor, multi-o...
Although first in terms of number of clinical systems per hospital,
still not integrated and standardized at hospital leve...
Government investment
Denmark is investing 41.4 billion DKK, or 4.1
billion £ in improving Danish hospital facilities.
Cen...
Denmark is investing 4.1 billion £ in improving Danish hospital facilities.
BUT demanding efficiency gains in return from ...
Basic Facts about New OUH - set to be ready by 2022
• 1.Expansion -Faculty of Health Sciences
at the University of Souther...
Vision
People First: Through Research, Education, Development and
Collaboration
Digital solutions at New OUH will be for a...
Nodes/Places
Touchpoints
Digital wayfinding information can thus be divided into three geographic
levels. These are:
1. Fr...
Digital Touchpoints
Way-finding stands
• Larger stands with touch screens for interactive use, for example in a vestibule....
1. Decision: Open field construction from
scratch
2. Benefit: Opportunity to differentiate from
existing thinking (out of ...
Maturity assessment of the Region of Southern Denmark
Check: Principal coherence between ”Basis for operation”, strategy a...
Strategic design
a) Patient centered treatment
b) Better strategical alignment
c) Higher integration and standardization o...
Lessons learned
• So far the clinical services individually had been the focus of cost reductions -do more for less– but t...
Planning/
scheduling/
capacity
management
(Patients, clinicians,
equipment, rooms,
beds, special needs)
Emergency departem...
5 system areas that support 5 main business areas –we will focus on 1-3
BYGHERRE
BYGHERRERÅDGIVER
TOTALRÅDGIVER
1.Planning...
BYGHERRE
BYGHERRERÅDGIVER
TOTALRÅDGIVER
Servicelogistic:
Bed ready
Medical devices
Patient cloth
doctor
Room
Planning:
Ref...
Patient flow – Acute -clinical input as to logistics flow
After workshop
Analysis and pilot studies in parallel
Test and implement as many
new logistics concepts at the
existing hospital as possi...
BYGHERRE
BYGHERRERÅDGIVER
TOTALRÅDGIVER
• Other activities at the moment – besides process group
interviews
• Market asses...
Questions? Comments?
3
Rapid innovation
and transformation
Approach
Steps
Casting
Overcoming modelling bias
Enterprise Design
Modelling
Language (EDML)
Activity
Quality
Demo
Customer Insight
“Our patients don’t like
waiting. They wait a lot.”
Business Challenge
“People don’t show up,
are late, and mess up
our schedule.”
Source: Optiflows / The financial impact of...
Challenge Statement
How might we eliminate waiting
altogether?
How might we better adapt to our patient’s
planning?
How mi...
Prototype/MVP
Enterprise Design Framework
eda.cx/edf
Thanks for joining!
John Gøtze, Editor-in-Chief
QualiWare
@gotze
Milan Guenther, Partner,
Enterprise Design Associates
@en...
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
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Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design

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Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design

  1. 1. Reshaping Healthcare Enterprises By Design John Gøtze, QualiWare Milan Guenther, Enterprise Design Associates
  2. 2. Joining in today and beyond • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtag #EdgeTalks and the handle @horizonsNHS • Send a request to join our Facebook group School for Health and Care Radicals and The Edge NHS
  3. 3. The Team Today Presenter John Gøtze, QualiWare @gotze Presenter Milan Guenther, EDA @ent_des Session Chair Janet Wildman @jwildman1 Insert photo here
  4. 4. Thank you Dennis Middeke, Berlin Benjamin Falke, Düsseldorf Philip Hellyer, London Tomomi Sasaki, Paris Kuno Brodersen, Copenhagen Simon Montague, London Eirik Hafver Rønjum, Oslo Guro Røberg, Oslo Ronny Grønvold, Oslo Andreas Richter, Oslo Gerry McGovern, Dublin Sinead Moodie, London
  5. 5. Enterprise Design Associates helps organizations of all shapes and sizes to innovate and transform. We work with a global network of experts to design whatever is needed to make enterprises deliver.
