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•Transforming hospitals •across a network
•CONFIDENTIAL AND PROPRIETARY •Any use of this material without specific permission of McKinsey & Company is strictly prohibited
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Transforming hospitals across a network
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Topic Speaker Timing
•▪ Introduction •▪ Case studies •– N. Henke on Monitor (UK) – Ch. Anastasy & H. de la •Boutetière on ANAP (France) •▪ N. Henke •▪ Group discussion •▪ Al l •10 min •10 min 10 min •30 min •McKinsey & Company | 1
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UK’s Monitor and France’s ANAP adopt different approaches to lead
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hospitals improvement effort
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Key features of UK’s Monitor
• ▪ Monitor is
the independent regulator of NHS foundation trusts
- created in 2004, independent from central government and reporting to Parliament •▪ 3 main roles: • –
Determine whether a NHS Trust is ready
to become a Foundation Trust • •–
Ensuring that NHS Foundation
•
trusts comply
with the conditions they signed up to – that they are well-led and financially robust –
Support Foundation Trusts’ development
(e.g., through capability building of management) •
Key features of France’s ANAP
• ▪ ANAP is
France’s national agency for performance of healthcare providers
created in 2009 and reporting to 3 •▪ ministries (Health, Social Affairs, Budget) 2 main roles: • –
Provide field support to healthcare providers
to improve their performance • –
Provide support to regional regulators
in their mission of operational management and performance improvement of healthcare providers
support to MoH and provide
in its mission of strategic management of the provision of healthcare services •SOURCE: Monitor and ANAP’s websites McKinsey & Company | 2
The Foundation Trust sector has grown considerably since 2004, although the rate of growth has slowed over the last twelve months
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Number of FTs authorised
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14 0
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12 0
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10 0
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8 0
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6 0
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4 0
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2 0
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0
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2 5
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3 2
5 trusts referred year to date 2010/11 7 trusts referred in 2009/10 23 trusts referred in 2008/09 •
5 9
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8 9
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11 5
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12 9
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13 7
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Monitor has improved hospital performance in the UK through a rigorous assessment and compliance process
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Assessment
Improves applicant efficiency Improves board •composition (where •applicant board is weak) Improves governance: •
Compliance
Intervention delivers faster turnaround Improves governance Improves commercial awareness Improves performance transparency •
FT development
Successful training (for new roles) Helped engage senior clinicians in management of the business | 8
There are 75 Acute Trusts (“non-FTs”) remaining in the pipeline and the rate of authorisations has slowed in the past year
Percent of all acute Trusts Approvals for acute FT status •15 0 •10 0 •
Number of Acute Trusts remaining in the pipeline 1 at end of year 2
•14 4 •13 2 •11 5 •9 9 •8 3 •5 0 •0 •2004 2005 2006 2007 2008 2009-10 •
Percent of acute Trusts still in pipeline
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88 80 70 60 51 46
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Number of 20 12 17 16 16
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authorisations
•7 5 Acute Trusts remaining in pipeline •
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•SOURCE: NHS FouNDTtion Trust Directory, Monitor 2010 McKinsey & Company | 5 •McKinsey & Company | 8
Each Trust has signed a tri-partite performance contract which will be supported by a new Provider Development Agency
• • •
The DoH approach Performance Contract
Tri-partite contract – Department of Health / Regional Strategic Health Authority / Trust All trusts transition by April 2013 target •
Early indications
Lots of local action
A number of NHS Trusts “alternative” solutions are required Timetable Provider Development Agency
Will be responsible for managing the pipeline, governance & performance of Trusts Dissolved in April 2014 •
The Provider Development Agency will need to explore a range of alternative
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solutions
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– mergers with FTs
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– service reconfiguration – private sector
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There are up to 15 requiring reconfiguration, and a further 25 must transform performance to reach FT status
• •
Issues to be resolved for non-FTs to meet financial and quality requirements for FT status 1
•7 5 •Could be resolved through significant operational improvement •
22-35 2
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4-17 2
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16 –24 3 Requirements for staNDTlone viability 2012/13 (cumulative)
•Total acute FTs •Strongly improve productivity (3.5% annual CIP 2010-2013) •Solve quality issues •Transform productivity (additional 0.5%-1.0% annual CIP) 3 •5 •Deal with legacy debt 4 •7– 15 •Drive reconfiguration SOURCE: Acute non-FT financial forecast model 2008/09 – 2012/13; Care Quality Commission 2009/10; Laing & Buisson NHS Trust accounts 2008/09 | | 8
• • •
In France, national agency ANAP aims at improving performance
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of healthcare providers
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Contex t
