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Improving the efficiency of health care management. Case Study 1: Improving quality at BUPA’s private hospital in Leeds Case Study 2: BUPA’s role in managing the UK government’s first Diagnostic Treatment Centre (DTC) at Redwood Case Study 3: Manises, Spain.

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Presentation Transcript
slide2
Case Study 1: Improving quality at BUPA’s private hospital in Leeds
  • Case Study 2: BUPA’s role in managing the UK government’s first Diagnostic Treatment Centre (DTC) at Redwood
  • Case Study 3: Manises, Spain
redwood diagnosis and treatment centre

RedwoodDiagnosis and Treatment Centre

Case Study 1:

Improving quality at BUPA’s hospital in Leeds

operating performance 2001 2004
Operating performance 2001 - 2004
  • Revenues + 34.6%
  • Operating profit + 28.9%
  • Operating return 27.6%
  • Staff costs - 0.5 pp
satisfaction indices 2001 2004
Satisfaction Indices 2001 - 2004
  • Consultant satisfaction

2001 = 44, 2004 = 74 (top hospital)

  • Patient satisfaction

2001 = 89, 2004 = 89 (top quartile)

  • Staff satisfaction

2001 = 51, 2004 = 68 (top quartile)

slide9
Improving quality through…

“If we look after our staff and

focus them on improving our processes

we will attract and retain more customers.”

slide10
(1) Business Plan

(3) FOCUS

Scorecard

(2) Quarterly

Action

Plan

slide11
(2)

Quarterly

Action

Plan

slide12
(3)

FOCUS

Scorecard

slide14
Governance structure

Staff Group

Clinical

Governance

Customers

Hospital

departments

Quality

Health & Safety

Medical Advisory

Committee

drives communication
Drives communication
  • BUSINESS CO-ORDINATION
  • COMPLAINTS MANGAGEMENT
  • FINANCE REVIEW
  • SCORECARD REVIEW
  • CUSTOMER INFORMATION
  • 2 WAY COMMUNICATION
  • DRIVES PROFIT

Hospital

departments

slide16
Staff

Newsletter

drives clinical quality
Drives clinical quality
  • SET AND REVIEW CLINICAL TARGETS
  • AUDIT EFFECTIVE OUTCOMES OF CARE
  • CONSULTANT MANAGEMENT & APPRAISAL
  • ADVERSE INCIDENTS & CLINICAL COMPLAINTS
  • EXTERNAL REGULATION

Clinical

Governance

consultant data reports
Code

Type

Cases

Returns

%

Re-admit

%

Re-dos

%

LOS

B3120

BBA

89

6

6.7

6

6.7

7

7.9

1.15

B3100

BBR

51

7

13.7

0

0

3

5.9

2.13

S0120

Face lift

18

3

16.7

1

5.6

4

22.2

2.41

S0210

Abdom

48

1

2.1

4

8.3

10

20.8

2.43

E0260

Rhino

41

0

0

0

0

4

9.8

1.12

Sub

Total

247

17

6.9

11

4.5

28

11.3

Grand

Total

937

26

2.8

19

2.0

55

5.9

Consultant data reports
slide24
Case Study 2:

BUPA’s role in managing the UK government’s first Diagnostic Treatment Centre (DTC) at Redwood

about redwood the history
About Redwood – The History
  • Located on East Surrey Hospital site
  • Private patient unit
  • Prototype – opened December 2002
  • BUPA investment of approx US$ 15.0m
  • Treated 43,000 patients to date
about redwood the facilities
About Redwood – The Facilities
  • 24 inpatient beds (individual rooms)
  • 12 day case trolleys (4 bays)
  • 2 theatres and 3 endoscopy rooms
  • 10 endoscopy trolleys
  • Outpatients, minor ops and x-ray
about redwood the services
About Redwood - The Services
  • Orthopaedics
  • General Surgery
  • Gynaecology
  • Urology
  • Maxillo-facial
  • Endoscopy
about redwood activity
About Redwood - Activity
  • 2003 - 8,913 patients
  • 2005 - 12,633 patients
  • 2006 - 14,000 patients
partnership and integration
Partnership and Integration
  • Co-located
  • Strategy
  • Operational management
  • Medical staffing
  • Nursing
  • Service level agreements
partnership and integration cont
Partnership and Integration (cont)
  • Shared risk agreement
  • Governance Committees
  • Shared pathways
  • Management of complaints
  • Protocols and policies
  • Training
  • Service planning
demonstrating the benefits
Demonstrating the Benefits

Priority: achieving the balance

  • Clinical quality
  • Stakeholder satisfaction
  • Patient numbers

Patient Numbers

Stakeholder Satisfaction

Clinical

Quality

demonstrating the benefits cont
Demonstrating the Benefits (cont)

How can we measure success?

