Slides from EdgeTalks October 2017 – Reshaping healthcare enterprises by design
Enterprises By Design
John Gøtze, QualiWare
Milan Guenther, Enterprise
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School for Health and Care Radicals and
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The Team Today
John Gøtze, QualiWare
Milan Guenther, EDA
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
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.
UX, SD, DT...
From Old French via Middle English and Middle French
“entreprise”, feminine past participle of entreprendre (“to
undertake”), from entre (“in between”) + prendre (“to
A company, business, organization, or other purposeful
An undertaking or project, especially a daring and
A willingness to undertake new or risky projects; energy
An active participation in projects.
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
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.
HIMSS Analytics Continuity of
Care Maturity Model
Knowledge driven engagement for a dynamic, multi-vendor, multi-organizational
interconnected healthcare delivery model
Closed loop care coordination across care team members
Community-wide patient record using applied information with patient engagement
Care coordination based on actionable data using a semantic interoperable patient
Normalized patient record using structural interoperability
Patient-centered clinical data using basic system-to-system exchange
Basic peer-to-peer data exchange
Limited to no e-communication
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
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
Denmark is investing 4.1 billion £ in improving Danish hospital facilities.
BUT demanding efficiency gains in return from every one of the new
• 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)
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)
– 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
– Funded by the Region of Southern Denmark
– 25.000 m2
– 600 million DKK.
853 beds including 131 for mental health services
People First: Through Research, Education, Development and
Digital solutions at New OUH will be for all, to all, between all, everywhere –
Digital solutions must support all users of the hospital and its functions.
Digital solutions for all are regarded as any productive process at New OUH is digitally supported
Digital solutions between all tie individuals, work processes and solutions together in a holistically orientated network
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.
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.
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.
• Larger stands with touch screens for interactive use, for example in a vestibule.
• Smaller screens for digital signage for either use in hallways vertical or horizontal signs or possibly as elevator
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 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.
1. Decision: Open field construction from
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
a. Business strategy and readiness/maturity
b. Processes ,data and applications and
c. Transitions and ”to be” application map
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
Result : Low organizational architecture maturity
-> more groundbreaking changes required to achieve strategy
a) Patient centered treatment
b) Better strategical alignment
c) Higher integration and standardization of processes and IT
• 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.
beds, special needs)
ICU and bed Ward
Operating (stationary and day surgery)
Out patient Clinics
Return flow /
Enterprise View on the hospital logistics
Patient flow management
Ressource management /
Just in time
Warehouse management system
Sterile Processing Department
Real Time Location System
Supply chain management
To document the treatment and healthcare service in
the appropriate IT solution(s)
Electronic Health Care Journal
Lab and radiology
5 system areas that support 5 main business areas –we will focus on 1-3
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
Effect Optimizing of resources, re
Reducing buffer capacity
Optimizing patient flow,
Better patient treatment
Overview and accessible
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
”Abstract” – we document
relevant parts of the
System type ex. Booking systems, supply
Sterile central system, task
Clinical logistics, nurse call,
smart phones, etc.
Patient scanning, test and
treatment equipment etc.
journal, Patient admin
systems, acute journal etc.
Technology Optimizing -algorithms Production- and
systems with order entry
architecture, client server
1 Planning 2 Supply chain 3 Execution
Prehospital warning board
Capacity/ resource check
Booking of equipment/Doctors
Patient preparations (depot of
Service assistance ordering.
”Ordering of home care service
Plan for potential further
Reservation of doctor, room, etc.
Equipment preparations (sterile
Transport to next treatment spot
Equipment check /preparation
Transport to pick
Generic patient flow – Acute flow – workshop with emergency department
Patient flow – Acute -clinical input as to logistics flow
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
• Other activities at the moment – besides process group
• 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
“Our patients don’t like
waiting. They wait a lot.”
“People don’t show up,
are late, and mess up
Source: Optiflows / The financial impact of missed appointments in a gastroenterology outpatient clinic and evaluation of preventive strategies, M Pirson & B N’Guama
How might we eliminate waiting
How might we better adapt to our patient’s
How might we achieve more