Blog 5: One organisational model, four care models

A new perspective supports quality and cost management

By: Sander Visser, Marcel Otten  |  Published: October 19, 2018

To ensure that quality initiatives actually succeed and are embedded in care institutions, we need a different type of organisation. The transition from production- to patient-centred care requires another approach to management. Strategy& has joined forces with Bernhoven Hospital in developing a new perspective on hospital organisations, based on four care models designed to respond to patient needs and demands. This organisational form makes it possible to support quality and cost management. Bernhoven Hospital is the first hospital in the Netherlands to be structured along these four care models.

One organisational model, four care models

Most hospitals are organized by specialism

Most Dutch hospitals are divided into departments organised into result responsible units (RVEs), for example cardiology, surgery or urology. This is not always the most logical approach for patients because they are increasingly in the care of more than one specialist. Some hospitals recluster departments into a new organisational structure. The new clusters are often made up of similar groups of specialisms, for example a cluster of surgical specialisms, or disorders, or patient groups, such as an oncological centre or a children’s hospital.

“Diagnosis & Needs Assessment is the environment where we work with patients to arrive at the right diagnosis and draw up an appropriate treatment plan in consultation with them. We can only do this when patients are properly informed about all the various options. In my view, being quality-driven also involves focusing on the quality of decision-making to avoid unnecessary diagnoses and unnecessary treatment. That means that we can take the time to reflect on decision-making in D&I, so that we can determine the right treatment plan together with the patient. In fact, being overly concerned with efficiency may be counterproductive here.”

Inge Blokzijl-Boezeman
Medical Coordinator for the Diagnosis & Needs Assessment Care Model and paediatrician at Bernhoven Hospital

Another perspective on the hospital organisation: four care models

Strategy& and Bernhoven Hospital in the Province of Noord-Brabant have developed a new perspective on hospital organisations that not only aligns with patients’ care needs but also with the three main activities of care professionals: advising, treating, and supervising patients. Each of these three activities has its own purpose and therefore requires a different type of support. We have divided these three activities across four care models:

  • Diagnosis & Needs Assessment (D&I), where the focus is on advising patients
  • Intervention Care, where the emphasis is on treatment
  • Chronic Care, which is largely about supervising patients
  • Acute Care, which stresses advising and also treating patients in an acute setting

Bernhoven Hospital has divided the entire spectrum of patient care into these four care models.

“At first, it obviously costs more money to have relatively expensive specialists and A&E doctors in the casualty department. In the long run, however, we’re actually lowering the cost of care because better diagnoses lead to fewer hospital admissions and fewer visits to our outpatient clinics. We’ve made firm agreements with health insurers over the next few years, giving us leeway to work in this way. I’m convinced that the new approach will ultimately lead not only to better but also to less expensive care throughout the entire chain.”

Simone Gielen-Wijffels
Medical Coordinator of the Acute Care cluster at Bernhoven Hospital

Bernhoven Hospital has retained departments alongside the four care models, but their role and position have changed. They now deliver services to the various care models. The purpose of each department is to continuously improve the quality of care and specialist knowledge. Care is now organised within the care models, taking the operational pressure off the departments.

“There’s tension in every department between complete autonomy as an independent unit versus working in a logistical organisation, while retaining professional autonomy, of course. Departments have two functions, as it were. On the one hand, they second professionals to the care models and are thus responsible for scheduling and staffing within those models (seeing that the right doctor is in the right place at the right time). On the other hand, the department also nurtures talent, shares professional knowledge, ensures a high standard of quality and initiates innovation.”

Simone Gielen-Wijffels
Medical Coordinator of the Acute Care cluster at Bernhoven Hospital

The new organisational model supports quality and cost management

An “average” hospital is made up of large number of RVEs, making it a highly complex operation to manage. The four care models simplify management and are better suited to supporting patient and other processes leading to better quality. The patient processes within the D&I care model differ from those in the Acute Care chain. For example, within Chronic Care, coordination with the different chain partners outside the hospital is the most important form of process optimisation. Process optimisation in each care model improves quality, including flow in the chains.

In addition, by embedding management in the four care models, the financial responsibilities are also clustered, making it easier to manage costs. Having a new organisation divided into four care models allows the hospital to build what it needs to deliver the aforementioned care from the ground up. In Strategy&’s experience, this is more conducive to process adaptation and cost reductions than making changes while retaining the status quo. It also opens up opportunities to optimise the provision of support services. By reducing the hospital organisation to these four care models, hospitals can more easily determine which services are required, desirable and actually necessary.

Strategy& sees possibilities for a different development path for healthcare professionals

Looking from an HR perspective, the new care models will also offer possibilities for different career development path for healthcare professionals.  For example, one professional may be especially good at one-on-one conversations with patients and at handling the complexity necessary for a good diagnosis and sound decision-making, while another may have a talent for performing medical procedures, and yet another may be better at working with other caretakers.

The new organisational model also requires a different funding methodology. Next month’s blog will therefore focus on the future-proof funding of care.

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