Optimized value in Healthcare - BMJaws-cdn.internationalforum.bmj.com/pdfs/2016_F10.pdf ·...

Optimized value in HealthcareOur Journey: towards excellent patient outcomes against reasonable costs

Prof. dr. Michael Jacobs

Professor and chairman Department of SurgeryExecutive director Heart+Vascular CenterMaastricht University Medical Center, The Netherlands

Agenda

• Introduction

• Ambitions

• Operational Excellence

• Project outcomes

• Value Based Healthcare

Maastricht University Medical Center

Heart+Vascular Center Maastricht

Our Journey

towards excellent patient outcomes against reasonable costs

2001CENTER OFEXCELLENCEAMBITION

500

QUALITY

• Less incidents

• Better clinical outcomes

• Transparency on outcomes

PATIENT EXPERIENCE

• Less waiting

• Seamless integration of patient appointments

• Better upfront awareness about the individual health journey

EMPLOYEES

• Become an employer of choice

• Employee involvement

COST

• Capacity to cure more patients with same resources

Center of Excellence Ambitions

Center of Excellence Ambition (2)

Phlebology

VASCULARSURGERY

CTCCARDIOLOGY

VASCULAR NEURO-

LOGY

VASCULAR INTERNAL MEDICINE

Sustain European top 10 position in Cardio-

vascular research

Reach top 10 position of best Cardio-vascular

Centers in Europe

Our Journey


2001

2011

CENTER OFEXCELLENCEAMBITION

HOSPITAL WIDEOPERATIONAL EXCELLENCEPROGRAM

Hospital Wide Operational Excellence program:

Becoming a continuous learning organization

2011: Phase 1

pilot

• Pilot projects

• First YB trainings

• Create ambassadors

2012-2013 Phase 2

MDT led deployment

• Best practice visits

• Board trained

• 1000 YB trained

• 70 GB trained

• 3 BB trained

• > 50 projects

2014-present Phase 3

MUMC led deployment

• PMO installed

• 100 Lean managers

• 3000 YB trained

• > 140 projects

• Stable “tools” phase

Hospital Wide Operational Excellence program:

Becoming a continuous learning organization (2)

Ad Hoc(don’t know)

Tools(know how)

System(know when)

Principle(know why)

Time (years)

Matu

rity

Level

Theoretical Model

More likely Model

Some companies

don’t make it

MUMC+

2015

MUMC+

2020

Our Journey


20012012

2011



INTEGRATION OFCARDIOVASCULARSPECIALTIES

Integration of cardiovascular specialties

(Organizationally and Physically

Timelime Partnership Maastricht UMC+ & Medtronic

Outpatient

clinics

Neurology

Cardiology

Cardiothoracicsurgery

Functional examinationsFrom silo-oriented

Heart+

Vascular

Center

Maastricht

Internalmedicine

Dermatology

Vascular Surgery

Patient-oriented

Our Journey


20012012

2011

2014



PARTNERSHIPMEDTRONIC


Medtronic Integrated Health Solutions portfolio

Infrastructure Design and Room Fitting

Capital Equipment Financing, Purchasing

and Installation

Demand Generation

Patient Experience

Ongoing Physician Training

Clinical Service Setup and Expansion

Material Management

Equipment Management and Repair

Planning and Schedule

HR Enablement

Operational Excellence

IT Enablement

Clinical Pathways

TURNKEY SET-UP MANAGE

OPTIMISEDEVELOP

Our Journey


20012012

2011

2014

2015




PROJECTOUTCOMES


Example 1:

Eliminating last-minute cancellations Bypass Surgery

Goal: Increase number of surgeries by eliminating cancellation reasons

Significant increase in # of bypass surgeries

Value:

• Average increase of surgeries: +/- 150 per year > $2M additional revenue

• Reduction of pre-op tests (X-ray): $65K

+ 36%

60% reduction of consultation to

surgery time (green=no rework)

Example 2:

Optimization cardiac diagnostic carepathway

Goal: Improve time to diagnosis of new patients by better patient triage

Validated data by BIM-team, source: SAP

Blood ECG EchoConsul-

tationTreadmill

One stop

shopIntake

From: 2 months and 6 visits To: 2 hours, 1 visit

Value:

• 20% Care Street capacity

• Waiting time reduction

• Patients satisfaction: ↑

• Efficiency-win: $66K

Example 3:

Reducing expendable Echocardiography

# of preventable echo requests reduced…

…waiting list echocardiography

decreases fast

Preventable tests

Value:

• Reduction of echo requests: $156K

Goal: Eliminating expendable functional examinations

Example 4:

Increasing Cathlab utilization

Goal: Improve Cathlab efficiency by installing a holding area and new

planning methods

Significant decrease of cancelled procedures

Validated data by BIM-team, source: Registration forms Cathlab

Year

Cancelled procedures

Pro

ced

ure

s/m

on

thValue:

• Substitution to more complex care

• Reduction of rework: -37%

• Patient privacy by holding area: ↑

P=0.004

Positive trend in plan performance

% realized vs scheduled % realized vs scheduledP-Value = 0,036

- 37%

Pla

n p

erfo

rma

nce

Example 5:

Optimization of out-patient clinic planning capability

Goal: Increase plan capability by integration and standardization of planning

processes

Staff satisfaction improvedPlan productivity per planner doubled

Validated data by BIM-team, source: SAP BW

Value:

• 15% costs savings FTE: $ 120K

Value:

• Staff Satisfaction: ↑

# p

ati

ents

time (months)

# p

atie

nts

time (months) NaVoor

9

8

7

6

5

4

NP

S s

co

re

6,3

7,2

Significant increase NPS project Dedication (P=0,020)

Before After

PROJECTOUTCOMES

CRT Pathway CABG Cardiacrehab

Outpatientclinic

planningCare street

Medicalstaff

support

Echo-cardiography

Call center

cathlabplanning

Length of Stay

# Visits

FTE

# of tests

Utilization of OR / Cathlab

Productivity

Patient Satisfaction

Economic Value (in $1.000) 118 1.850 116 120 66 196 66 122.544

Project results divided over outcome areas

Our Journey


20012012

2011

2014

2015

2016




PROJECTOUTCOMES

VALUE BASED HEALTH CARE


Porter’s value agenda

@ Heart+Vascular Center Maastricht

1. Organize into

integrated care units

(IPU’s)

4. Integrate care

delivery across

separate facilities

5. Expand excellent

services across

geography

3. Move to bundled

payments for care

cycles

2. Measure

outcomes and costs

for every patient

6. Build an enabling IT platform

Measure outcomes and costs for every patient

Relation with operational excellence project outcomes

Outcomes thatmatter to patients

Costs per patient

PR

OJE

CT

PO

RTF

OLI

O

PR

OJE

CT

OU

TCO

MES

= VALUE

VBHC PILOT HVC:TAVI W ho How

Metrics Definition Meetbaar Beter ICHOM BHN MUMC+ Responsible Datasource Timing Step Status N ext Steps

Publications / Impact factor ? ? ? c 1

# of Research projects ? ? ? c 1

Patient Survey ? Questionnaire app? ? 9 1 Questionnaire app?

Partner survey ? Questionnaire app? ? c 1 Questionnaire app?

Patient Satisfaction HAe/MVer Excel file 30 days after OR 9 3 Questionnaire app?

Patient Related Experience Measures (PREMS)Employee Satisfaction ? Questionnaire app? Quarterly? c 1 Questionnaire app?

Clinical Specific data

- hospital data

- Patient questionnaires

All-cause Mortality x x x x WDo SAP BW / Lumira- 3 / 30 /90/ 120 / 365 days after OR

- in hospitalc 4 Dashboard 2.0

Free of valve reïnterventionValve replacement, reparation or

PVL for same valve. x x x x Wdo / Pbar SAP BW / Lumira Function of days since intervention 9 4

Check complication

clustering

Acute renal failure New requirement for dialysis x x x Wdo / Pbar SAP BW / Lumira within 30 days post OR 9 4Check complication

clustering

CVA <72H CVA diagnostes (excluding TIA) x x x x Wdo / Pbar SAP BW / Lumira3 days post OR (MB) reported

at 1-5 years (ICHOM)9 4

Check complication

clustering

PMimpl<30dgnPost-operative implemention of

NEW pacemakerx x x Wdo / Pbar SAP BW / Lumira 30 days post OR 9 1

Check complication

clustering --> Registered?

