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I’d like to add to Ted’s referral to the ante-room design in Leipzig. As a manager of the surgical / OR departments in the past, we worked according to exactly this concept.
What I think is important to add, is that this concept only thrives when the competencies of everyone involved from the anesthesia department are aligned and that -as far as I know- this system only works well in combination with a ‘two-tabel’ system for the anesthesiologists themselves.
And be aware that implementing such a system maybe requires the proper layout of your OR-site i.e. demands a redesign / restructuring of the total OR-site; going in through one door and leave through another door at the opposite site of the OR. Could be quite a threshold, in terms of costs and time.

This is without any doubt a very frustrating situation, while such a banal problem actually will surely influence patient / visitor satisfaction

What strikes me in your case is that there seems to be no policy to disencourage the use of the automobile as such. Is it not-done to talk about measures to encourage the use of public transport by employees or going to work with a bike ? I don’t know of course the situation in West London (?), but we are talking ‘2017’ i.e. an era in which corporations start to feel responsible for the trias ‘people, planet and profit’.

Not as severe as SCH, but our hospital had the same problem and is now for some years trying actively to get employees out of their cars. And there is a change noticeble. But maybe we had a cultural advantage from the start; in the Netherlands, employees are probably more willing to travel with a bycicle than the British…

Hi Sunita,

I’d like to add a (very) practical point of view to Jen’s comprehensive, undeniable and only right answer.

Can you ask with every new acquisition, partnership, etc, to make an estimate of all the kinds of benefit from RPCI’s point of view ? For example in terms of the dimensions that Jen suggested earlier. And then validate / measure it after 12 months and then file it and make it a part of a yearly report.
Or make a (semi-)standardised quaestionnaire to inventory the opinion of the most important stakeholders about the benefits of acquisitions, joint ventures and partnerships

It is not very sophisticated, but it is easy to implement and gives at least something whereas now, as I understand, there is nothing.

On May 9, 2017, Theo commented on Vertical integration in a changing landscape :

This sounds like a risky experiment into area’s ‘where no man has gone before’. ‘Large scale’; that is thrilling.
I have two remarks.
Given the experimental status and the large number of management uncertainties, I would make the problem as small/tangible as possible. And then take it one step at a time. Limit yourself to look for solutions for only a well defined ‘service line’, which is probably interesting for profit organisations and which is relatively high protocolized. (it seems to me that a profit organisation will only engage itself with more protocolized treatment programs, thus reducing (financial) risk) And than start to discuss the different (vertical) roles in the treatment of these clients. My point is; make the subject well defined and design processes about who does what in which situation. Stay away from discussions about abstract ‘concepts’. Maybe (not to severe) alcohol or drug abuse would be a workable first service line.
My second remark is that I am a little sceptic about a vertically integrated profit/non-profit complementary treatmant program, because the profit-organisations always will define their part of the treatment process in such a way that they will take care of the profitable part of the treatment and leave the non profit with ‘the bleeders’. So you have to get the health unsurers involved, to avoid a situation where you are being left with the role of ‘carbage can’, as teaching hospitals tend to do.

Hi there Kais.
Thank you for your comment. I can imagine that you consider the repetitiveness of the processes a relevant factor, but I can assure you that some of these laboratories are highly robotized. Still, you have a point.
But also, the span of control is dubbled, not some some percentage higher. So, it will really have an impact on the HOD.
And it surely is a good idea to have a supporting projectteam for an extended period, so that we have the time to tune the coordination of workprocess in an action oriented, incremental way.
Having said that, you come up with about the same suggestion as Julia; spread responsibilities across more memebers of the staff. We will explicitly discuss that with the teams involved.

Thank you for your comment !
It sounds quite plausible and the fact that you did something similar with succes in your organisation, makes it worth exploring.


On May 8, 2017, Theo commented on Concentrating prostate care in the Netherlands :

Hi Erik,

This is not a management issue, but a national health care policy issue. That means that you have to deal with all kinds of different interests from different parties within the helath care system. At the least, the interests of parties involved will not all be ‘entirely alligned’. For sure, the patients’ health is paramount to everybody working in health care, but when the consequences of a new medical treatment insight is obviously not in the interest of hospitals in general or to a specific group of medical professionals as a whole, defense strategies can be anticipated.

Your case is quite stunning with regard to these seemingly clear medical facts. I wonder therefore in the first place how controversial these facts are ? How broad are they accepted ? What is the opinion / reaction of the national society of urologists on this issue ? They risk to position themselves as merely stakeholders of the urologists, if a non supportive reaction is not substanciated with thorough arguements.
The case reminds me of the imminent concentration of childrens oncology in the Netherlands. I think that the some high esteemed paediatricians together with some national patient organisations, started a discussion, where no other paediatrician in the end could keep himself apart from.
In the case of a patientgroup mainly consisting of man around their sixties, it cannot be too hard to have a well-organised and well-informed lobby organisation, actively influencing the public opinion on this issue.
So, as an insurer, I would avoid direct lobbying, but would strongly facilitate the debate between professionals/urologists in public settings. And let the patient organisations participate, aside scientific journalists; ‘Let the spirit out of the bottle’.