Healthcare Organisation

Introduction

In the field of Technical Medicine a lot of people work ín the healthcare sector, but  select group also works ón the healthcare sector. These people are gathered in a cluster called: Healthcare Organisation. The public domain in the Netherlands has a very unique and interesting structure with a lot of different stakeholders such as healthcare providers, insurers, regulators and government organisations. They all must work together to provide the best healthcare for all patients. The technical physicians in this sector are working with and for various stakeholders to help them keep the balance between quality, accessibility and affordability of healthcare. This can be done by creating new strategies, monitoring safety, managing implementations for new med-tech innovations, and more. Here the technical physician typically acts as a connector between different hospital departments, between different organisations and between different stakeholders. The job descriptions of technical physicians in healthcare organisation are not solely reserved for technical physicians. However, the technical physician gives its role a very unique perspective to solve the assignments in a specific way. They use the knowledge gained from the study of Technical Medicine in a helicopter view to improve the healthcare sector all together.

General field of work

The cluster Healthcare Organisation covers the technical physicians working in the healthcare landscape around the process of patient care. They operate outside the medical domain. So, this technical physician does not focus on the physiologic ‘what’ they do for patients, in terms of diagnostic or therapeutic interventions. But they focus on the ‘how’ they organise and orchestrate healthcare.

Technical physicians in cluster Healthcare Organisation share core aspects with other technical physicians in their field of work: technology, innovation and optimization. They often work in a project structure together with a team. The different roles and fields of work of technical physicians in this cluster are presented in terms of proximity around the process of direct patient care. As of August 2023, the roles are defined as follows:

Shared expertise in field of work

The jobs of technical physicians from cluster Healthcare Organisation are not exclusive to people with a background as TP. In fact, the positions can also be filled by people with different educational backgrounds. However, the training as a technical physician forms a unique and solid foundation that creates an additional value on the job. This added value comes in terms of competences and mindset.

The first highlighted competence is the ability to collaborate with different stakeholders. By having repeatedly formed the connection between medical and technical domains during multiple internships, technical physicians speak both professional languages. This is not limited to simply vocabulary, but also includes different communication styles, ways of thinking and perception of problems. Being in the centre of a multidisciplinary mix of professionals leads to a better understanding of the experienced problems by the domains. It also creates awareness of colleagues that may not master a specific domain and require different communication in terms of content and style.

The second competence is the analytical skill in problem solving, acquired in education. This is an uncommon skillset for a healthcare worker to have. Not that one is particularly better than the other, but in a sector that seems to be predominantly occupied by alpha and gamma studies, beta analytical skills contribute to more diverse teams. And the analytical view in combination with the understanding of problems in health care enables the technical physician to work on complex problems.

A third competence is the ingenuity that comes with a technical physician. They have a thorough knowledge of the different domains in healthcare. This gives them the ability to quickly adapt to new situations and put in creative ideas and solutions.

In terms of mindset, technical physicians show multiple common positive mindset traits. This could be induced by the study programme’s interest, selection and training. The first highlighted trait is the desire to be caring. technical physicians generally want to do good, care for each other and contribute to a better society. Therefore, technical physicians generally include the possible impact on the patient and healthcare workers in their decision making. This caring mindset unlocks the drive to come up with sustainable solutions with a durable impact on patient care.

Technical physicians are pioneers by natural selection and by design. They dared to take a different path and chosen for an education as a new breed of healthcare professional. This results in risk tolerance to start a new or drive an existing project. Also, the multiple clinical internships of ten weeks each developed independent thinking and resourcefulness. As a student you had to do things ‘your way’ to reach your goals, one way or the other, within the deadline despite undoubted setbacks.

The third trait of being goal-focussed can also be deduced from the mentioned internships, which required a student to be goal focussed from the start. As in every internship a plan, execution and the report of a study had to be produced within a short time span of ten weeks.

Healthcare Organisation: Consultancy

Authors: Imke Gevers and 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 technical physicians in the role of consultant is to add value to organisations that improves patient care. However, this goal is the diametrical opposite of sentiment that can be perceived towards consultants in healthcare. Consultants in healthcare can face initial resistance by sceptics that see consultants as over-priced workforce, giving obvious advice without practical experience. However, technical physicians have experience and understanding of healthcare workers and strive to maximise this experience to 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 and (4) implementation. Each level requires a different set of skills, approach and mindset. Two different examples of these levels are stated at the end of the chapter.