Vasc VARC-2

Vascular complication. 0: No

complication 1:major 2:minor +

specify what complication

x x x x Wdo / Pbar SAP BW / Lumira within 30 days post OR 9 1Check complication

clustering --> Registered?

Intitial Conditions

Previous (CVA, HeartSurg), age,

sex, EF linkerventrikel,

mintraalklep/nierinsuf, urgentie

x x SAP BW / Lumira 2 1 Definition?

PROMS (SF -36) Kwaliteit van leven x x HAe/Mver/Phun Questionnaire app?- Pre-OR (max 2 months)

- Post OR (between 10-14 monts)2,9 1 Questionnaire app?

PROMS (Specific)= NYHA-

klasseNYHA--score for heart failure x PBar/Phun SaP BW / Lumira

- Pre-OR (max 3 months)

- Post-OR (between 30-60 days)2,9 1 Questionnaire app?

PROMS (Specific)=

Edmonoton Frail Scale

Score per individual question needs

to be registeredx PBar/Phun Questionnaire app? - Pre-OR 2 1 Questionnaire app?

Guideline adherence MVer? ? Quarterly audit? c 1 Questionnaire app?

% Topreferent WDo SAP BW / Lumira Patient contact c 4 Check Definition

Euroscore 1 en 2 WDo SAP BW / Lumira Patient contact 1 4 Euroscore 2?

Production (ZP) Wdo/TJo SAP BW / Lumira Continuous c 4 Dashboard 2.0

Production (Verr) Wdo/TJo SAP BW / Lumira Continuous c 4 Dashboard 2.0

Revenue (ZP) Wdo/TJo SAP BW / Lumira Continuous c 4 Dashboard 2.0

Prevented personnel costs SSch Manually? Quarterly? 1

Prevented material costs SSch Manually? Quarterly? 1

Length of stay WDo SAP BW / Lumira Continuous 3,5,6,7,8 4 Dashboard 2.0

Surgery time WDo SAP BW / Lumira Continuous 4 4 Dashboard 2.0

Access time WDo SAP BW / Lumira Continuous 0,1,4 4 Definition

Number of visits WDo SAP BW / Lumira Continuous c 2 Definition

Total Cost (ZP) WDo SAP BW / Lumira Continuous c 4 Dashboard 2.0

Cost per Patient WDo SAP BW / Lumira Continuous c 4 Dashboard 2.0

Inventory costs ? ? Continuous c 2 SAP BW Budget vs Kosten?

FTE (#,€) WDo SAP BW / Lumira Continuous c 4SAP BW Budget vs Kosten? /

HR?

W henW hyW hat

Direct Cost Savings

(Inventory, Fte)

Value =

Costs per patient

Satisfaction

(Patients, Staff)

Outcomes that matter to patients

Transition To Complexity

(More Complex With Same Staff)

Reputation

(Publications, Brand)

Indirect Cost Savings

(Los, #Visits, Space)

Higher Quality And Performance

(Guideline Adherence)

Increased Production

(Do More With Same capacity)

Prevented Costs

(Prevent Resource Expansion)

Measure outcomes and costs for every patientWhat, why, who, how, when? (e.g. TAVI)

Referral Pt triage /

identification

Surgery Stabilize

at IC / MC

Pre-op

consultation

Admission Discharge

from ward

Follow-up

consultation

Access

time

Euro score Surgery

time

Access

time

Length of

Stay

Initial

conditions:

PROM (sf-

36)

NYHA-class

Edmonton

Frail Scale

Length of

Stay

Length of

Stay

Patient survey

-Patient

satisfaction

-Free of valve

reintervention

-Acute renal

failure

-CVA <72h

-Pmimpl <30dd

-vasc VARC-2

PROMS (sf-36

NYHA-class

Continuous measurement of outcome parameters:

Partner survey, all-cause mortality, guideline adherence

Continuous measurement of process / business parameters

%topreferent, productivity, production, revenue, number of visits, total costs, costs per patients, inventory costs, FTE, employee

satisfaction, research projects, publications.

Measure outcomes and costs for every patient:

next step: automated real time VBHC dashboards

Optimized value in Healthcare

Our Journey: towards excellent patient outcomes against reasonable costs

THANK YOU

Optimized value in Healthcare - BMJaws-cdn.internationalforum.bmj.com/pdfs/2016_F10.pdf ·...

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