The future of hospitals in conditions of financial ... · The case of a large Italian Hospital...
Transcript of The future of hospitals in conditions of financial ... · The case of a large Italian Hospital...
The future of hospitals in conditions of financial constraint.The case of a large Italian Hospital
Pietro Grasso
Athens, June 5 th, 2019
Topics
▪ The Context
▪ Policlinico Gemelli Hospital
▪ The istitutional evolution
▪ The organizational changements
▪ Principals results
▪ Next challenges
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❖ Good health indicators ( life expectancy in good health conditions)
❖ Good healthcare coverage, but
❖ Reduced rates of universal coverage & equity (-13,4 % = 8,1 mln);
❖ Increasing waiting list
❖ Economic sustainability of Italian health Service
❖ Insufficient capacity of investments
❖ Increased costs on new technologies, drugs and medical devices
❖ Block of public fundings
❖ Disparty between the services provided in the different Regions
❖ Increasing number of people who forego the treatments
❖ Increasing out-pocket health spending ( +9% from 2013 to 2018)
THE NATIONAL CONTEXT
\
❖ A big debt burden for Health Care❖ The Commissioner for the Regional goverment❖ The aid package❖ The hiring freeze❖ The budget squeeze on Hospitals ❖ The spending cuts on pharmaceuticals❖ Increased controls and economic sanctions on inappropriate
admissions
THE REGIONAL CONTEXT - LAZIO
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Net loss€ -100.000.000
201
1
Next projects
201
9
Third Change
management
Foundation
Gemelli-IRCCS
2018
Second Change
management.
The birth of the
Foundation Gemelli
201
5
First Change
management
The slimming diet
The steps of our route
2012
No financial agreement.
2011 Problems
Relationship problems with regional health authority
New standards in hospital bed equipment
Gemelli had to reduce costs
Rigid organization & management
Gemelli had to reduce 100 beds.
Strategic Plan 2012-2016
01
02
03
04
Increase efficiency &
appropriateness in performing
hospital activitiesDevelop Gemelli recovery plan in
the regional, national
&international context.
Develop revenues from
private activities .
Develop the bridge between
research and heathcare .
THE HR COST CUTTING MEASURES (2012-2014)
Results at the end of actions: Cutting staff (490 fte units) Saving € 30 M
• Include reduction of the duration of seasonal contracts equivakent to 25 FTE
• Breakdown 5/10% of severance pay on the exit year; 90 % the following year
)- 490FTE
8819075
36
100
FTE Aggregate
At the end in 2015 savingfor € 29,5 M
Gli interventi sui costi esterni
Results at the end of measures : Saving € 25 M on external costs(reduction of 12%)
Cost items Costs 2011 (M€)Impact of
interventions• Renting, leasing
• Energy & water
• Manteinance
• Outsoursing
• Chemicals
• Purchasing
• Medical devices
• Fharmacy (except File F)
61
14
18
28
12
16
11
56
211
8%
11%
11%
15%
22%
19%
26%
7%
12%
Pharmacy provides the medical supplies;Purchasing provides Oxigen, Laboratory & Trasfusional materials
Goods , Raw materials, Consumables
12,1M€
Outsursing Services& Utilities
7,7 M€
OTHER COST CUTTING MEASURES (2012-2014)
L’evoluzione dell’offerta di posti letto SSN
Hospital Bed Equipement Gemelli + Columbus 2011-2016
Cut 240 hospital bed in 5 years , 205 inpatients and 35 day hospital
-242 PL
Gli interventi di ottimizzazione della degenza media SSN
TARGET: REDUCE 240 BED WITHOUT NEGATIVE IMPACT
Enhancing performances for reducing the averege lenght
stay of one day (-1,0)
Riduzione complessiva degenza 1,0gg
• Improving the appropriateness of hospital treatment: Shifting from inpatient to outpatient treatment and day hospital
• Enhancing the hospitalizationefficency for reducing the averagelenght stay:
Reducing pre-op stay;
Reducing waiting time of radiological examinations;
Discharging and moving patientswho need long term care;
The new hospital organization
01 02
03
0405
06
01
02
03
04 CardiovascularHub
05
06
NeurologicalHub
DepartmentsProgramsCentersPathways
Cancer Hub
EmergencyHub
WomenHub
Hubs and Centers/Programs the interfaces between hospital organization and patients
PoloOncologico
PoloCuore
PoloDonna
PoloNeuro
PoloEmergenza
Hubs Centers and programs
Departments
Department 1 Department 2 Department 3 Department 4 ...
Management of the academic staff according to the teaching classes
Patient
Policlinico A. Gemelli – 5 Hubs
Policlinico “Agostino Gemelli”Strategic Evolution 2012-2016
Oncologic diseases’ clinics
Emergency Department’s clinic
Neurological diseases’ clinic
Cardiovascular diseases’clinic
Woman's hospital clinic
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
40,00
45,00
50,00
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Ma
rke
t s
ha
re L
azio
Re
gio
n(
% )
ISI H-INDEX Average
Competitiveness and attractivenessStrategic area of development
Hub Tools
HUB
Medical Chief
Case/Care Manager Clinical
PathwaysCoordinator
OperationPlanning Center
Information System
ManagerialControl
Gemelli Foundation Strategy 2015-19FPG birthday is August, 1st 2015
Lease contract of company branch
with Columbus Hospital,
November, 1st 2015 .Increase extra budget for
“patient admission mobility”
from other Regions
Consolidation/Improveme
nt of cost containment
measuresNew employment contract
Apply to Ministry of Health to recognize
Gemelli as a Research Institute
Our MissionCare as a valueLOOKING TO THE FUTURE
VISION 2021
• TO ESTABLISH AS A POLE OF
EXCELLENCE IN ATTRACTING
PATIENTS & PROFESSIONALS
• COMMITTING ONESELF TO BEING A
HOSPITAL AT THE SERVICE OF
EVERYONE WHO CARE FOR PEOPLES
AND JUST NOT THEIR ILLNESSES
Award IN MARCH 2018
POLICLINICO GEMELLI FOUNDATION WAS AWARDED AS
ISTITUTE OF SCIENTIFIC CHARACTERIZATION & TREATMENT (IRCCS)
FOR “PERSONALIZED MEDICINE” AND “INNOVATIVE BIOTECHNOLOGIES”
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TREEMAP - GEMELLI
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Strategic Plan 2018-2021
Enhance the
economic performance
01
02
03
04
Consolidate the achieved
results
Improve the operational and
managerial processes
New strategic Projects
Goals
03
01 Increase the
revenues ofhospital activity
Achieve a
sustainable
growth
Improve EBIT
Increase Net Worth
Improve Net Financial
Position
02
Growth Perspective
Option 01Option 02
Option 03
Option 05
Option 04
01
02
Network
Gemelli
New
Aquisitions
04 Increase
private
revenues
05 New
generations
of Clinical
leadersJoint
Commission
Accreditation03
thanks
Success is not final, failure is not fatal.
it is the courage to continue that counts.W. Churchill