1. Future of Hospitals
9 June, 2014
Penelope Dash
Senior Partner
McKinsey & Co
Nuffield Trust

2. 1
What I will talk about today
Where have we come
from?
Where are we today?
Where to next?

3. 2
Spot the hospital

4. 3
What does it feel like to be a hospital today?
24x7 healthcare needs
…. 120 babies ……
New technologies
arriving almost daily ….
Major tariff pressures
….
The “incontinence”
challenge …….
Confused old ladies
who shouldn’t be there
………..
Ever increasing
standards….

5. 4
No wonder hospitals are on the edge

6. 5
So what could we do?
Drive productivity1.
Tackle quality2.
Tier and manage3.
Reframe the hospital4.

7. 6
Compared to other industries, healthcare is still lagging behind in
efficiency gain
Optimise estates
Support self
service/self care
Innovate the
workforce
Standardise
processes
Drive productivity1.

8. 7
Standardized processes and routine monitoring
Trackable
RFID chip
Transmitter for
equipment
localization
Transmitter
for staff
localization
Intelligent room
surveillance for
status
Maintenance
status by
remote hand
held

9. 8
Look at Aravind?
SOURCE: Rockefeller Foundation; Interviews; 2010/11 National Schedule of Reference Costs; 2010/11 Aravind Eye Care
System Activity Report; Global Insight; Conversation with Dr. Sathya Ravilla at Aravind; Team Analysis
UK-NHS
$PPP 1,400
Aravind
$PPP 250
UK-NHS
6%
Aravind
4%
Unit cost of cataract surgery in 2010/11
Infection rate per 10,000 patients
… at ~1/6th the
cost…
… and with better
outcomes
10%

10. 9
Innovate the workforce – what can technology do?
Say hello to intelligent pills –
digital system tracks patients
from the inside out
Nature
The doctor is out, but new
patient monitoring and
robotics technology is in
Scientific American

11. 10
Lots of technology but slow adoption

12. 11
Innovate the workforce?
GP obstetricians in
Australia
Midwives administer
epidurals in Canada
Primary care
paediatrics in the US

13. 12
Optimise the estate ……… it is 20% of costs

14. 13
Support self care – changing the paradigm?

15. 14
Tackle quality2.
▪ How much experience does she have? How many cases a
year does she do? Is that enough?
▪ How up to date is she in the latest thinking/knowledge?
▪ What are best practice protocols for the conditions she is
managing?
▪ How good are her results? What are the main complications
in her speciality and how do her results compare to
colleagues in your hospital, the one down the road, the
leading edge centre, the best in class globally?
▪ How well are patients’ symptoms resolved? How often does
she publish her results?
▪ What do her patients think of her?
▪ How much research has she done this year? How many
articles were published?
▪ What do her medical colleagues think of her? Is she in top
10% of all doctors they work with or bottom 30%?
▪ What do other staff think?
▪ What do juniors think of her? How well do they assess her
teaching style, knowledge, impact?
▪ How efficiently does she care for and manage patients?
▪ Do you
measure this
every month?
Every year?
▪ How often do
you publish it?

16. 15
Tier3.
Complexity of care summary for maternity service levels
Service level
1 2 3 4 5 6
Emergency Care
Resuscitation, stabilisation and retrieval      
Complexity of Care needs
Normal      
Moderate complexity   
High complexity 
Antenatal Care
Outpatient care      
Inpatient care     
Maternal fetal medicine service 1
Planned Birthing Care
Gestation >37 wks     
Gestation 34 wks   
Gestation >32 wks  
Less than 32 wks 
Elective caesarean section > 39 wks gestation    
Unplanned Birthing Care
Access to or onsite facilities for emergency caesarean section     
Intrapartum EFM + fetal blood sampling (scalp pH I lactate)   
Postnatal Care
Outpatient care      
Inpatient care     
1 Access to
Source: Standing Council on Health (2012) National maternity services capability framework
(http://www.qcmb.org.au/media/pdf/The%20National%20Maternity%20Services%20Capability%20Framework.pdf)

