Insights Series Issue 7: "Do one thing, and do it better than anyone else"

Siemens Healthineers Insights series Issue 7 Do one thing, and do it better than anyone else A paper on how to ‘Optimize clinical operations’ co-authored with Professor Hartwig Huland, MD siemens-healthineers.com/transforming-care-delivery SIEMENS Healthineers About Siemens Healthineers Insights series Today, every health system struggles with rising costs and varying quality. Diagnoses and treatments are designed for typical patients. Delivery of care is fragmented and focused on volume. The patient experience journey is in its infancy. And healthcare does not leverage the full potential of data. How can we change that? At Siemens Healthineers, our insights make it possible to turn challenges into opportunities. Our purpose is to enable healthcare providers to increase value by expanding precision medicine, transforming care delivery, improving patient experience, and digitalizing healthcare. As your partner for better outcomes in healthcare, we strive to provide a forum for addressing these issues, and to offer insights and new approaches. By joining the conversation with industry thought leaders and change makers, we are sharing forward-thinking ideas and solutions. We are also establishing a platform for leaders in healthcare to connect and exchange with peers. The Insights series offers actionable insights on how to tackle challenges and create solutions that work. Be inspired by best practices and engage with experts at the interface of technology and care. Please visit siemens-healthineers.com/insights-series Paper The Martini-Klinik: do one thing, and do it better than anyone else Executive summary strategies and protocols that optimize effectiveness. In the case of the Martini-Klink, Prof. Huland embraced three Efforts to optimize clinical operations operational principles: I) specialization combined with high are an intrinsic part of the broader goal volumes; II) a rigorous commitment to follow-up and evaluation of outcomes; and III) strong patient orientation. of delivering high-value care. Providing In addition, they follow the overarching principle of being a healthcare with greater effectiveness, ‘faculty,’ not a ‘hierarchy,’ which permits intense specializa- better outcomes, and greater patient tion, collaboration, and encourages organization-wide satisfaction provides clear benefits to excellence. The successful application of these three principles has allowed the Martini-Klinik to enter into what patients as well as to caregivers, providers, we call the ‘virtuous cycle,’ a self-sustaining sequence of and other stakeholders. factors that enable lasting success, growth, stability, and ongoing improvement. Hamburg’s Martini-Klinik has attained singular success in The virtuous cycle optimizing their clinical operations through the disciplined and strategic application of a number of operational 1 principles. This private clinic within the University Hospital Hamburg-Eppendorf (UKE) is the global leader in prostate surgery. They perform more procedures than any other hospital or clinic and, more importantly, in studies, their reported outcomes were among the best in Germany or comparable countries.¹–³ In all key criteria including 4 2 post-surgical urinary incontinence and erectile dysfunction, the Martini-Klinik was the leader by a wide margin.¹–³ They are also recognized as pioneers in academic and medical research related to prostate surgery and related medical conditions, as well as trailblazers in the collection and application of patient reported outcome data (PROMs). 3 1. Superior medical outcomes 2. Exceptional patient satisfaction This paper reviews the achievements of the Martini-Klinik, 3. Strong economic success examines the factors that are the foundation of their 4. Impactful strategic investments success, and evaluates how these can be applied in other contexts. The Martini-Klinik’s founder, Professor Hartwig Once an organization has successfully navigated its way Huland, made the decision to focus narrowly on one field, onto this circuit, it becomes a continuous loop of success, prostate surgery. This choice – whether to ‘go broad’ or ‘go enabling even better performance within all four segments deep’ – is a necessary first step in developing care delivery of the cycle. Siemens Healthcare GmbH, 2020 3 About the Martini-Klinik The Martini-Klinik is a private facility The Martini-Klinik, affiliated with the University Hospital a private clinic, founded 2005 Hamburg-Eppendorf (UKE). It focuses exclusively on prostate cancer, serving Key figures (as of 2019) both patients who are privately insured 2,600 prostate procedures p.a. as well as those with statutory insurance, 5,000 outpatient visits p.a. and is the world leader by volume in radical prostatectomies – one of the most 72 beds complex and risky urological procedures. 