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A Better Pill to Swallow a Global View of What Works in Healthcare

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A Better Pill to Swallow a Global View of What Works in Healthcare HEALTHCARE A Better Pill to Swallow A global view of what works in Healthcare KPMG INTERNATIONAL “The good news is that there are many more similarities than differences between national healthcare systems. The globalized nature of healthcare in developed countries offers the opportunity to share knowledge about what works like never before.” Mark Britnell Head of Healthcare for Europe, KPMG in the UK © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. Foreword Global healthcare: same diagnosis, similar remedies It is becoming increasingly evident that healthcare systems around the developed world are facing many similar challenges – higher quality for less cost. Although healthcare is primarily organized within national geographies, the market trends are truly global. Changing demographic profiles, an aging population, new technologies, pharmaceutical developments and rising consumer demands all create unprecedented fiscal pressures. The good news is that there are many more similarities than differences between national healthcare systems. The globalized nature of healthcare in developed countries offers the opportunity to share knowledge about what works like never before. To share some practical insights from healthcare organizations around the world that have successfully tackled productivity and efficiency challenges, KPMG worked with the Manchester Business School in the UK to select ten industry best practice examples that could be underpinned with a solid research and evidence base. We draw on in-depth interviews with healthcare leaders in Australia, Canada, Germany, Spain, New Zealand, the UK and the US, all of whom are passionate about their programs and interventions. These findings, together with desk research and insight from KPMG firms’ partners seek to offer a global perspective and practical guidance on how healthcare organizations can successfully manage the changes required. Whether you are a healthcare practitioner who runs, insures or commissions clinical services, we hope you find it useful. We would like to thank all those who gave up their time to participate in this study. Mark Britnell Alan Downey Head of Healthcare for Europe, Global Head of Healthcare, KPMG in the UK KPMG in the UK © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. CONTENTS Executive Summary Conclusion Case Studies s 'EISINGER(EALTH3YSTEM 53 s 6IRGINIA-ASON-EDICAL#ENTRE 53 s .EW3OUTH7ALES(EALTH !USTRALIA s #!3!0 #ATALONIA 3PAIN s -C-ASTER5NIVERSITY #ANADA s 4ORBAY#ARE4RUST 5+ s )NTERMOUNTAIN(EALTHCARE 53 s 0HARMAC .EW:EALAND s 4ECHNIKER+RANKENKASSE 'ERMANY s .ATIONAL(EALTH3ERVICE 5+ Acknowledgements © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. A BETTERPILLTOSWALLOW © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. All rights reserved. A BETTER PILL TO SWALLOW %8%#54)6%35--!29 Our case studies draw strength from s !T6IRGINIA-ASON-EDICAL#ENTRE many continents: Seattle, US, the comprehensive “The globalized application of ‘lean’ methodologies to s )N.EW3OUTH7ALES !USTRALIA all staff has substantially increased nature of healthcare, large-scale clinical system re-design productivity and saved millions of saved over three million bed days. dollars in budgeted capital investment. once harnessed, s 2ESEARCHAT-C-ASTER /NTARIO s )NTERMOUNTAIN(EALTHCAREIN3ALT,AKE can spread rapid Canada, demonstrates how City, US, praised by President Obama improvements to expertly stratified long-term for offering “high quality care at costs condition care provided active case below average, ” transformed its patient care.” management at around 20 percent mental health pathway and of traditional costs. successfully integrated its service Mark Britnell Head of Healthcare for Europe, s !TTHE4ECHNIKER+RANKENKASSE offering in primary care – reducing insurance fund in Germany, active costs by 10 percent while increasing KPMG in the UK health coaching for ‘at risk’ groups patient and carer satisfaction. has started to shift responsibility to s 4ORBAY $EVONINTHE5+ALREADYHAS the patient and has provided attractive demographic profiles similar to that rates of return on investment. predicted for the UK population by s )N#ATALONIA 3PAIN PRIMARYCARE 2050. An innovative health and social center