Hospitals’ new strategy agenda after Covid-19
22
Presented by January 13, 2021 Hospitals’ new strategy agenda after Covid-19 Advisory Board This webinar is sponsored by Medtronic for educational purposes only. The content, views and opinions contained within the webinar are copyrighted by Advisory Board and all rights are reserved. Advisory Board experts wrote the content, conducting the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.
Transcript of Hospitals’ new strategy agenda after Covid-19
Presented by
January 13, 2021
Hospitals’ new strategy agenda after Covid-19
Advisory Board
This webinar is sponsored by Medtronic for educational purposes only. The content, views and opinions contained
within the webinar are copyrighted by Advisory Board and all rights are reserved. Advisory Board experts wrote the
content, conducting the underlying research independently and objectively. Advisory Board does not endorse any
company, organization, product or brand mentioned herein.
© 2020 Advisory Board • All rights reserved • advisory.com
Today’s Research Expert
Vidal Seegobin
Managing Director, International Research
Vidal is the managing director for Advisory Board International’s
research.
Prior to joining the Advisory Board, he worked as a researcher on
disease surveillance and pandemic response. He holds a master's
degree in international economics from American University and a
bachelor's degree in international business from Carleton University
in Ottawa, Canada.
[email protected] @SeegobiV
Vidal photo
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3
No shortage of challenges and hurdles to overcome
Advisory Board International interviews and analysis.
A non-comprehensive list of change areas from Covid reported on thus far in 2020
Site-of-care shifts, into
community and homes
Closed or
‘buffered’ EDs
Emotional resilience
and burnout
Health system’s
role in public health
Data privacy in
health care
Board’s role in
transformation
Pharmaceutical
spending
Equity and racism
in health care
Hospital
throughput
Medical mis- or
disinformation
The primary
care industry
Workforce and
physician supply
Behavioural
health demand
Flexible
staffing models
Supply chain
resilience
Public-private
partnerships
Senior and
long-term care
Virtual-first
delivery model
Public’s perception
of health care
Hospital bed supply
and footprint
Alternative payment and
reimbursement models
Vertical and horizontal
consolidation
How we do planning
and forecasting
Chronic disease
prevalence
Artificial intelligence
in health care
Social care’s place in the
health system portfolio
Surgical and
outpatient waitlists
Care
standardisation
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But let’s talk about opportunitiesSubstantially different, here-to-stay changes from Covid that demand your focus
1. Focus and collective action on health equity
2. More flexible and agile strategy operations
3. Shifts in sites of care and ability to rebase costs
Advisory Board International interviews and analysis.
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1. National Committee for Quality Assurance.
Long standing problem gets much deserved attention
Advisory Board International interviews and analysis.
The Washington Post
15 September, 2020
“Coronavirus kills far more
Hispanic and Black children
than White youths”
BBC
16 July, 2020
“Aboriginal Australians
‘still suffering the effects
of colonial past’”
Health equity dominates the press
CBC News
25 August, 2020
“National research project to
probe racism in health care
amid COVID-19 pandemic”
Reuters
10 June, 2020
“COVID could worsen
existing UK inequality”
National governments rushing to respond
The Guardian
20 April, 2020
“Coronavirus exposes how
riddled Britain is with racial
inequality”
New York Times
29 April, 2020
“A terrible price: The
deadly racial disparities of
COVID-19 in America”
Source: Villarosa L, “’A Terrible Price’: The Deadly Racial Disparities of COVID-19 in America,” The New York Times, 20 May 2020;
Khan O, “Coronavirus exposes how riddled Britain is with racial inequality,” The Guardian, 20 April 2020; “National research project to
probe racism in health care amid COVID-19 pandemic,” The Canadian Press, 25 August 2020; Schomberg W, “COVID Crisis Could
Worsen Existing UK Inequality,” Reuters, 10 June 2020; Khalil S, “Aboriginal Australians 'still suffering effects of colonial past’,” BBC
News, 16 July 2020; Wan W, “Coronavirus kills far more Hispanic and Black children than White youths, CDC study finds,” The
Washington Post, 15 September 2020; Chen P, Li F and Harmer P, “Healthy China 2030: moving from blueprint to action with a new
focus on public health,” The Lancet, 01 September 2019; “Latest sote healthcare reform proposals move to next phase,” News Now
Finland, 15 June 2020; “Executive Overview,” New Zealand Health and Disability System Review, March 2020.
