optimizing skill sets, processes and technology to boost the effectiveness of healthcare delivery to...

OPTIMIZING SKILL SETS, PROCESSES AND TECHNOLOGY TO BOOST THE EFFECTIVENESS OF HEALTHCARE DELIVERY TO CUSTOMERSCase studies, Concepts, and Debatable Ideas

Kenny OngCNI Holdings Berhad

www.myCNI.com.my www.OOBEY.com

http://www.mycni.com.my/

http://www.oobey.com/

Summary:

Long-term

Objectives

Strategies

Enablers

Resources

Also known as L.O.S.E.R.




Summary: Today’s presentation

1. Solution Model

2. Strategy

3. Resources




Issues and Obstacles

1. Increasing costs1. Staff2. ‘Cover cost’ overbooking

2. Public-sector burden3. Shortage of specialist

Doctors1. Geriatrics (2%)

4. Less time per patient5. Population Growth6. Disparity and

Maldistribution7. Untested, risky new

Technology

8. Safety of patients1. Medical errors2. Hospital infections3. Medical fraud4. Malpractice

9. IT: Privacy and Confidentiality

10.Episodic Care -> On-going care

11.Communicable Disease -> Non-communicable disease

12.Rich and Poor segments




Issues and Obstacles

13.Unregulated private sector

14.Variations in Quality and Performance

15.Cultural and language barriers

16.Access17.H/C workforce instability18.Black Market19.Fail to enforce

Regulations20.Expensive insurance

premiums

21.Lack of coordination22.Poor customer service23.Short on personnel and

medication24.Long waiting time25.Access to self-care

resources26.Absence of clear

admission/referral policies

27.No standard protocols for different levels of H/C

28.Over-focused on Profit




Income Groups

Urban, Affluent

Middle Class

Poor,Rural

Expensive, cutting edge, private funds

Government priority, high subsidy, rural stations, cheap

No money for high-end, no access to low-end




Our Role?

Healthcare Industry

Customers, Patients

Main Healthcare Providers

Delivery

Request

Request

Service

Request

Service




What is the Business Model?

USP

Market Discipline

Profit Model




What is the Healthcare Model?

USP

Market Discipline

FundingModel




Intro: Market Discipline

• Mamak stall




Intro: Market Discipline

"They are the most innovative"

"Constantly renewing and creative"

"Always on the leading edge"

"A great deal!"

Excellent/attractive price

Minimal acquisition cost and hassle

Lowest overall cost of ownership

"A no-hassles firm"

Convenience and speed

Reliable product and service

"Exactly what I need"

Customized products

Personalized communications

"They're very responsive"

Preferential service and flexibility

Recommends what I need

"I'm very loyal to them"

Helps us to be a success

Product Leadership

OperationalExcellence

CustomerIntimacy




Operational Excellence(low cost producer)

Ref: The Discipline of Market Leaders, Michael Treacy & Fred Wiersema; 1995

Product Leadership(best product)

Customer Intimacy(best total solution)

Intro: Disciplines





1. Solution Model

2. Strategy

3. Resources

Done




Set the Strategies




What is the End Objective?

“…in the past 18 months, we have heard that profit is more important than revenue,

quality is more important that profit, people are more important than profit,

customers are more important than our people, big customers are more important than small customers, and that growth is the key to our success. No wonder our

performance is inconsistent"CEO, Anonymous





In the old days of HR…• Average training hours per staff• % of staff attending training• # of training programs• % of training programs conducted• Training needs analysis conducted• Competency models developed• Training budget as % of payroll

What’s wrong with this picture?www.myCNI.com.my www.OOBEY.com




Moral of the story…

1. Innovation:– Business models– Products– Services

2. Market Leadership

3. Competitive differentiation

End Objective?www.myCNI.com.my www.OOBEY.com



“What is the moral of the story?”




What then are the End Objectives?

1. Level of Population Health

2. Health Inequalities

3. Level of Health System Responsiveness (patient satisfaction)

4. Distribution of Responsiveness within the population (segment satisfaction)

5. Distribution of health system’s financial burden within the population (who pays)

The World Health Report 2000, World Health Organization




Expectations and Objectives

1. ↓ cost

2. ↑ access

3. ↑ Quality

4. ↓ Variations in performance

5. ↑ Utilization of resources

6. ↓ Disparity ↑ Equity

7. ↑ Prevention

8. ↓ Overcrowding in urban

9. ↑ Profiting from High-end

10.↑ FDI to ↑ H/C System

11.↑ Meet segment needs

12.↑ Workforce Management




Some broad Solutions and Strategies…

1. Patient-centered care

2. Inpatient -> Outpatient

3. High-end care

4. Rural care

5. Public-Private sector collaboration

6. Preventive Healthcare

7. Government subsidy -> Private sector funding

8. Disruptive Innovation (“Just Good Enough”)




Side Note: Disruptive Innovation

Per

form

ance

Time

Performance that customers

can absorb or utilizePerformance of present te

chnology driven

by sustaining technological improvements

New Performance trajectory

*The Innovator’s Solution, Clayton M. Christensen





• begin in unattractive or overlooked markets• high-quality, affordable alternatives• more convenient• less centralized locations• increasingly lower prices• for less complicated cases• less specialized training to deliver