  6. 6. intersectionbook.com intersectionconf.com enterprisedesign.io
  7. 7. Coherency ConsensusConsistency
  8. 8. Design Thinking
  9. 9. Agile, lean, UX, SD, DT... Christopher Webb Deloitte 2016
  10. 10. Enterprise From Old French via Middle English and Middle French “entreprise”, feminine past participle of entreprendre (“to undertake”), from entre (“in between”) + prendre (“to take”): A company, business, organization, or other purposeful endeavour. An undertaking or project, especially a daring and courageous one. A willingness to undertake new or risky projects; energy and initiative. An active participation in projects.
  11. 11. Where do we fit? Michael Porter
  12. 12. Where do we fit? Michael Porter
  13. 13. #entarch #entawk @entawk retweets #entawk
  14. 14. #entawk your call is important to us!
  15. 15. Reshaping Healthcare Enterprises by Design 1 Challenges worth tackling 2 Working with systems at scale 3 Rapid innovation and transformation
  16. 16. 1 Challenges worth tackling
  17. 17. The elephant in the room
  18. 18. A space of intermingled concerns
  19. 19. Enterprise Design Framework: Stack
  20. 20. Creating links
  21. 21. Enterprise Design Framework: Assessment
  22. 22. Take Action Scores
  23. 23. Top Tasks: Norwegian Hospitals
  24. 24. Tiny Tasks: Norwegian Hospitals
  25. 25. A patient story When I got sick, I had to orient myself in a whole new day. I wondered what was wrong, what kind of treatment I would get and what would happen to me afterwards. I was also concerned with which hospital was best on the type of treatment I was going through. Before the appointment at the hospital I had many practical questions: Where can I park? What building do I need to go to and where is the front door? Can my spouse be with me at the hospital? It was difficult to find the answers.
  26. 26. Fra mosaikkkaos til kjernestruktur
  27. 27. Fra mosaikkkaos til kjernestruktur
  28. 28. Fra mosaikkkaos til kjernestruktur
  29. 29. “...part of the solution” Utredning Preoperativfase Behandling Mobiliering Rehabilitering Hjemreise Kontroll TREATMENT INFORMATION NEEDS
  30. 30. Pasienter Pårørende Forskere Media AndreJobbsøkereHelsepersonell
  31. 31. 2 Working with systems at scale
  32. 32. PAGE 39 Programs and Services Customer Relationship Care Delivery Operations Revenue Management Business Administration Research Direct (strategy,planning) Control (manage,monitor,track) Execute Research Portfolio Planning Service P&L Management Supply and Demand Matching Market Tracking Customer Services & Communications Service Administration Joint Ventures Patient Planning Customer Satisfaction Assessment Disease Management Support Therapies Strategy Pharmacy Supply Chain Planning Revenue Cycle Planning Pricing/Contracting Planning Patient Access Mgmt Planning Contract Negotiations Oversight Finance Control/ Audit Referrals, Authorizations & Claims Management Facility Planning Information Technology Planning Human Resource Planning Physician Planning Corporate Strategy And Planning Service Line Planning Ambulatory Services Planning Brand Strategy Payer Planning Service Issue Tracking Physician Services Patient Relations Customer Servicing Models of Care Planning Patient Safety Leading Practices & Evidence-Based Medicine Case Management Specialty Care (OR, ED, Critical Care) Capacity & Utilization Management Staffing & Scheduling Clinical Documentation Wellness & Prevention Outcomes Measurement Physician Clinical Practice Post Acute Services Information Management Patient Scheduling Procurement & Logistics Oversight Documentation & Coding Results Management Inventory Management, Procurement, Standardization & Utilization General Ledger Registration / Admission Patient Accounting Denial Management Accounts Receivable Education & Training Risk Management Facility/Equipment Management HR Administration IT systems & Operations Protocol Administration Grant Administration Consent Management IP Maintenance Research Tracking Policy & Regulation Compliance Oversight Funding Tracking Recruitment & Retention Business Performance Mgmt Organization Process & design Legal and Regulatory Compliance Quality Management Laboratory, Radiology Research Facility Planning Information Management Health Care IT?
