OPTIMIZINGOPTIMIZING QUALITY FOR BETTERBETTER PATIENTPATIENT OUTCOMES

DOMINIK RETERSKIVICE PRESIDENT, QUALITY AND REGULATORY AFFAIRS

27 September 2016

AFFAIRSASIA PACIFIC

WHYWHYAREARE WE HERE?WE HERE?

A LEGACY OFA LEGACY OFPARTNERSHIPSS

BROKEN EQUIPMENT WASEQUIPMENT WAS SLOWING DOWN HOSPITALSHOSPITALSUNTIL WE OFFEREDOFFERED FAST REPAIRS

WHEN A DOCTOR WANTEDWANTED TO SAVE MORE LIVESMORE LIVES,WE COLLABORATEDCOLLABORATED TO DEVELOP ALIFESAVINGLIFESAVING THERAPY

OUR MISSION

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OUR MISSIONTENET 3TENET 3

“To strive without reserveTo strive without reserve for the greatest possible reliability and quality in our products; to be theour products; to be the unsurpassed standard of comparison and to be

i drecognized as a company of dedication, honesty, integrity, and service.”

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SO WHATSO WHATDO WE DODO WE DO ABOUTABOUT QUALITY?

MEDTRONIC’S FOCUS ON QUALITY

MEDTRONICQUALITY IMPERATIVES

MEDTRONIC STRATEGIESTherapy

Innovation

GlobalizationPRODUCT SUPERIORITY

EFFECTIVE AND

MINDSET OF EXCELLENCEGlobalization SUPERIORITY

Providing products of highest quality

AND EFFICIENT COMPLIANCEComplying with applicable

EXCELLENCEIngraining a proactive and patient-centric quality culture

Economic Value

quality and reliability

applicable regulations efficiently

quality culture and quality talent management

Be known as a trusted partner by living up to stakeholders’Be known as a trusted partner by living up to stakeholders expectations, continuously improving our quality culture, and upholding our commitment to the Mission.

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GLOBAL QUALITY5 STRATEGIC PILLARS5 STRATEGIC PILLARS

PRODUCT EFFECTIVE & MINDSET OFPRODUCT SUPERIORITY EFFICIENT

COMPLIANCE

MINDSET OF EXCELLENCE

2 3 4 51 2 3 4 51

DESIGN MANUFACTURE SUPPLIER VIGILANCE & COMPLIANCE

ORG CAPABILITY& CULTURE

Design, Reliability, Manufacturability (DRM) Operations in Product

Development

Medtronic Operating System (MOS) Workflow maturity

(WFM)

Supplier Quality improvement CM/OEM Quality

Improvement Strategy

Acquisition Excellence MCARE Global QMS

Simplification &

Quality Begins with Me Efficiency & Quality cost

reductionDevelopment Design for Cell

Operating System (DFCOS)

(WFM) Cell Operating System

(COS) First Time Quality (FTQ)

Improvement Strategy Simplification & Standardization

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QUALITYQUALITYBEGINSBEGINSWITH MEWITH ME

QUALITY BEGINS WITH MEOUR EMPLOYEES PLEDGE TO BEOUR EMPLOYEES PLEDGE TO BE….

PATIENTCOURAGEOUSWe all speak up when we notice

PREVENTIVEWe all share and implement ideas to

PATIENT-FOCUSEDWe all understand

ACCOUNTABLEW llwhen we notice

something wrong and have a blame free environment

implement ideas to continuously improve processes and procedures

We all understand how our actions affect patients.

We all are accountable to deliver on our

it tfree environment. and procedures. commitments.

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MITG QUALITY AND OPERATIONAL PERFORMANCE

7000.04.3

QIP Score vs. DPM - MITG Sites QIP Total DPM Total

98.90%4.3

QIP Score vs. FPY - MITG Sites QIP Total FPY Total

4.03.9

4.0

5000 0

6000.04.0

4.03.9

4.098.80%

98.85%

4.0

3.7 4000.0

5000.0

3.8

smen

t Sco

re

3.7

98 65%

98.70%

98.75%3.8

smen

t Sco

re

3.32000.0

3000.0

3.3

3.5

Ass

ess

3.3

98.55%

98.60%

98.65%

3.3

3.5

Ass

ess

0.0

1000.0

3.0

3.3

2 3 4 5 798.45%

98.50%

3.0

3.3

2 3 4 5 7

QIP – Quality Improvement ProgramDPM – Defects Per Million FPY – First Pass Yield