5 operating theaters Its affiliation with Hamburg’s University 200 staff hospital permits the clinic to operate independently while also benefiting from Source: Martini-Klinik the resources and support offered by one of Germany’s largest hospitals. In case of unforeseen emergencies, patients can quickly receive care from necessary experts, tests and other procedures can be carried out almost immediately. On a typical morning, the Martini-Klinik’s team arrives at 7:15 a.m. for their meeting to review the surgical procedures planned for the day, to discuss any especially problematic cases, and to conduct a short overview of new developments. The discussion is quick and professional. A radiologist projects scans of the patients to be operated on that day onto two large, high-resolution screens as the medical team – surgeons, oncologists, urologists, nurses, and supporting staff – carefully look on. Each morning is different, with new patients and focus topics, as well as short presentations during which various specialists 4 Siemens Healthcare GmbH, 2020 2.5× more prostatectomies than the second busiest hospital up to 2,500 Martini-Klinik Johns Hopkins Medicine Memorial Sloan Kettering Cancer Center (MSKCC) Cleveland Clinic Mayo Clinic MD Anderson Cancer Center 0 500 1,000 1,500 2,000 2,500 Number of radical prostatectomies per year⁴ Comparison of the six biggest academic centers take turns sharing information with their colleagues. for traditional open surgery. Others have chosen to have The surgeons seated around the table at the morning their procedure performed through a minimally invasive meeting have collectively performed more than 30,000 robotics-assisted system that supports doctors during prostate procedures over the course of their careers. laparoscopic operations (also referred to as ‘keyhole Each has earned the distinction ‘high-volume surgeon.’ surgery’). In either case, the patient and his family can be There is little that surprises this team; the experience and confident they are in good hands and will benefit from expertise of the assembled doctors allows them to move outstanding outcomes in prostate care. briskly through the day’s topics. Questions are asked with precision. Answers are short and factual. Decisions are taken quickly. Then it is off to the clinic’s operating rooms where the patients are already waiting. Some have opted Siemens Healthcare GmbH, 2020 5 “The worldwide differences in outcomes after prostate surgery are truly horrific!” Prof. Hartwig Huland The challenge and his team. Particularly in light of the potentially life-altering complications related to prostate surgery, Prostate cancer remains a uniquely Prof. Huland realized that a prostatectomy is more than challenging and complex illness, with a medical procedure, it is a profound and frightening experience for patients and must therefore be approached significant complications and unpredictable with particular care and sensitivity. He asked himself the treatment outcomes. Despite the advances simple question, “If I were a patient facing such a proce- made in recent years, it remains the fifth dure, how would I want to be treated?” leading cause of death worldwide and the Prof. Huland was also determined to create a stimulating second most frequent cancer diagnosis in working environment that would attract and retain leading men. More than 1.3 million new cases were experts in the field. Instead of a team of surgeons that reported worldwide in 2018.⁵ performs a variety of procedures without developing expertise in one specific area, his vision for the Martini- Klinik was of highly-focused specialization that would Fewer complications, more predictable outcomes directly contribute to leading research and create an environment of ‘intellectual stimulation’. He wanted a Having dedicated his professional career to the field working environment in which every member of the team urology, Prof. Huland was well acquainted with the was highly motivated and part of a collegial, collaborative prevalence of prostate cancer and with its unique risks fraternity. In keeping with UKE’s mandate as a teaching and frequent complications. He was also troubled by the hospital, the clinic’s expertise was also to be passed on to inconsistencies in the way the disease was treated and by others, with young doctors learning how to become the highly unpredictable results of radical prostatectomies. experts in the field of prostate surgery. Decisions about whether or when to perform prostate surgery varied widely, not only from country to country but Finally, for Prof. Huland, the goal of establishing a world- even between hospitals within the same region. Medical class specialized prostate surgery clinic was personal in protocols were vague and imprecise. And for patients many ways. He had already attained significant profes- whose prostate cancer was successfully treated, related sional success, serving as a full professor and chief complications could be life-altering. Prof. Huland’s primary physician of urology at one of Germany’s most respected motivation in establishing the Martini-Klinik was to deliver academic centers, the UKE. Yet he was motivated to take consistently better outcomes. on another challenge. A more patient-centered environment Optimize clinical operations Prof. Huland was also determined to create a strongly In order to achieve these goals, Prof. Huland and his team patient-centered environment where each patient would understood that it was necessary to define clear strategies receive personal, end-to-end attention from one physician to optimize clinical operations within the newly-established 6 Siemens Healthcare GmbH, 2020 Martini-Klinik. Every aspect of the clinic’s internal opera- The decision to ‘go broad’ carries with it the responsibility tions and set-up had to be carefully considered and to offer a wide range of care and services to as many evaluated in order to contribute to the clinic’s aims. patients as possible – a course of action that requires providers to expect the unexpected on a daily basis. Go broad? Or