Healthcare Organisation

Healthcare Organisation: Consultancy [1]

Authors: Imke Gevers, Max Ligtenberg

What does the job entail?

In this example the term ‘Consultancy’ is reserved for bringing external expertise into a healthcare organisation on a project basis. The service of consultancy described in this chapter is not limited to advice, but also includes the work implementation by ‘boots on the ground’ from outside the client’s organisation.

Clients come from a variety of organisations from the healthcare landscape: Healthcare organisations (e.g., hospitals, general practitioner organisations, elderly homes), organisations from the public domain (e.g., institutes, government organisations) or companies (e.g., insurance companies, med-tech companies).

The shared ultimate goal of consultants in the healthcare landscape is to add value to organisations so that patient care eventually improves. In certain instances, consultants can face initial resistance by sceptics because they give advice from an external perspective. In these situations, the TPs as consultant bring a considerable benefit since they have practical experience in patient care and can help the particular healthcare organisation in the best way possible.

Consultancy adds value to a healthcare organisation on different levels, in hierarchy ranked from top to bottom as: (1) vision, (2) strategy, (3) tactics, (4) implementation, and (5) adoption. Each level requires a different set of skills, approach, and mindset. Most consultants combine two or more of these different levels in their work. Two different examples of the execution in these levels are stated at the end of this chapter.

Multiple reasons exist to hire consultants for problems in healthcare organisations. Below, two categories of added value of consultants are defined: the consultant gives independent advice, and the consultant brings specific expertise to the organisation, partly acquired in other similar projects.

Firstly, being independent from the organisation brings multiple benefits, such as:

• Out-of-the-box mindset: not troubled by culture or history of the client’s organisation. The organisation can be ‘stuck’ in a certain mindset and can benefit from an outside view.
• An accelerating effect: This is created by the presence of external people (in both physical presence and any burn rate of budget). The increased sense of urgency increases the tempo in which a project or problem is handled in the organisation.
• The ability of giving independent advice: Consultants can be requested to give advice on sensitive topics and decisions or to bring uncomfortable messages. Without any strings attached to the line-organisation, messages brought by external consultants are experienced as more credible and trustworthy.

Secondly, a consultant brings benefits as one has a specific expertise, partly acquired in multiple similar organisations.

• Knowledge and expertise: With experience from previous clients or work the dependencies within a problem are defined more quickly. This contributes to better problem definition and accompanying solutions. As the client’s project can require a sudden and temporary demand in a specific area of expertise, consultants with experience in this field can be an efficient solution to fill this gap.
• Connection: A consultancy firm often works in several domains in healthcare organisations. They can combine the knowledge of multiple organisations to bring a full thought-out solution. In addition, they can connect the client with other organisations or experts that can help them to come to a fitting solution.

What makes a Technical Physician special in the role of healthcare consultant?

The six years of education and experience from internships in patient care creates a feeling for the healthcare landscape. This results in a better understanding of the problems that other healthcare workers face or problems that live in other healthcare areas. But also, the technologic foundation of the study leads to the ability to fairly judge technical problems and to have an in-depth discussion about it with the relevant stakeholders.

The combination of both medical and technical knowledge is a particularly strong asset in forming the connection between both domains, which is required for the consultancy work that they do.

Example of strategic consultancy in healthcare – Gupta Strategists [2]

Author: Imke Gevers

As a strategy consultant the goal is to demonstrably improve healthcare by providing advice on strategic issues, providing innovative ideas and implementing new strategies. In addition, support is offered wherever complex (market) analysis is required, new business models need to be developed, or major change is imminent. The way of working is characterised by creatively combining in-depth knowledge with a practical approach. Even though this role can be fulfilled by people with different backgrounds, TPs have several unique benefits. A TP is trained to combine their analytical skills with knowledge about healthcare and trained to come up with potential solutions quickly. In addition, a large portion of new strategies contains implementing new technological solutions and hereby the extensive knowledge of TPs is useful as well.

An example of a project where the Gupta team, including a TP, worked on was the strategic plan to implement the quality framework for palliative care. Part of this project was analysing the effects of nationwide implementation of the framework regarding improvement of quality and availability whilst reducing costs. For these types of projects the background of the TP can be very useful to analyse the effect of certain technological implementations and also to understand the difficulties in combining different departments and organisations in the local region. This type of care leads to an essential transformation in healthcare which eventually leads to general improvement of patient care and involves all stakeholders in healthcare.

Example of tactical, implementation & adoption consultancy in healthcare – KINASE Consulting [3]

Authors: Lidy Kuster, Max Ligtenberg

Implementation consultants are triggered by opportunities to improve the healthcare organisation by the use of technology. The best patient care and best clinical work environment is the result of synergy between people, processes, and systems. These domains form three pillars to which parts of a problem can be attributed to.

One thing is characteristic for implementation consultancy. One can have brilliant goals, aspirations, and wonderful technology. But without implementation all are useless. It is the implementation and adoption phase where the goals are realised, change is felt, and change is made. Therefore, the goals, combined with personal practical resistance and conservatism, need to be translated to a categorised and structured approach.

At KINASE Consulting, we believe successful impact in healthcare is achieved by following the equation of C × (L + C + P). In short, this is the multiplication of Consultancy skills (C), e.g., analytical and structured thinking, with the (more important) principles of Listening (L) carefully to identify the real challenge, Connecting (C) with people to understand their needs and Practical (P) healthcare experience so you can put yourself in the shoes of the healthcare professional. This combination will lead to sustained change, improved patient care and the initiation of fruitful collaborations.