China launched ten-year initiative to expand
health coverage and increase quality of
health services to improve public health
Finland proposed latest round of major
system reforms to reduce inequalities in
health and well-being
New Zealand commissioned a review
recommending an overhaul of the current system
and the creation of a Māori health authority
England created an independent Commission
on Race and Ethnic Disparities to review
inequalities in key areas
Shift #1: The health equity mandate
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ProMedica’s National Social Determinants
of Health Institute
• In 2017, ProMedica created the Institute in part through
a $28.5M donation and internal investments after years
of community efforts around food insecurity.
• The Institute works across ProMedica’s provider and
payer arms to integrate health equity into all care
delivery and payment models in the organisation. It
also houses ProMedica’s ‘data nerve center’ and
SDOH partnerships.
• To lead the Institute, ProMedica appointed a President
of SDOH, the first role of its kind in the world.
SPOTLIGHT
Source: “Kate Sommerfeld, President of Social Determinants of Health at ProMedica,” Beckers Healthcare Podcast, 11 August 2020; “ProMedica’s President of Social Determinants of Health Named Top 25 Emerging Leaders
by Modern Healthcare Magazine,” ProMedica NewsRoom, 12 October 2020; Vaidya A, ‘ProMedica appoints president of social determinants of health,” Beckers Hospital Review, 07 December 2017; ProMedica, Ohio, US.
Systems finally giving their mission some strategic weight
Advisory Board International interviews and analysis.
“Whoever you are, and wherever you live in our extensive service area,
our mission is to improve your health and well-being.”
National SDOH Institute drives focus on health
equity across all of ProMedica’s business lines
Payer
CEO
Post-acuteAcute Ambulatory
National SDOH Institute
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President of SDOH leads effort to embed
SDOH across all parts of the business
Chief Medical Information Officer acts as
‘clinical diplomat’ to secure clinician buy-in
“How do we make
prioritising health equity
a system-wide habit?”
• Drives integration of SDOH through EHR-
based patient screenings and pathways
• Oversees all SDOH investments and
interventions
• Expands network of community partnerships
to scale SDOH interventions nationally
• Supports the Institute’s internal functions
and external SDOH consulting services
• Leads SDOH data collection efforts
• Works closely with partner company to
provide data inputs and gather analytic
outputs on quarterly basis
• Leads charge on clinician buy-in by
sharing analytic outputs
Equity-focused roles critical to changing organisational culture
Leadership dyad signals top-down commitment to health equity and drives changes in day-to-day behaviour
Source: ProMedica, Ohio, US.
Advisory Board International interviews and analysis.
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Source: ProMedica, Ohio, US.
ProMedica scaled data collection by introducing ‘no hassle’ workflow changes
SDOH data first step in addressing community inequities
Advisory Board International interviews and analysis.
2010
Two-question paper
screening identifies
food insecurity in
community
2015
Food insecurity
screening built
into EHR
2016
External, asynchronous
SDOH survey tool
launched which screens
for 10 social risk domains1
2017
10-domain1
screening tool
embedded
into EHR
2019
No-touch workflow
tool embedded in EHR
that notifies clinicians
of patient social risk
1. Behavioural health, financial strain, food insecurity, training and employment, education, housing insecurity,
transportation, childcare, social connection, intimate partner violence. The screening has since been expanded to
include four additional domains: alcohol use, stress, physical activity, and broadband internet access.
8,000 screens 80,000 screens4,000 screens 20,000 screens
“Clinicians told us, ‘if you can simplify the workflow so that you don’t slow down the care I have to provide, keep
me abreast of the situation and what social care solutions you’re doing for the patient that I don’t need to proctor, and
show me the data [about how those interventions are helping the patient], then we don’t have any issues.’”
--Dr Brian Miller, CMIO
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1. ProMedica’s Hub Center team consists of social workers, community health
workers, and RNs who connect patients to interventions and make referrals.
A new frontier to how we identify inequities in outcomes
Advisory Board International interviews and analysis.
