Reconfiguring services line location is a growing need among most integrated delivery systems. In this context, it is important to remember that strategic decisions such as opening new facilities and closing others include both functional and emotional factors. This is also called speaking to the “mind” and “heart.” The effective combination of these factors results in faster decisions and a higher level of commitment to seeing these changes through. Through this illustrative case study, we will explore how to effectively integrate the components together as part of the same stream of decision-­‐making.

1. Building a Solid Business Case
For Service Line Optimization
1
1 This white paper is based on a webinar presentation delivered through The Beryl Institute by Froedtert Health and Gelb Consulting
Gelb Consulting, An Endeavor Management Company
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2. Building a Solid Business Case
For Service Line Optimization
Introduction and Overview
Reconfiguring services line location is a growing need among most integrated delivery
systems. As mergers and acquisitions continue, fueled by changes to our US healthcare
delivery model, strategic planners must be very deliberate about which data to gather and how
to present such for effective decision making.
In this context, it is important to remember that strategic decisions such as opening new
facilities and closing others include both functional and emotional factors. This is also called
speaking to the “mind” and “heart.” The effective combination of these factors results in faster
decisions and a higher level of commitment to seeing these changes through.
Through this illustrative case study, we will explore how to effectively integrate the
components together as part of the same stream of decision-­‐making.
You will see:
•
•
•
•
Patient and physician “stories” help build support for change
Demand estimation tools are sophisticated, but necessary
Multi-­‐million dollar decisions require some investment in data acquisition
Buy-­‐in throughout – process, insights, and actions is critical
Background
Froedtert Health sought to examine and redesign orthopedics, orthopedic surgery services,
and the rehabilitation unit into a musculoskeletal service line. This new design would
streamline the treatment process by organizing existing assets of communication, clinical care,
and care coordination based on an understanding of the ideal patient experience. Given the
variety of interests with internal stakeholders, common alignment around patient needs and a
collaborative approach was required. These needs included, identifying problems and creating
solutions to the problems.
The desired changes are not insignificant as Froedtert Health is the only academic-­‐community
partnership in southeastern Wisconsin. The system includes over 772 beds, admits over
40,000 patients, and completes almost 850,000 outpatient visits per year.
© 2013 Endeavor Management. All Rights Reserved.
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3. Building a Solid Business Case
For Service Line Optimization
Approach
A framework focused on the customer experience was paramount to gaining alignment. By
concentrating insights and strategic decisions on the direct impacts to patients/families and
their community-­‐based physicians, a holistic view can be achieved.
Our customer enchantment model serves to align the
various aspects of achieving exceptional experiences.
These include customer expectations of the brand,
leadership setting expected behaviors and priorities,
and ensuring the culture supports such.
Ideally, we look to design experiences that create
resonance to encourage patients and physicians go to
out of their way to recommend you. This is beyond
simple satisfaction and likelihood to purchase.
This strategic decision-­‐making required the following
inputs:
• Utilization review
• Site visits
• Patient and physician experience
interviews
• Trade-­‐off research (quantitative) to
assess true impacts of change
© 2013 Endeavor Management. All Rights Reserved.
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4. Building a Solid Business Case
For Service Line Optimization
Utilization Review
Examining the inventory of current services provided,
frequency of use, geographic spread and profitability is
paramount to understand whether reconfiguring is
possible. In some circumstances, this data might suggest
a full-­‐optimized system; in others, it becomes clear that
services are underutilized.
Additional analysis can be performed to look
prospectively:
• Effects of internal cannibalization
• Condition incidence rates and corresponding
services (from you and competitors)
• Site location
• Staff models and movement across locations
• Lease expiration timing
Site Visits
Site Visits can provide a meaningful way to assess what customers see and whether locations
require updates. A chair exercise can be used for this purpose. During such, you sit in every
chair that patients sit – from parking lots to exam rooms – and take pictures from their
perspective. This exercise produces insights regarding what patients see and also how many
different environments patients sit during a single encounter.
Across multiple sites, it will also be important to review how distinct or common these
physical environments are. If there is one service line program, many of the touchpoints
should be the same, especially if the patients visit more than one location. Examples of this
consistency might include: Way finding, signage, waiting area amenities, privacy at reception
desks, exam rooms, and other common areas.
© 2013 Endeavor Management. All Rights Reserved.
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5. Building a Solid Business Case
For Service Line Optimization
Parking can be more difficult at larger
facility (and result in appointment
cancellations when the weather is bad)
Unique options for therapy exercises
Specialized treatment…hand therapy
area
Co-­‐location of therapists and physicians
is beneficial for patients
Consider this: During this exercise, it is often very useful to take advantage of the time onsite
and discuss experiential successes and barriers with staff members. They often have great
ideas but obstacles in their way to implement such.
Experience Mapping Interviews
Experience mapping interviews are organized using an experience map – a visual cue to aid
respondents to recall specific episodes of their journey. This aids interviewers in identifying
activities and the variety of touchpoints customers encounter. These maps can be used for
staff, patients, and physicians. In addition to gathering inputs, the experience map later serves
as a framework for action – from front-­‐end marketing, communication, through transition of
care. The intent is to understand the nature of the current experience, define functional and
emotional needs at each step, and elicit recommendations for improvement.
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6. Building a Solid Business Case
For Service Line Optimization
These interviews yield powerful audio clips and comments to ensure planners understand
functional and emotional needs.
Through this process, you will identify a number of key patients and physicians who can later
provide marketing-­‐related testimonials if their stories are compelling and align with your
brand.
“I want the patient to have an efficient experience,
like an appointment in a timely manner.
The quality of therapy is expected.”
