Hospitals are becoming more cost-efficient

Hugo Casteleyn combines his job as general manager of the general hospital AZ Sint Blasius in Dendermonde with a part-time job as strategic coordinator of the Flemish Hospital Network K.U.Leuven - and he is vice president of the VOKA department in East Flanders. This gives him a unique view on the processes in hospitals and medical institutions, especially on the current evolution towards more cost-effective and more collaborative hospitals.

The hospital AZ Sint Blasius in Dendermonde is a nice example of the evolution of the hospital landscape in the last decades, Hugo explains: "Once we had five hospitals in the city, but in the period from 1994 to 1997 they merged. This is part of a broader evolution: in a period of 10 to 15 years, the number of general hospitals in Flanders decreased from 150 to 50 because of mergers. But after more than ten years, even this consolidation doesn't seem to be sufficient." 

According to Hugo, one of the reasons for this consolidation trend is the progressive specialisation in the field. For example, a few decades ago we had just surgeons and internists as job descriptions, while we now have surgeons and internist for various specialisations. This 'subspecialisation' is an ongoing trend, and as a result doctors need a high enough volume of patients to be able to do their job well enough. "To give an example: it wouldn't make sense for our hospital in Dendermonde to aim at a top heart surgery department, because we already have top heart surgeons in Aalst, only 12 kilometers away."

But there's also an economic reason for this trend: the hospitals feel pressure from the community and the government to manage their money more efficiently. "It's not really that they explicitly ask us to do this, but we notice that hospitals are getting less money: their budget has been shrinking in the last eight years. We don't have to be sulky about this; I actually believe this is a good thing, as long as hospitals get the freedom to choose how they achieve this efficiency boost. Mergers are one way to do this."

An important challenge

So we will see more and more mergers of hospitals, as well as all kinds of collaboration between hospitals. An example of the latter is the Flemish Hospital Network K.U.Leuven, which consists of 19 hospitals in Flanders. Of course collaboration is always a big organisational challenge. First of all, you have to decide which departments and services you merge and which ones the hospitals keep doing on their own. Cost efficiency and the economics of scale play a role in this decision, but some services just have to be near the patients because of medical reasons. Even transport costs, how fast you need a result and how long medical samples last are factors that you have to take into account.

"Personally I think that hospitals can share a lot of services that they now do themselves. Why does each hospital have a purchasing department, an IT department and a cleaning service? These are not part of the 'core business' of a hospital, it's duplicated work and we should wonder if these supporting services couldn't be made more efficient in a centralised model," Hugo says.

And when you have finally decided what to merge and what to keep at each hospital, the next hurdle is communication. Hugo explains: "You need common protocols, the same quality systems, you need to be able to share medical records, and so on. If doctors in different hospitals use the same computer systems or protocols, it allows them to exchange knowledge in a simple way. This is beneficial to the patients, as the doctors can then easily consult each other, ask for advice, and get a second opinion. But to streamline this, the computer systems of regional hospitals should become qualitatively better." Thanks to the Flemish Hospital Network K.U.Leuven, the clinical workstation of the hospital in Leuven is now also used in the hospitals of Diest, Brugge, Aalst, Ronse, Kortrijk and Dendermonde.

More than technology

But Hugo warns that the challenge is not just technological: "Installing the same computer system and communicating by the same protocols isn't enough. You really have to share the medical praxis. We continuously bring doctors of the same discipline from different hospitals in contact with each other. Of course technology can play a supporting role in this. For instance, each doctor of the Flemish Hospital Network K.U.Leuven has access to a videoconferencing network, which we also use for our doctors in training: they are simultaneously in different campuses while their professor is at another campus showing a case.

Hugo is also a big proponent of process analysis: "Too many tasks in hospitals are managed off-the-cuff instead of by doing a thorough process analysis. The processes in a hospital are really much more complex than for example in an automotive or textile factory. At AZ Sint Blasius we have a business process management (BPM) department, which is looking at a couple of high-priority processes and trying to optimise them. Of course we share our experiences with other hospitals from the Flemish Hospital Network K.U.Leuven when we meet monthly, but this is still rather ad hoc. I think a lot of hospitals could benefit if they would share their process analyses with other hospitals, as we are all coping with the same processes."

The BPM department at AZ Sint Blasius already had quite some good results. For example, it unraveled the process behind the radiology department: a patient enters the hospital, gets a radiograph taken, visits one or more doctors to discuss the results, and so on. But the process can diverge in various circumstances. "For example, if the patient is ambulant, the protocol has to go to his general practitioner; if the patient is hospitalised, the protocol is settled in the hospital. Moreover, there are many different scanners and other machines with specific requirements, and we have investigated how fast the patient can go through the whole process."

Another process that has been analysed with a big efficiency improvement as a result is the cleaning of a room after a patient is dismissed from the hospital. "There are a lot of questions in this process: when can you start cleaning? What do the cleaners do and which tasks are the responsibility of the nurses? We have streamlined the process and started a specific team that is responsible for cleaning the rooms after the dismissal of patients. As a result, when a patient leaves now, his room is ready for another patient within an hour. This way, our hospital utilises its capacity much more efficiently and new patients don't have to wait so long anymore for their room."