As an example, we helped a group of medical specialists to set up a regional network of expertise for their specific patient population. The goal of the specialists was to transform their pilot network structure for tertiary patient care in the region into a professional and sustainable collaboration. A strategic healthcare consultancy company defined the long-term goals, such as a more structured organisation, clinical evaluation indicators and financial compensation. We translated the long-term goals into processes and working agreements for daily practice. By using a practical and agile implementation plan with prioritised actions, timelines, and intermediate goals, we implemented the new processes and agreements and achieved a new regional multidisciplinary care network. Regional multidisciplinary consultations replaced referrals of secondary medical centres to the expertise centre, without losing quality of care. A huge success for patients and doctors, as the best patient care was accessible close to home.

Due to multiple circumstances, our primary focus had to shift to the formation of an application for structural financial compensation for the multidisciplinary consultation. Even though health finance is not the main expertise of TPs, we quickly took up the new knowledge area. The previous practical healthcare experience of KINASE consultants is a major advantage in in understanding the daily priorities of healthcare personnel and which information they need to make decisions in the project. Both flexibility in planning and matching the knowledge area are essential to establish a successful process change in healthcare.

Healthcare Organisation: Change, project, and program management

Authors: Daan de Jong, Malou Peppelman

What does the job entail?

Besides high-complex technological innovations it is also important to start organising our healthcare sector differently, especially with its upcoming challenges. Often the solution can be found in low-complex but widely applicable technologies. Hereby it is not only important to choose the right technology, but also to customise it to fit the tasks of an individual.

The customisation takes place on different levels, from change and program management to concrete implementation projects. In the bigger picture the job is focused on projects to change healthcare in the area of innovation, organisation and digitalisation. Despite the specific challenges and methodologies being different on every level, the recurring theme is designing the future way of work in which the desires of the users are matched with the technological possibilities. Eventually this leads to implementation of innovations in common practice. At that stage there are also crucial design decisions to be made to ensure the match between user, task and technology (see example 1). This begins with a well-thought-out design and is followed by a sufficient implementation process in which the focus is not on the specific technology but more on the intended users.

What makes a Technical Physician special in change, project and program management?

Despite the fact a TP is not primarily educated for this job position, you can definitely be of added value with a TP background and even make a mark in the field. This is due to the fact that a TP can easily come along with the way of work (project based and goal oriented), can quickly analyse complex situations and can easily connect between different areas of expertise. During the study they have learned to comprehend technological (im)possibilities and how to make it work in the healthcare field. Below a more extensive explanation:

• Used to project based working, both in bigger projects and in subprojects where the goal is not already defined.
• Having a good understanding of the technical needs and where the impossibilities lie, but also comprehending the wishes of the end-users. They are aware of how it should work in practice and how to provide a safe implementation without extra unnecessary actions.
• Being able to differentiate what will make a difference in the daily practice and what is a technical gadget for a specific need.

Example of change management in setting up a ‘Smart hospital’ – Consultancy Group PVI, Radboudumc

Author: Daan de Jong

The Radboudumc focusses on creating a ‘smart hospital’, in anticipation of a new hospital building. This includes implementing smart technologies that are common in daily practice (such as smartphones) into the care process of their hospital. Eventually, this resulted in the replacement of their pagers with smart-health-phones for nurses, which also included a new informative alarm system. During this project a TP, in the role of change-manager, was asked to determine, work out and test the design requirements with help of the nurses. On top of that they have worked on a patient tablet from which the patient can do differentiated nurse calls. In this particular case they decided to not use the extensive list of alarms from the supplier but to only put five call options for patients in place: urgent medical, restroom, helping hand, request for drinks/food and materials. The specific list has been put together carefully and they entail the different categories that ask a varying need in the work processes of the nurses. This shows an example of how you can work together with the end-user and use their process to create a customised technical solution.

The TP helped in designing an intuitive system based on the clinical work process. A byproduct of this innovation was the increased awareness that technology can assist in the healthcare process. The older generation of nurses are often thought to be more technology sceptical. However, due to this project, the older generation also recognised the additional possibilities and added value of new possibilities by the support of technology. Furthermore, to ensure a good transfer to the new hospital building, it was necessary to train all nurses. The TP helped in providing an effective training for implementing the ‘smart hospital’. This resulted in adequate training of every nurse, well and on time before the transfer. This ‘smart hospital’ infrastructure became the foundation for the entire hospital.

Example of implementation of telemonitoring

Author: Malou Peppelman

The implementation of telemonitoring in the hospital infrastructure is a complex process. In this example a TP implemented a telemonitoring tool for chronic conditions such as COPD and heart failure. The goal was to develop a selection of different platforms that offer a variety of technological solutions. The selected platform had to be a well-fitted solution that needed to suffice for the design requirements and possibilities in the healthcare process. This meant that the TP needed to take the intended purpose for implementation of telemonitoring into account.

A TP is capable of swiftly becoming an expert in the specific healthcare processes and translating that knowledge to the required functionalities for patients and healthcare providers. They provide the necessary bridge function between those two stakeholders. The results-oriented mindset of a TP accelerates the implementation into the healthcare infrastructure.

Conclusion

In this chapter two specific examples were elaborated upon in the field of healthcare organisation. Of course, there are many more possible work fields than specified here. This overview is based on the currently involved TPs in this cluster. The number of TPs and variety of job profiles within the cluster is expected to grow over time because of new and existing TPs joining the cluster Healthcare Organisation. The TP plays an essential role in healthcare organisation because they understand the position of patients, healthcare providers and other stakeholders in our health system. By overseeing the bigger picture, improving the systems around healthcare, and using practical experience, TPs from this cluster work towards the same goal as other TPs; “the best healthcare to all patients”.