Designing the future Hospital

“Hospital care as we currently know it is at the end of its life cycle"


Help MUMC+ to design the future hospital.


New, validated and implemented prototypes of services for Orthopedics, Oncology, Mother & Child and Dermatology Department.

“Hospital care as we currently know it is at the end of its life cycle. Other health care and business models will take over and if we want to keep playing a role, we will have to shape our own future”, says Frits van Merode, member of the board of directors at the Medical University Centre+ in Maastricht. The hospital, now called Medical Center is currently designing a better business model on the principles of design thinking. Every organization sets up a strategic plan, which often ends up in a desk drawer. They are hardly, if ever, carried out because implementation turns out to be more difficult than initially assumed. After all, implementation entails changing processes and forcing staff to change the way they work. If they are not involved during the creation of the strategic plan, the chances of the plan actually succeeding are slim.
Moreover, a strategic plan demands a vision for the future. Most organizations have a vision, but do not test it in the real world. Reality may be, in fact, quite different from what they thought, meaning a different strategy may be necessary during the implementation phase. Not to mention the fact that ‘reality’ can change rapidly.

A future of uncertainty

“That’s why we take a different approach”, says Frits van Merode. ‘We’ refers to the entire board of directors. They see challenges ahead: financial means are limited and laws and regulations have increased. “This leads to a more business-like approach in all aspects of the organization. More and more, we are considering how diagnostics and certain treatments weigh up against the costs.” Moreover, patients are also customers and increasingly act as such.

What’s more, the hospital has known for some time that its traditional role – making ill people better – will diminish. Instead, its role may shift to prevention and advising the population on healthy living. Maastricht UMC+ wants to play a role in these areas. “Also, due to the developments of new technologies like eHealth and wearables, we expect major changes in the healthcare system”, adds Van Merode.

Because of these reasons the academic hospital started formulating a strategic plan in 2009. They applied a new approach, involving health care professionals in the development of new business models. “Our staff consists almost exclusively of highly trained professionals who are used to think autonomously and take responsibility for their actions. Why shouldn’t we make use of all that brainpower?”

Design thinking

In his search for a method to get his staff to take control, Van Merode settled for design thinking. He met Patrick van der Pijl, author of Design Better Business, and found in him an effective sparring partner. Van Merode: “Patrick’s agency Business Models Inc. is specialized in using the principles of design thinking to create a new business model. It is common practice for a designer to test whatever he creates in the real world, for instance by using a prototype. I believe that if you want to change the healthcare system, you have to keep testing the added worth of your business models with your customers. In our case, the customers are our patients. Only by testing in the real world do you know if you’re heading in the right direction.”

Van Merode discovered another benefit of checking if a business model answers to the demands of your patients. “In reality, you have already started implementing, thereby keeping the new strategic plan from ending up in a desk drawer.”

Departments in control

In late 2009, the departments of Dermatology and Orthopedics started their separate tracks of design thinking. “Both departments had already started implementing new practices in their work, making it an ideal moment to introduce the principles of design thinking.”, says Van Merode. He gave the departments the responsibility and means to completely redesign the way they worked.

Each department named a committee, containing the head of department and several senior physicians. The committees built teams consisting of relevant staff from all layers of the department, ranging from medical specialists to nursing staff and from paramedics to desk staff. “The fun part”, says Van Merode, “is that these people usually never meet or cooperate in such a structure. Just sharing their knowledge is very inspiring to everyone involved.”

The board of directors played a facilitating role, but made no demands. They only ordered the teams to involve patients in the process after the second session. “We want to make sure the teams receive feedback on their discussions as soon as possible. Moreover, by adding patients, we force the teams to actually put their plans to work. We don’t want the new strategy to become a paper tiger.”

New health care and financing model

The two departments independently developed and implemented new health care systems and matching financing systems, completely adapted to the patients’ needs. “In other words, we don’t try to implement an overall strategy for the entire hospital, but we start from the bottom up”, explains Van Merode. “After all, an overall strategy can offer an outline, but the individual hospital units, or ‘business units’, deal with highly varying customer groups, technologies and processes. It is therefore necessary that business models are developed by the individual units themselves.”

At the same time, the approach works as an organizational change process. “Most staff members were very happy to be involved in the process. It got them to think about ways to improve the quality of health care while at the same time decreasing the costs. The results were very different from the Lean approach, which does not change core processes, but merely makes them slimmer. As such, it does not offer substantial benefits to organizations. Design thinking instead focuses on the customer, in our case the patient. This leads to the creation of entirely new business models and processes”, says Van Merode. “The way we see it, business modeling is essential for process optimization. We call it ‘operational excellence’. Lean tools are one element in our toolbox. It is our philosophy to focus on the customer and to direct all attention to him or her.”

After several departments had applied the methods successfully, the prospective Mother and Child Center also started to apply design thinking. The Center combines specialisms, which were hitherto separated. “You could say we are designing a brand new organizational system. This results in very different dynamics when compared to redesigning an already existing process”, says Van Merode.

He saw the same thing happen at the center for Oncology. “They had wonderful ideas but lacked a business model. The tools handed to them by Patrick allowed them to translate those ideas to a specific business model and matching processes.”

New role for the board of directors

In the meantime every department in the hospital has started using design thinking to create a new health care model. The model is not only focused on rehabilitation, but also on public health and development. This shift has changed the role of the board of directors. They no longer set out strategies, instead they provide communication between the different departments. “As an academic hospital, we have three tasks: to provide health care, train medical professionals and do research. We carry out these tasks in dozens of medical disciplines. The board of director’s important task is to make sure that the different departments do not individually reinvent the wheel. Moreover, we keep an eye on departments to make sure they use the same basic components, like imaging technology. In other words, we have to be smart in the way we share things like expensive technology and expertise. It speaks for itself that cost management is a part of that.”

These developments have changed the role of the board of directors, concludes Van Merode. “We facilitate and offer ideas. We no longer think up and decide strategies. Instead, we want the different units to carry out their roles individually, based on their ideal health care and business model. This makes sense, because every department deals with different patients and different demands.”

Changing management systems

In its current stage, Maastricht UMC+ has started changing its management systems. In traditional health care systems, these management systems are not accessible to customers. Van Merode: “Allowing hospital units to develop their own care and business models will have consequences for our management systems. At the moment there is still a gap between patient care, earnings, customers and so on, on the one hand and costs and budgets on the other. You don’t have to be an anthropologist to recognize the different worldviews. The next phase in our approach will deal with this issue. We are convinced that we will be successful, because we have put people in charge who truly understand health care and revenue models. A proper canvas shows very clearly how to measure earnings, costs, activities and resources.”

A continuous process

Design thinking has completely changed the way Maastricht UMC+ creates strategy. It’s a never ending process, emphasizes Van Merode. “Your strategy is never finished, especially during periods of rapid change. As a hospital, we have a good idea of what we can offer and which tasks are best left to our partners. But we’re also aware that our market vision may change over the course of a few years. We have to keep going with the flow. This is not a process you go through once; you have to keep repeating continuously and adapt to your changing environment.”

Hoogleraar logistiek Frits van Merode Het interview met Frits van Merode, hoogleraar logistiek en lid van de RVB van AZM Hij vertelt onder meer dat we qua organisatie heel wat van ontwikkelingslanden kunnen leren.

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