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A high performing healthcare system for quality of care, but with more and more unsustainable costs,
and a large part • ▪ coming from hospitals
Recent reforms reinforcing the State’s, governance over public providers
•– Evolution in hospital governance • – Creation of regional healthcare authorities (ARS) for a better coordination between payor & provider, and also to intensify hospital performance management • ▪
Belief that, beyond performance management, there is a need for operational support to providers
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Role of ANAP
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Key facts:
•– ANAP was founded in 2009 • – It is a
public interest agency
that reports to the Ministry of Health, Ministry of Social Affairs and Ministry of Budget •▪
Key missions:
• • –
Provide field support to healthcare providers
to improve their performance –
Provide support to regional regulators
•McKinsey & Company | 8
• •
ANAP drives a newly launched nationwide transformation
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program to improve the performance of hospitals
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Six key levers for ANAP’s actions
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High performing healthcare providers
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Program objectives:
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target sustainable performance in a holistic way
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A balanced, yet ambitious set of objectives:
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3
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4
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5
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Quality at optimal cost
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Optimized patient pathways
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Best-in-class human resources
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Efficient investments
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Quality of care
(e.g., reducing nosocomial infections, seeing 80% ER patients in less than 4 hours) •–
Quality of people’s working conditions
•(e.g., reducing absenteeism, putting in place service line management) • –
Operational and financial efficiency
(e.g., reducing ALOS by 25%) – overall cost reduction target of 2.5% of hospital costs • ▪
Program launched end of 2009, targeting a first series of 30 hospitals
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6 Pervasive performance culture
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At hospital level, the program encompasses two phases, with
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a formal commitment via a performance contract before phase 2
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Phase 1 :
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Diagnostic & roadmap
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Diagnostic & roadmap
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Pilo t
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Performance contract
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Contains
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5 to 8 performance initiatives selected based on the diagnostic, among a series
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potentia l themes
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Phase 2:
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Performance initiatives
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Strateg y
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Organization & HR
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Clinical operations
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Non clinical operations
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Real estate
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I T
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Financ e
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Codin g
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Based on 18 months of experience, we have identified 6 key
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dimensions “to get right”
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1. Optimally involve regional regulator (ARS)
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2. Fight inertia by showing rapid change is possible
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3. Restore accountability
•Involve ARS from the outset •Performance contract co-signed by ARS •Programs include pilot conducted at the same time as diagnostic •Have hospital sign “performance contracts” •Ensure adequate top level focus (Steerco at Presidency) •
Ensure
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impact
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4. Build capabilities
•Dedicated agency ANAP with ~80 professionals •Train hospital project leaders •Build ARS capabilities •
5. Phase smartly
•10, then 20 hospitals launched in 2010 •Next to be rolled out in 2011-2012 after impact reached on first 30 •
6. Share and disseminate best practices
•Identify approaches that work •Multiply experience sharing •Build toolkit • •
Ensur e
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scale
•McKinsey & Company | 1 1
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Questions for discussion
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What approaches have you seen work to achieve
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improvement at scale? What levers are key?
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How do you achieve true accountability of a hospital
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site leadership team?
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How prescriptive / tight (like Aravind) can the centre
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set the operating model?
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What have you seen to develop capabilities at
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scale?
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