Dublin, May 2002

Public SPACE is an initiative of Boer & Croon Strategy and Management Group.This report is solely for the use of our clients. No part of it may be circulated, quoted, or reproduced

for distribution outside the client organization without prior written approval from Public SPACE.

HOSPITALCARE in 2010 A substantiated vision

drs S.P.M. de WaalBoer & Croon/Public SPACE

On the authority and assignment of NVZ

Dutch Hospital Association

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Trends

Stakeholders

Medical curative supply

BASICS OF THE STUDY

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Researched Trends

(Macro) economy and purchasing power

Medical technology and treatments

Demography and patient populations

Mobility

E-health

Education and job market

Political affiliation and influences of European Union

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Stakeholders

Society/political opinion

Pressure groups/NGOs

Health insurer(s)

Public Administration

Insurance Policy principles Minimum levels Corporate

Governance Quality and failure

Insurance Policy principles Minimum levels Corporate

Governance Quality and failure

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Medical curative supply 2010

Four dominant paths of development, own strategic choices needed!

Medical clinicalsetting of the future

Open & connected

1 Modular2

Professionaland

high risk3

Civil enterprise

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Patients Diseases Professionals Technique Organization and

management Accommodation

Patients Diseases Professionals Technique Organization and

management Accommodation

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Open and connected

Self-guiding in patient logistics

Seamless care chain Small-scale techniques

(diagnosis, alert) Further development in

outpatient treatment Telemedicine

Core Trends Concrete possibilities

Hospital Control Room Specialists in the

neighbourhood/shop Hospital-at-home General practitioner Case manager Vertical and horizontal

alliances in the whole industrial column (including HRM, real estate, insurance, pharmacy)

Curative care home-to-home

including prevention

Curative care home-to-home

including prevention

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Modular

Diversification of financing and entrepreneurship

Different routines and specialties with high logistic demands

Mobility and Europe Power patient

AND power doctor

‘War for talent’ Small scale org Feeling of ownership

Core trends Concrete possibilities

General hospitals and specialties

Concessions on acute care

Hospital owned ambulance service

Shop-in-the-shop, satellites, PMC units, boulevards

General specialist Active de-concentration Separation care/real

estate-development

Entre-preneur-

ship

Collective insurance

Routine and

purchasing power

Speciali-zation and technique

GovernmentGovernmentManagementManagement

PatientPatient DoctorDoctor

Core influence

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Which specialties can perform stand-alone?

Otolaryngologist

Dental surgery

Gynaecology/ fertility

Urology

Cardiology

Pulmonology

Orthopedics

Surgery

Cosmetic surgery

Ophthalmology

Nasal septum correction, earduct, removal adenoids/tonsils, paranasal sinuses

Implants, dental surgeries

IVF, abortion

Sterilization man, prostate surgery

Non-invasive treatments

Non-invasive treatments

Endoscopic surgery, hernia, tennis elbows, ankle and knee ligaments Groin rupture, navel rupture, varicose veins, stomache balloon

Various surgeries

cataract, laser treatments

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A la Carte…

Specialization in : chronic afflictions (heart clinics) or tropic/rare diseases (Havenziekenhuis Rotterdam)

Specialization in technique: gene technology, robotics, non-invasive treatments

Specialization in demography: elderly care, migrant care

Centers of excellence: international acknowledged excellence (George Pompidou Hospital in Paris)

Specialization in sector: corporate hospitals, private clinics,cash-driven specializations

Specialization in real estate management: shop-in-the-shop, satellites, dual-use of real estate

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Professional and high risk

‘War for talent’ Internationalization and

normalization job market

Risk diversification in care chain

Legal claims and publishing

Reputation management

Part time personnel/ professionals

Core trends Concrete possibilities

PR strategy with professional excellence

Broad range of contracting, rewarding and control of professionals

Hospital as principal of education

Temporary licenses/concessions

More specialist nurse Michelin system of

quality

Illuminative Example: airline company: Position pilot Accident

regulations

Illuminative Example: airline company: Position pilot Accident

regulations

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Organizing the professionals Unique or just rare?

Monodisciplinary or multidisciplinary treatment?

Attitudes of Enterpreneur or employee?

Added Value organization for core process?– Reputation, Branding and Identification– Technology– Legal shell– Staff Management and Recruitment– Customer Continuity– Power over the market/ who owns the brand?

Varieties in contracts and remuneration Range of structural models Divisions in Competences (clustering,

steering)?

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Civil entrepreneurship

Legitimacy gap of politics

Anticipating at public responsibility

Back to the roots/ communityfeeling

Rationing, here to stay Power and impact of

NGO(-like) actions

Core trends Concrete possibilities

Participation in social/civil activities/debates

Broaden and deepen the accountability-structure and information (corp.governance)

Alliances with pressure groups and individual health insurers

Excellent employership ‘Neighbourhoodstrategy

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De fundamentals of Civil Enterprise

Excellent Operational management : Good financial monitoring, no leaks, no financial secrets Cost structure in accordance with benchmarks

Public values and transparency on target: Public priorities are watched (emergency care, waiting

lists, medical quality) No misappropriations with public funding Public capacity is (medically, legally) objectively

attributed to the public demands

(Growing) opportunities for ‘additional’ or portfolio-activities

Both commercial and societal. Own strategy necessary

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Much legislation, little room for decentralization

Planning of supply, independent from demand

Stringent and scarce due to outside care policy (premium = collective burden)

Sector itself very collectively organized

Dissappearance of citizen’s trust Demotivation of employeesSlow progress of system changesNew policy is ‘too little, too late’

Current Steering in Care (Netherlands)

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Current Care Steering

Actual purchasing power increases, and ‘leaks’ abroad:• Pensions• New policies• Buying power of

citizens and their priorities

Modern patient wants another type of care (consumerism)

Health Care is not just about cost but also investing:• Employers/economic

development• Prevention

Competition on the job market is cutthroat

More private funding and public impotence ask for more private, differentiated (civil) entrepreneurship

Strong forces press upon the system

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Hospitals must make their own strategy!

Personal vision and ambitions

Excellent Operational and Professional Management

Public Transparancy and Compliance

Analyse strategic opportunities

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Public SPACE is an initiative of Boer & Croon

Consults top management on strategy and complex organizational changes

Boer & Croon Corporate Strategy

Boer & Croon Process Managers

Boer & Croon Corporate Communication

Boer & Croon Executive Managers

EIM Executive Interim Management

NeXtrategy

InterMaat Masters in Change

Boer & Croon Professional Governance

Academy for Young Executives

Public SPACE

Boer & Croon Corporate Finance+

Provides on temporarily basis with experienced and independent final responsible managers

Makes communication on the highest organizational level debatable, resolvable and embeddable

Supervises mergers and co-operations. Carries out valuation and search processes for candidates and assists with the integration

Guides and supervises complex change and decision processes

Provides on temporarily basis with change managers, project managers and operational managers

Provides with chairmen and members of the boards of management and of supervisory boards

Management development programs for young talent

Designs and implements internet and e-business strategies

Joint Venture with Egon Zehnder. EIM is our network of management and consultancy firms in Europe, the United States and Australia

International consultancy and research center in the field of Strategies

for Public And Civil Entrepreneurs

About 300 professionals are employed at Boer & Croon in the Netherlands and about 150 professionals in Europe.

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