KPMG's 2018 Global Healthcare conference* was held in Berlin, Germany, bringing together nearly 150 clients, consultants, and colleagues from 34 countries. This year, the agenda focused on the challenges and opportunities around healthcare quality, digital health, and international healthcare.
The conference opened with a welcome address from Mark Britnell, Senior Partner and Global Chairman of KPMG's Healthcare, Government & Infrastructure practice, who emphasized the need for all healthcare organizations to ensure they are attending to the needs of tomorrow. Mark flagged KPMG's `Staying Power' report, which showed that a majority of healthcare leaders felt that fundamental change was required in the industry, while only a third felt this was needed in their organization. This paradox, he stressed, acts as a barrier to organization's achieving operational excellence.
This set the scene for Dr. Ed Fitzgerald, Global Healthcare Executive, who introduced KPMG's new global thought leadership project, focusing on operational excellence in healthcare. Dr. Fitzgerald explained that operational excellence (OE) is a culture that empowers staff to address the issues that get in the way of delivering better care, and that establishing an organizational culture of continuous improvement with a management system to support this is a key differentiator in delivering positive change.
Professor Dr. Volker Penter, Head of Healthcare for KPMG Germany, then provided delegates with an update on current issues confronting the German
Opening keynote: Professor Dr. Detlev Ganten
As President of the World Health Summit and former CEO, Charité Hospital, Professor Dr. Ganten provided wide-ranging reflections on his experiences in healthcare. Charité is its own legal entity, and the CEO is the head of research, teaching
Professor Ganten outlined the work of the M8 Alliance - a unique academic network which contains an inter-Academy partnership. Its focus is on improving the conditions of life, including the environment, with senior European politicians as patrons. The crucial context for their conversation, Professor Ganten added, is that of quality, management, risk and patient safety in healthcare. Value-based healthcare is vital: to improve outcomes, reduce overall costs, and increase value by delivering better care at equal or lower costs. Combining these leads inexorably to a more integrated approach, following the World Health Organization roadmap for sustainable development goals.
Continuing the theme of quality in healthcare, the next session turned to focus on opportunities for building a culture of continuous quality improvement in healthcare organizations. Operational excellence (OE) approaches to continuous improvement are about creating sustainable change - but perhaps not a quick one, given that quality and finance issues are often the symptoms, not the root causes, of problems in healthcare.
Kim Barnas described her journey with ThedaCare, who went on a 12-year journey using OE approaches to become one of the best healthcare providers in the USA on quality and cost. In the UK, Western Sussex NHS Hospital Trust
A culture of continuous improvement is one with a focus on developing leaders as coaches, whose job is supporting the right behaviors and embedding improvement into the organization's DNA. OE is a fundamental shift in mindset from seeing improvement as a series of events to improvement
The second theme of the day focused on digital healthcare. Daniel Nathrath described the background to ADA Health, an organization that's developed a free-to-download artificial intelligence (AI) based app for doctors and patients. This app uses a dynamic flow of questions, each based on the last bit of information given. It supports accurate diagnosis, especially of rarer conditions.
ADA is potentially important for health system and payers as it could help get the patient to the right place at the right time, avoiding people going straight to emergency. It outlines `next step' options for information and relevant treatment, to extend the user journey past diagnosis and into action. ADA is fully customizable as per the local health system. When ADA was trialed on patients in a waiting room in a UK NHS clinic, the findings showed that 15% of the patients there would not have needed that visit if they had used the ADA app at home. You can read more about their technology and approach to AI-based healthcare diagnostics in our interview with Daniel in Healthcare Review.
Richard Corbridge explained that digital transformation in healthcare is not about IT, hardware, software and wires, and less and less of a Chief Information Officer's (CIO) job is about the technology. The job today is how to get digital and analytics on the CEO's agenda. As an industry comparison, technology budgets in the finance sector are about 15% of profit. In the UK NHS, they are about 1.2% of income.
For 12 years, Leeds Teaching Hospitals NHS Trust have been building their own electronic health record (EHR) - Leeds Care Record - which has now been accessed 50 million times. To improve IT, an organization's culture dials need to move; culture has to be the advantage in healthcare IT: if you're planning an IT project, you need to consider the impact on the whole network of the organization(s) involved. Doing this is less about computer science, and more about behavioral science.
Dr. Sander Timmer opened his presentation with a quote from Satya Nadella, Microsoft CEO: “AI isn't another piece of technology. It could be one of the world's most fundamental pieces of tech the human race has ever created”. AI is about computers understanding the world. For Microsoft, AI is about data (quality and trustworthiness has value) leading to intelligence (driving interactive experiences). AI will be part of the evolution of health systems towards systems of insight; new experiences and conversations. Timmer cited examples of Ochsner Health System's Epic `pre-code alerts' reducing codes outside of ICU by 44%.
AI and machine learning are good for automating laborious tasks and enhancing reproducibility. Adaptive biotechnologies are now trying to sequence an immune system, to diagnose disease in very early stages from blood samples.
Tonic is a comprehensive digital health service platform for information, support
The Tonic digital wallet works everywhere and everything from subscriptions to mobile payment mechanisms can be performed using this platform, but their biggest learning was getting consumers to invest in it. Poorer populations use what economists call a very high discount rate. That behavior change takes time to crack. Persuading customers of the merits of balancing everyday affordability and long-term protection, and of an insurance that balances customer experience with the budget, takes time.
Tonic is now working with researchers from Imperial College to quantify its social impact. They have done this as a private provider, and they can now tell governments where things like dengue outbreaks are happening at the outset.
Tim Quek provided an overview of the health system in China, and introduced Gem Flower Healthcare, which runs over 300 hospitals across the country. Given the size and growth potential of the Chinese healthcare market, Tim believes China represents one of the most attractive in the world for foreign healthcare investors. The overall market is currently growing at 12% year-on-year, despite relatively low GDP expenditure in comparison to other countries. Expenditure is growing, but out-of-pocket expenses are still a significant funding source.
Quek explained that in China, there are few hospital deals made with international providers. In the Chinese market, building trust with a local organization as a partner would present an ideal opportunity for international firms wishing to enter the Chinese healthcare market. A local guide to understanding the ways of working in China, many of which may be extra-contractual and highly trust-and-relationship-based, is likely to be vital to successful market entry and sustainability.
Dr. Francesco De Meo, CEO, Helios Health provided the closing keynote presentation, looking at growth, quality, innovation and transformation across Helios. Revenues and EBIT has more than quadrupled in a span of 10 years, helped by a focus on economic efficiency and medical quality. Their international approach has adopted different strategies to address different healthcare systems, and their digital transformation has included developing a patient portal providing online education and engagement. Dr De Meo highlighted the advantages of being a private hospital operator as including greater financial power and group advantage, management know-how and importantly political independence.
*KPMG's Global Healthcare conference is an annual invitation-only international conference, bringing together both local and global clients and relevant industry leaders to collaborate, learn from and inspire each other to help shape the future of our global healthcare systems.
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