Also known as ‘Downwards Innovation’






Examples of Disruptive Innovation in serving the “Under-served” markets:

1. Angioplasty

2. LASIK

3. Home Pregnancy Kit

4. MinuteClinic - diagnoses < 20 conditions

5. Sonosite – portable ultrasound machine

6. Quantum Dot – self diagnosis of complicated conditions such as prostate cancer






Abi

lity

to D

iagn

ose

and

Tre

at

General Hospital Inpatient

*Will Disruptive Innovations Transform Healthcare, 19 August 2001, John W. Kenagy, MD

Specialty Hospital Inpatient

MD Outpatient

Non MD O

utpatient

Alternative Care




Healthcare Objectives

Strategy

Customer

Who do we define as our customer? How do we create value for our customer?

How do we enable ourselves to grow and change, meeting ongoing customer needs

Employee Learning and Growth

Internal Process

To satisfy customers while

meeting budgetary

constraints, at what business

processes must we excel?

Financial

How do we add value for customers

while controlling costs?

Main Healthcare BSC




Financial

“To satisfy our stakeholders, what Financial objectives must we accomplish?”

Internal Process

“To satisfy our customers, in which internal business processes must we excel?"

Customer

“Who are our target customers?

What is our value proposition?”

Learning & Growth

“What capabilities and tools do our employees require to help them execute our strategy?

Healthcare Industry BSC




Revenue Growth

Base Retention

Share Gain Positioning Adjacent Market

New Business

Operational Excellence

Product Leadership

Customer Intimacy

Competencies Information Systems

Motivation, empowerment,

alignment

Financial

Learning & Growth

Internal Process

Customers

Investment Strategy

Productivity Market Value

Linking BSC to Strategy








Segmentation vs. Solution Model




The McPlaybook*

Make it easy to eat• 50% drive-thru• Meals held in one

hand

Make it easy to prepare• High Turnover• Tasks simple to learn

& repeat

Make it quick• “Fast Food”• Tests new products

for Cooking Times

Make what customers want• Prowls market for new

products• Monitored field tests

*Adapted from: Businessweek , Februrary 5th 2007





• Competitive price

• Error free, reliable

• Fast (on demand)

• Simple

• Responsive

• Consistent information for all

• Transactional

• 'Once and Done'


• Competitive price

• Error free, reliable

• Fast (on demand)

• Simple

• Responsive

• Consistent information for all

• Transactional

• 'Once and Done'

Customer Intimacy

• Management by Fact

• Easy to do business with

• Have it your way (customization)

• Market segments of one

• Proactive, flexible

• Relationship and consultative selling

• Cross selling

Customer Intimacy

• Management by Fact

• Easy to do business with

• Have it your way (customization)

• Market segments of one

• Proactive, flexible

• Relationship and consultative selling

• Cross selling

Product Leadership

• New, state of the art products or services

• Risk takers

• Meet volatile customer needs

• Fast concept-to- counter

• Never satisfied - obsolete own and competitors' products

• Learning organization

Product Leadership

• New, state of the art products or services

• Risk takers

• Meet volatile customer needs

• Fast concept-to- counter

• Never satisfied - obsolete own and competitors' products

• Learning organization

Strategy: Value Disciplines








Strategy: Value Disciplines




Sample KPIs for Each Discipline


• Price• Selection• Convenience• Zero Defects• Growth


• Price• Selection• Convenience• Zero Defects• Growth

Customer Intimacy

• Customer Knowledge

• Solutions Offered• Penetration• Customer Data• Customer-success

focus

Customer Intimacy

• Customer Knowledge

• Solutions Offered• Penetration• Customer Data• Customer-success

focus

Product Leadership

• Marketing• Functionality• # of Successes• # of Failures• Learn from key

users• Interdisciplinary

teams• Pipeline

Product Leadership

• Marketing• Functionality• # of Successes• # of Failures• Learn from key

users• Interdisciplinary

teams• Pipeline





1. Business Model

2. Strategy

3. Resources

Done

Done




Optimizing Resources to Meet Strategy




Alignment: 4-Wheels Service Model

Principles

Model

StrategyStructureResources

Leadership

Person




Alignment: Framework

• Equity• Protection of the Poor• Cost-effectiveness• Efficiency

Principles





• Org Structure• Job Design• C&B• Policies & procedures• Decision making• Job fit• Management Systems• BSC and KPIs• Decentralized & Empower

