Public-Private Partnership

The experience of Ribera Salud

London, November 11th, 2013

Alberto de Rosa

Introduction

2003

2009

100

181,97

Strenghts:Values and principles: the Welfare State (cost-free, universal, equal)

Good healthcare indicators.

Weaknesses:A growing budget deficit in an economic structure with 17 Autonomous

Communities.

A bureaucratic system with high structural costs.

Lack of flexibility to face new

challenges in the coming future.

Conceptual Basis

Public Property:

The contracted-out center is built on public land and belongs to

the public hospital network

Private Provision:

The provision of the health service (both clinical and non-clinical) is awarded for a pre-

established time to a concessionaire

Public Financing:

Based on a capitative payment. The Government pays the

concessionaire a fixed and pre-established annual amount for

each adscribed inhabitant

Public Control:

The concessionaire is subject to complying with the clauses established

in the contract

A new Model

“To achieve

the best health

conditions for

the citizens”

“Money follows

the patient”: Quality and

patient loyalty

TWO

CONCEPTS

The companyis answerable

to itsshareholders

The Administration

achievesobjectives

Promoting Health

Improving healthcarequality

Improvingaccesibility

Improving efficiency

Capitative Payment

C I T I Z E N - P A T I E N T PRIMARY

CARE

<C I T I Z E N - P A T I E N TPRIMARY

CARE<C I T I Z E N – P A T I E N TPRIMARY

CARE

The Evolution of our

Health Model Approach

The most important thing: cultural change of the politician and healthcare organization

managers.

The most important thing is not the hospital.

The most important thing is to stand by the whole healthcare network, its professionals

and other agents involved (City Councils, Schools, Nursing homes, old people’s homes,

etc)

To create a corporate culture: Population Health Management

Ribera Salud healthcare integration

management model

Capitative payment ….

Objective:

“To achieve the best health conditions for the citizens”

Strategic tool : healthcare integration

Strategic Vision

Activity schedulingCost controlQuality controlClinical guidelinesHigher efficiency

Sustainability of economic equilibriumTalent retentionPerformance evaluation. SalaryCareer development Professional competences as the focal point of HRpolicy.

Clinical and non-clinical areas integrationAccurate information for decision-makers Optimal use of resources

Healthcare Strategies

Population Healthcare Management: PROACTIVITYTo promote preventive and health promotion activities

To be proactive in patient’s care

Healthcare management of demand and needs

Challenge: Chronic Diseases Management

Professional Alignment: Primary Care Doctor – Hospital Doctor.

Specialist Consultant in Primary Care and Hospital.

Primary Care: higher resolution for higher value. Mangement of demand

Nurses: new roles, competences and responsability: emergency triage

case history management, more qualification in Primary Care, etc.

Integration Model

Clinical Management

Health objectives alignment across the whole organization

Variability decrease in clinical practice

- Heatlhcare processes

- Medical paths

- To define “what”, “who” and “which” is the best place

for diagnosis, therapy and patient monitoring

- High resolution

Healthcare continuity

Care longitudinality

IT integration

Integration Model

Clinical Management

Retribution based on post and professional´s development:

training and experience retribution basis

Salary composition

Fix salary

Variable salary

Flexible

incentive plan Personalized compensation, “flexible incentive schemes ”

“more and best working recognition”

Fix salary

Variable salary

Public servants

Private employees

Quantitative work

objetives

Variable salary depending

on activity and aims

achieved by the

professional.

Qualitative work objetives

Healthcare quality and

efficiency criteria: mean stay,

readmission rate…

Professional Management

Training: Financed by the organization

Teaching: Hospitals with MIR (Resident Medical Intern) and University

accreditation; Professionals as University teachers.

Research: research projects and performance of clinical trials

HR Policies aligned with strategic objectivesHR Strategy

• Recruitment according to competency profiles

• Training FINANCED BY THE ORGANIZATION

• Variable salary depending on activity and aims achieved.

• To promote synergies and shared services between the Group’s administrative concessions, getting higher efficiency.

Working conditions customizationTalent Retention

• Professional stability: more than 90% contracts are indefinite

• Family and work balance: work-shift adaptation, nursery in work centers, adjusting work conditions to personal situations. Teleworking.

• Internal career development between concessions.

Flexible salaryCompensation and

Benefits

• Fixed salary: guarantees internal equity

• Variable salary: performance evaluation

• Flexible salary pack:

• Adapted to the employee’s individual needs

• House rent, nursery, vehicle’s, daily expenditure

Personnel Management

Professional careers for all professional categories

Training and

Development

• Training, Teaching and research

• In-house management and technical training,

• Teaching: Hospitals with MIR (Resident Medical Intern) and University accreditation; Professionals as University teachers.