go deep? Alternatively, the decision to ‘go deep’ entails narrow specialization with one clearly identified patient segment, The first essential question healthcare providers must accompanied by a working environment in which efforts answer is whether they aim to offer an expansive range of are actively made to avoid the unexpected. The Martini- healthcare services in order to serve as wide a range of Klinik opted for the second choice, to ‘go deep’, the path of patients as possible, or whether they aim to provide super-specialization. services that focus narrowly on one particular field, procedure, or area of expertise. Various hybrid models are possible, yet the strategies for applying the principles of optimized clinical operations This decision about the volume and variety of services has within such settings require a very different approach and profound consequences for every subsequent operational are beyond the scope of this paper. aspect, including establishing the optimum process flow. Excursus siemens-healthineers.com/optimize-clinical-operations The three-step framework to ‘Optimize clinical operations’ 1. Improve your competitive position by defining your target market and understand population needs to shape your clinical portfolio and level of care. Then implement optimal workflows and inclusion of patient types. 2. Deciding on your delivery archetypes: a) ‘Go deep’ (specialization and high volumes) b) ‘Go broad’ (overcome resource constraints in interdisciplinary care) c) ‘Go to your patients’ (enable low-acuity centers and establish universal standards and ensure compliance to de-escalate care) 3. Direct patients: Qualify and guide patients through quick assessment for referral to the best possible care delivery archetype. Siemens Healthcare GmbH, 2020 7 The solution Hamburg’s Martini-Klinik has developed an approach and operational model that represent a departure from conventional medical wisdom. Their ‘faculty system’ runs contrary to traditional hierarchical hospital structures; their dedication to What is a high-volume surgeon? ⁶, rigorous patient follow-up and monitoring ⁷ of outcomes is groundbreaking; perhaps • High-volume surgeons in urology perform more than 40 surgeries annually most essential to their success is their • In many surgical fields, the technical skill of commitment to super-specialization. the surgeon is a crucial – or even the decisive – determinant of surgical outcomes Doing one thing only – radical prostatec- • A large body of academic literature tomies – has enabled the Martini-Klinik to illustrates that in radical prostatectomy, higher surgical volumes correlate to better develop routines, expertise and a wealth patient outcomes as well as reduced costs of experience that directly contribute to to the healthcare system superior outcomes. Super-specialization and high volumes The decision to develop the Martini-Klinik as a singularly specialized institution runs contrary to that of many other medical practices and facilities who seek to boost their profitability by catering to all the needs in their communi- ties. Yet Prof. Huland was convinced that the high volume/ specialization model was preferable. As he has said, “I quickly realized that I could be far more helpful as a physician within one narrow field than in a broad area with many illnesses.” The high volume/high specialization model offers numerous benefits. 8 Siemens Healthcare GmbH, 2020 “Patients are certainly enthusiastic [about our follow-up]. They think it’s great, and we have very high response rates.” Prof. Hartwig Huland Every surgeon is a high-volume surgeon continues for a patient’s entire lifetime. Treatment and monitoring of any side effects or conditions is also part of Every faculty member at the Martini-Klinik has personally this research, not just during the time immediately before performed more than 1,000 prostate surgeries – and and after surgery but lifelong. Patients are evaluated six continues to perform between 200–300 annually. This months after their procedure, again after one year, and generates an extremely high level of competence. Today, then once every following year. The follow-up after six approximately half of all radical prostatectomies in months and one year is more comprehensive than subse- Germany are performed in hospitals where fewer than 50 quent questionnaires, with a stronger focus on complica- such procedures are performed a year. Even if these were tions. In the following years, a total of 26 questions are all performed by the same surgeon – which is not always asked, including questions that go beyond the usual the case – that still results in less than one such procedure oncological results (e.g., local recurrence and follow-up a week on average. Research suggests that a surgeon treatment), with data gathered on issues including the reaches a plateau in terms of quality of outcomes only patient’s quality of life, continence, and general health. after 200–300 procedures.⁶, ⁷ Anywhere below that a surgeon is still climbing a steep learning curve. High Patient participation is voluntary, but response rates are volumes directly contribute to higher standardization, as consistently between 70–80% in the year of treatment and procedures become more routine and the team gains remain close to 70% five years after treatment. The experience in coping with unexpected situations and Martini-Klinik database has served as the foundation for sub-interventions. High volumes allow small differences in the definition of a standardized outcome data set that is the disease or patient to be identified and treated accord- intended for benchmarking across institutions.