PRIVATKLINIKGRUPPE HIRSLANDEN
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1 SÉMINAIRE PRATIQUE SANTÉ 2018 BENCHMARK AND BEST PRACTICE IN AN INTERNATIONAL HOSPITAL GROUP PRIVATKLINIKGRUPPE HIRSLANDEN DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN PRIVATE HOSPITAL GROUP I. HIRSLANDEN PRIVATE HOSPITAL GROUP II. MEDICLINIC INTERNATIONAL III. INTERNATIONAL WORKSTREAMS IV. CASE EXAMPLE Privatklinikgruppe Hirslanden 1
2 SÉMINAIRE PRATIQUE SANTÉ 2018 BENCHMARK AND BEST PRACTICE IN AN INTERNATIONAL HOSPITAL GROUP PRIVATKLINIKGRUPPE HIRSLANDEN DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN PRIVATE HOSPITAL GROUP I. HIRSLANDEN PRIVATE HOSPITAL GROUP II. MEDICLINIC INTERNATIONAL III. INTERNATIONAL WORKSTREAMS IV. CASE EXAMPLE Privatklinikgruppe Hirslanden 2
3 HIRSLANDEN PRIVATE HOSPITAL GROUP AT A GLANCE 1/2 Key Figures 2016/17 Hospitals (as of 1 July 2017) 17 in 11 Cantons Patient days 2, Affiliated doctors (as of 1 July 2017) Newborns Employees (including employed doctors) (as of 1 July 2017) Length of stay days Patients Turnover CHF m Key Figures as of: 31 March 2017: 1 Inpatient admissions, without newborns / 2 Adult and maternity patients, source H+ / 3 Average in days, source H Hirslanden International Hospital Group 3
4 HIRSLANDEN PRIVATE HOSPITAL GROUP AT A GLANCE 2/2 24% Basic 45% Semi-private Private 31% Hirslanden International Hospital Group 4
5 HIRSLANDEN PRIVATE HOSPITAL GROUP MEDICAL NETWORK Hospitals Outpatient clinics Radiology institutes Radiotherapy institutes Aarau Bern Biel Cham Zug Geneva Heiden Lausanne Lucerne Meggen Basle Münchenstein Schaffhausen St. Gallen Zurich Lucerne Bern Schaffhausen Düdingen Aarau Bern (2) Biel Cham Zug Düdingen Lausanne (3) Lucerne (2) Basle Münchenstein St. Gallen Zurich (3) Aarau Lausanne Männerdorf Zurich Hirslanden International Hospital Group 5
6 FIN FINANCES POT POTENTIALS PRO PROCESSES. MCP MARKET, CUSTOMERS, PARTNERS. HIRSLANDEN PRIVATE HOSPITAL GROUP STRATEGY HIRSLANDEN PATIENTS FIRST! THE INTEGRATED HEALTHCARE GROUP WITH A SYSTEM, MAKING AN IMPACT. BSC2 FOCUS QUALITYSAFETY/ PATIENT BENEFIT Patient safety ensured through excellence in our structures, processes and indication quality. BSC3 FOCUS PRODUCTIVITY Patient mix ensured by actively managing partnerships and networks. GROW2020 BSC5 FOCUS GROWTH Business areas from adjacent fields generate additional revenue. BSC12 Patient steering through direct customer contact. BSC4 Service differentiation per insurance class secured in relation to infrastructure, services and processes. BSC6 BSC7 Affiliated doctors (new) are acquired through attractive offers and existing ones are retained. Hospital positioning by strengthening the local market position. BSC8 BSC10 Medical system provider model implemented. Medical staff ensured through appropriate and actively managed partnerships. HIT2020 BSC9 WE2020 BSC11 Process-, organisation- and system-level implementations for optimal support of the primary process. Group identity established through a culture of thiniking and acting as a group. BSC1 Cost-effectiveness ensured by reaching targeted margin. CUSTOMER ORIENTATION TRUST AND RESPECT PERFORMANCE ORIENTATION TEAM ORIENTATION EXCELLENCE
7 SÉMINAIRE PRATIQUE SANTÉ 2018 BENCHMARK AND BEST PRACTICE IN AN INTERNATIONAL HOSPITAL GROUP PRIVATKLINIKGRUPPE HIRSLANDEN DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN PRIVATE HOSPITAL GROUP I. HIRSLANDEN PRIVATE HOSPITAL GROUP II. MEDICLINIC INTERNATIONAL III. INTERNATIONAL WORKSTREAMS IV. CASE EXAMPLE Privatklinikgruppe Hirslanden 7
8 MEDICLINIC INTERNATIONAL HIRSLANDEN AND MEDICLINIC 1/2 Minority holding (30%) Mediclinic Southern Africa operates 52 hospitals. Beds: Hirslanden operates 17 hospitals and 4 outpatient clinics. Beds: Mediclinic Middle East operates 5 hospitals and 29 specialised clinics. Beds: 714 Spire Healthcare operates 39 hospitals and 13 specialised clinics. Beds: Hirslanden International Hospital Group 8