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FPY First Pass Yield

HOSPITALHOSPITAL SOLUTIONSSOLUTIONSIMPACT ONIMPACT ON QUALITY AND SAFETY

QUALITY CHARACTERISTICSLINKED TO QUALITY REQUIREMENTS IN HEALTHCARE*LINKED TO QUALITY REQUIREMENTS IN HEALTHCARE

Appropriate; correct care Availability Continuity of

Care

Effectiveness Efficiency EquityEffectiveness Efficiency Equity

Evidence / PatientEvidence / Knowledge

Based

Patient –Centered

CarePatient

involvement

Patient Safety

Timeliness/ Accessibilityy y

EN 15224:2012

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INTEGRATED HEALTH SOLUTIONSDESIGNED FOR HIGH QUALITY CAREDESIGNED FOR HIGH QUALITY CARE

Provide Manage

TURNKEY SET-UP MANAGE

affordable access to state-of-the-artinfrastructure and

technologies

non-clinical operations to enable focus on patient care

DeliverAccelerate Deliver best-in-class cost efficiency and patient

Accelerate patient access

to care; develop

services and and patient outcomes

services and enhance

reputation

OPTIMISEDEVELOP OPTIMISEDEVELOP

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CUSTOMIZED OFFERINGSTO MEET INDIVIDUAL NEEDSTO MEET INDIVIDUAL NEEDS

Infrastructure Design and R Fitti

Material ManagementRoom Fitting g

Equipment Management and RepairTURNKEY

Capital Equipment Financing, Purchasing and

Installation

Planning and Scheduling

SET-UP MANAGE

Demand

HR Enablement

Generation

Patient Experience

Operational Excellence

Ongoing Physician Training

IT EnablementOPTIMISEDEVELOP

Clinical Pathways

Clinical Service Setup and Expansion

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IHS SOLUTIONS AND IMPACTON QUALITY & SAFETY REQUIREMENTSON QUALITY & SAFETY REQUIREMENTS

BEST BEST POSSIBLEBEST POSSIBLE

BEST POSSIBLE SHARED RISK &

REWARDOUTCOMES REWARDSupport hospitals,

physicians payers and health

Tailored solutions which help clients optimize their

physicians, payers and healthsystems to deliver high-qualitycare in a cost-effective way.

help clients optimize their outcomes enabling them

to :

The business model is thereforebased on taking an active role

with long-term partnerships

Improve quality of care

that hinge on risk- and value sharingscheme.

Enhance operational

performance

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p

Boost financial returns

EXAMPLES OF ENHANCEMENTS

Raised awareness of Quality & Safety standards among clinical personnel

Assigned Quality & Safety responsibilities in the clinical team

INCREASE AWARENESS QUALITY &SAFETY

Support the hospital with the creation improvement and

g y y p

Included Quality & Safety topics in team meetingsSAFETY

Support the hospital with the creation, improvement and implementation of hospital protocols and guidelines

Improve adoption of Radiation Protection protocols; i

HOSPITAL PROTOCOLS / raise awareness

Ensure that protocols are followed with the hospital’s Point of Care and implement training and allocation of responsibilities

d t k

PROTOCOLS / GUIDELINES

and tasks

DOUBLE CHECK Implementation of a double check procedure to track complianceDOUBLE CHECK PROCEDURE

Implementation of a double check procedure to track compliance with protocols and guidelines

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EXAMPLES OF ENHANCEMENTS

EXTERNAL ASSESSMENT Use of external expertise to assess the Hospital’s Q&S framework from the external accreditation point of viewQ&S FRAMEWORK from the external accreditation point of view

Implementation of internal audits

Implementation of a protocol for external audits / inspectionsAUDITS Implementation of a protocol for external audits / inspections

Support the hospital with the execution of external audits / inspections

AUDITS

TRAINING / EDUCATION

Creation of a training curriculumEDUCATION

Implementation of a training matrix for the hospital staff

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EXAMPLES OF ENHANCEMENTS

CLINICAL INCIDENTS Raise awareness on the better capturing of clinical

incidents

Improve reporting on failed products Improve reporting on failed products

PATIENT SATISFACTION Pilot Patient Satisfaction Survey and presentation of results to the hospital for improvement purposes