⁸ All patient ingly. Finally, high volumes justify and effectively amortize responses (today primarily online) are subject to data investments in technology and training. privacy protection. Rigorous follow-up and monitoring of outcomes The information gathered through this follow-up has allowed the Martini-Klinik to create the world’s largest The Martini-Klinik’s decision to specialize also entails a database on prostate cancer, providing unique insights into commitment to thoroughly understand and carefully what works, what does not, and actionable ideas on how monitor all patient outcomes, not just immediately after to further improve treatment. Managing this information surgery but for as long as possible. After discharging a presents unique challenges. As Prof. Huland recalls, in their patient, most hospitals have almost no information on the early years they were able to manage this incoming data results of their treatment. Follow-up is usually done with minimal staff. Today, however, this database requires elsewhere, often with a patient’s family doctor or in a a dedicated team including two document assistants, a hospital closer to home. biostatistician, and an IT specialist. Additionally, PhD students are often involved in registering and evaluating Prof. Huland realized that this post-surgical patient data the data. This rich pool of data also serves as the source for was a vital source of information and developed a system many publications in academic and medical journals. of in-house follow-up with every patient. This follow-up Siemens Healthcare GmbH, 2020 9 Every patient has Each surgeon performs his own doctor 200–300 surgeries per year S 12 senior surgeons with Every surgeon has a lifelong commitment a unique field of to the clinic sub-specialization Faculty System physician’s individual performance, which encourages all members of the team to support one another and reduces The decision to specialize also enabled the Martini-Klinik to pressure to ‘out-perform’ others. establish a unique ‘faculty system’ that ensures collabora- tion and helps maintain their clinical excellence. The This non-hierarchical system also produces clinical ben- conventional set-up of surgical departments in hospitals in efits. Several years ago, one of most junior members of the Germany and many other regions rests on a model with Martini-Klinik’s surgical team, a colleague Prof. Huland one physician-in-chief (‘Chefarzt’) at the top of a hierarchi- jokingly refers to as ‘an upstart,’ developed a surgical cal structure. Below this position is a team of senior technique of following the sphincter directly into the physicians (‘Oberärzte’) and below them is a group of prostate, a practice more senior surgeons felt brought assistant physicians. The Martini-Klinik rejected this model them too close to the cancer. But when faculty-wide results from the outset, opting instead for what Prof. Huland calls were reviewed, it became apparent that his technique was a ‘team of physicians-in-chief.’ All surgeons regard their in fact producing superior outcomes. Initially, the more positions as life-long jobs and are equal in terms of rank senior faculty were, as Prof. Huland concedes, somewhat and status, but with unique specializations and responsi- skeptical of this new technique. But the clinical evidence bilities permitting surgeons to achieve high volume within was clear: his positive margin, where the cancer extends their various sub-specializations. These puzzle pieces come right up to the cut, was no worse, and otherwise his together to form the clinic’s overall picture. outcomes were better. This technique was then adopted by the entire team – with the result that clinic-wide, one-year This equality is also reflected in the Martini-Klinik’s full continence climbed from 80% to over 90%. Under a incentive and compensation system. The variable compo- more hierarchical system, more senior surgeons may not nent of each physician’s income is determined according to have demonstrated such a willingness to learn from a the clinic’s overall performance and outcomes, not each junior colleague. 10 Siemens Healthcare GmbH, 2020 The virtuous cycle – a self-sustaining system for enduring success and profitability 1 The virtuous cycle 4 2 The decision to embrace the high volume/high specializa- tion model, combined with Prof. Huland’s dedication to outcome measurement, patient orientation, and a faculty system, has enabled the Martini-Klinik to benefit from a self-sustaining cycle of success that consistently improves their overall outcomes, clinically as well as economically. This can be referred to as the ‘virtuous cycle,’ a self-sustain- 3 ing sequence of factors that enable lasting success, growth, stability, and ongoing improvement. The four phases of the virtuous cycle are: 1 Superior medical outcomes Due to the superior medical outcomes that 1. Superior medical outcomes matter to patients, patients want to be 2. Exceptional patient satisfaction treated by Martini-Klinik. 