17. 16
A single campus where patients can access high quality integrated care and diagnostics
Primary care
GP surgeries
Community care
Full range of community services
Fast response teams
Re-ablement and day-care unit
Physiotherapy, SALT, OT
Wellbeing services
Health advice, weight watchers
Smoking cessation
Information centre
Social care
Co-located social care services
to create sense of place focused
in the centre of the community
Acute services
24x7 urgent/
emergency care
MLU
GP OOH
Short stay acute medical unit
Day cases Outpatients
Diagnostics ISCAT
Reframe the hospital4.

18. 17
101 GP
practices
50 community
care centres
39 Sure Start
centres
5miles
0miles
Reframe the hospital?4.
And four major hospitals ………………..

19. Abingdon Community Hospital
Catchment
- 5 market towns in SW
- 140,000
Co-located services
- Minor Injuries Unit
- Diagnostics (X-ray)
- Mental Health base
- Outpatients
- Primary Care
- GP practice
- out-of-hours base
- Inpatient wards
- 45 beds
- stroke, hip fracture, ‘generic subacute’
- close relationship with ‘acute Trust’
Reframe the hospital4.

20. PRELIMINARY DRAFT 19SOURCE: Rochdale EUCC Operational Policy 2012
Care Model: Rochdale ‘EUCC’ onsite MAU
Patients/conditions treated
Key goals and achievements
• Minor nose bleeds (not on Warfarin)
• Minor cuts, bites and stings
• Burns and scalds
• Infections (including abscesses)
• Foreign bodies in wounds, ears and noses
• Muscular sprains and strains to shoulders, arms and legs
• Fractures to shoulders, arms, legs & ribs
• Dislocations of fingers, thumbs and toes
• Minor eye conditions including conjunctivitis and foreign bodies
• Minor chest, neck and back injuries
• Minor head injuries with no loss of consciousness or alcohol-
related
• Minor allergic reactions
• Minor ailments such as coughs, colds, flu symptoms, sore
throat, earache, urinary tract infections and sinusitis
• Diarrhoea / Constipation
• Emergency contraception
Support services provided
• Basic Laboratory services
• X-ray diagnostics 08:00 – 24:00, 7 days a week
• Ante-Natal Ultrasound 08:00 – 17:00, Monday – Friday
• CT when coverage is available, 09-17, Monday – Friday
• MRI 08:00 – 20:00 Monday - Friday
• Step-up/ Resuscitation room
• Pharmacy support 7 days a week
• Retains 80% of old A&E activity and growing
• Patients assessed within 20 minutes of arriving
• Patients will be seen by a Clinical Decision Maker
within an hour of presenting
Reframe the hospital4.

21. COMMERCIAL IN CONFIDENCE – DRAFT FOR DISCUSSION
Urgent care centre (24x7)
• GPs work in minor injury
unit to ensure maximum
number of patients can be
safely cared for
• GP out of hours services
co-located and fully
integrated
• Diagnostics co-located and
x ray open 7 days a week
Outpatient clinics
• GP run fracture clinic
Therapy services
• Occupational therapy
• Physiotherapy
• Rehabilitation
• Podiatry
Maternity services
• 400 women managed
ante-natally per year
• 200 deliveries
Inpatient care
• 12 bedded older people
mental health unit
• 2 wards for 40 medical
and surgical patients (one
male, one female)
GP services
• One practice (~14
doctors) based on site
• Other practice on other
side of town but plans to
relocate
Base for community
teams
• Community mental health
teams
• Health visitors, school
nurses, district nurses
• Public health
Day case surgery unit
• Two theatres
Reframe the hospital4.

22. COMMERCIAL IN CONFIDENCE – DRAFT FOR DISCUSSION
But …. Here’s what the doctors think ….
`
21

23. 22
So …….. What could a future look like?
100 major emergency
centres
300 local hospitals
600 health centres