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The Right Healthcare in the Right Place

An optimal healthcare portfolio, more relevant than ever

An optimal healthcare portfolio is more relevant than ever. Wouter Evers of Turner observed during the COVID-19 crisis how decisions regarding healthcare services were made rapidly. Services were scaled back, coordinated, and redistributed at lightning speed. Nevertheless, an optimal healthcare offering requires a more careful decision-making process: one driven by vision, not by crisis. Why is making choices about healthcare services particularly important right now? And what does such a decision-making process look like?

An optimal healthcare portfolio, more relevant than ever

At the onset of the COVID-19 crisis, we saw how changes to the institution’s healthcare offerings were implemented in a very short period of time. Routine elective healthcare was scaled back, and acute and chronic healthcare was distributed in a fairly coordinated and controlled manner through effective regional coordination and collaboration. The risks of delayed diagnosis and treatment—such as fewer or more complex treatment options and additional costs—are evident. Nevertheless, making decisions regarding healthcare provision offers an opportunity for improvement in outcomes, quality, and safety of care and can lead to cost savings through more effective and efficient service delivery—provided that a careful, vision-driven process is followed rather than one driven by crisis.

Ernst Kuipers recently made it clear, through the acute care working group, that regional coordination should be “the norm” under the leadership of the Regional Acute Care Chain Consultative Body (ROAZ). But other examples—not limited to acute or highly complex healthcare—are also importantalso illustrate the shift toward greater collaboration and redistribution, such as Alrijne’s partial takeover of primary care from the LUMC, the transfer of Middin’s elder care division to Laurens, or the “Healthcare voor regio” initiative in Drenthe and Southeast Groningen.

No healthcare administrator can avoid making restructuring decisions. Do you have the vision and tools to seize this opportunity? This article provides some answers to the “why?” and“how?” questions.

Why? To optimize the utility and necessity of the healthcare portfolio.

Why does regional redistribution of healthcare make sense? You want the best outcomes and health gains for patients, but the current range of services or mix of treatments isn’t sufficient to achieve that. There are two main challenges: the need for expertise and a shortage of personnel and resources.

The quality of diagnosis, treatment, and follow-up care demonstrably improves with higher volume and the consolidation of expertise rather than its fragmentation. Furthermore, regional concentration can yield attractive economies of scale. This requires making choices: what do we do ourselves, what do we do with or through partners, and what do we no longer do?

We expect that the need for and pressure surrounding this discussion will increase significantly as a result of the broader debate on healthcare costs and a future-proof healthcare system. You’d be wise to get a head start on that discussion. Better to do it now of your own free will than later under pressure as an obligation. Moreover, “The Right Healthcare in the Right Place” (JZOJP) provides excellent justification, as well as a solid framework for addressing the issue with, for, and by stakeholders.

How to? Successfully Carrying Out Critical Steps

How can we achieve a focused approach to our offerings? How do we ensure a careful decision-making process that does as much justice as possible to the diverse interests of our stakeholders? The point is this: it all hinges on trust. And by that we mean “it has to be done right the first time.” If trust is lost, it won’t quickly return for a second chance, and the willingness to change will undoubtedly suffer, leaving you at a double disadvantage.

Portfolio decisions are made collaboratively, not in isolation. You operate within a regional network that includes referrers, partners, other providers, and stakeholders such as funders and government agencies. However, we advocate for a concise initial assessment at the institutional level. This will allow you to enter joint sessions and network dialogues better prepared! All too often, we see far-reaching or loosely defined partnerships stall or fail due to initial enthusiasm without careful self-assessment, an internal mandate or support base, and a realistic understanding of“what we bring to the table.” A three-step action plan:

1. Concise vision development at the institutional level

You have typically already determined, together with medical professionals and support staff, the organization’s fundamental purpose and its general ambitions as part of the regular multi-year planning process. What you specifically aim to achieve over the next 5+ years needs to be defined more precisely. The “how” of this is ultimately critical, but of limited importance at this stage.

Three questions to answer as part of this vision-building process:

  1. What implications do general and healthcare-related developments have for our current position and future positioning?
  2. So, which valuable qualities, achievements, and competencies of our organization would we like to preserve and strengthen?
  3. And what specific role in the supply chain and in the local/regional/national network do I hope to play in the future?

The choices regarding service offerings that are necessary or worth considering are determined as objectively as possible based on insights derived from data, not on gut feelings or sentiment. An understanding of the region, care needs broken down by client groups, and the organization’s own performance are all prerequisites for sound decision-making.

Of course, this does not automatically mean there is internal support for any decisions. Organize a dialogue between the medical staff and the board as soon as possible. Work with the medical professionals to draft an initial set of decision-making and selection criteria. You will need to establish a shared understanding of the broad outlines of the legal frameworks, strategic principles, quality standards, and a financial and organizational framework.

Then work together to identify a number of specific options. An initial rough screening might look something like this:

Ideally defined from a coherent “outside-in” perspective on patient care pathways, Integrated Practice Units (IPUs), or themes that place the integrated care chain at the center rather than roles or the hierarchical structure of departments and divisions. However, a structure based simply on medical specialties also works.

This step is undoubtedly one of the most important activities for successful execution. It involves various well-known barriers and risks—ranging from accessibility requirements and funding barriers to labor law considerations, the professional opinions of individual specialists, or concerns about the necessary capacity for change. If this step is not initiated in a timely and careful manner, there is a high risk that effective communication with external parties and stakeholders will become problematic. Important: Stay focused on the main objectives and issue clear follow-up tasks to prepare for decision-making regarding healthcare offerings. Instruct clinical groups and departments to further elaborate on medical decisions to enable careful decision-making when the time comes.

2. Deepen the understanding of collaboration in preparation for a network dialogue

Before entering into a conversation, you should ideally take a moment to explicitly consider what your organization brings to networking discussions. A concrete and realistic picture of what you have to offer and what you’re looking for will undoubtedly benefit the exploration and matchmaking process with other healthcare providers. Not everything needs to be worked out in detail at this stage. Focus on elaborating your vision for the collaboration:

Five questions to answer to help you prepare for your interviews:

  1. What do we want to try to achieve together? What will the result of our collaboration look like?
  2. What types of patients/clients will be able to receive what kind of healthcare from us or from (which) other providers in the future?
  3. What value do we offer, and what does the potential partner value about us?
  4. What assets (offering, expertise, capacity, etc.) are we looking for in a partner, and what assets is the partner able and willing to offer?
  5. What is our vision for the governance and structure of the collaboration, including our own role?

You will work out the “how” of the collaboration later in a letter of intent and a service agreement or a transition plan, along with an adapted business model of your own.

However, it is a good idea to develop a clear understanding of the desired ground rules, principles of cooperation, and practical procedural arrangements with third parties prior to the discussions, as part of the ongoing exploratory process.

3. Conduct a network dialogue on redistribution within the regional healthcare landscape.

Carefully redistributing healthcare and establishing collaboration agreements is no easy task. You want to be able to downsize the Portfolio with confidence and maintain control over investments in sustaining and developing services. Support from the government, regulators, health insurers, banks, and referring physicians is essential to this process. These stakeholders will scrutinize the negative effects of consolidation: Will accessibility and market forces remain sufficient? Is a comprehensive and consistent range of services in the region guaranteed?

There are areas where agreement can be reached easily, and areas of healthcare that many—or few—providers find appealing. And there are redistribution issues that involve so many interdependencies, complexities, and risks that they require separate studies. It is precisely with regard to these latter potential redistribution issues that it makes sense to work with the relevant partners to further detail the impact, consequences, and “how” of any potential outsourcing, transfer, or collaboration.

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