ANNUAL REPORT 2015/16 EXPERTISE YOU CAN TRUST. HIRSLANDEN A MEDICLINIC INTERNATIONAL COMPANY 2 FINANCIAL YEAR AT A GLANCE THE HIRSLANDEN PRIVATE HOSPITAL GROUP IN FIGURES* 16 2,030 8,750 6,570 hospitals in 11 cantons affiliated and staff (without employed full-time jobs employed doctors doctors) 98,600 469,200 6,230 inpatients care days** newborns * Financial year 2015/16 ** based on midnight census, without newborns CONTENTS FINANCIAL YEAR PERFORMANCE Editorial 3 Financial year 2015/16 in figures 38 Interview with the Executive Committee 4 Range of services 39 End-of-year review 6 SwissDRG 40 Key data 8 Diagnoses and operations 42 Organisational structure 9 ICD and CHOP 43 Investments 10 Diagnosis related groups (DRG) in figures 44 HR Report 12 Specialties at each hospital 46 Health policy 13 Specialty: heart medicine 47 QUALITY REFERENCES Improving the quality of treatment 14 Infrastructure of the hospitals 48 Patient satisfaction 16 Glossary 50 Unplanned readmissions, unplanned Swiss sites 52 reoperations and falls 20 Strategic partnerships and company details 54 Infection monitoring and patient safety 24 Mortality in the intensive care unit 28 Quality medicine initiative 30 Peer review procedure 3 1 Comprehensive quality management system 34 CIRS 36 FINANCIAL YEAR 3 EDITORIAL DEAR HIRSLANDEN FRIENDS LADIES AND GENTLEMEN Throughout its history, the Hirslanden Private Hospital This results in a higher quality of care and added efficiency. Group has always adapted itself successfully to changes in We are also following this goal in our core business at the the healthcare system. In order for this to continue in the hospitals, where we are further refining the provision of our future, we have decided to make some changes to our stra­ services. We see ourselves as a service provider that not tegic vision. Hirslanden is currently in the midst of trans­ only offers the necessary infrastructure for affiliated doctors, formation from a pure hospital operator to an integrated but also provides all common medical functions. These healthcare group. This means two things: On the one hand, include internal medicine, radiology, anaesthesia, intensive we want to increasingly offer a range of services that care and emergency care, and are carried out by both builds on our established core business. On the other hand, affiliated and employed doctors. The interdisciplinary cen­ we are establishing uniform, group­wide structures and tres of expertise can access these services at any time and processes that we can use to further increase patient bene­ thus concentrate fully on their main specialist tasks. This fits. This includes both an absolute focus on the quality division of tasks not only has a positive effect on treatment of medical care and patient satisfaction, plus improvements results, but also on the satisfaction of patients, employees in productivity. and referrers alike. Growth around our core business primarily focuses on We are convinced that we can once again significantly in­ expanding our range of outpatient and diagnostic services. crease the benefits for our patients as an integrated health­ Hirslanden already operates four practice centres, eleven care group. And that’s not all – as the largest medical radiology centres and four radiotherapy centres. Other simi­ network in Switzerland, we also make an important contri­ lar facilities are currently being planned, as are outpatient bution to a high­quality, efficient healthcare system in operation centres close to the hospitals. Moreover, we are our country. also examining the opportunities for growth in related spe­ cialties, such as psychiatry. The goal is to offer a range of services that covers all levels of outpatient, day patient and inpatient treatment, from family medicine through to diag­ nostics and highly specialised medicine. With our range of outpatient services, we are not only react­ ing to an increased market demand and the shift in medical services from the inpatient to the outpatient sector. We are also strengthening patient care across sectors and from a DR OLE WIESINGER single source, and all without delays or loss of information. Chief Executive Officer 4 FINANCIAL YEAR INTERVIEW WITH THE EXECUTIVE COMMITTEE Dr Christian Westerhoff, CCO, Dr Daniel Liedtke, COO, Magnus Oetiker, CSO, Dr Ole Wiesinger, CEO, and Andreas Kappeler, CFO (from left to right) THE PRESSURE ON TARIFFS IN THE HEALTHCARE SYSTEM DR CHRISTIAN WESTERHOFF: We not only wish to increase IS INCREASING, WHICH IS ONE OF THE MAIN REASONS productivity with this best practice approach, but patient BEHIND THE DESIRE TO FURTHER INCREASE THE benefits as a whole. In addition to improving efficiency, this PRODUCTIVITY OF THE CORE BUSINESS. HOW ARE also includes enhancing the quality of medical treatment YOU ACCOMPLISHING THIS? and patient satisfaction. DR DANIEL LIEDTKE: Anyone wishing to improve them­ “ANYONE WISHING TO IMPROVE selves has to first be aware of where they stand. The best way of finding this out is by comparing yourself to others – THEMSELVES