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OPERATIONAL EXCELLENCE

Operational excellence consulting services are offered to boost operationalOperational excellence consulting services are offered to boost operational and cost efficiencies while maintaining or improving quality of care.Typical solutions components offered are:

Lean Sigma Academy: to build strong Lean Six Sigma skills and competencies in the hospital and embed continuous improvement capabilities;

Benchmarking services assessing performance against national and international peers and defining best-in-class level targets;p g g ;

Optimization of operational processes, workflows, patient pathways and information systems, incorporating international best-practices;

Develop performance management systems measuring costs andDevelop performance management systems, measuring costs and performance against outcomes and patient satisfaction during the contract period.

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OPERATIONAL EXCELLENCEMAKES AN IMPACT ACROSS THE CARE CONTINUUMMAKES AN IMPACT ACROSS THE CARE CONTINUUM

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LEAN ACADEMYCREATING ENGAGEMENT AND CHANGE CULTURECREATING ENGAGEMENT AND CHANGE CULTURE

TRAINING in Lean Thinking for all levels

PRACTICE from daily improvementThinking for all levels

from work floor to C-suite

from daily improvement to cross departmental projects

REFLECTION AND COACHINGREFLECTION AND COACHING by experienced Medtronic Master Black Belts

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DEVELOP

PATIENT EXPERIENCE Equip clinical staff with tools and advisory services to embed patient

experience best-practices into current daily practice

ONGOING PHYSICIAN TRAINING Ensure all personnel are up to date on clinical knowledge in a context of time

and resource constraintsand resource constraints

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TURNKEY SET-UPSTATE -OF -THE ART FACILITIESSTATE OF THE ART FACILITIES

Access to and guidance on best design and technology to support clinical needs and workflow

Continuous R&D and implementation of state-of-the-art techniques( f b i t d l ti b t i l f )

QUALITY

(e.g., pre-fabricated panels, anti-bacterial surfaces)

Experienced local project managers oversee and manage entireRELIABILITY Experienced local project managers oversee and manage entire turnkey project to ensure on-time and on-budget execution

Regional expertise to ensure adherence to local codes and regulations

RELIABILITY

g

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END-TO-END MANAGEMENT OF CONSTRUCTIONAN EXAMPLE: HYBRID OR AT CASA DI CURA COLUMBUSAN EXAMPLE: HYBRID OR AT CASA DI CURA COLUMBUS MILANO

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CASECASE STUDIESSTUDIES

CASE STUDY: IMPERIAL COLLEGE

C S SHEALTHCARE NHS TRUST, UKIMPACT

Cardiology transformation program

5 CathLabs refurbished and under maintenance contract

Vendor-independent material management

4 experienced CathLab & inventory managers on-site

Operational Excellence programs

Lean Academy training: change management and knowledge transfer program to embed continuous improvement capabilities

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CASE STUDY: SACCO HOSPITALSACCO HOSPITAL, MILAN, ITALY

IMPACT

Efficiency and cost savings through consolidation of multiple supplier contracts into a simple service arrangementsupplier contracts into a simple service arrangement

Reduced risk and maximising uptime and availability of high-value equipment and devices

CAPITAL INVESTMENT.

Reduced procedure costs through access to higher buying power

Efficient operations management experienced staff andEFFICIENCY GAINS.FOCUS ONFRONTLINE CARE.

Efficient operations management, experienced staff and uncompromising professionalism

Reduced waste level and obsolescence rate

Responsive and convenient single point of contact for all maintenance issues

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CASE STUDY: MAASTRICHT UNIVERSITY MEDICAL CENTER, THE NETHERLANDSIMPACT

Heart + Vascular Center: Five-year partnership started in 2014 including:including:

Operational excellence programs

Optimization of clinical pathways Optimization of clinical pathways

- Heart Failure and Cardiac Resynchronization Therapy (CRT)

- Bypass Surgery (CABG)

Onsite management of CathLab operations

- Managing daily operations

- Optimized planning and scheduling

Hospital-wide:

Lean Academy training to embed continuous improvement capabilities

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LET’S TAKELET S TAKE HEALTHCAREHEALTHCARE FURTHERFURTHER, TOGETHERTOGETHER

THANK YOUOU