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Advanced Operations Management in a Spanish Healthcare Public/Private Partnership

Advanced Operations Management in a Spanish Healthcare Public/Private Partnership. San Francisco, 2014. Vicent Moncho Mas CIO Marina Salud S.A. INDEX. Introducing Denia’s Health Department IT Strategy & Oracle Applications overview Using Oracle Apps in Logistics

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Advanced Operations Management in a Spanish Healthcare Public/Private Partnership

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  1. Advanced Operations Management in a Spanish Healthcare Public/Private Partnership San Francisco, 2014 Vicent Moncho Mas CIO Marina Salud S.A.

  2. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  3. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  4. GEOGRAPHICAL SCOPE Denia’s Health Department (I) • Population: More than 150,000 residents (Healthdepartmentisfinancedmainly per capita) • Tourism: FromMarchtoOctober • Municipality: 34 towns [ Dènia: approximately 40,000 – Valld’Alcalà: around 200 ] • Total area : 297 square miles (759 km²) • Populationdensity: 635 people per squaremile (245 hab/km²) • Geography: Complex orography. Numerous mountains, valleys and hilly coast

  5. RED ASISTENCIAL MARINA SALUD OPERATIONAL SCOPE Department of Health. Dénia. 1 Hospital 4 IntegratedHealth Centers (Specializedcare) 32 PrimaryCare Centers (11 Basic areas)

  6. Public Service PrivateManaged Administrativeconcessiongrantedfor 15 yearsDirectsupervisionvia AVS commissioner Marina Salud buildsthe new Hospital Marina Salud builds a new CSI in Calpe Marina Salud builds a new CSI in Denia Service improvementinvestment Integration of professionals PublicHealthIntegrated Management HealthDepartment’sintegrated Management (bothPrimaryCareanSpecializedCare) OPERATIONAL SCOPE (II) Department of Health. Dénia. Therewas a previous Hospital (100 % managedby regional government; allemployeesdependsfrom AVS HR Resourcespolicy as civil servants and locum) At the time Civil servants (28%) and privateemployees (72 %)

  7. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  8. IT STRATEGY (I) Department of Health. Dénia.

  9. IT STRATEGY (II) Department of Health. Dénia.

  10. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (I)

  11. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (II) BillingDept. Logistics Dept. Accounting and FinanceDept. HumanResourcesDept. Maintenance Dept.

  12. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (III) • 2,700 suppliers • 14,000 receivingtransactions • 120 receivingtransactions per day • DailyAutomatedPurchaseplanning

  13. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (IV) • 5,800 articles • 120 receivingtransactions per day • Patientconsumptionassignment • More than 1.5 millionlines in trans.

  14. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (V) • 20,800 invoices • 65,800 invlines

  15. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (V) • 86% per capitafinanced • 12% compensationfinanced • 2% privatefinanced

  16. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (V) • Privatefinancedinvoices • privateclients • insurancecompanies

  17. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (VIII) • 5.400 Workorders

  18. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (IX) • 1,200 employees • 34 contracttypes (5) • Absencerequests 7,811 • Holidays 57%

  19. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (X) • 134 shifttemplates • 80 Shiftexecutiontypes

  20. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (XI) • 12 regular payroll • 2 extra payroll • 4 variable salary

  21. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (XII) • 450 positions • 70 Departments • 56 HealthCare • 13 Administrative

  22. Denia’s Health Department (VII) – CERNER MILLENNIUM’s implantation scope ORACLE APPLICATIONS OVERVIEW (XIII) • 334 courses • 1,294 attendees • Evaluation

  23. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  24. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (I) • LOGISTIC PROCESS PURCHASING WAREHOUSING DISTRIBUTION PROCESS CONTROLLING

  25. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (II) • PURCHASING • Medical supplies & materials, medication, laboratory, Sterilization, blood bank, office-supplies, prosthesis and osteosynthesis • Purchase orders and claims planned and executed every day using: • Inventory planning report (min/max) • Consumption in twenty days for each article • Demand reports based in inpatient medication orders, preference cards, high economic impact activity schedulling (Outpatientspecialmedication, Oncology) PURCHASING WAREHOUSING DISTRIBUTION PROCESS CONTROLLING

  26. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (III) • WAREHOUSING • General warehouse (KARDEX) • 2 Automated horizontal carouselsystems • 3 Automated vertical storagesystems • 1 Automated vertical coldstoragesystem • Distributedwarehouses • 42 Kanban (double box system) • 23 + 7 (fluids) in the Hospital • 12 in PrimaryCare • AutomatedDispensingSystems (PYXIS) • 32 forMedication • 7 forMaterials • (*) Stock real time sinchronizedfrom PYXIS, dailyfor General Warehouses & Kanban PURCHASING WAREHOUSING DISTRIBUTION PROCESS CONTROLLING

  27. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (IV) • DISTRIBUTION • Daily distribution from the General warehouse to Distributed warehouses in the Hospital • 15 days based distribution for Primary Care Centers • Monthly distribution for external elderly care centers PURCHASING WAREHOUSING DISTRIBUTION PROCESS CONTROLLING

  28. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (V) • CONTROL • Daily distribution and stock control • Discrepancies and consumption Analysis per Cost Center and Department (monthly feedback) • Centralized out of date medication & drugs control • Patient imputation control (patient based dispensation control) • LogisticsBalancedScorecard (average storage time, breaks of stock, not served orders, …) PURCHASING WAREHOUSING DISTRIBUTION PROCESS CONTROLLING

  29. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) PYXIS TRANSACTIONS • Medication consumption control and cost assignment BOTTOM-UP 85% KANBAN TRANSACTIONS INTERNAL PURCHASE ORDERS TOP-DOWN 15% PROSTHESIS AND OSTEOSYNTHESIS REGULARIZATIONS MANUAL ADJUST.