Proactive ‘pursuit rosters’ for those in need of care
AI tool creates cost proxy for patients with
high disease burden and high SDOH risk
Patients with high-risk scores are added to
a ‘pursuit roster’ and proactively pursued by
Hub Team for social intervention
ProMedica’s ‘Data nerve center’ enables system to flag social risk before it materialises
• Created in partnership between ProMedica and Socially Determined, a health care data analytics company
• Centralises ProMedica’s data sets and Socially Determined’s external data and analytics capabilities to expand
understanding of the impact that socioeconomic risk factors have on health outcomes
• Combination of clinical, social risk, claims, and public & proprietary data allows ProMedica to create individual
risk scores that signal need for intervention, and ‘pursuit rosters’ of at-risk patients currently not seeking care
SP
OT
LIG
HT
Real-time risk identification for those seeking care
EHR fields give clinicians real-time social risk
scores and referral recommendations based
on responses to asynchronous SDOH survey
If survey is taken before a visit and there is
social risk, the Hub Team1 is informed and can
proactively connect patients with interventions
Source: ProMedica, Ohio, US.
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Systems at risk of backsliding into pre-pandemic efficiencies
Advisory Board International interviews and analysis.
Time
Ag
ility
Path 1: Modernise your ‘strategy operations’
• Clearer, refocused set of system priorities
• Clearer ownership of workstreams and KPIs
• Shift from static to dynamic planning
• Faster ways to make decisions
• Predetermined pathways for allocating new
responsibilities or priorities
• New tools to maintain leadership team’s focus
Path 2: Backslide into pre-Covid habits
and organisational structures
Shift #2: The ‘strategy operations’ of tomorrow
CEs have a unique opportunity to hardwire more agile ways to set strategy, allocate decisions, and recalibrate
Historic ways
of working
New baseline
during pandemicNow
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Covid demanded rigorous organisational focus
Source: “Developing the 3 Year Plan for the Period 2021/22 - 2023/24,“ Hywel Dda Board Meeting documents, 24 September 2020; Hywel Dda University Health Board.
Hywel Dda decluttered build-up of overlapping priorities and objectives into a clearer operating framework
Advisory Board International interviews and analysis.
Audited the build-up
Leaders evaluated all 458
strategic decisions made
since 2017 to determine
where there was overlap
Consulted with leadership
The CE and medical director
consulted the board around
how to reorganise priorities
into a clear and scoped
operating framework
458Total strategic
‘priorities’
Previous strategic
recommendations
E.g., 2017-20 strategic
plan, long-term system
transformation plan
Current strategic
priorities
E.g., 2020-23
strategic plan,
Covid-19
requirements
One-off recs and
national guidance
E.g., Welsh
Government recs,
quality assurance
targets
Hywel Dda’s new operating framework
Strategic objectives that set out
the system’s high-level aims6
Planning objectives that will
tactically move Hywel Dda towards
achieving the strategic objectives65
A narrow set of clear metrics with
defined timelines
Each planning objective has:
A single executive director owner
that oversees its achievement
1
2
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Being dynamic still requires an end-point
Advisory Board International interviews and analysis.
Hywel Dda’s six strategic objectives broadly outline the system’s ‘True North’
Source: “Developing the 3 Year Plan for the Period 2021/22 - 2023/24,” Hywel Dda Board Meeting documents, 24 September 2020; “Strategic Discover Report,” Hywel Dda University Health Board, July 2020; Hywel Dda University Health Board, Wales, UK.
New ‘planning objective’ structure adds flexibility to how the system pursues its strategic aims
Strategic objectives #1-5
come from previous cultural
values and strategic priorities
“We wanted the words in the strategic objectives to have meaning that can evolve over time. They’re ideals that we aspire
to—they’re smudges on the horizon. And the planning objectives are paddle strokes that will take us there. The
planning objectives can change and morph over time as our environment and directives change, but the direction is clear.”
Steve Moore, Chief Executive
Strategic objective #6 borne
out of Covid-19 experience
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Allocating decision power to “best positioned”
Source: “Strategic Discover Report,” Hywel Dda University Health Board, July 2020; Hywel Dda University Health Board; “Public Board:
Maintaining Good Governance COVID-19,” Hywel Dda Board Meeting documents, 30 July 2020; Hywel Dda University Health Board.
Advisory Board International interviews and analysis.
The interesting thing about a command
and control structure is that it can be very
empowering. It’s fundamentally
democratic—we tell our teams, ‘We have
this problem and a vision, can you solve it
for us?’ It emphasises personal
accountability. The clarity around roles
and responsibilities forces everyone to
stand and deliver and take ownership of
their tasks, instead of making excuses
or waiting to be told to go and act.”