9 MEDICLINIC INTERNATIONAL HIRSLANDEN AND MEDICLINIC 2/2 MEDICLINIC INTERNATIONAL HIRSLANDEN SWITZERLAND MEDICLINIC SOUTHERN AFRICA MEDICLINIC MIDDLE EAST 17 hospitals 52 hospitals 6 hospitals + 31 polyclinics 74 hospitals Beds Patients (inpatient) Patient days Theatres Employees (with employed doctors) Key Figures as of: 31 March 2017: Hirslanden International Hospital Group 1 Inpatient admissions without 9 newborns, 2 Patient days, without newborns
10 SÉMINAIRE PRATIQUE SANTÉ 2018 BENCHMARK AND BEST PRACTICE IN AN INTERNATIONAL HOSPITAL GROUP PRIVATKLINIKGRUPPE HIRSLANDEN DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN PRIVATE HOSPITAL GROUP I. HIRSLANDEN PRIVATE HOSPITAL GROUP II. MEDICLINIC INTERNATIONAL III. INTERNATIONAL WORKSTREAMS IV. CASE EXAMPLE Privatklinikgruppe Hirslanden 10
11 OVERVIEW International workstreams at MCI Human Resources Marketing Clinical Services ICT Procurement Hirslanden International Hospital Group 11
12 HUMAN RESOURCES MARKETING CLINICAL SERVICES ICT PROCUREMENT Hirslanden International Hospital Group 12
13 HUMAN RESOURCES Employee survey Your Voice : Yearly employee survey since 2015 with internationally renowned institute Gallup Measures employee satisfaction and employee engagement group-wide Goal: Enhance effectice workplace practices by doing annual surveys across all corporate management levels Gallup offers detailed action plans to improve various factors related to satisfaction and engagement Hirslanden International Hospital Group 13
14 HUMAN RESOURCES: YOUR VOICE 1/2 Emotional attachment: *MCME 2016 and 2015 without Abu Dhabi. (+0.17) (+0.02) (+0.06) (+0.07) (+0.12) (-0.06) (+0.06) (+0.06) Percentile Mean value Mediclinic International (24.054) Mediclinic Southern Africa (11.662) Mediclinic Middle East* (4.994) Hirslanden (7.398) Hirslanden International Hospital Group 14
15 HUMAN RESOURCES: YOUR VOICE 2/2 Total satisfaction: Dubai: (+0.01) 3.90 (+0.04) (-0.06) Abu Dhabi: (+0.02) 3.86 (+0.01) 4.09 (+0.19) 3.90 (-0.04) Hirslanden MCME MCSA Response rate 79 % 88 % 73 % Number of participants Hirslanden International Hospital Group 15
16 HUMAN RESOURCES: HR ALIGNED Aim of HR Aligned: The implementation of one HR system Connect for all Hirslanden employees by standardised and automated HR processes Benefits of HR Aligned: Employee and management self-service, including mobile access to most functionality Supports streamlined administration, more effective processes and the reduction of paper(work) Enablement of the HR Service Delivery Model Greater standardisation of global HR processes Fast, integrated, accurate reporting across all platforms Hirslanden International Hospital Group 16
17 HUMAN RESOURCES MARKETING CLINICAL SERVICES ICT PROCUREMENT Hirslanden International Hospital Group 17
18 MARKETING 1/3 International collaboration in five areas: Brand Management (Merchandising) Digital Customer Portfolio Management Content Social Media Hirslanden International Hospital Group 18
19 MARKETING 2/3 Cooperation with Mediclinic Design Studio (SA) Internationale Markenkonsolidierung sorgt für mehr Markenwert und schafft eine solide Grundlage für eine konsistente Corporate Identity weltweit Digital: Integration of MCI websites Application of the Swiss Website-Design for all Mediclinic-platforms Swiss lead in regard of service, hosting and development Etablishment of a global governance Hirslanden International Hospital Group 19
20 MARKETING 3/3 Synergies between MCI and Hirslanden: Hirslanden International Hospital Group 20
21 HUMAN RESOURCES MARKETING CLINICAL SERVICES ICT PROCUREMENT Hirslanden International Hospital Group 21