• Research: research projects and performance of clinical trials

• Healthcare quality objectives

• Performance evaluation

• Individual objectives definition, measuring and evaluation

• Professional competences

• Evaluation according to assigned competences

• Defined competences that are aligned with the Group’s values

Corporate identity

InternalComunication

• Intranet and employee’s site

• A single channel: continuous and direct communication

• Higher efficiency in administrative processes

• A common database to promote knowledge management

Personnel Management

Comunicación interna

SSII

Análisis y descripción de

Puestos

Reclutamiento & Selección

Evaluación & Gestión del desempeño

Formación & Desarrollo

Carrera y Promoción profesional

Detección & Análisis del potencial

Planificación de la Sucesión

Política Retributiva C&B

From a scene of separate work … to a scene of teamwork, where all the

information is shared.

Guide, test protocols or medication protocols.

Alerts, controls and automatic help.

Common processes, guaranteeing healthcare quality.

IT Development:

Support for Professionals

Technological Development

For the Citizen For the Professional For the Manager

• SMS notice

• Touch screen

• Emergency waiting time

• Simultaneous

translation

• Family patient

information

• Electronic medical history and

digital radiology

• Integrated processes. “Florence

directo”

• Medical History access from mobile

phone

• Telemedicine. Teleworking in

radiology

• Quality evaluation

• Emergency response time

• Services and professionals

workloads

• Technology and

management

• Systems innovation

91%

7%2%

Positiva

Regular

Negativa

Satisfaction Survey

General Satisfaction Index : 8.51/10

Satisfaction Survey

On the Management Model of Hospital de la Ribera

Spontaneous answer Suggested answer

94% don’t

know the

model

Spontaneous answer Suggested answer

Conclusions &Challenges

Challenges at present

To assume that a change, an unprecedented new management model was possible. To start from square one

Alignment of Private sector and Public Administration objectives

Long-term business perspective. No short-term profit. Transparency

Alternative financing methods, Constant innovation in management, New integration models

For the first time in a NHS, a capitative model in healthcare management was implemented

Challenges Faced 15 Years Ago:

To be able to adapt to the circumstances: The private sector adapts to Government’s needs. To take advantage of

public-private partnership to innovate.. To question the bases of the Model (services portfolio, capita including incentives

for health results, etc.)

Corporate identity. “Think globally and act locally” To attract and train new professionals aligning objectives

To face 21st century challenges, with 21st century tools New action plans for chronicity, benchmarking, best

practices… Patients’ needs have changed. We must adapt to a competitive scene

Shared services Development of networked management model

Multi-hospital management models

Global approach to the patient

Challenges for the Near Future

Benefits of this Model

For the Local Government• Offloading of the public budgets.

• A lower-than-average costs public management of a public service (25% less).

• Investments are the concessionaire’s responsibility during the management

period.

• Capitative payment. Transfer of financial risk.

• Innovation in Management Technologies and Systems.

• Contribution of complementary HR

For the professionals• Job security. Innovative salary system.

• Opportunity for development and a professional career.

• Teaching and Research.

• Commitment to technology.

For the citizen-patient

• Perceived quality. Humanization of care.

• Personalized treatment. Greater privacy and comfort.

• Greater accessibility. Quicker response time.

• Free choice of hospital and doctor.

• Technology informs and educates the patient

1.- STABLE LEGAL FRAME to guarantee the public-private

collaboration contract.

2.- Solid projects based on PLANNING, establishment of

PRIORITIES and calendar for procedures.

3.- RESOURCES MANAGEMENT, traditional budget systems and

additional financial resources must be managed to achieve the

same objective.

4.- RISK TRANSFER, from public sector to private sector,

focusing on providing high added value.

5.- Optimization based on EFFICIENCY. VALUE FOR MONEY

Double vision: citizen-patient, citizen-taxpayer.

10 Basic Principles

6.- The greater private participation, the greater PUBLIC CONTROL

7.- Appropriate choice of partners. Public service focused on

PATIENT/CITIZEN, and long term vision.

8.- CLEAR CONTRACTUAL RULES . Avoiding the commercial

vision takes precedence over healthcare vision.

9.- TRANSPARENCY. Independent observatory to assess other

systems or methods, with objective criteria, and whose data and

results are regularly published.

10.- To count on PROFESSIONALS. They are the most important

asset of the system. They must accept a new corporate culture.

10 Basic Principles

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