Improving the efficiency of health care management

1. Improving the efficiency of health care management

2. Case Study 1: Improving quality at BUPA’s private hospital in Leeds • Case Study 2: BUPA’s role in managing the UK government’s first Diagnostic Treatment Centre (DTC) at Redwood • Case Study 3: Manises, Spain

3. RedwoodDiagnosis and Treatment Centre Case Study 1: Improving quality at BUPA’s hospital in Leeds

4. The Challenge: can we stop BUPA’s most successful hospital from haemorrhaging money?

5. Operating performance 2001 - 2004 • Revenues + 34.6% • Operating profit + 28.9% • Operating return 27.6% • Staff costs - 0.5 pp

6. Satisfaction Indices 2001 - 2004 • Consultant satisfaction 2001 = 44, 2004 = 74 (top hospital) • Patient satisfaction 2001 = 89, 2004 = 89 (top quartile) • Staff satisfaction 2001 = 51, 2004 = 68 (top quartile)

7. The Challenge: how do we implement a Quality Programme?

9. Improving quality through… “If we look after our staff and focus them on improving our processes we will attract and retain more customers.”

10. (1) Business Plan (3) FOCUS Scorecard (2) Quarterly Action Plan

11. (2) Quarterly Action Plan

12. (3) FOCUS Scorecard

13. The Challenge: how do we improve communications?

14. Governance structure Staff Group Clinical Governance Customers Hospital departments Quality Health & Safety Medical Advisory Committee

15. Drives communication • BUSINESS CO-ORDINATION • COMPLAINTS MANGAGEMENT • FINANCE REVIEW • SCORECARD REVIEW • CUSTOMER INFORMATION • 2 WAY COMMUNICATION • DRIVES PROFIT Hospital departments

16. Staff Newsletter

17. The Challenge: how do we monitor and improve clinical quality?

18. Drives clinical quality • SET AND REVIEW CLINICAL TARGETS • AUDIT EFFECTIVE OUTCOMES OF CARE • CONSULTANT MANAGEMENT & APPRAISAL • ADVERSE INCIDENTS & CLINICAL COMPLAINTS • EXTERNAL REGULATION Clinical Governance

19. CLINICALTARGETS % against activity

20. Clinical Targets

21. The Challenge: how do we improve the productivity of the hospital?

22. Clinical Risk Tool

23. Code Type Cases Returns % Re-admit % Re-dos % LOS B3120 BBA 89 6 6.7 6 6.7 7 7.9 1.15 B3100 BBR 51 7 13.7 0 0 3 5.9 2.13 S0120 Face lift 18 3 16.7 1 5.6 4 22.2 2.41 S0210 Abdom 48 1 2.1 4 8.3 10 20.8 2.43 E0260 Rhino 41 0 0 0 0 4 9.8 1.12 Sub Total 247 17 6.9 11 4.5 28 11.3 Grand Total 937 26 2.8 19 2.0 55 5.9 Consultant data reports

24. Case Study 2: BUPA’s role in managing the UK government’s first Diagnostic Treatment Centre (DTC) at Redwood

25. About Redwood – The History • Located on East Surrey Hospital site • Private patient unit • Prototype – opened December 2002 • BUPA investment of approx US$ 15.0m • Treated 43,000 patients to date

26. About Redwood – The Facilities • 24 inpatient beds (individual rooms) • 12 day case trolleys (4 bays) • 2 theatres and 3 endoscopy rooms • 10 endoscopy trolleys • Outpatients, minor ops and x-ray

27. The Challenge: how do we reconfigure a private hospital for state patients?

28. About Redwood - The Services • Orthopaedics • General Surgery • Gynaecology • Urology • Maxillo-facial • Endoscopy

29. About Redwood - Activity • 2003 - 8,913 patients • 2005 - 12,633 patients • 2006 - 14,000 patients

30. The Challenge: how do we work with all the new stakeholders?

31. Partnership and Integration • Co-located • Strategy • Operational management • Medical staffing • Nursing • Service level agreements

32. Partnership and Integration (cont) • Shared risk agreement • Governance Committees • Shared pathways • Management of complaints • Protocols and policies • Training • Service planning

33. The Challenge: how do we implement a Quality Programme?

34. Demonstrating the Benefits Priority: achieving the balance • Clinical quality • Stakeholder satisfaction • Patient numbers Patient Numbers Stakeholder Satisfaction Clinical Quality

35. Demonstrating the Benefits (cont) How can we measure success? • Clinical indicators • Satisfaction surveys • External review

36. The Challenge: how do we monitor and improve clinical quality?

37. Clinical Indicators 2005 • Patients treated - 12,633 • Mortality - 1(emergency admission) • Transfers to other provider - 14 (0.1%) • Returns to theatre - 5 (0.08%) • DC unplanned admissions - 54 (0.5%) • Joints - surgical site infections - 11 (2.3%) • Incidents reported to NPSA - 0 • Referral protocol rejection Q1 2006 - 23 (2.2%)

38. 2005 Patient Satisfaction Survey (0)‘Neither’ 2% (-1) ‘Poor’ 1% (+1) ‘Quite Good’ 10% (-3)‘Excellent’ 43% 87% 87% 85% (+4)‘Very Good’45% 43% 45% 46% Trends…? 40% 41% 44%

39. Patient Views

40. Patient Comments I received very sympathetic and good advice from the surgeon and anaesthetist along with excellent and patient nursing staff. The food was first-class and the cleanliness can't be faulted! I could not have received kinder, more considerate treatment from nurses or doctors - they really had patients’ needs as a priority! I received respect and care as an individual - not just a number. In fact, I was quite amazed to be treated so well! From start to finish, I was treated courteously, on time and involved with my treatment. I was given a good explanation of my treatment and operation by clinical staff, with a touch of humour!

41. 2005 Consultant Satisfaction Survey ‘Neither’ 6% ‘Poor’ 6% ‘Excellent’ 50% ‘Quite Good’ 17% ‘Very Good’22%

42. Consultant Comments Proper and accurate communication, prompt actions taken if needed and a very friendly atmosphere. Well organised theatre lists, good patient care and easy to communicate. Over the first 2-3 years, we have developed effective working relationships between the two management teams. A flexible and responsive service that works with the NHS in a participative way.

43. The Challenge: how do we improve the productivity of the hospital?

44. Utilisation - Theatres Redwood Target – 87%

45. Utilisation - Consultants Redwood Target – 87%

46. Efficiency MeasuresStaff Costs / Patient Procedure

47. At BUPA Hospital Leeds & Redwood DTC…. …Quality is the key to success “If we look after our staff and focus them on improving our processes we will attract and retain more customers.”

48. Case Study 3: Manises, Spain

49. Welfare State THE SPANISH WELFARE STATE Long Term Care Pensions Education Health

50. MAIN PROBLEMS SPANISH NATIONAL HEALTH SYSTEM Duplicative health system: Demographic challenges: Medical provision: • Overcrowding • Waiting lists • Dissatisfaction • Budget deficits