Future Hospital - Interview
Cologne, October 10, 2019 – Talking with: Prof. Dr.-Ing. Thomas Bauernhansl, Fraunhofer Institute for Manufacturing Engineering and Automation IPA, Institute for Industrial Manufacturing and Factory Operation IFF – University of Stuttgart, Germany; Dr.-Ing. Martin Schönheit, managing director, Dr. Schönheit + P. Consulting GmbH; Prof. Dr. med. Ralf-Joachim Schulz, Chief Physician of the Clinic for Geriatrics, St. Marien-Hospital, Cologne, Germany
If you want to remain competitive in the future, you cannot close your eyes to digitization in the workplace and in healthcare. Which important aspects do you think need to be considered?
Dr. Bauernhansl: The industry’s digital transformation has two major fields: the front end and the back end. The front end asks: How can I develop and monetize my services and products for the market in a very customer-centric way? This is about leadership in benefits, less about technology or market leadership. In the back end, it's all about: What does my service provision look like? How can I make it efficient and waste-free in order to generate this benefit? Applied to healthcare, the customer is the patient. This means designing the business processes end-to-end in a highly efficient manner with the aim of generating optimal benefits for the patient, meaning rapid recovery, for which he himself or the insurance company is prepared to pay.
Dr. Schönheit: Looking at manufacturing companies, we have the vision that the business of the future can organize and control itself. Artificial intelligence should support the responsible person in the work process with timely information in his decision-making process. I understand the technical possibilities of data networking as a second digital skin in the environment of the acting person. This has long been the case in numerous manufacturing companies, market leaders in their sector. The same approaches to digital value creation can be transferred to the knowledge- and experience-controlled operative work between doctor and patient in the hospital of the future. That's what it's all about.
Dr. Schulz: Hospital digitalization means a considerable additional effort in data protection and data backup and also requires a well thought-out failure concept. The implementation of paper-based work and documentation processes requires IT support that is often underestimated and often overwhelms existing work groups. A new "occupational group" should therefore be planned in the hospital before implementation; the planned measures should be conceptually expandable and, if possible, integrable into existing systems. Good digitalization also means regular updates with regular costs and training efforts.
Architecture and interior design have a great influence on people and their well-being in the room and at the workplace. This can be of use both in patient care and in hospital operations. What will meaningful interior design look like for you in the future?
Dr. Bauernhansl: It makes sense to also think in patient-centered terms and to design the room accordingly. As a layman of architecture, I can only take the perspective of the patient or the process optimizer. Of course the design of workplaces/examination rooms/patient rooms has a big influence on the well-being. Today, when you enter the hospital, you see what you expect. You know immediately that you are in a hospital. If you were to differentiate yourself pleasantly here, that would certainly be positive. Correctly implemented, it would certainly support the benefit-oriented and process-oriented approach.
Dr. Schönheit: To begin with, the meaningful design of a room can be defined by the needs of the people living and working in the room. Before planning, people should firstly be asked about their user expectations as a basis for planning from the inside out. Light, color and the biological rhythm of the daily routine and the annual cycle have an influence on a meaningful interior design. Architects and process planners create changeable, agile spaces in which concentration, dialogue and relaxation can be experienced in a balanced way. I believe it is imperative to transfer these themes to a hospital of the future.
Dr. Schulz: Interior design in hospitals is an important way to improve staff satisfaction. Only then will the quality and effectiveness of patient care be right. The operating result and the reputation of the hospital depend to a large extent on this. Through clear structures, architecture can influence the character of a building and the mood or well-being.
What does the optimal management culture look like in a company? How can this be transferred to the hospital of the future?
Dr. Bauernhansl: There is both a transactional and a transformal perspective. Because of the responsibility the hospital has, there are necessarily many rules and a hierarchical system has evolved - the transactional approach. On the other hand, in addition to the medical and economic perspective, there is also the patient perspective, the transformational approach: How can I bring the patient, the medical professional and the economy into a balanced cooperation, a cooperation in which all their goals can be achieved responsibly and yet the applicable rules are adhered to? This is the challenge: to build organizations accordingly, but also to develop an appropriate leadership culture.
Dr. Schönheit: As an optimal leadership culture in an agile organization, I see the fusion of commitment and action of all people involved in the performance process, aligned to a common goal. The organization is experienced as a demand-oriented "organization on-demand". The willingness of a manager to change as well as the ability as an enthusiastic and credible person to motivate people to this common goal are decisive. Thus, the soft skills of the past become the hard facts of today. With regard to the future hospital, the customer "patient" experiences an optimal medication, treatment and therapy tailored to his personal needs from the acting doctors and nursing staff.
