From cars to care

Dr. ir. Roel W. Schuring

WHO ranking (excl. Small countries)

9. Portugal (1.469)10.Greece (1.390)11.Netherlands (2.255)12.U. Kingdom (1.774)13. Ireland (1.944)14.Switzerland (3.229)15.Belgium (2.269)31.USA (4.499)

9. Portugal (1.469)10.Greece (1.390)11.Netherlands (2.255)12.U. Kingdom (1.774)13. Ireland (1.944)14.14. Switzerland (3.229)Switzerland (3.229)15.Belgium (2.269)31.31. USA (4.499)USA (4.499)

1. France (2.335)2. Italy (2.040)3. Singapore (913)4. Spain (1539)5. Oman (448)6. Austria (2171)7. Japan (2009)8. Norway (2373)

US Growth of HC expenditures

0

2

4

6

8

10

12

14

1994 1995 1996 1997 1998 1999 2000 2001 2002

grow

th c

ost %

WHO ranking (excl. Small countries)

9. Portugal (1.469)10.Greece (1.390)11.Netherlands (2.255)12.U. Kingdom (1.774)13. Ireland (1.944)14.Switzerland (3.229)15.Belgium (2.269)31.USA (4.499)

9. Portugal (1.469)10.Greece (1.390)11.Netherlands (2.255)12.U. Kingdom (1.774)13. Ireland (1.944)14.14. Switzerland (3.229)Switzerland (3.229)15.Belgium (2.269)31.31. USA (4.499)USA (4.499)

1. France (2.335)2. Italy (2.040)3. Singapore (913)4. Spain (1539)5. Oman (448)6. Austria (2171)7. Japan (2009)8. Norway (2373)

France Says Heat Wave Death Toll Is 11,435 / AP 31aug03

PARIS — France's first comprehensive tally of the searing heat wave stirred fresh

outrage Friday when the government revealed that an alarming 11,435 people

had died — far beyond its initial estimates.

Healthcare is under pressure

• Reduced economic growth • More old people• New technologies available• Increasing demands• Complaining workers in the sector

Where do we stand?

• To err is human: 48.000 – 98.000 deaths due to medical error in the US: yearly

• UK: NHS: 27 – 86 % prescription error• Netherlands: 17 – 37 % distribution error

of medication in hospitals• Variance in practice

Variance in practice (I)

Post Operative Wound Infections

Best 25% Worst 25%

Breast Surgery < 3% > 9 %

Hip Replacement < 2% > 25%

Knee Replacement < 1% > 4%

Source: CBO/RIVM 1999

Variance in practice (II)

Variance kneearthroscopics

least (4 locations)

largest (3 locations)

Minutes 10 min. ± 40 min.

We really do our best, but everything is not under control!

What do we do about it?

• System changes, capacity planning, budget-control

• Budgeting / pricing• Cochrane standards

• System changes, capacity planning, budget-control

• Budgeting / pricing• Cochrane standards• Management instruments• High-Tech & IT solutions

Budgeting / pricing

• Administrative burden• Selection of most attractive patients

(cream-skimming• Tendency to upgrade patients • Large control system is needed• Basic properties of care unaffected.

Source: www.marklin.com

Chevy Monza Sports 1966

So what do they do?

• Clear process design • Continuous measurement & feedback• Continuous improvement• Predictable & fun• Scale is “just right”• Part of value chain (specified pathway)

They say: yugo, but you don’t.

• Healthcare is under pressure• Performance is disappointing• Current approaches limited impact• Examples of solutions in other sectors

Sad story

Happy end?

Creating Continuous Flow

Continuous Flow

Replenishment System

Outlook (I)

1. Healthcare performance will be more transparent

2. Healthcare will be organized in processes

3. Hospitals will no longer offer “all services”

Outlook (II)

4. Each process will continuously optimized

5. There will be bigger networks with a role for each provider

6. Technology is an important enabler

Welcome to our workshop