Structure




Alignement: Framework

• Role modeling• Vision/Mission/Philosophy• Leadership Style• Delegation & Empowerment• C&B, Promotions• Sense of Urgency• Customer focused• Best practices• Bottom line management• Tradeoff between Cost vs. Value

Leadership




Great Social Transformations happen when:

1. Public Awareness and Engagement

2. Political Leaders followed rather than led

3. Scientists, Engineers, Religious Leaders, Young People who led the way





• Identification and Recruitment• Incentives• Training• Values• Motivation• Competency Analysis• Education/Curriculum

Person





Enablers• Technology• Equipment• Materials• Intellectual

Property• Partners• Property

Resources

Funding • Public• Private






Customer Intimacy

Customer Intimacy

Product Leadership

Product Leadership

Organization, jobs,skills

Management systems

Information and systems

Culture, values,norms

Each Discipline Requires Different Priorities & Resources



•Central authority, low level of empowerment•High skills at the core of the organization

•Disciplined Teamwork•Process, product- driven•Conformance, 'one size fits all' mindset

• Integrated, low cost transaction systems•The system is the process

•Command and control•Quality management


•Central authority, low level of empowerment•High skills at the core of the organization

•Disciplined Teamwork•Process, product- driven•Conformance, 'one size fits all' mindset

• Integrated, low cost transaction systems•The system is the process

•Command and control•Quality management

Organization, jobs, skills

Management systems






Management systems



Product Leadership

•Ad hoc, organic and cellular•High skills abound in loose-knit structures

•Concept, future-driven•Experimentation and 'out of the box' mindset

•Person-to-person communications systems•Technologies enabling cooperation

•Rewarding individuals' innovative capacity•Risk and exposure management•Product Life Cycle profitability

Product Leadership

•Ad hoc, organic and cellular•High skills abound in loose-knit structures

•Concept, future-driven•Experimentation and 'out of the box' mindset

•Person-to-person communications systems•Technologies enabling cooperation

•Rewarding individuals' innovative capacity•Risk and exposure management•Product Life Cycle profitability




Management systems



Customer Intimacy

•Empowerment close to point of customer contact•High skills in the field and front-line

•Customer-driven•Variation and 'have it your way' mindset

•Strong customer databases, linking internal and external information

•Strong analytical tools

•Customer equity measures like life time value•Satisfaction and share management•Focus on ‘Share of Wallet’

Customer Intimacy

•Empowerment close to point of customer contact•High skills in the field and front-line

•Customer-driven•Variation and 'have it your way' mindset

•Strong customer databases, linking internal and external information

•Strong analytical tools

•Customer equity measures like life time value•Satisfaction and share management•Focus on ‘Share of Wallet’




Principles

Model

StructureResources

Leadership

Person

Strategy


Example: Inpatient -> Outpatient for Rural

Ethnic H/C Workforce

↑ Nurses and para-medical staff

Increased competence

Continuing education for staff

Clear referral policies

Reward for performance vs. input

Expand specialist services in periphery

Government funds

Clarity of roles

Ensure protection and value for money

Regulate

Basic facilities in all areas

Technology: robust and withstand electrical fluctuations

Routine maintenance, replacement, renewal

Expand insurance coverage

In-store clinics


Example: Patient-centered Healthcare to ↓ Costs

Quality of Patient decision making

Education to change mind-set

Skills to make decisions

Training patients with chronic diseases

Reward providers who push patients

Measures to focus on patient competency

Definition of roles

Tools to make decisions

System to capture patient experiences and consequences


Different types of Patients

Self Reliant Need Help

Seek Change

Seek Stability

Searchers Collaborators

Streamliners Delegators




End Notes


Activity Grid to optimize resources

Increase (↑)What are features/

activities/services to increase?

Create (+)What are features/

activities/services to introduce?

Reduce (↓) What are features/

activities/services to reduce?

Eliminate (-)What are features/

activities/services to eliminate?


What’s Next?

Areas in urgent need of research:

1. Health System Delivery

2. Health Promotion

3. Non-communicable Diseases

4. Nutrition

5. T/CM

6. Health Economics


Solution to ‘Global’ problems

All it takes are:

1. A Clear Objective

2. An Effective Technology

3. A Clear Implementation Strategy

4. A Source of Financing

Example: Eradication of Small Pox

*Time magazine, March 24 2008, Jeffrey D. Sachs


“There is no shortage of examples of how we can attain our goals, only a shortage of will and stamina…”


Thank You.

soft copy of slides: www.totallyunrelatedrandomanddebatable.

blogspot.com