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Creating

disruption

Nigel Edwards

Healthcare Expert, KPMG

Senior Fellow, The King’s Fund

Honorary Visiting Professor, London School of Hygiene & Tropical Medicine

1 © 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.

Sources of disruption

Process changes

Changing how assets are used

Changing systems

Strategic choices

Patients & communities



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



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



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




Process changes




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.



7

Royal Liverpool Children's Hospital



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



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



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



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




Process changes


Changing systems



Systems are changing

Integration Networks

Primary care

redesign

Centralisation &

deconcentration Dis-

intermediation



Steps towards value based payment



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



From this



To more like this



Integrate the specialists



Add multidisciplinary support

Community nursing

OT, Physio & other AHPs

Telephone support

Mental health

Social work

Housing and benefits

Voluntary sector

Etc.




Process changes


Changing systems

Strategic choices



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




Process changes


Changing systems

Strategic choices

Patients & communities



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



Patients and communities

■ Patients and their networks as a source of value

– Self service

– Co-production

– Informed decision making

– Goal oriented medicine



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.



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.

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