  30. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) PYXIS TRANSACTIONS • Medication consumption control and cost assignment (special control medication) BOTTOM-UP 90% KANBAN TRANSACTIONS INTERNAL PURCHASE ORDERS TOP-DOWN 10% PROSTHESIS AND OSTEOSYNTHESIS REGULARIZATIONS MANUAL ADJUST.

  31. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) PYXIS TRANSACTIONS • Material consumption control and cost assignment BOTTOM-UP 25% KANBAN TRANSACTIONS INTERNAL PURCHASE ORDERS TOP-DOWN 75% PROSTHESIS AND OSTEOSYNTHESIS REGULARIZATIONS MANUAL ADJUST.

  32. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) PYXIS TRANSACTIONS • Material consumption control and cost assignment (Surgery Theaters Area) BOTTOM-UP 70% KANBAN TRANSACTIONS INTERNAL PURCHASE ORDERS TOP-DOWN 30% PROSTHESIS AND OSTEOSYNTHESIS REGULARIZATIONS MANUAL ADJUST.

  33. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (II) • Stock reduction by 30% in three years FROM 2009 35%

  34. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (III) • Average storage time reduction in 54 % (35 days, 30 days for medication)

  35. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  36. IT SYSTEMS INVOLVED Department of Health. Dénia.

  37. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (I) • HEALTHCARE ACTIVITY MANAGEMENT PROCESS DATA CAPTURE INTERFACING ECONOMIC PROCESS APPLYING PER CAPITA FIN. COMPENSATION FIN. PRIVATE FIN. PROCESS CONTROLLING

  38. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (II) • DATA CAPTURE INTERFACING • Patient Information • Encounter Information • Charges Information • SpeciallizedCareactivity • PrimaryCareactivityforPrivatefinancedencounters DATA CAPTURE INTERFACING ECONOMIC PROCESS APPLYING PER CAPITA FIN. COMPENSATION FIN. PRIVATE FIN. PROCESS CONTROLLING

  39. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (III) • ECONOMIC PROCESS APPLYING • Aggregation/Division • Per capita financed encounters processing • Compensation financed encounters processing • Private financed encounters processing • Incident Management DATA CAPTURE INTERFACING ECONOMIC PROCESS APPLYING PER CAPITA FIN. COMPENSATION FIN. PRIVATE FIN. PROCESS CONTROLLING

  40. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria PROCESS SCOPE (IV) • PROCESS CONTROLLING • Encounter status summary (per type, per accreditation) • Incident analysis for operation improvement • Activity based provisioning for receivables DATA CAPTURE INTERFACING ECONOMIC PROCESS APPLYING PER CAPITA FIN. COMPENSATION FIN. PRIVATE FIN. PROCESS CONTROLLING

  41. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) • HEALTHCARE MEDICAL SERVICES BUDGETING AND CONTROL • Healthcare activity and consumption based • For each Medical Service, Nursing Unit and Medical Center • Specialized care and PC

  42. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) • HEALTHCARE MEDICAL SERVICES BUDGETING AND CONTROL • Healthcare activity and consumption based • For each Medical Service, Nursing Unit and Medical Center • Specialized care and PC

  43. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (I) • HEALTHCARE MEDICAL SERVICES BUDGETING AND CONTROL • Healthcare activity and consumption based • For each Medical Service, Nursing Unit and Medical Center • Specialized care and PC

  44. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (II) • COST PER PROCESS ANALYSIS • Bottom-up cost assignment based • From activity, consumptions and structural costs • Specialized care and PC

  45. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (II) • COST PER PROCESS ANALYSIS • Bottom-up cost assignment based • From activity, consumptions and structural costs • Specialized care and PC

  46. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (II) • COST PER PROCESS ANALYSIS • Bottom-up cost assignment based • From activity, consumptions and structural costs • Specialized care and PC

  47. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria RESULTS (II) • COST PER PROCESS ANALYSIS • Bottom-up cost assignment based • From activity, consumptions and structural costs • Specialized care and PC

  48. INDEX • IntroducingDenia’sHealthDepartment • IT Strategy & Oracle Applicationsoverview • Using Oracle Apps in Logistics • Healthcare activitymanagement • Conclussions

  49. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria CONCLUSSIONS (I) • Daily supply planning & distribution based in reliable and integrated information • Receiving, Storage and DistributionProcessEfficiency • Healthcare and managementsystemsintegration • Healthcareprofessionalsfocussed in patient • Healthcareprofeesionalsengaged and commited in processimprovement • Processeficiencyfromthepatientpoint of view • New projects: • Inter-departmental Workflow improvement • Cash and treasury module implantation • Budget module implantation • Preventive Asset management maintenance routes implantation

  50. Selección e integración de profesionales en modelo concesional preexistiendo estructura sanitaria CONCLUSSIONS (II) • We are using Oracle Applicationssince 2009 • In 2009, 2010 and 2011, we were focused in vertical process improvement, working in the specific operative workflows for each department • From 2011 to 2012 our company makes a hard job trying to involve representative users in driving both the healthcare systems and the management systems, prioritizing coordination and cross vision in process inprovement, with this change we achieve an inflection point and this implied processes to improve • In 2012 we get HIMSS level 7 certification as a consequence of this change in our way of work and using IT • Currently we are focused in transversal processes improvement and how to get valuable results from development, IT it is only a tool in this target • We can work this way bacause we can measure • We can measure because we have the tools to do that • Today we are very proud about our culture, our tools and our partners, like oracle, because this is the key to generate together valuable results

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