Multiple reasons exist to hire consultants for problems in healthcare organisations. Below, two categories of added value of consultants are defined as: 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 frame of mind that 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 other organisations 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 6 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.

Lastly, again the pioneering and future-focussed mindset proves to be an advantage in consultancy. The study programme encouraged free and independent thinking that led to a resourceful and problem-solving mindset. In combination with the ‘getting things done in a short internship’ the study of technical medicine forms a solid foundation for the next generation of professionals that drive the positive impact on healthcare, as shown by the examples below.

Example of (tactical) implementation consultancy in healthcare - Kinase consulting

Authors: Lidy Kuster and Max Ligtenberg

Implementation consultants are triggered by opportunities to improve the healthcare organisation and the use of technology. The best patient care and best clinical work environment is the result of synergy between people, processes and systems. These also 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 where the results are booked, change is felt, and change is resisted. Therefore, the goals, combined with individual practical resistance, need to be translated to a categorised and structured approach. Within our company, successful impact on healthcare is achieved by following the equation of C * (L + C + P). In short, this t is the multiplication of hard-line Consultancy skills, e.g., structured thinking, with the (more important) principles of Listening carefully to identify the real problem, Connecting with people to understand their needs and Practical healthcare experience to speak the same language. This combination will lead to sustained change, improved patient care and the initiation of fruitful collaborations.

As an example, we helped a tertiary expertise centre of medical specialists in the professionalisation of their innovative way of working. The goal of the expertise centre was to transform their pilot network structure of providing patient care into a professional collaboration with a sustainable payment structure. As part of their pilot network, they organised a regional multidisciplinary consultation. This replaced the referrals of secondary medical centres to the expertise centre, without a losing quality of care. A huge success for patients and doctors, as the best patient care was accessible close to home. However, current pilot structure had to be professionalised to make the regional multidisciplinary consultation sustainable. Another, strategic healthcare consultancy company defined ‘the goals on the horizon’, such as a more structured organisation, clinical evaluation indicators and a form of financial compensation. We translated the goals on the horizon to an implementation plan with prioritised actions, timelines and intermediate goals.

After creating the implementation plan, we also were the front runners in executing the implementation plan. Due to multiple circumstances, our primary focus was the formation of an application to structural financial compensation for the multidisciplinary consultation. In the process, previous practical healthcare experience was a major advantage in formulating the application, but mainly in understanding the unavailability of healthcare personnel and which information they need to make decisions in the project. With the education as technical physician, we could present the desired information and know how to circle around healthcare and how to adapt where necessary.

One could hardly be against this form of multidisciplinary consultation, as in theory it improved every aspect of the quadruple aim. However, it still proved challenging to arrange any financial compensation. And even though health finance is not the main expertise of technical physicians, it showed we quickly take up a new knowledge area and can travel the untrodden paths.

Source: KINASE.nl

Healthcare Organisation: Change, project and program management  

Authors: Daan de Jong and 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 customization 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 technical physician is not primarily educated for this job position, you can definitely be of an added value with a technical physician background and even make a mark in the field. This is due to the fact that a technical physician 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 has in anticipatoion of a new hospital building focused on creating a ‘smart hospital’. This means implementing smart technologies that are common in daily practice (such as smartphones) into the care process of their hospital. Eventually this has resulted in smart-health-phones for nurses to replace their pager including a new informative alarm system. During this project a technical physician, 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 technical physician helped in designing an intuitive system based on their work process. A surprising observation was that on top of that it gave extra assistance for the older generation, which are often thought to be more technology sceptical, recognized to directly experience the additional possibilities and added value of the new process supported with the technology. Furthermore, to ensure a good transfer to the new hospital building, it was necessary to provide training to all nurses. The TP helped in providing an effective training for implementing the ‘smart hospital’. This resulted in the fact that every nurse was trained well and on time before the transfer. This ‘smart hospital’ infrastructure is now the foundation for the entire hospital. 

Example of implementation of telemonitoring 

Author: Malou Peppelman 

The implementation of telemonitoring in the hospital infrastructure is always a complex process. In this example a TP has implemented a telemonitoring tool for chronic conditions such as COPD and HF. They had to make 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, aka which purpose is intended for the implementation of telemonitoring. A TP is capable of swiftly becoming an expert in the specific healthcare processes and translating that to the required functionalities for patient and healthcare provider. 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 have been elaborated in the field of healthcare organisation. Of course, there are many more possible work fields than there has been 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 and improving the systems around healthcare, TPs from this cluster work towards the same goal as other TPs; “the best healthcare to all patients”.