  33. 33. PAGE 40 Programs and Services Customer Relationship Care Delivery Operations Revenue Management Business Administration Research Direct (strategy,planning) Control (manage,monitor,track) Execute Research Portfolio Planning Service P&L Management Supply and Demand Matching Market Tracking Customer Services & Communications Service Administration Joint Ventures Patient Planning Customer Satisfaction Assessment Disease Management Support Therapies Strategy Pharmacy Supply Chain Planning Revenue Cycle Planning Pricing/Contracting Planning Patient Access Mgmt Planning Contract Negotiations Oversight Finance Control/ Audit Referrals, Authorizations & Claims Management Facility Planning Information Technology Planning Human Resource Planning Physician Planning Corporate Strategy And Planning Service Line Planning Ambulatory Services Planning Brand Strategy Payer Planning Service Issue Tracking Physician Services Patient Relations Customer Servicing Models of Care Planning Patient Safety Leading Practices & Evidence-Based Medicine Case Management Specialty Care (OR, ED, Critical Care) Capacity & Utilization Management Staffing & Scheduling Clinical Documentation Wellness & Prevention Outcomes Measurement Physician Clinical Practice Post Acute Services Information Management Patient Scheduling Procurement & Logistics Oversight Documentation & Coding Results Management Inventory Management, Procurement, Standardization & Utilization General Ledger Registration / Admission Patient Accounting Denial Management Accounts Receivable Education & Training Risk Management Facility/Equipment Management HR Administration IT systems & Operations Protocol Administration Grant Administration Consent Management IP Maintenance Research Tracking Policy & Regulation Compliance Oversight Funding Tracking Recruitment & Retention Business Performance Mgmt Organization Process & design Legal and Regulatory Compliance Quality Management Laboratory, Radiology Research Facility Planning Information Management IT ”everywhere” …
  34. 34. Digital Hospital http://www.himss.org/2015-leadership-survey
  35. 35. digital-innovation.dk http://cimt.dk/
  36. 36. HIMSS Analytics Continuity of Care Maturity Model Stage 7 Knowledge driven engagement for a dynamic, multi-vendor, multi-organizational interconnected healthcare delivery model Stage 6 Closed loop care coordination across care team members Stage 5 Community-wide patient record using applied information with patient engagement focus Stage 4 Care coordination based on actionable data using a semantic interoperable patient record Stage 3 Normalized patient record using structural interoperability Stage 2 Patient-centered clinical data using basic system-to-system exchange Stage 1 Basic peer-to-peer data exchange Stage 0 Limited to no e-communication
  37. 37. Although first in terms of number of clinical systems per hospital, still not integrated and standardized at hospital level HIMSS Healthcare Information and Management Systems Society (HIMSS)
  38. 38. Government investment Denmark is investing 41.4 billion DKK, or 4.1 billion £ in improving Danish hospital facilities. Centralisation – Hospitals in fever locations The investment is part of a structural reform to place hospitals centralized in fewer locations and community health centers will maintain more health care services in the local area. Goal – modernization and improve patient treatment/care and more specialization among clinical staff Background
  39. 39. Denmark is investing 4.1 billion £ in improving Danish hospital facilities. BUT demanding efficiency gains in return from every one of the new Hospitals: • Efficiency increase by 2 pct./year until the project is finished • Further efficiency increase by 8% within the first year of operation • Ambulatory activity must increase by 50% • Reduction of bed capacity by 20% • Treatment capacity usage of shared facilities must increase to 245 days 7 hours a day (Surgery, ambulatories etc.) • Reduced storage facilities and no departmental medicine rooms – all just in time deliveries (regional)
  40. 40. Basic Facts about New OUH - set to be ready by 2022 • 1.Expansion -Faculty of Health Sciences at the University of Southern Denmark (part of Univ. SDU) Government financing – 50.000 m2 – 1.1 billion DKK • 2. New building -University hospital, somatic health services (OUH) – Funded by the Region of Southern Denmark and Ministry of Health – 224.000 m2 – 6.3 billion DKK • 3. New building -University hospital, Mental Health Services (MHS) – Funded by the Region of Southern Denmark – 25.000 m2 – 600 million DKK. 853 beds including 131 for mental health services 2. New OUH 1.Univ SDU 3. New MHS
  41. 41. Vision People First: Through Research, Education, Development and Collaboration Digital solutions at New OUH will be for all, to all, between all, everywhere – always. For all Digital solutions must support all users of the hospital and its functions. To all Digital solutions for all are regarded as any productive process at New OUH is digitally supported Between all Digital solutions between all tie individuals, work processes and solutions together in a holistically orientated network Everywhere Digital solutions “over all” mean that the solutions must be available and integrated for all, in and around the hospital, patients as well as external partners. Always Digital solutions must always be present and support the user at any given time to be able to procure the requested information – regardless of place and time.