22 CLINICAL SERVICES: CLINICAL QUALITY Quality management = management systems + process management + clinical quality/outcome Clinical quality is obtained by observing the guidelines of patient safety, documenting and measuring outcomes (register, indicators) and measuring the indicator-related quality of life Hirslanden International Hospital Group 22
23 CLINICAL SERVICES: QUALITY AT HIRSLANDEN 4 The patient is Value-based at the heart care of MCI s strategy Volume to value Integrated practice units Bundled payments for care cycles Integration across separate facilities Expanding geographic search 3 Patient benefit is to be enhanced by means of clinical performance, Cost event management a high degree of Clinical cost efficiency Best care at patient satisfaction and integrated services lowest possible cost Appropriate care settings Process improvement Health technology MCCH incorporates 2 this international Appropriate approach care in at its strategy Clinical outcomes (focus: patient safety / benefit) Clinical effectiveness the right time for the right reason Reliable care, minimum variation Utilisation ratios, min case volumes Not over servicing 1 Patient safety Prevent patient harm No never events Serious adverse events Patient safety indicators Infection control indicators Hirslanden International Hospital Group 23
24 MCI BOARD MCI Board Subcommittee Clinical performance and sustainability committee (CPSC) Clinical services committee Medical documentation Patient safety + infection prevention Nursing Clinical coding Platformsformsforms: Plat- Plat- MCI MCCH MCI MCCH MCI MCCH MCI MCSA MCSA MCSA MCME MCME MCME Platforms: MCCH MCSA MCME MCI: MCCH: MCSA: MCME: Mediclinic International Mediclinic Switzerland Mediclinic South Africa Mediclinic Middle East Hirslanden International Hospital Group 24
25 CLINICAL SERVICES: QUALITY MANAGEMENT ORGANISATION MCI includes : Clinical Performance and Sustainability Committee (CPSC) Subcommittee of the MCI Board Clinical Services Committee (CCO international and CCOs of the platforms together with MCI clinical staff) Subcommittee of the MCI EXCO Both bodies prepare reports on the clinical outcome of the platforms and initiate corrective measures where necessary EXCO Steering Board Clinical Services Platform Clinical Services Committee Hirslanden Network Quality Managers Hirslanden International Hospital Group 25
26 CLINICAL SERVICES: QUALITY MANAGEMENT MCI Patient Safety Management Systems - Certification Effectiveness Efficiency Value-based Patient Safety - Standards Indicators Register Quality of Living Clinical Quality CIP Measures Hirslanden International Hospital Group 26
27 CLINICAL SERVICES: INDICATORS 1/5 Measurments dictated by MCI are adapted across the Group in order to allow for comparisons. Indicator Method Patient safety General mortality Mortality on the ICU IQIP fatality rates in the number of inpatients MDSI minimal data set intensive care medicine, determination of the mortality index Hirslanden International Hospital Group 27
28 CLINICAL SERVICES: INDICATORS 2/5 Indicator Rehospitalisations Re-operations Liability cases Method IQIP continuous measurement of rehospitalisations in accordance with the International Quality Indicator Projects criteria relative to the total number of discharged patients IQIP continuous measurement of re-operations in accordance with the IQIP criteria relative to the total number of operated patients Reporting all new liability cases within the scope of a defined process at the Corporate Office Serious adverse events Reporting all serious events in patient treatment to the Corporate Office Hirslanden International Hospital Group 28
29 CLINICAL SERVICES: INDICATORS 3/5 Indicator Method Nursing quality Falls IQIP continuous measurement of the number of falls in a month relative to the total number of inpatients in the month Pressure ulcers IQIP continuous measurement of the number of patients with pressure ulcers in a month relative to the total number of inpatients during this month Hirslanden International Hospital Group 29