Referring Physician
Initial Insights
Through the empathy building approach, it is easier for executives to understand WHY change
is required. For this particular case study, there were several strategic insights discovered,
which then provided support to fund additional exploration regarding HOW the changes will
take place.
In particular:
• Patients were highly satisfied with their current therapist, but had mixed feelings about
changing sites and/or therapists in the middle of treatment.
• The keys to therapy success: Motivation, expertise and thorough explanations.
• While information regarding the program’s capabilities is available, such was not
getting in the hands of patients (which is both facility and physician driven). In
addition, there were inconsistencies across the facilities in terms of the materials
distributed.
• Community physicians also expressed concern with the duplication of services. In
addition, they were not aware of the variety of services provided under the program.
• For on-­‐going treatment, physicians sought to obtain information or build relationships
with individual facilities and professions to match patients with the most appropriate
therapist (this was not only clinical, but also approach).
• Toward that end, physicians prefer to be co-­‐located with the outpatient services group.
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7. Building a Solid Business Case
For Service Line Optimization
Leadership Business Case for Decision Support
To organize collective thinking about information gaps and decisions to be made, insights were
organized into two categories, reflecting the sources of insight: Experience and Economics.
As a result of developing empathy with their customers, executives came to the following
conclusions:
There is a burning platform to carefully examine the current patient experience and identify
opportunities for streamlining operations:
• Economics: Internal competition for referrals
• Experience: Confusion around facilities located closely together
The ideal design will support the identification and translation of best practices across
locations so that this service line does things consistently, regardless of where the patient
accesses care.
There was commitment to championing changes required to achieve these objectives.
Trade-off Analysis (Quantitative)
To mitigate risks between both economic and experiential factors, trade-­‐off techniques such as
adaptive conjoint analysis can be used. Conjoint analysis, meaning considered jointly, provides
a research mechanism to force decisions based on a set of features/benefits/brands/costs. For
healthcare, it is often the case that cost considerations involve – distance traveled and co-­‐
location of services (number of visits to accomplish the same programmatic outcome).
To inform this set of decisions, we designed an executed conjoint survey to examine the
choices that patients and physicians make regarding episodes of care.
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8. Building a Solid Business Case
For Service Line Optimization
An example of these trade-­‐off or purchase simulation exercises is featured below:
Through this analytical process, the following results can be determined:
• Impact of brand (i.e., who provides)
• Need for co-­‐location of services (i.e., number of services under one roof)
• Distance trade-­‐ offs (e.g., how far from home/work)
• Estimated demand for services given competitive choices
• Identification of attractive segments
In the examples below, relative importance of attributes is highlighted and the drop offs for
demand with changes:
Healthcare provider (Brand) trumps other factors:
© 2013 Endeavor Management. All Rights Reserved.
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9. Building a Solid Business Case
For Service Line Optimization
To maximize demand, location is more important than co-­‐location, even for referring
physicians:
Key Insights
•
•
•
Froedtert Health has the strongest brand in the market for these services
Physicians share the same perceptions as patients for proximity (even to the 20
minutes drop off)
Co-­‐location becomes less of an issue when trade-­‐offs are required
Key Strategic Inputs
•
•
•
•
•
Consolidation possible as long as changes optimize around 20 minutes
A freestanding facility is attractive with limited scope of services
Alignment of services is important to maintain/increase market share
Future growth can be driven by market potential and from whom to take market share
Employee communication will focus on long-­‐term commitment to solidifying market
leadership position and patient/physician access
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10. Building a Solid Business Case
For Service Line Optimization
Strategic Plan Highlights
Patient-­centered Design
• Multidisciplinary teams led by a Steering Committee
• Voice of the patient is a required input
• Functional design based on needs of the patient
• LEAN workflows for staff / physicians developed prior to construction
Operations
• Consolidate rehab services into a single organizational structure at health system level
• Reduce the number of sites in over-­‐served markets and ensure smooth transition for
patients
• Define system-­‐wide musculoskeletal service line structure, leadership and objectives
• Complete construction of free-­‐standing facility (January 2014) and service line
deployment plan
• Identify additional initiatives to optimize service line to best meet the needs of our
patients and providers
Communications
• Current and future patients
• Referring physicians (internal and external)
• Orthopedic specialists
• Rehab services leaders and staff
• Community members at large
• Health system leaders and staff
• Medical group practice leaders and physicians
© 2013 Endeavor Management. All Rights Reserved.
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11. Building a Solid Business Case
For Service Line Optimization
About Endeavor
Endeavor Management, is an international management consulting firm that collaboratively
works with their clients to achieve greater value from their transformational business
initiatives. Endeavor serves as a catalyst by providing pragmatic methodologies and industry
expertise in Transformational Strategies, Operational Excellence, Organizational Effectiveness,
and Transformational Leadership.
Our clients include those responsible for:
• Business Strategy
• Marketing and Brand Strategy
• Operations
• Technology Deployment
• Strategic Human Capital
• Corporate Finance
The firm’s 40 year heritage has produced a substantial portfolio of proven methodologies,
deep operational insight and broad industry experience. This experience enables our team to
quickly understand the dynamics of client companies and markets. Endeavor’s clients span the
globe and are typically leaders in their industry.
Gelb Consulting, a wholly owned subsidiary, monitors organizational performance and designs
winning marketing strategies. Gelb helps organizations focus their marketing initiatives by
fully understanding customer needs through proven strategic frameworks to guide marketing
strategies, build trusted brands, deliver exceptional experiences and launch new products.
Our websites:
www.endeavormgmt.com
www.gulfresearch.com
© 2013 Endeavor Management. All Rights Reserved.
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