the future of university hospitals : standing alone together...the future of university hospitals :...
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The Future of University Hospitals : Standing Alone Together
Marc Noppen, MD,PhD
CEO, UZ Brussel
The Role of UH’s in the current system
• Unique and systemically integrated triple role of care ( including “basal” care!), research (translational and clinical), and training
• “Design” comparable with most other EU and USA systems ( basal & referral care , dual financing for clinical & academic role, #/pop,...)
• 15% of “hospital market”, 80% of clinical studies
The Role of UH’s in the current system
• Characteristics, challenges, features..:– Budgettary pressure↑(Antares!)
• For profit & back• Loss of independence• Loss of attractivity
– Free choice, competition, lack of compulsary stearing• “Free” networking = € competition• Triple assignment = undiviseable, and leads to
– Quality• Accreditation, first use, innovative treatments, systemic integration
– Independence• Academic & clinical governance ; fixed income staff
– Valorisation• Economically, societal
– Multidisciplinarity• Within care, between disciplines
20%
6% 6%
9% 9%
34%
9%
20%
0%
5%
10%
15%
20%
25%
30%
35%
Duitsland Canada(Québec)
Denemarken(RH)
Spanje Frankrijk Nederland Zweden(Scanie)
Zwitserland(CHUV)
België
4,6%
The Role of UH’s in the current system
• Characteristics, challenges, features..:– Budgettary pressure↑(Antares!)
• For profit & back• Loss of independence• Loss of attractivity
– Free choice, competition, lack of compulsary stearing• “Free” networking = € competition• Triple assignment = undiviseable, and leads to
– Quality• Accreditation, first use innovative treatments, systemic integration
– Independence• Academic & clinical governance ; fixed income staff
– Valorisation• Economically, societal
– Multidisciplinarity• Within care, between disciplines
Hospital Networks – federal & regions
Focus on CARE in
horizontal networks
Focus on specialisation
in clinical networks
Clinical Networks :
Medical Offer
Subsidiarity Principle
Care- and task distribution in continuity
Can change over time
Architecture
• 25 locoregional “basic care”hospital networks in Belgium
• Each serving a 400-500.000 population
• Bottom up approach with (very) little governement framework
• Complementary portfolio within a network
• Supra-network collaborations in referral care
• Programming ( and financing) would follow...
• “Light” governance models
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Considerations
Planability
TechnologyCritical
mass
Prevalence
ContinuityDistance
timeMobility
Manpower
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Ziekenhuizen gaan eindelijk samenwerken
Elk puntje staat voor een campus, de zone errond geeft weer voor wie dit het dichtsbijzijnde ziekenhuis is. Die zones geven we vervolgens een kleur om aan te duiden tot welk (potentiëel) samenwerkingsverband een ziekenhuis behoort. U kunt met uw muis over een zone bewegen om te zien over welk ziekenhuis het gaat. Let op: in de regio Brussel – Halle – Vilvoorde gaat het momenteel nog over aftastende gesprekken. Voor de regio Oudenaarde – Ronse zijn er nog geen gesprekken gestart, de ziekenhuizen sluiten zich wellicht aan bij een ander netwerk
(Supra) regional networking : “R” or “U”
Referral/U networking
• Informal formal
• Across basal care hospital networks
• No strict programming/regulation of “R” or “U” functions and services ( which really should be defined...)...basal care programming will start with Maternity, Pediatrics, A&E, Stroke, Radiotherapy, Low Volume surgery
• …awaiting regulation and decree’s…sometime...
Inter-university collaboration
• Informal formal
• In general: “light”
• Specific area’s ( rare diseases, research collaborations, protontherapy, biobanking, genetics, case-by-case issues,…)
• “everybody keeps on doing everything”
But…
• Why “networking” ?
• Is networking a goal or a means?
• What’s the difference between networking and collaboration?
• What’s the science behind networking?
• ...
Berwick, Nolan & Whittington, Health Affairs 2008;27:759-69
No more Business as Usual in the current “Healthcare System”
Five disruptive forces:
– The Greying patient ( and Provider…)
– The Lifestyle Epidemic
– The Information Revolution
– The Blessing and Curse of Technology
– The New Health Care Consumer ( and Provider...)
...which has reached its limit, and where spending yet more money is insane...
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…where 1 out three dollars/euro’s/…spent is pure waste…
…where 50 % of the total budget is spent on 5% of the population…
= “networks”
( or rather :
“Integration”)
How to maximize value for patients in the HC system
Volume-based Value-based
Payment FFS Outcome based
Incentive Volume Value
Focus Acute episodes Populations
Role of provider Single episodes Care continuum
Information Retrospective Real-time & predicitve
Leadership style Managerial divisional/departemental thinking
Thinking across organisation
How to maximize value for patients in the HC system
Volume-based Value-based
Payment FFS Outcome based
Incentive Volume Value
Focus Acute episodes Populations
Role of provider Single episodes Care continuum
Information Retrospective Real-time & predicitve
Leadership style Managerial divisional/departemental thinking
Thinking across organisation
= “networks” ( or rather :
“Integration” )
= “networks”
Or rather:
“Integration”
Netwerking : the New Holy Grail..?
The Hospital of the Future is a Network
•Published on February 17, 2017185
Jeroen Tas
Chief Innovation & Strategy Officer at Philips
Connecting Care for Continuous Hlth
Hospital networks: quo vadis?
Message here :
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Braithwaite et al: Complexity Science in Healthcare. Aspirations, approaches, applications and accomplishments. A White Paper. Australian Institute of Health Innovation.
The major problem with the healthcare system, is that it is not really a “system”
Traditional Systems
• Improvement by decomposing performance and management into component elements, and subsequently recomposing it by integrating the designed solution for each element
• Chaacteristics:– Ability to de- and recompose the
elements of the system; “designed”– Linearity, predictability, “dead”– Can be complicated, but not
“complex”– Power with authority and resources
to (re)design the system– Works well in automotive,
manufacturing, retail,…
CAS
• Can NOT be addressed thru hierarchical de/recomposition!
• Characteristics:– Non-linear & dynamic : system behaviour
may appear to be random/chaotic– Composed by individual agents who’s
behaviour is based on physical, psychological, or social rules rather than on demands of the system
– Agents are often conflicting and intelligent : the overall system behaviour learns and adapts
– Hence may lead to self-organisation : patterns emerge rather than being designed
– No single point of control : no one is in charge
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What is missing today...
• The realization and acceptance of “Healthcare” as being a CAS (Complex Adaptive System ) with it’s own governing laws
• Hence in need for a longterm purpose (“Ikigaï”) and design, and allowing the role of Serendipity
• If Integrated Care is that purpose, the obvious first step is...(re)integration
• Hence, “networking” is (only) a means, not a goal• The human factor : “collaboration”, “networking”,…
is foremost dependent on human interaction (sometimes two are sufficient…)
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“Personal
Ikigai”
“Public
Health
Ikigai”
DENK EN DIALOGEER MEE!
…