30 CLINICAL SERVICES: INDICATORS 4/5 Indicator Method Hygiene quality Nosocomial infections (indicator operations) SwissNoso National Centre for Infection Prevention, measurement of the infection rates during indicator operations (e.g.hip joint replacement, etc.) Device-associated infections NRZ National Reference Centre (Berlin), measurement of infections on the intensive care unit during ventilations, use of central venous and urine catheters Hirslanden International Hospital Group 30
31 CLINICAL SERVICES: INDICATORS 5/5 Indicator Method Patient satisfaction Patient satisfaction Press Ganey continuous measurement of patient satisfaction with a set of 80 questions in different measurement dimensions Hirslanden International Hospital Group 31
32 CLINICAL SERVICES: PRESS GANEY 1/5 Benefits: A standardised survey for all three platforms International benchmark Outcome for patient safety Best practice examples and consulting in patient experience management All results are applicable on a webportal Hirslanden International Hospital Group 32
33 CLINICAL SERVICES: PRESS GANEY 2/5 Aims: Continuous survey of patient satisfaction Internal and external benchmarking Identification of best practice-cases Priority Index allows precise improvement with high impact on patient satisfaction Primarily distribution of survey by mail Hirslanden International Hospital Group 33
34 CLINICAL SERVICES: PRESS GANEY 3/5 PATIENT EXPERIENCE INDEX = HCAHPS: Recommendation of hospital + HCAHPS: score of hospital PG: total average value (including customer-specific questions) Hirslanden International Hospital Group 34
35 CLINICAL SERVICES: PRESS GANEY 4/5 Findings: Overall satisfaction Satisfaction with attention to special/personal needs All hospitals Rank in comparison to whole data base Participants Hirslanden International Hospital Group 35
36 CLINICAL SERVICES: PRESS GANEY 5/5 Overall recommendation rate (quarterly trend all hospitals) n: Q Q Q Q Percent Top Box Percentile Rank Q1 GJ 17/18 Q2 GJ 17/18 Q3 GJ 17/18 Q4 GJ 17/ Hirslanden International Hospital Group 36
37 HUMAN RESOURCES MARKETING CLINICAL SERVICES ICT PROCUREMENT Hirslanden International Hospital Group 37
38 ICT 1/2 Overall goal is to leverage ICT capabilities and resources across the Group for further benefits and/or also lowering the ICT risk profile through ICT synergies ICT standards and standardisation ICT sharing ICT centralisation (where justified) These must be enabled through an ICT Operating Model that facilitates collaboration and appropriate governance Hirslanden International Hospital Group 38
39 ICT 2/2 Synergies are leveraged on international level through Sourcing: ICT hardware and software from one supplier (SAP, HP, Microsoft or Cisco). Combined negotiaton power due to volume and establishment of just one subject matter expert on international level Software metering: software licenses are bought jointly and usage is exchanged across the platforms to avoid over- and/or under-licencing Projects: where sensible, projects are being done jointly across all countries to a) leverage know-how and b) resources Services: some ICT services (e.g. video-conferencing) are being provided out of one platform to all of the group Knowledge sharing Hirslanden International Hospital Group 39
40 HUMAN RESOURCES MARKETING CLINICAL SERVICES ICT PROCUREMENT Hirslanden International Hospital Group 40
41 PROCUREMENT 1/3 Classification of articles: MCI internationally uses classification eclass, every article used group-wide is linked to a eclass number eclass is available in German, French and English Assigment of eclass numbers to articles is conducted by team in SA for the whole group Advantages: Better possibilites to analyze and report Faster identification of comparable articles Detailed classification facilitates strategic procurement and streamlining of product range Hirslanden International Hospital Group 41