3. Strong economic success 2 Exceptional patient satisfaction 4. Impactful strategic investments Smooth, well-tested processes, ultra-experi- enced staff, and superior technology excite Superior medical outcomes directly contribute to excep- patients. This is coupled with a focus on tional patient satisfaction, which in turn brings in more the customer’s needs. With highly-satisfied patients who recommend the institution, the business and fuels the clinic’s economic success. This Martini-Klinik is well utilized. robust economic success makes it possible to continue to invest – in the best technology, the best people, and new 3 Strong economic success and specialized infrastructure. These investments, if With high utilization, the clinic is economi- intelligently made, are the backbone of ongoing clinical cally viable and successful. excellence and contribute to continued superior patient 4 Impactful strategic investments outcomes. Each segment of the cycle is essential to the As long as there is economic leeway, high performance of the next section. Martini-Klinik can invest in the best people and an optimum infrastructure. This means the Martini-Klinik can maintain its unique standard of quality and strengthen it going forward. Siemens Healthcare GmbH, 2020 11 Dramatic variations in outcomes on national 1 Superior medical outcomes and international level¹–³ Hamburg’s Martini-Klinik has achieved a remarkable level The Martini-Klinik Germany of clinical excellence, significantly ahead of medical norms Sweden elsewhere. A large body of data on patient outcomes after radical prostatectomies exists in Sweden and Germany, from various sources. The results in both countries are quite similar in each of three key areas: one-year full 93.5% continence, one-year severe erectile dysfunction, and 56.7% one-year severe urinary incontinence.¹–³ More limited data suggests that results in other countries are comparable to 50.0% those in Sweden and Germany.⁹ At the Martini-Klinik, One year results are dramatically better in all three areas – not by full continence (annual averages) just a few percentage points. According to studies¹–³, erectile dysfunction, one of the most common and disruptive complications following prostate surgery, is on average twice as common in Germany and Sweden as in 34.7% the Martini-Klinik’s patients. Average urinary incontinence 75.5% is ten times more common in Germany and twenty times more common in Sweden than amongst Martini-Klinik’s 80.0% patients (see left). These are remarkable differences – with One year severe profound consequences for patients and their day-to-day erectile dysfunction (annual averages) lives (for example, does a patient have to wear inconti- nence products – ‘adult diapers’ – for the rest of his life after surgery?) 0.4% A study conducted by Barmer GEK, one of the largest 4.5% statutory health insurers in Germany, provides similarly astonishing results.¹ This study indicates that the rate of 10.0% erectile dysfunction among patients who have their One year severe procedure performed at the Martini-Klinik is less than urinary incontinence (annual averages) half the German hospital average.¹ The percentage of patients suffering from severe incontinence is one tenth the German average. And in preventing and avoiding complications such as pulmonary embolism and thrombo- sis, the results at the Martini-Klinik are eight times better than the German averages. 12 Siemens Healthcare GmbH, 2020 2 Exceptional patient satisfaction Patients also appreciate the ‘one-stop-shopping’ offered by the Martini-Klinik. For a patient, the knowledge that a team At a time when more attention is being paid to of experts are evaluating his case and are able to deliver patient experience, patient satisfaction scores play the full range of treatment options, from ‘watchful waiting’ an increasingly meaningful role for all health institu- to radical prostatectomy, is reassuring and convenient. In tions. At the Martini-Klinik, these scores are excep- addition, the team is highly attentive, committed, experi- tional. At UKE this boils down to the question of enced, and service oriented. whether a patient would recommend the clinic to family and friends. Across the more than 40 depart- Intense specialization also provides patients with a high ments and clinics that are part of the University degree of confidence. Knowing that the team responsible Hospital Hamburg-Eppendorf, the average patient for your medical care is following clear and carefully-devel- satisfaction score (i.e., patients answering the oped processes based on empirical data is not simply a question with ‘yes’) is a solid 86.2. The lowest grade technocratic detail, it is profoundly reassuring for patients, is a 73.5. particularly as this expertise is evident in everything the medical team does. Every aspect of their routine is based The Martini-Klinik’s three wards receive scores of on evidence, experience, and best practices. 98.9, 99.6, and 100, giving them the top-three rankings in the hospital. Even the lowest of these Finally, the faculty model introduced by Prof. Huland scores, 98.9, is six points higher than UKE’s next permits more personal patient interaction. All patients best performing ward/department. have their ‘own’ doctor, who advises them before their procedure, meets with them daily during their time at the clinic, performs the operation, and treats them should any Patients of all 40 UKE wards were asked: complications or issues arise after surgery. The important “Would you recommend the clinic to family and friends?” discharge briefings are also conducted one-on-one with the surgeon assigned to that case. This contributes to high 100.0% Martini-Klinik patient satisfaction, before and after surgery. wards 99.6% 98.9% 91.5% next highest UKE ward ..... 