Presentation at PSSJD Hospital of the study Hospital of the Future

1. Els Hospitals del Futur
Gabriel Antoja
IESE Business School
Taller d’innovació al PSSJD, 14 de Juny de 2018
Center for Research
in Healthcare
Innovation
Management

3. Las competencias del innovador
3
Asociación
Cuestionamiento
Observación
Experimentación
Networking

4. Enric Barba:
”… la fòrmula 1 …”
The American Society for Quality www.asq.org Page 1 of 5
Making the Case for Quality
Great Ormond Street Hospital for Children:
Ferrari’s Formula One Handovers and
Handovers From Surgery to Intensive Care
Great Ormond Street
Hospital for Children
(GOSH) benchmarked
its handoff from cardiac
surgery to the intensive
care unit against pit
stop techniques of the
Ferrari Formula One
race car team.
Process improvements
resulted in increased
patient safety and
decreased error rates.
This case study is
excerpted from chapter
10 of Benchmarking for
Hospitals: Achieving Best-
in-Class Performance
Without Having to Reinvent
the Wheel, by Victor E.
Sower, Jo Ann Duffy,
and Gerald Kohers.
At a Glance . . .
Seldom does a hospital receive front page coverage in the Wall Street Journal, especially in an article about
Ferrari racing crews, and seldom are a hospital’s physicians invited to speak to boards of directors of multi-
million dollar corporations. Great Ormond Street Hospital for Children (GOSH), London, England, did both.
Why? Because they had successfully benchmarked their handoff from cardiac surgery to the intensive care
unit (ICU) against pitstop techniques of the famous Ferrari Formula One race car team.
About the Hospital
GOSH has long been recognized for its care of children from throughout the world. Founded in 1852
during a time of high infant mortality and malnutrition, GOSH was the first children’s hospital in the
English-speaking world. According to Sir Cyril Chantler, Chairman of GOSH Board of Directors,
“GOSH cannot be average.”1
This echoes the mission of the hospital:
To improve the health of children by being a leading centre of excellence in Europe for special
pediatric services and for research, evaluation, and education in the field of child health.2
The 335-bed hospital has 315 doctors, 900 registered nurses and healthcare assistants, and 135 allied
healthcare professionals, representing the widest range of children specialists under one roof in the
United Kingdom. GOSH is the largest pediatric epilepsy surgery center in the United Kingdom, the
second largest in Europe, the largest unit treating children’s brain tumors (over 100 per year), and the
largest pediatric intensive care unit in the United Kingdom (48 beds, plus eight high dependency beds
and five transitional beds).
The rating of excellent is the highest possible rating given by the independent Healthcare Commission.
Only six trusts out of 157 in the United Kingdom received this rating with GOSH being one. The rat-
ing is based on the level of care delivered to hospitalized children in five areas: access to child-specific
service, access to care near their homes, appropriate levels of trained staff, staff having child-specific
training, and opportunities for staff to maintain their skills.
Why Focus On the Handover?
External and internal drivers made GOSH aware of dangers in handover procedures. In the mid-1990s
in Bristol, England, there was very high mortality for surgery in congenital heart disease followed by
contentious public inquiry. One of the important findings of a subsequent study was that the journey
from the operating room to the intensive care unit (ICU) was high risk. This external environment
impetus to change was followed by an internal driver for change. Interest in human factors led staff
physician, Professor Marc de Leval to question whether staff-related factors, such as exhaustion, were
more important than patient-related factors, such as the position of the coronary arteries. De Leval
reviewed all the arterial switch procedures done in the United Kingdom over a two-year period with
by Victor E. Sower, Jo Ann Duffy, and Gerald Kohers
August 2008

5. IESE Business School
IESE is the Business School of the University of Navarra (Spain):
was founded in 1958 based on an alliance with Harvard Business School
has campuses in Barcelona, Madrid, Nueva York, Munich and Sao Paulo
focuses on Executive Education, “developing and inspiring business leaders”
has an alumni network of +40.000 professionals
has +160 professors of +25 nationalities
has a strong research activity, though its International Research Centers
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Barcelona Campus Madrid Campus

6. CRHIM
Center for Research in
Healthcare Innovation Management
6
… es un centro de investigación del IESE creado en 2012
para la mejora de la calidad de la atención asistencial y
de la sostenibilidad del sistema sanitario mediante la
promoción de la innovación en la gestión
… se centra en el estudio de un conjunto de temas
prioritarios que reflejan los principales retos a los que se
enfrentan los sistemas socio-sanitarios
… combina capacidades de Investigación, Educación y
Consultoría para ayudar a transformar la práctica a través
del análisis, la compartición del conocimiento y el debate.

