Can future Healthcare Management professionals correspond to increasing needs?

Transcription

1 Success in a Changing Market EHMA, Innsbruck 2009 Can future Healthcare Management professionals correspond to increasing needs? Dr. Barrie Dowdeswell, Director of Research, ECHAA Kadarpeta Rahul, Speckbacher Maria, Yiangou Giorgos, MCI IHCM MA Students

2 Agenda The changing Health environment Introduction Context Healthcare Managers Education - MCI The context of change The context of need Evidence Coxa and Rhön Klinikum Critical Success Factors Discussion

3 MCI Healthcare Managers Education

4 MCI Healthcare Managers Education Founded in 1995 by the University of Innsbruck and other regional institutions Approximately 2,000 students from all over the world Bridging university with local and international business International Healthcare Management Master s Program introduced in 2008

5 Competencies to be acquired: International Healthcare Management Healthcare Managers Education Advance knowledge on social welfare systems and the different national health systems Administrative and management skills for a career in private and public organizations Analytic skills to solve problems of high complexity Competencies in effective communication and team work Adapting to a rapidly changing, unpredictable environment Overcoming the innovation road blocks inherent in an organization Building competitive advantage by making a difference for patients

6 Fundamental & Methodological Competencies Quality Management and Controlling HTA International Healthcare Management Business, Labour and EU Law Medical Information Systems Healthcare Managers Education Health and International Economics Human Resource Management Trends and Markets in Healthcare Business Soft skill competencies (social, communication and personal) Intercultural Communication and Management Additional opportunities Semester abroad On location training

7 Context of change Challenges in Healthcare

8 Context of change Challenges in Healthcare The impact of an ageing population Europe The total population size is projected to fall by 2020 More than one quarter of the Region's population is expected to be over 65 years (increasing by 60 %) Decreasing work force By 2015 EU average dependency ratio will increase from 24% (2005) to 30% By 2050 Dependency ratio will vary from 36 % (Denmark) to 61 % (Italy) Working-age population (15 64 years) is projected to be 18 % smaller than currently

9 Rapid and growing incidence of chronic diseases Context of change Challenges in Healthcare Atherosclerotic Cardiovascular Diseases Autism Spectrum Disorders Cancer Dementia Depression Diabetes Hematological Malignancies Multiple Sclerosis Musculoskeletal Conditions Asthma Increased vulnerability and dependency In Sweden, 90% of the total costs of musculoskeletal conditions have been calculated to be indirect: 31.5% for sick leaves and 59% for early retirement. Co-morbidity: By 2050, At least 35% of men aged over 60 have been found to have two or more chronic conditions DEMOGRAPHIC CHANGES AND AGGREGATE HEALTH CARE EXPENDITURE IN EUROPE(ENEPRI) RESEARCH REPORT NO. 32 AHEAD WP6B DECEMBER 2006

10 Context of change Challenges in Healthcare Patient choice Patient as a consumer Availability of choice Cross border health care and Health tourism Legal Empowerment Autonomy of patient Issues in Advertising and Marketing of health care Patient responsibility Patient as a co-producer of own care

11 Technology Context of change Technological changes in healthcare delivery Challenges in Healthcare Changing technology New Medical technology Incremental innovations Expertise of Medical personnel Information and communication technology Electronic Patient and Health Record E-health Telemedicine (hospital-at-home)

12 Context of change Challenges in Healthcare Global credit crisis Many countries forced to revise budget Price of health-related commodities, such as pharmaceuticals and medical devices, increasing Call for solutions to the economic crisis that do not threaten health objectives, despite budgetary constraints. Necessary actions: prioritizing health, sharing information, reducing the cost of medicines, expanding vulnerable groups (scope and scale of safety nets) access to services will help to address health inequalities supporting new and innovative sources of funding (Mark Danzon, WHO Europe Regional Director)

13 Context of need Challenges in Healthcare Equity Barriers for access Proxies for need Health status, utilisation of health care facilities Horizontal Equity those in equal need should be treated equally Doorslaer et al.: Survey on visits of GPs and Specialists Evidence for rich having easier access to specialists Organisational barriers Geographical barriers Gaps in coverage for the population Disadvantaged groups (e.g. older people) Financial obstacles Co-payment, Out of pocket payment Health literacy, awareness (Quality and Equality of Access to Healthcare Services, EC)

14 Context of need Challenges in Healthcare Quality in Healthcare Department of Health (UK) 1997: doing the right things (what) for the right people (to whom) at the right time (when) and doing right things at first time WHO (2000): Quality of care is the level of attainment of health systems intrinsic goals for health improvement and responsiveness to legitimate expectations of the population

15 Context of need Challenges in Healthcare Dimensions of quality Effectiveness Timeliness Efficiency Acceptability Access Patient Satisfaction Safety Health Improvement Equity Continuity of care Appropriateness (Quality and Equality of Access to Healthcare Services, EC)