  • Clinical indicators
  • Satisfaction surveys
  • External review
clinical indicators 2005
Clinical Indicators 2005
  • Patients treated - 12,633
  • Mortality - 1(emergency admission)
  • Transfers to other provider - 14 (0.1%)
  • Returns to theatre - 5 (0.08%)
  • DC unplanned admissions - 54 (0.5%)
  • Joints - surgical site infections - 11 (2.3%)
  • Incidents reported to NPSA - 0
  • Referral protocol rejection Q1 2006 - 23 (2.2%)
2005 patient satisfaction survey
2005 Patient Satisfaction Survey

(0)‘Neither’ 2%

(-1)

‘Poor’ 1%

(+1)

‘Quite Good’ 10%

(-3)‘Excellent’

43%

87%

87%

85%

(+4)‘Very Good’45%

43%

45%

46%

Trends…?

40%

41%

44%

patient comments
Patient Comments

I received very sympathetic and good advice from the surgeon and anaesthetist along with excellent and patient nursing staff. The food was first-class and the cleanliness can't be faulted!

I could not have received kinder, more considerate treatment from nurses or doctors - they really had patients’ needs as a priority!

I received respect and care as an individual - not just a number. In fact, I was quite amazed to be treated so well!

From start to finish, I was treated courteously, on time and involved with my treatment. I was given a good explanation of my treatment and operation by clinical staff, with a touch of humour!

2005 consultant satisfaction survey
2005 Consultant Satisfaction Survey

‘Neither’ 6%

‘Poor’ 6%

‘Excellent’

50%

‘Quite Good’ 17%

‘Very Good’22%

consultant comments
Consultant Comments

Proper and accurate communication, prompt actions taken if needed and a very friendly atmosphere.

Well organised theatre lists, good patient care and easy to communicate.

Over the first 2-3 years, we have developed effective working relationships between the two management teams.

A flexible and responsive service that works with the NHS in a participative way.

utilisation theatres
Utilisation - Theatres

Redwood Target – 87%

utilisation consultants
Utilisation - Consultants

Redwood Target – 87%

slide47
At BUPA Hospital Leeds & Redwood DTC….

…Quality is the key to success

“If we look after our staff and

focus them on improving our processes

we will attract and retain more customers.”

slide49
Welfare State

THE SPANISH WELFARE STATE

Long Term Care

Pensions

Education

Health

slide50
MAIN PROBLEMS SPANISH NATIONAL HEALTH SYSTEM

Duplicative health system:

Demographic challenges:

Medical provision:

  • Overcrowding
  • Waiting lists
  • Dissatisfaction
  • Budget deficits
slide51
PFI - PRIVATE FINANCE INITIATIVES

Objective: Control health care costs by transferring risk to more efficient private provider

PFI models are estimated to generate savings for the Autonomous Communities of 10%-20% of current costs

  • Traditional PFI
  • PPP – Valencia model
slide52
Public Private Partnerships

Health System

Provider

Insurer

Public

Private

Public

Private

  • Muface

NHS

Infrastructure

PFI

Health care provision + Infrastructure

PPP

manises model
Manises Model
  • Traditional PFI + provision of core clinical services: primary, secondary and specialist care also delivered by the private sector
  • “The money follows the patient”: The Autonomous Community pays the private company a premium per person registered in the area –capitative payment
  • 5 hospitals in Valencia
  • 1 hospital in Madrid
challenges of manises model
Challenges of Manises Model

First time working for the public system providing:

  • Universal coverage of population, covering all illnesses, including dialysis, HIV, transplants, etc.
  • Management of public sector employees
  • Provision of primary care services
  • Project undertaken with an external partner
slide56
Thank-you!

Paul Gregersen

[email protected]

1391 016 9830

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