7. Some CRHIM reports
InnPACT
Healthcare Innovation Impact Study
JAUME RIBERA / MAGDA ROSENMÖLLER / PABLO BORRÁS
Hospital of the Future
Center for Research
in Healthcare
Innovation
Management
A New Role for Leading Hospitals in Europe
Abridged version
Jaume Ribera / Gabriel Antoja / Magda Rosenmöller / Pablo Borrás
7

8. Estudi de l’impacte de la
innovació en salut
8
InnPACT
Healthcare Innovation Impact Study
JAUME RIBERA / MAGDA ROSENMÖLLER / PABLO BORRÁS

9. Valor de la innovación … a partir de la
perspectiva de todos los actores

10. El Hospital del Futuro
Un nuevo rol para los hospitales líderes en Europa
%% % !
10

11. Motivación
¿Una nueva era para los hospitales?
11
“to give a voice to hospital
managers and clinicians about the
challenges and the role of leading
public hospitals in a changing
healthcare ecosystem”

12. Inaugurated in 1940, it is the StockholmCounty
Council university hospital
Budget in 2014: €1,7 billion
1,700 beds
109,000 inpatient admissions
15,000 employees
2,200 scientific articles per year
Founded in 1906, as community hospital for
300,000 inhabitants in Barcelona
Budget in 2010, €450million
850 beds
46,000 inpatient admissions
4,500 employees
1,005 scientific articles per year
Excellence in results
Range and complexity of services
Reference and support role
Innovation and adaptation
Industry recognition
Our associates in this study:
Leading Hospitals
12

13. Metodología del estudio
13
Literature
review
Conceptual Framework 14 key messages
76 study findings
Individual
Interviews
Individual
Interviews
Mapping
and analysis
Review findings
and debate
Review findings
and debate
Processes
Results
Value
Creation
Resources
Capabilities
Final
conclusions

14. Innovation Competencies for
Leaders
Innovation
Creativity
Enterprising
Integrating
Perspectives
Forecasting
Change
Management
# $
!

15. Probabilidad e Impacto
de los cambios
15
01 Life expectancy will grow
02 Demand services will grow
03 Chronicity costs will grow
10 Patients in the
design of healthcare
12 Health expenditure
will decrease
26 Focus on complex services
40 Process-oriented teams
45 New generation of IS
67 Outcomes-based indicators
IMPACT
LIKELIHOOD
4. VERY LIKELY
2. UNLIKELY
4.
VERY
HIGH
3.
HIGH
2.
LOW
3. LIKELY

16. 1. EL TRIPLE RETO
EN EL CONTEXTO HOSPITALARIO
Los hospitales líderes en Europa tendrán que lidiar en un contexto difícil,
que combinará un incremento en las necesidades sanitarias, una reducción
de recursos y un cambio en los valores sociales.
16

17. 2. HOSPITALES “MÁS PEQUEÑOS”
Y MÁS COMPLEJOS
Se espera que los hospitales líderes se enfoquen en proporcionar servicios
de alto valor y alta complejidad y que consigan altos niveles de eficiencia
sin necesitar grandes volúmenes de actividad.
17

18. 3. HOSPITALES OFRECIENDO UNA NUEVA
GAMA DE SERVICIOS ASISTENCIALES
Los hospitales líderes incorporarán nuevos servicios como la medicina
personalizada, los diagnósticos sobre genoma, y servicios extendidos como
la gestión de la atención crónica.
18