Castelldefels Agents de Salut’s care organization offers holistic, cost- (CASAP) improved staff motivation, effective health and social care which, training and appraisal systems have against its benchmarked group, has incentivized dramatic improvements resulted in only 47 percent of the in primary care productivity. anticipated emergency bed days for people over the age of 85. s !T0HARMAC THE0HARMACEUTICAL Management Agency in New s &INALLY THE.ATIONAL)NSTITUTEFOR Zealand have made enormous Innovation and Improvement in the savings in the purchase and use of UK successfully launched ‘The pharmaceuticals through a dynamic, Productive Ward’ series; this has commercial approach to suppliers. dramatically released more time for nurses to care for patients through s )NTHE'EISINGER(EALTH3YSTEM patient flow re-design. This one Pennsylvania, US, the introduction initiative is now being adopted and of the ‘medical home’, where delivered throughout the world, primary and secondary care is presenting a striking example of how provided by a single health system, the globalized nature of healthcare, has resulted in a 20 percent once harnessed, can spread rapid reduction of hospital admissions. improvements to patient care. © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. A BETTER PILL TO SWALLOW “Patient centric care has not only been the Holy Grail in the quest for quality but it is also the nirvana for productivity and efficiency.” Mark Britnell CONCLUSIONS Head of Healthcare for Europe, KPMG in the UK Three clear characteristics dominate these case studies: s &IRSTLY THEPROJECTSALLHAVEINSPIRATIONALANDDETERMINEDSPONSORSHIPFROMLEADERS s 3ECONDLY CLINICIANSANDSTAFFARESUPPORTEDINAVARIETYOFWAYSTOCRITICALLY re-examine care processes and simplify patient flows. s 4HIRDLY ANDMOSTIMPORTANTLY THEMOSTSUCCESSFULANDSUSTAINABLECHANGESHAVE been made by looking at the care process from the patients’ point of view. Put the patient first Patient centric care has not only been the Holy Grail in the quest for quality, but it is also the nirvana for productivity and efficiency. High quality, patient focused care can, and does, save money but these benefits cannot materialize without dedicated planning, program management, excellent information and highly supportive technology. Often, disruptive innovation comes from external agencies to the organization but the change has to be owned by the staff. Work in partnership There are other characteristics of high performing health systems which may point to some global convergence. A key facet of high performance seems to relate to the individual and organizational capacity to partner – be it with patients, clinicians, social care organizations or insurance companies. In both the UK (Torbay) and Canada (Ontario), the ability to look holistically at an individual’s needs and provide funding and care support from ‘pooled’ budgets has reduced unnecessary bureaucracy and streamlined the care process, thereby making it more personal to the user, and more effective and efficient as a result. Similarly, purchaser-provider partnerships in different parts of the US have demonstrated impressive results in SHARINGCAPITATIONRISKSANDINTEGRATINGCARE$RAMATICIMPROVEMENTSINPRODUCTIVITY © 2010 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with International. All rights reserved. A BETTER PILL TO SWALLOW seem to occur where a single organization and dedicated team of clinical staff take responsibility for the entire value chain and use sophisticated information “A key facet of high technology to stratify patient need and focus attention and effort for those at risk. performance seems Support innovation with evidence to relate to the What is also clear is that sustainable change cannot be ‘an evidence free zone’. All OFTHEMAJORCLINICALCHANGEPROGRAMSNOTEDINOURSTUDYHAVERELIEDHEAVILYUPON individual and good baseline information, excellent modeling capability, risk stratification and change management skill, often facilitated by external agencies. Radical change organizational often requires disruptive innovation and the ability of any healthcare system to be capacity to open-minded and inquisitive is a fundamental pre-condition for success. partner – be it !LIGNOBJECTIVES ACCOUNTABILITYANDINCENTIVES with patients, Finally, countries have different funding and payment systems reflecting both cultural and political differences which range from socialized insurance
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