42 PROCUREMENT 2/3 International contract: Considerable savings through MCI volume agreement Cost reduction through bundling of acquisition of highly complex facilities International investment and price comparisons support negotiation No purchasing of obsolete technology through group-wide coordination Hirslanden International Hospital Group 42
43 PROCUREMENT 3/3 Counterexample «non-sterile disposable gloves»: MCSA and MCME import disposable gloves directly from Asia MCCH does not participate in this purchasing group because prices of Swiss manufacturer are not significantly higher than the prices of the Asian import Learning: joint procurement is often but not always the cheapest option. Situation analysis is vital! Hirslanden International Hospital Group 43
44 SÉMINAIRE PRATIQUE SANTÉ 2018 BENCHMARK AND BEST PRACTICE IN AN INTERNATIONAL HOSPITAL GROUP PRIVATKLINIKGRUPPE HIRSLANDEN DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN PRIVATE HOSPITAL GROUP I. HIRSLANDEN PRIVATE HOSPITAL GROUP II. MEDICLINIC INTERNATIONAL III. INTERNATIONAL WORKSTREAMS IV. CASE EXAMPLE Privatklinikgruppe Hirslanden 44
45 CASE EXAMPLE MEDICLINIC CITY HOSPITAL 1/4 Comprehensive Cancer Centre Inter-platform collaboration Mediclinic MCCH & MCME Inter-platform project board to combine expertise and to transfer know-how Hirslanden International Hospital Group 45
46 CASE EXAMPLE MEDICLINIC CITY HOSPITAL 2/4 Scope of Service Medical Oncology (including chemotherapy, immunotherapy and endocrine therapy) Radiotherapy (with TrueBeam linear accelerator and CT Simulator) Surgical Oncology Radiology (breast cancer diagnostic imaging etc.) Nuclear Medicine (diagnostic and therapeutic service including PET & SPECT CT, automated injector/fdg) Reference Laboratory Specialised pharmacy for chemotherapy Supportive Care (psychological support, physiotherapy, nutrition and Pain Clinic) Hirslanden International Hospital Group 46
47 CASE EXAMPLE MEDICLINIC CITY HOSPITAL 3/4 Inter Platform Project Board Project Inter platform project board Combine expertise/transfer Know-how Infrastrucure Support for floor plans, equipments orders, Commissioning of machines Financial Coordinate investments Discussion of KPI s Clinical Discuss concepts (Centres of Excellences, Certifications, Organisation of MDT s, Data collection) Establish Peer reviews vice versa Run Inter Platform Board for individual cases Organize Second party Audit Build up and maitain the professional and clinical relationships Processual Compare patients pathways Site visits vice versa for learning experience Staff exchange (Techs, Nurses) for training Hirslanden International Hospital Group 47
48 CASE EXAMPLE MEDICLINIC CITY HOSPITAL 4/4 Collaboration Benefits: Use know-how and synergies over platforms: clinical, organisational and financial Value adding for staff and patients Hirslanden International Hospital Group 48
49 THANK YOU DR CHRISTIAN WESTERHOFF CCO HIRSLANDEN AG CORPORATE OFFICE BOULEVARD LILIENTHAL GLATTPARK Hirslanden International Hospital Group 49
50 Private Hospital Group Hirslanden: Hirslanden Klinik Aarau - Klinik Beau-Site, Berne - Klinik Permanence, Berne - Praxiszentrum am Bahnhof, Berne - Salem-Spital, Berne Klinik Linde, Biel - Praxiszentrum Düdingen, Düdingen - AndreasKlinik, Cham Zug - Klinik Am Rosenberg, Heiden - Clinique la Colline, Geneva - Clinique Bois-Cerf, Lausanne - Clinique Cecil, Lausanne - Klinik St. Anna, Lucerne - St. Anna am Bahnhof, Lucerne - Hirslanden Klinik Meggen - Klinik Birshof, Münchenstein Basle - Klinik Belair, Schaffhausen - Praxiszentrum am Bahnhof, Schaffhausen - Klinik Stephanshorn, St Gallen - Klinik Hirslanden, Zurich - Klinik Im Park, Zurich Hirslanden International Hospital Group 50
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