  42. 42. Nodes/Places Touchpoints Digital wayfinding information can thus be divided into three geographic levels. These are: 1. From the remote location (or home) to the hospital Patients, relatives, business etc must be helped to find their way between a remote location and forward to hospital. This could also be navigation for internal transport between different hospitals within an organizational unit. 2. From the hospital premises to parking and entrance When patients, families, external suppliers etc. arrives at the hospital, they are offered navigation to the area that are closest to their destination. For patients, this information may be retrieved in a clinical booking system, while external transport will have to navigate to the goods reception. 3. From the entrance to the local destination. Patients, families, employees, etc. should be able to get navigation aid within the hospital, which are contextual and based on the relative position between their current position and their destination.
  43. 43. Digital Touchpoints Way-finding stands • Larger stands with touch screens for interactive use, for example in a vestibule. Digital signs • Smaller screens for digital signage for either use in hallways vertical or horizontal signs or possibly as elevator sign Digital information screens • Larger screens for use as info screens for use in waiting rooms, receptions and other places where patients and relatives are present. Way-finding Apps • Way finding apps on the smart phone could focus on the parking area, entrances or guiding to final destination. Digital door signs • Small door signs with text on room number and booking info as relevant clinician or type of room. Digital signs in terrain • Larger signs in the terrain that can show info on contextual directions, overview maps and general information.
  44. 44. 1. Decision: Open field construction from scratch 2. Benefit: Opportunity to differentiate from existing thinking (out of the box) – meet the government demands Realize a vision of a digital hospital 3. Architecture Methodology: Chose Togaf/ADM as methodology for the IT challenge Approach a. Business strategy and readiness/maturity b. Processes ,data and applications and infrastructure c. Transitions and ”to be” application map
  45. 45. Maturity assessment of the Region of Southern Denmark Check: Principal coherence between ”Basis for operation”, strategy and vision Basis for operation: • Operational model • Core business • IT principles Maturity Result : Low organizational architecture maturity -> more groundbreaking changes required to achieve strategy
  46. 46. Strategic design a) Patient centered treatment b) Better strategical alignment c) Higher integration and standardization of processes and IT
  47. 47. Lessons learned • So far the clinical services individually had been the focus of cost reductions -do more for less– but the potential for savings in the future are limited due to growth in the demand for services. • The ”greenfield construction” was giving an opportunity to “reinvent” the logistical setup • A dedicated proportion of the governments funding must go to IT improvements (approx. 5 %) • Logistics is the area that will generate most of the efficiency needed and improve quality 1. Planning (before patient arrives) 2. Clinical logistics – executing the flows during the patients visit 3. Service logistics – supporting the clinical flows • The logistics will be the focal point for the digitalization of the hospital at OUH It is about the quality of the healthcare delivered by the empowered hospital.