16 Context of need Challenges in Healthcare Sustainable and affordable Healthcare Quality improvement potentially creates additional costs (or opposite!) Any action taken must not adversely affect system sustainability Opportunities for cost-saving innovations New measures needed for: Health financing Health promotion Cooperation between industry and government E-health Patient responsibility and empowerment Interaction of health care with education, employment, lifestyle, etc. Prevention

17 Evidence of managing with change

18 Coxa Hospital Evidence Regional centre for joint replacement Location: Tampere, Finland Volume: 2500 endoprothestic surgeries in 2005 Employees: 11 specialised doctors, 46 nurses and physiotherapists Offers nation-wide services in the field of endoprothestic revisions

19 Need for a specialized hospital Growing need for surgeries Lack of quality Pressure from legislation to buy more services Long waiting times Coxa Hospital Evidence Measures taken in Coxa Concentration of services to one place (formerly in 5 district hospitals) Creation of a limited company with a Public Private Partner mix Clinical directors trained in Business Management Integrated and systematized care pathways A quality and low-cost combination guaranteed Principle of KISI (Knowledge Intensive Service Industry)

20 Rhön Klinikum Evidence Private hospital group Purchases State hospitals with the operating licenses Provision of the full range of services Focus on small and medium sized hospitals Owns 46 hospitals Aiming in patient-centred quality services and increased efficiency

21 Rhön Klinikum Evidence Characteristics High initial investment and ongoing renewal and capital expenditure Ensuring a high level of liquidity Motivated employees Multi-disciplinary working Patient-focused process optimisation Moving into the integrated care market Design rationalisation

22 Critical Success Factors and Conclusions

23 Identifying the problems Critical Success Factors Exploding costs, limited resources Demographic and epidemiological changes, new needs for services Increasing demand for quality What is the actual cost of treatments? (EU cross-border treatment directive) National-regional characteristics (legacy, culture) Need for more comprehensive data collection and analysis for a new design of healthcare services delivery system

24 Getting the right data Identifying problems Critical Success Factors Collecting, analyzing and interpreting data properly Performance measured and compared over time Aspects of performance measured: Quality of services Personnel performance Patient satisfaction Patient safety Benchmarking with other hospitals Adapted from Johnson T., 2009

25 Identifying problems Evaluating cost effectiveness and efficiency Work Relative Value Units (RVUs) Getting the right data Critical Success Factors Developed for the Center for Medicare and Medicaid Services (CMS) RBRVS: Resource-Based Relative Value Scale Assigns numerical values to services Quantifies relative work and cost Takes into considerations time, skill needed and psychological strain caused Comparison of entirely different procedures possible Integrated care pathways Measurable inputs and outcomes Essential for process and structure design Tool for communication

26 Fitting service and capital investment together Getting right ideas Critical Success Factors Who can best and more efficiently offer services? Difficulty in sustaining an exclusively state-funded delivery system Private sector more innovative and efficient? Ideological constraints PUBLIC PRIVATE PARTNERSHIP Concession Full Service PFI Private Finance Initiative DBFO Design Build Finance Operate BOO(T) Build Own Operate Transfer Integrated Building and clinical service delivery Need to find balance between a centrist performance management and outsourcing that will maximize cost effectiveness and cost efficiency Lifecycle investment co-relating service with cost efficiency and effectiveness

27 Fitting Vision service for and new capital concepts investment models Critical Success Factors New and refreshed concepts: Focus on prevention Integrated care pathways Outsourcing services Utilizing new technologies Application of business management methods Six Sigma Lean Is healthcare open to new ideas? (Professionals, patients) Overcoming resistance to change

28 Leadership and management qualities Leaders Leadership and Management qualities Critical Success Factors Within the political system and the healthcare organizations Aligning stakeholders Supporting innovation Contrast between policymakers and entrepreneurs Managers Dealing with complexity of implementation Ensuring effectiveness and efficiency Professionalism Clinical decisions as resource decisions Top-down approach ineffective (sub-systems complexity) Ensuring knowledge development and exploitation

29 Conclusions The changing health ` environment Business as usual simply impossible in healthcare Changing environment reveals weaknesses of the past, creates new challenges Intuitive decision making unlikely to provide solutions Healthcare services delivery on a professional level Need for professionals with interdisciplinary competences Need for innovation

30 References: 1.Dowdeswell B., 2008: Strategic Capital Investment in Healthcare within Europe, a supranational overview of current trends across Europe and beyond Powerpoint presentation, MCI, Johnson T., 2009: Use and Value of Information in Health Care, Powerpoint presentation, MCI Demographic changes and aggregate health care expenditure in Europe (ENEPRI) Research Report No.32, AHEAD WP6B 12/ Braun A. 2005: Healthcare: Key technologies for Europe,CORDIS 5.Huber M. et al., 2008: Quality in an equality of access to healthcare services, DG Employment, Social Affairs, and Equal Opportunities, EU Com. 6.Dowdeswell B. (2008): Case Study: Rhoen Klinikum AG, Germany, European Observatory on Health Systems and Policies 7.Dowdeswell B., Vauramo E. (2008): Case Study: The Coxa Hospital, Tampere, Finland, European Observatory on Health Systems and Policies