Steve Moore, Chief Executive
HYWEL DDA UNIVERSITY HEALTH BOARD
• Board and chief executive craft the system’s strategic
objectives and its overall strategic direction
• Group approves new planning objectives that TSG1/SEG2
develops in response to ongoing environmental scans
GOLD
GROUP
• Executive directors develop tactical plans for
each new objective approved by the Gold group
• Group oversees—but is not directly involved in—
the operational responses at the Bronze level
SILVER
GROUP
• Unit/divisional directors craft and carry out
operational responses with their teams that deliver
on each tactical plan created by the Silver group
• Group is responsible for managing resources within
their given area of responsibility
BRONZE
GROUP
Hywel Dda’s Transformation Governance system offers clear, standardised path for allocating new responsibilities
1. Transformation Steering Group.
2. Strategic Enabling Group.
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Covid narrowly disrupted strategy, broadly disrupted operations
Advisory Board International interviews and analysis.
Degree of disruption from Covid-19
Proximity
to patient
How do we set strategy, forecast, and decide
on how to reach our desired destination?
How do we configure our assets,
cost structures, and resources to
better serve our population?
What care models do we
provide care through and how
do patients access them?
Predominance of change occurring where and how consumers access care
Planning
Infrastructure
Delivery
What are the fundamental principles
guiding where our system is going?Identity “This is the only sector where
demand goes to supply. We need
more of the other way around.
Thankfully, Covid made us start
to change our care and cost
models and start providing more
things that patients actually are
asking for—a system that
provides the right care, in the right
place, at the right time, in the right
mode, and is frictionless.”
- Vaman Rao, CEO
Innoneo Health System
Shift #3: Shifts in how and where we deliver care
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Covid accelerated three shifts in how and where we work
Advisory Board International interviews and analysis.
1 2
System’s physical assets
redesigned to promote out-
of-hospital care and
decrease overall utilisationPhysical
footprint
Acute-centric Community-centric
Delivery no longer tied to in-person
models and clinician preference, but
instead are virtual-first and elevate
patient-defined valueCare
models
Provider preference Patient preference
3
Flexible staffing approach
retains staff and allows
system to redeploy acute
staff into the communityWorkforce
Tied to site Flexible across system
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What care model shifts are you pursuing?
Advisory Board International interviews and analysis.
Ambulatory Surgical Centers (ASCs)
What it is: Off-site ORs for surgical procedures
that do not require overnight hospital stay
What it replaces: Need for inpatient capacity
Examples: ASCs in the US; joint ventures between
management companies and physicians in Alberta
Naturally occurring retirement communities
What it is: Unplanned communities with large
populations of elderly residents
What it replaces: Traditional long-term care homes
Examples: Congregate living communities in
Ontario; retirement villages in Japan and Scandinavia
Emergency Department ‘buffers’
What it is: Alternate locations or triage tools that
route non-emergent cases away from the ED
What it replaces: Traditional front-door to the hospital
Examples: Appointment-only A&Es in UK and
Ireland; COVID-19 assessment centers in Ontario
High-value surgical substitutions
What it is: Range of non-surgical care options
focused on prevention and pain management
What it replaces: Non-urgent surgeries
Example: physiotherapy, palliative care, pain
clinics, virtual rehab, patient activation
Four new care models shifts taking off around the world
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Bottom of waiting list a clear opportunity for care substitution
Global Forum for Health Care Innovators interviews and analysis.
31% of new
outpatient referrals
on waiting list have
been waiting for
>22 weeks
DATA SPOTLIGHT
5,200
2,300
>22
weeks
<22
weeks79% of follow-up
outpatient referrals
on waiting list
deemed low priority
4,500
16,500
Low
priority
High
priority
CHFT2 wait list data shows sizeable number of patients could benefit from alternative care models
1. Integrated care system.
2. Calderdale and Huddersfield NHS Foundation Trust in England, UK. Source: Calderdale and Huddersfield NHS Foundation Trust; West Yorkshire and Harrogate ICS.
“Secondary care is going to have limited capacity to treat patients for some time to come…Unless we take
some action, people are going to miss routine operations and diagnostics. More people are going to be
stuck languishing at the end of wait list because of Covid.”—Anthony Kealy,
Locality Director,
West Yorkshire and Harrogate ICS1
Substitute in care alternatives
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Source: Calderdale and Huddersfield Clinical Commissioning Groups, England,
UK; Calderdale and Huddersfield NHS Foundation Trust, England, UK..
Care models won’t change unless physicians buy into them
Advisory Board International interviews and analysis.