  48. 48. Planning/ scheduling/ capacity management (Patients, clinicians, equipment, rooms, beds, special needs) Emergency departement ICU and bed Ward Operating (stationary and day surgery) Out patient Clinics Clinical logistics Goods reception Storage WCS/WMS Distribution / delivery Return flow / disposal Service logistics Enterprise View on the hospital logistics Workflow management Patient flow management Ressource management / execution Just in time Cleaning Warehouse management system Transportation technologies Bed management Task management Sterile Processing Department Food management Real Time Location System Booking Equipment management Supply chain management Resource planning Capability planning Documentation To document the treatment and healthcare service in the appropriate IT solution(s) Electronic Health Care Journal Lab and radiology Clinical databases Anesthesia system Focus of the EA analysis
  49. 49. 5 system areas that support 5 main business areas –we will focus on 1-3 BYGHERRE BYGHERRERÅDGIVER TOTALRÅDGIVER 1.Planning 2. Service logistics 3. Clinical logistics 4. Para clinical 5. Documentation Focus Planning and preparation Support for clinical flows Execution Treatment/ Examination Documentation Time limit Days, weeks before Days, weeks before and real time changes Real-time ”here and now” Based on clinical production Historical data Effect Optimizing of resources, re disposition JIT supply Reducing buffer capacity Optimizing patient flow, resource management Better patient treatment and research Overview and accessible data World view “theoretically” – we plan the ideal world ”Service” – we deliver to the real world ”Practical” – We handle the real world in real time “clinical” we treat the patient ”Abstract” – we document relevant parts of the world. System type ex. Booking systems, supply chain management, resource management, etc. Sterile central system, task management, cleaning system, etc. Clinical logistics, nurse call, smart phones, etc. Patient scanning, test and treatment equipment etc. Electronic healthcare journal, Patient admin systems, acute journal etc. Technology Optimizing -algorithms Production- and transportation technologies Incident based technologies with integrations Local/regional productions systems with order entry Classical IS/DB architecture, client server 1 Planning 2 Supply chain 3 Execution 4 Treatment/ Examinination 5 Documentation
  50. 50. BYGHERRE BYGHERRERÅDGIVER TOTALRÅDGIVER Servicelogistic: Bed ready Medical devices Patient cloth doctor Room Planning: Referral Prehospital warning board Capacity/ resource check Booking of equipment/Doctors and rooms Servicelogistic: Transport ordering Device provision Patient preparations (depot of goods ?) Planning: Service assistance ordering. Documentation/closing wards report ”Ordering of home care service at municipal” Medication Plan for potential further treatment Planning: Reservation of doctor, room, etc. Equipment preparations (sterile equipment etc.) Servicelogistic: Transport to next treatment spot Room preparations Equipment check /preparation Servicelogistic: Transport to pick up spot Provision of helping aid/ equipment Trine Generic patient flow – Acute flow – workshop with emergency department
  51. 51. Patient flow – Acute -clinical input as to logistics flow After workshop
  52. 52. Analysis and pilot studies in parallel Test and implement as many new logistics concepts at the existing hospital as possible – no surprises when you go live! Prototyping and testing
  53. 53. BYGHERRE BYGHERRERÅDGIVER TOTALRÅDGIVER • Other activities at the moment – besides process group interviews • Market assessment – good examples of structures, systems, processing, etc. • Experience sharing with among others , the other new hospital projects in DK and with vendors, etc. • Technical study of existing portfolio of systems (what to continue, replace, fade out) • Naming conventions alignment (place, location, treatment) • Planning methodology – capacity, replenishment, change management, bookings etc. • Trace & tracking , network capabilities and other infrastructure activities
  54. 54. Questions? Comments?
  55. 55. 3 Rapid innovation and transformation
  56. 56. Approach
  57. 57. Steps
  58. 58. Casting
  59. 59. Overcoming modelling bias
  60. 60. Enterprise Design Modelling Language (EDML) Activity Quality
  61. 61. Demo
  62. 62. Customer Insight “Our patients don’t like waiting. They wait a lot.”
  63. 63. Business Challenge “People don’t show up, are late, and mess up our schedule.” Source: Optiflows / The financial impact of missed appointments in a gastroenterology outpatient clinic and evaluation of preventive strategies, M Pirson & B N’Guama
  64. 64. Challenge Statement How might we eliminate waiting altogether? How might we better adapt to our patient’s planning? How might we achieve more flexible scheduling?
  65. 65. Prototype/MVP
  66. 66. Enterprise Design Framework eda.cx/edf
  67. 67. Thanks for joining! John Gøtze, Editor-in-Chief QualiWare @gotze Milan Guenther, Partner, Enterprise Design Associates @ent_des

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