HAS TO FIRST BE while always taking comparability into account, of course. AWARE OF WHERE THEY STAND.” This is why we only make comparisons between those Hirslanden hospitals that have a similar profile. For example, APART FROM LEARNING FROM THE BEST, WHICH CON- we take the orthopaedics department at Klinik Am Rosen­ CLUSIONS CAN YOU DRAW FROM THE COMPARISONS berg and compare this to the same department at Klinik BETWEEN THE HOSPITALS? Birshof. Such comparisons allow us to derive internal bench­ marks that the hospitals are then required to follow. These DR DANIEL LIEDTKE: We also take the results into account benchmarks range from the materials used per operation among other things when it comes to putting together to the costs per minute during operations and the bed occu­ the range of services offered by the individual hospitals. This pancy per hospital. They create healthy competition between takes place within the framework defined by the cantonal the hospitals and promote the concept of learning from hospital lists and the associated service obligations. It is thus the best, which in turn consistently increases the perfor­ obvious that we have to strengthen those specialties in which mance level within the hospitals. the hospitals can generate a high level of patient benefits. FINANCIAL YEAR 5 The days of our hospitals only providing the infrastructure “ACCUSATIONS OF CHERRY for affiliated doctors from many different specialisations are now long gone. Nowadays, the specialties must be com­ PICKING HAVE ALWAYS BEEN patible and complement each other. In this way, we aim UNFOUNDED – MORE SO to raise the profile of the hospitals and further improve our position on the market. TODAY THAN EVER BEFORE.” DR CHRISTIAN WESTERHOFF: In addition, the individual IN THE PAST FINANCIAL YEAR, HIRSLANDEN INTRO- specialties will also be integrated into a holistic system in DUCED A NEW MANAGEMENT STRUCTURE. WHY DO the future. This system is based on a clear division of tasks YOU NEED AN OPERATIONS COMMITTEE IN ADDITION between common medical functions such as anaesthesia, TO THE EXECUTIVE COMMITTEE, AS IT IS NOW KNOWN? radiology and intensive care, and the increasingly important sub­specialised or super­specialised teams of doctors. DR OLE WIESINGER: This structure enables tasks to be We call this type of organisation the “system provider ap­ assigned in a way that has proven practical in top manage­ proach”. ment of companies of our size. The Executive Committee (EXCO) is responsible for the long­term strategic planning SO THE PROFILING OF THE HOSPITALS IS NOT AIMED of the company, something which is incredibly important AT STRENGTHENING THE PARTICULARLY PROFITABLE due to the growing complexity involved. In contrast, the RANGE OF SERVICES FOR PRIVATE PATIENTS? Operations Committee (OPSCO) deals with implementing corporate strategies and optimising performance in the DR OLE WIESINGER: Accusations of cherry picking have here and now. always been unfounded – more so today than ever before. 15 of our 16 hospitals are on the hospital list of their re­ WHO IS ON THE OPERATIONS COMMITTEE? spective cantons. This means that we are obligated to admit patients with basic insurance without restrictions, which DR DANIEL LIEDTKE: The OPSCO includes both hospital is also exactly what we wish to do. The proportion of pa­ managers and managers from the Corporate Office, who tients with basic insurance has risen once again in the then jointly assume operational responsibility for the Group. last financial year and now stands at 43.5 percent, with This means we can achieve close co­operation between some sites even reaching figures above 60 percent. headquarters and the organisational units, make decisions that enjoy wide support and ensure a consistent imple­ THE TASKS ASSIGNED TO HEADQUARTERS, THE CORPO- mentation of the group strategy. RATE OFFICE, AND THE OPERATIONAL UNITS ARE BEING PUT ON A NEW FOOTING AT HIRSLANDEN. WHAT DOES THIS MEAN IN PRACTICE? MAGNUS OETIKER: In the coming years, we will be standard­ ising and further centralising many non­medical services. By doing this, the workload for the hospital management on site will be reduced, thereby enabling it to concentrate fully on its main task – namely to enhance patient benefits as previously mentioned. By combining such services, we can also achieve significant economies of scale. We want to fully utilise the potential here for reducing costs. Only if we exploit group benefits to the full can we also continue to grow profitably while tariffs are falling. ANDREAS KAPPELER: This not only applies to the growth of our existing range of services. Unifying and centralising support functions is also necessary for growth through the acquisition or development of new operational units. These can then be integrated much easier into the Group and benefit from group­wide standards right from the outset. DR OLE WIESINGER: We would also like public hospitals to take advantage of these group benefits, for example by our taking on management tasks on a contractual basis.