19. 4. ORIENTACIÓN DUAL DEL HOSPITAL:
TERCIARIO Y TERRITORIAL
Los hospitales líderes tendrán que combinar la prestación de servicios
complejos a los pacientes derivados y la provisión de servicios agudos y
crónicos a los pacientes de su área de influencia.
19

20. 5. EL HOSPITAL REDISEÑANDO LOS
SERVICIOS EN BASE AL CONOCIMIENTO
El conocimiento de los hospitales líderes jugará un papel esencial en la
planificación y el rediseño de servicios de atención sanitaria.
20

21. 6. HOSPITAL COMO UNA ORGANIZACIÓN
ABIERTA Y DISTRIBUIDA
Los hospitales líderes no se definirán en función de sus estructuras físicas
y se organizarán para poder proveer servicios en distintas ubicaciones y
entornos.
21

22. 7. CENTROS DE INNOVACIÓN EN
TECNOLOGÍA Y SERVICIOS
Los hospitales líderes serán centros de referencia para el diseño de
servicios de atención de salud y para la innovación de procesos y
tecnologías.
22

23. 8. LA INVESTIGACIÓN Y LA DOCENCIA
COMO RESULTADOS CLAVE
Los hospitales líderes seguirán siendo los núcleos principales de
investigación, docencia y educación de nuevos profesionales, generando
nuevos conocimientos y capacidades.
23

24. 9. MODELOS DE COMPARTICIÓN DE
RIESGO Y VALOR CON OTROS ACTORES
Los hospitales líderes desarrollarán nuevos modelos de riesgo compartido
con aseguradoras, servicios nacionales de salud, industria y otros
proveedores.
24

25. 10. LOS PROFESIONALES PARTICIPAN
EN EL GOBIERNO DEL HOSPITAL
Los profesionales del hospital participarán activamente en la definición de
la estrategia y ocuparán posiciones de liderazgo de la institución.
25

26. 11. INTEGRACIÓN DE LA ATENCIÓN Y
EQUIPOS ORIENTADOS A PROCESOS
Los hospitales líderes se organizarán por equipos orientados a procesos y
se orientarán a la creación de modelos de atención integrados
(virtualmente o por fusión de instituciones).
26

27. 12. HOSPITALES CONECTADOS
La mejora de la experiencia del paciente nos conducirá a hospitales
conectados donde los gestores de casos se conectarán con otros
profesionales para coordinar la atención del paciente en su domicilio.
27

28. 13. NUEVAS PROFESIONES
Los hospitales líderes necesitaran “coaches” de salud, consejeros
genéticos, gestores de casos para enfermedades específicas, expertos en
gestión de información, ingenieros de la salud, etc. y las asignaciones de
competencias a las profesiones actuales deberán redefinirse.
28

29. 14. INNOVACIÓN SISTEMÁTICA
CENTRADA EN EL PACIENTE
Los hospitales líderes rediseñarán de manera sistemática su experiencia de
servicio para el paciente y otros clientes con innovación realmente
centrada en el paciente.
29

30. EXPERIENCIA DEL PACIENTE
What do people want from their
health care?
!
#
!
#
30

31. 1
2
CENTRADO EN EL PACIENTE
DESIGN THINKING IN HEALTHCARE
Source: IDEO
https://www.ideo.com/post/design-kit 31

32. INNOVATION COMPETENCIES
OF LEADERS
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Opportunity
recognition
Conveying a
compelling vision
Maintain focus /
Adapt Resilience
Interdisciplinary
teamwork and
collaboration
Opportunity
assessment
Building and using
networks
Self-efficacy /
Confidence
Tenacity and
perseverance
Understanding of
healthcare systems
Ability to leverage
resources /
Bootstrapping
Risk management /
Mitigation
Creativity problem
solving /
Imaginativeness
Guerrilla skills /
Unconventional
approaches
Design thinking
Change
management
Cross-disciplinary
knowledge
Information
management
Behavioural
economics

33. TAKE-AWAY ...
33
SMALLER AND MORE COMPLEX PROCESS-ORIENTED TEAMS
PATIENT-CENTERED SERVICES
CONNECTED HOSPITALS

34. Moltes gràcies!
www.iese.edu/crhim
Gabriel Antoja
gantoja@iese.edu
34