Creating
disruption
Nigel Edwards
Healthcare Expert, KPMG
Senior Fellow, The King’s Fund
Honorary Visiting Professor, London School of Hygiene & Tropical Medicine
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Sources of disruption
Process changes
Changing how assets are used
Changing systems
Strategic choices
Patients & communities
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Odd design rules
■ Organise around
– Medical disciplines not patient problems
– Individual events
■ Disconnected from primary and home care
■ Treat repeat admissions as a surprise
■ The sickest patients see the most junior doctor
■ Batch and queue systems
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Flow rules
■ Treat each episode as a single (surprising event)
■ Anticipate need and manage years of care
■ Treat patients as though their time is free
■ Eliminate wasted time and travel
■ Move patients
■ Move staff and information
■ Batch and queue
■ Patients flow through the system
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New rules…
■ Most things stop at the weekend
■ Senior presence available 7 days
■ Specialists manage patients
■ Reinvent the generalists, specialists provide advice to generalists
■ Management is a cost
■ Invest in high quality management
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Sources of disruption
Process changes
Changing how assets are used
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Buildings
Use other people’s buildings
Let other people use your buildings
New building methods for rapid construction at low cost
Hybrid construction is an advanced form of
facility construction in which a building is built
partly using traditional building methods and
partly built using three-dimensional sections (or
modules) which are built and fitted out
completely off-site under factory production
line conditions.
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
7
Royal Liverpool Children's Hospital
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Workforce
Work design
Approach 1: ensure staff roles exactly match the job to be done, reduce the skill levels
Approach 2: extend the roles and scope of staff and let them work across a range of
tasks but as close to the top of the their licence as possible
Remove administrative tasks
Invest in teams & teach them improvement methods
Use technology to support and smooth workflow
Develop new roles and new rules
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
New process rules
■ Escalate up from junior to senior
■ See someone senior and delegate
■ See a doctor
■ See the most appropriate professional
■ Skill down – dilute the skills on wards
■ Make sure the right skills are present
■ Staff develop work-arounds for problems
■ Staff participate in finding the root cause
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Knowledge, data and analytics
• Workflow management
• Remote consultation
• Collaboration tools
• Knowledge management
• Predictive analytics
• Big data
• Mobile
1. Big Data leveraging heterogeneous sources
2. Move to Hybrid and Public Cloud exchanges
3. Advanced Patient Connected Health services
4. Evolution to Portals 3.0 (adding Collaboration)
5. Mobility for consumers and providers
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
TIME
By 2015 there will be 7.4 billion wireless devices
in the market.*
1.2 billion smartphones will enter the market over
the next five years, about 40% of all handset
shipments.*
Smartphone adoption growing 50%+ annually.**
Currently 16% of mobile data is diverted to Wi-Fi,
by 2015 this will number will increase to 48%.*
In 2013, more than 50% of mobile devices will ship
without wired ports.***
Source: *ABI Research, **IDC, *** Morgan Stanley Market Trends 2010
Mobility Changes Everything especially for healthcare . . . Driving
Data into real time
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Sources of disruption
Process changes
Changing how assets are used
Changing systems
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Systems are changing
Integration Networks
Primary care
redesign
Centralisation &
deconcentration Dis-
intermediation
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Steps towards value based payment
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Build a strong primary care platform
■ Manage patient and population health
■ From isolated individual businesses to federated networks or unified
providers
■ Wrap community services around them
■ With specialist input
■ Build networks with social care
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From this
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
To more like this
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Integrate the specialists
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Add multidisciplinary support
Community nursing
OT, Physio & other AHPs
Telephone support
Mental health
Social work
Housing and benefits
Voluntary sector
Etc.
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Sources of disruption
Process changes
Changing how assets are used
Changing systems
Strategic choices
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Dimensions of strategic choice
Acute providers face a number of strategic choices at
present, these will vary by specialty and are shown in the
diagram, they are:
• How far the current delivery model is appropriate and
whether new approaches area required
• Whether there is scope to offer services to new markets
• Whether to extend provision up or down the pathway or
to be the lead provider for some pathways
• How to drive the change process – should it be
incremental or more radical
• The extent to which a hospital has a particular focus
Models of
care
Markets
served
Role in the pathway
Pace of change
Current Model New Approach
Current New
Component
provider
Own the whole
pathway
Incremental
improvement
Rapid and
Radical
Change
Focus
Local Specialist
Decisions also to be made about:
Owner………contractor
Sole provider……..Partner
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Sources of disruption
Process changes
Changing how assets are used
Changing systems
Strategic choices
Patients & communities
23 © 2012 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Specialty Hub
w/ primary
care Primary
care with
ancillaries Micro-
Clinics
Mobile
Services
Employer
Clinics
Web Capital Investment
Resource Intensity
Length of Implementation Low
High
•New venues to access healthcare
•Changing paradigm of time and distance
•Personal technology
Tele-
medicine
Micro-
Hospital
Hospital w/
hospital based
specialty care
Kaiser Permanente – Coordinating Care
in Many Settings
Home as
the Hub
Mobile
Health
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Patients and communities
■ Patients and their networks as a source of value
– Self service
– Co-production
– Informed decision making
– Goal oriented medicine
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From God to Guide – ParkinsonNet
5 design criteria:
Helping to create an active patient able to
manage their care and take key decisions
Defining what value based care would look
like from the perspective of the patient
Changing the way that doctors and other
clinicians work with patients by shifting to a
partnership approach
Creating a network of experts
Linking all of these together with information
technology tools
Bas Bloem created
ParkinsonNet: a
revolutionary partnership
approach involving
Parkinson’s patients in
the Netherlands, leading
to a 50% reduction in
associated hip fractures
and €20 million worth of
savings.
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member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
Community engagement
Community development and activation
Using volunteers and communities to deal with social isolation and anxiety
Making decisions about resource allocation and design
Creating an orientation towards health improvement
© 2012 KPMG LLP, a UK limited liability partnership,
is a subsidiary of KPMG Europe LLP and a member
firm of the KPMG network of independent member
firms affiliated with KPMG International Cooperative,
a Swiss entity. All rights reserved. Printed in the
United Kingdom.
The KPMG name, logo and "cutting through
complexity" are registered trademarks or trademarks
of KPMG International.