Dr. Schulz: Today's generation of employees is looking for meaningful forms of cooperation. This does not mean, however, that hierarchies should be completely dissolved, but rather that a culture emerges under a clearly recognizable management structure according to which the person best suited for the task is assigned. The solution of a problem or the development of a task is the goal, but not in rigid organizations, but in a living system. Digitalization creates spatial independence, but human contact with its emotional stimulation and control should not be neglected. Because hospital staff have chosen a profession that requires human-human interaction as a basis.
The definition and the sequence of meaningful processes are the basis of a functioning clinic operation. Is there a need for optimization for the hospital of the future based on your observations? If so, which one?
Dr. Bauernhansl: We need a precise definition of the end-to-end processes that begin with the patient and end with the patient, always with the goal of improving the patient's health status and well-being. Digitalization can help us in the background to make our processes efficient enough to be affordable. It is precisely in these processes that we have to think and behind them build our organization, our network, our management system – with the help of digital tools. Once we have achieved this, we will end up with a highly efficient process landscape that will, I think, benefit everyone involved: economic and medical benefits as well as the well-being and state of health of the patients.
Dr. Schönheit: Based on our consulting experience in clinics, we observe a need for optimization in several areas. These are organizational principles, leadership skills, the lack of a common system idea for the interlocking of all performance processes. Often, clearly defined key performance indicators are simply missing as an orientation. First of all, it must be clear to everyone in the organization who sets the direction and who should be the customer of the values provided. Doctors, nursing staff, pharmacies, room care, hygiene, logistics, anesthesia and sterile processes, to name just a few, all have a impulse generator. The orchestra only tolerates one conductor. The patient must be the beneficiary at all times.
Dr. Schulz: Medical treatment methods are currently changing rapidly and increasingly require different focal points and logistics structures with increasing "outpatient treatment". The hospital must adapt to this in its self-image and its organizational charts. Hardly any medical field still needs the classical traditional structures of the 1990s. Functioning processes should be regularly checked for necessity: For example, will they still be relevant in 3 - 5 years? The introduction of new processes requires preparation times and coordination, which cannot be achieved ad hoc. In addition, when introducing a new process, it is important to consider the question of what can be replaced or abolished.
Future Hospital - What makes the hospital of the future different for you?
Dr. Bauernhansl: I believe that the boundaries of the individual institutions (doctor's practice, hospital, rehabilitation clinic) will disappear below the various phases in the future. The hospital can play a role in the prevention phase, also in the diagnosis phase and, of course, in therapy and aftercare. But there are also other institutions that will play a major role. The unlimited convergence of the range of services with the aim of focusing on patients is what makes the hospital of the future. The aim is to focus on the well-being of the patient. Around it there is a health ecosystem that ensures that I am healthy, that I am well.
Dr. Schönheit: The hospital of the future allows values to emerge at any time, systemically oriented towards the benefit for the patient. Physical value streams and digital value creation are like a second skin around the anatomy of the new hospital structure. All physicians access the same information in a digital patient file. The logistic system “hospital” controls itself in its value streams "on-demand", demand-regulated. Well-trained personnel are freed from routine work by a meaningful digitalization and find "more time" for the patient. The rooms offer a motivating environment in which it is fun to become healthy or to serve the patient. As a result, the future hospital will be smart, intelligent and needs-based.
Dr. Schulz: In order to be able to cope with medical-technical progress in the future, a high level of technical and professional competence with lively management structures is necessary, as is a high need for investment. The hospital of the future is strongly networked with outpatient care networks and is much more patient-oriented. There is improved communication with past and potential future patients, but especially with relatives via all technically possible channels. The hospital of the future can only survive if it is attractive for employees and the tasks are meaningful. Classical reward mechanisms are only partially successful.
Can doctors and managers from hospitals learn from the production world in industry? Which parallels do you see and which of them are easy to transfer?
Dr. Bauernhansl: If you transfer lean management, which is now standard in production, to the hospital, you can take big steps. All processes that do not contribute to the patient's health are initially considered wasteful and must be minimized or eliminated with the help of technical or organizational measures. If you then apply the principles of Industry 4.0, which once again open up a new innovation space in order to minimize waste and optimize processes, you are suddenly in a completely different world. The well-being of the patient, the trust in what is happening to him is already half the battle. The other half is, of course, professional medical work. Both together make up the success of the therapy.
Dr. Schönheit: We were selected as consultants from the production world to optimize the processes in the hospital in order to bring about exactly this transfer. Over the past 20 years, the industry has made enormous efforts to create value along the processes to an operations system with every move. The fundamental idea is to become a little better every day with small steps. "Continuous Improvement" shapes the principles of lean management and change management. These successful approaches to increasing value in every process can be easily transferred to the hospital of the future.
Dr. Schulz: While robotics and processual work in industry are an integral part of everyday life, medicine is still at the very beginning of supporting human-to-human interaction. The understanding that technology and algorithms support human actions qualitatively and in which form this is ethically justifiable must be evaluated in the exchange of experience.