Optimising Planning, Optimising Design
Dr FUNG Hong
Executive Director CUHK Medical Centre
Professor of Practice in Health Services Management Jockey Club School of Public Health & Primary Care The Chinese University of Hong Kong
Optimising Planning, Optimising Design
PART 1
Introduction
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The WHO Health System Framework
Source: WHO (2007) Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, WHO. 2 Optimising Planning, Optimising Design
Reforms interacting with building blocks
Source: Senkubuge et al. Glob Health Action 2014, 7: 23568 3 Optimising Planning, Optimising Design Rapidly Aging Population Population profile in 2014 & 2041
Age group Mid 2014 Age group Mid 2041 85 + 85 + 80 - 84 Male Female 80 - 84 Male Female 75 - 79 75 - 79 70 - 74 70 - 74 65 - 69 65 - 69 60 - 64 60 - 64 55 - 59 55 - 59 50 - 54 50 - 54 45 - 49 45 - 49 40 - 44 40 - 44 35 - 39 35 - 39 30 - 34 30 - 34 25 - 29 25 - 29 20 - 24 20 - 24 15 - 19 15 - 19 10 - 14 10 - 14 5 - 9 5 - 9 0 - 4 0 - 4
400 300 200 100 0 100 200 300 400 400 300 200 100 0 100 200 300 400 Thousands persons Thousands persons
Source: Census and Statistics Department Website 4 Optimising Planning, Optimising Design
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Source: The 2013/14 Budget, HKSAR 6 Optimising Planning, Optimising Design
Mounting Burden from Elderly
7 Optimising Planning, Optimising Design Hong Kong’s Dual-track Healthcare System
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Source: HK’s Domestic Health Accounts. Estimates of Health Expenditure, 2010/11 9 Optimising Planning, Optimising Design
Expansion in Public Sector
2014/15 Budget Speech • Renovation projects in 11 hospitals with 800 additional beds
2015/16 Budget Speech • New hospital in Kai Tak Development Area • Tin Shui Wai Hospital • Hong Kong Children’s Hospital • Redevelopment of Queen Mary Hospital & Kwong Wah Hospital • Expansion of United Christian Hospital • Providing 2,800 additional beds at HK$81 billion
2016 Policy Address • 10-year plan to provide some 5,000 public hospital beds at HK$200 billion
10 Optimising Planning, Optimising Design Healthcare Reform 2015
11 Optimising Planning, Optimising Design Regulate Individual Hospital Insurance
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Supporting Infrastructure
Facilitate private hospital development • New private hospital in Wong Chuk Hang (500 beds, commences operation in 2017) • Proposed new teaching hospital by Chinese University of Hong Kong • Expansion of existing private hospitals (~900 beds) — Hong Kong Baptist Hospital — Tsuen Wan Adventist Hospital — St Paul’s Hospital — Hong Kong Sanatorium & Hospital
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Regulation of private healthcare service facilities • Price transparency . Disclosure of price information . Written quotation of doctor’s fee and hospital charges . Packaged pricing for common procedures . Disclosure of historical statistics • Regulation of ambulatory centers where high-risk medical procedures are conducted
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PART 2
Optimising Planning
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Distribution of Hospital Clusters in Hospital Authority
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Cluster Composition
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Population Change Across HK by 2026
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Hospitals have their own roles within a cluster
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Clinical Service Plan (CSP)
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Functions of CSP
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The Process
• Capacity planning • Service delivery model • Consultation and engagement
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One Day Seminar
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Implementation of CSP
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Transforming Process
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PART 3
Optimising Design
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Healthcare Design Best-practices
• Current Best-practices in Hospital Design －Evidence-based Design (building blocks) －Lean-led Hospital Design (adding value to every step along the patient journey) . Using an inter-professional team-based approach to design a patient-centric healthcare facility . Using evidence-based design features as the building blocks to pave the patient journey
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Know-do Gap in Implementing Healthcare Design Best-practices
• Even if we know what the best-practices are, how can we implement them within the constraints of our healthcare reality? －Uncertain global economy －Increased healthcare cost －Aging-population associated increased users with chronic and complex diseases • Given that hospital construction is a multi-year project, how could we prepare for the changes and build in the flexibility in the hospital design in order to adapt to the future?
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OR/MS to Optimize Healthcare Design given the Real-life Constraints
In addition to integrating the building blocks of evidence-based design features along the patient journey using lean methodology: – Linear programing to optimise the patient outcomes and efficiency within the budgetary, infrastructural and human resources constraints – Simulation model based on the analytical programming to build consensus among inter-professional team, facilitate decision making and forecast future demands and constraints
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Story of QEH: Integrating Service Improvement and Design Optimisation
Queen Elizabeth Hospital • The largest public hospital in HK • 1,800 beds • Located in the heart of Kowloon – Kowloon Central Cluster • Provides in both inpatient and specialist outpatient services 50 years, outdated & long queue Transferring services to Kai Tak redevelopment site
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Story of QEH: Integrating Service Improvement and Design Optimisation
• Long history of working partnership between QEH & CityU HK to improve hospital logistics & care delivery – Reduce wait-time of the ambulatory clinic by improving the match between health service supply and demand – Improve Point-of-care Storage – “Cart-based” Ward Consumables; Stock Replenishment System – Improve porter service by optimising routes and location of the service hubs – Reduce adverse events and avoidable readmission by optimising resource allocation at different stages of the patient journey
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Story of QEH: Integrating Service Improvement and Design Optimisation
• But how can we leverage the improvement process developed at the old QEH hospital to inform the design and capacity planning of the new site?
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Story of QEH: Integrating Service Improvement and Design Optimisation
1. Revised previously built analytical models previously built to reflect the healthcare reality of the new neighborhood. 2. Developed Discrete Event Simulation based on the analytical models of specific logistical/care processes, and System Dynamics to simulate the overall system operations. 3. Using the simulation models above to build consensus within hospital to implement lean-led hospital design methodology more efficiently. 4. Starting with medical wards aiming to optimise resource allocation and discharge accuracy.
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CUHK Medical Centre
Our Vision : • To provide affordable, patient-centered, price transparent and quality healthcare • To contribute towards the social mission of CUHK to meet the healthcare needs of the Hong Kong community
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Planning & Design
• Use of operational modeling to optimise operational performance, system and spatial design, information People Flow and communication technology (ICT) design
Information Spatial Connectedness Relations
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Study Objectives
• Identify bottlenecks • Assess size of waiting areas • Model utilisation of key rooms with • Virtual patients • Patient flows • Care plans
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Process & Platform for Optimisation Study
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Acknowledgement
• Dr Libby Lee, The Hospital Authority, Hong Kong • Professor Eman Leung, City University of Hong Kong • Mr Eric Shen, Aditazz
41 Thank You