Calderdale and Greater Huddersfield wait list review empowers GPs and acute specialists to co-develop new care models
GP + acute
specialist group
in Calderdale
GP group in
Huddersfield
• Two clinical groups in adjacent localities
independently review all 22+ week referrals
• Discuss new care model options and work
with joint leadership group to embed them
Joint clinical
leadership group
Two GP-led referral
analysis teams
1. Clinical Commissioning Groups: local payers that commission care for geographic patches in England, UK.
Calderdale and Greater Huddersfield’s clinician-led referral
review and care model development approach
• Joint clinical leadership group has regional GP leaders, three clinical
hospital leaders, and two planned care leaders from the local payer1.
• Under this group, two GP-led groups in adjacent localities tasked
with independently reviewing quality and necessity of all referrals for
patients waiting over 22 weeks for care.
• Joint leadership group meets iteratively to discuss wait list referral
trends emerging from the independent reviews, and to co-develop
new care model approaches to manage wait-listed patients.
• This approach to co-developing new care models safeguards
clinical ownership and buy-in, ensures a broader set of
perspectives, and fosters clinician-to-clinician dialogue.
SPOTLIGHT
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New rules, responses, and moves to make for governing the system
The health system executive’s post-Covid playbook (pt. 1)
Advisory Board International interviews and analysis.
Rule #1: The health system’s mandate now
includes health equity.
Rule #2: The external environment will remain highly uncertain and
unpredictable far beyond vaccine approval.
Response: Elevate addressing health inequities
as a strategic, system-wide priority
Response: Declutter staffs’ plates Response: Hardwire agility
into your ‘strategy operations’
1. Define your role in addressing social determinants of health
2. Embed social determinants of health at executive-level planning
and activities
3. Pull community-focused projects, grants, and resources into
a centralised equity function that coordinates SDOH efforts
4. Collect critical SDOH data from upstream access points and
share the data frequently with key stakeholders
5. Overinvest in seeking out under-represented voices in any
change to care delivery
1. Streamline your organisation’s
priorities and clarify each one’s
owner and metrics
2. Create a principled stop-doing
methodology
1. Move from “annual” to problem-based
strategy planning
2. Diversify and upskill your board
to thrive amidst uncertainty
3. Incorporate emergency response
decision structures into your
day-to-day governance system
4. Develop tools to engage leaders in
making progress against their objectives
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New rules, Responses, and moves to make for operating and delivering value
The health system executive’s post-Covid playbook (pt. 2)
Advisory Board International interviews and analysis.
Rule #3: Moving forward, all cost structures must
successfully balance affordability and durability.
Rule #4: The opportunity and political will to shift care access
points will diminish quickly
Response: Identify
functions where
redundancy is needed
Response:
Think of space as a
flexible asset
Response: Sustain popular
workforce
changes from Covid-19
that will improve retention
Response:
Signpost new
system front doors
Response: Treat the
surgical backlog as an
opportunity to
implement long-sought
care model changes
Response: Invest
in aged alternatives
that prioritise safety
and scale
1. Invest in full-chain
data visibility to
mitigate risk
2. Use domestic
alternatives to
diversify—not
replace—overseas
suppliers
1. Pursue near-term
rationalisation of
administrative
spaces
2. Expand your
definition of
‘available space’ to
include non-health
care space as you
shift your footprint
1. Introduce pathways and
policies that enable
flexibility for all staff
2. Create flexible roles for
people who would
otherwise leave the
workforce
3. Build a staff support
library that all staff can
navigate and rely on
1. Calculate
defensible virtual
visit targets at the
specialty level
2. Create an ED
‘buffer’ that
continues to limit
unnecessary
presentations
1. Invest in ASCs or off-
site surgical locations
to safeguard safety
and productivity
2. Substitute in high-
value care
‘alternatives’ for non-
urgent referrals
1. Find and deploy
staff to naturally
occurring
retirement
communities
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Advisory Board has made efforts to verify the accuracy of the information it provides to members. This report relies on data obtained from many sources, however, and
Advisory Board cannot guarantee the accuracy of the information provided or any analysis based thereon. In addition, Advisory Board is not in the business of giving legal,
medical, accounting, or other professional advice, and its reports should not be construed as professional advice. In particular, members should not rely on any legal
commentary in this report as a basis for action, or assume that any tactics described herein would be permitted by applicable law or appropriate for a given member’s situation.
Members are advised to consult with appropriate professionals concerning legal, medical, tax, or accounting issues, before implementing any of these tactics. Neither Advisory
Board nor its officers, directors, trustees, employees, and agents shall be liable for any claims, liabilities, or expenses relating to (a) any errors or omissions in this report,
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