86.2% UKE average ..... 73.5% lowest UKE ward Patient satisfaction 60 70 80 90 100 [%] survey, source: UKE Siemens Healthcare GmbH, 2020 13 3 Strong economic success 4 Impactful strategic investments High patient satisfaction is a direct contributor to economic Much of the economic surplus generated by the Martini- success. While this should not be a medical organization’s Klinik is strategically reinvested in people, technology only objective, it must be one objective. Successfully help- processes, and research. The Martini-Klinik is committed to ing a patient in his battle to overcome prostate cancer is investing to attract the best people, and providing ongoing deeply rewarding; however, the organization must rest on learning opportunities to enable continuous improvement. an economically-sound business model. Hospitals and clin- They offer dedicated, long-term instruction to new ics face pressure from owners, investors, and shareholders personnel, and permit them to assist with surgeries for to operate profitably, even those operating in primarily 3–6 months prior to performing their first surgeries on public healthcare systems such as in Canada or Sweden. their own. There is a cost to such careful training, yet the Martini-Klinik recognizes this as an investment in their The Martini-Klinik’s economic success is clear. It is the future and in their reputation. best performing entity of the UKE. In fiscal year 2018 it generated revenue of €32 million as well as solid profit Another area of investment is technology. The Martini- for UKE. Klinik operates with cutting-edge technologies and is committed to pioneering new approaches along the The German healthcare system under which the Martini- prostate cancer care continuum from diagnosis to therapy Klinik operates regulates prices for inpatient services and and follow-up. One example: they are leaders in utilizing does not permit even the best-performing clinics to charge robot-assisted surgery in appropriate situations. This higher prices for their services. Nonetheless, the Martini- procedure, in which the operating surgeon uses a highly Klinik’s superior outcomes do contribute to lowering costs sophisticated machine that follows his own hand move- by decreasing complication rates and lowering the number ments, results in smaller incisions and scars and less blood of readmissions. Their optimized clinical operations also loss. Results are not significantly better than those of give a direct boost to the bottom line by ensuring that classical incision surgery or laparoscopic surgery. Yet for resources are utilized at maximum efficiency and by certain patients, for example those suffering from obesity, creating economies of scale. this relatively new technique can be a preferable option. For other patients, for example those with heart condi- As with all hospitals, doctors, and medical services, tions, it is not always suitable. word-of-mouth referrals are perhaps the most valuable form of “publicity”. Therefore, the Martini-Klinik’s consis- The Martini-Klinik also embraces a mindset of continuous tently superior results and high patient satisfaction are learning. In practice this means that everyone’s results are essential to their economic viability. Demand today is objectively evaluated and collectively reviewed. This extremely high, not just in Germany but worldwide – as benchmarking is made much easier through the patient evidence of their global reputation the clinic’s website is data that is being continually collected. If necessary, available in 12 languages including Arabic, Chinese, and retraining, coaching, or supervision is required of even the Russian. most senior surgeons. Again, investments in this type of 14 Siemens Healthcare GmbH, 2020 Watch the full video! Interview with Prof. Hartwig Huland siemens-healthineers.com/video-hartwig-huland retraining are not strictly necessary, yet for the Martini- Klinik this is part of the cost of maintaining their world- leading position. Publication is another element of this dedication to peak performance. The Martini-Klinik produces approximately 85 publications annually, resulting in 300–400 impact points annually. This supports optimization in the treat- ment, the attractiveness, and renown of the clinic for both caregivers and patients. Perhaps the most significant capital expenditure: a decision was made to expand the Martini-Klinik. In 2023 it will move to a custom-designed building currently under construction across the street from their existing location. The new building includes an optimized layout with short walking distances, eight operating theaters (an increase of three from the current capacity), on-site offices for both faculty and associated faculty (some of whom are currently quite far away), and greater and modernized bed capacity for patients. Everything from diagnosis to therapy is consolidated; the new facility even has its own MRI and x-ray unit providing greater opportunities for imaging enhancement. “This is where I see the largest potential for the future to optimize clinical operations as well as the overall patient outcomes,” says Prof. Huland. Siemens Healthcare GmbH, 2020 15 Conclusion mass-market approaches will accelerate iterative improve- ments and allow providers to excel in patient outcomes Across the breadth of today’s highly competitive and and performance. rapidly changing healthcare landscape, all providers are II) Go broad: Embracing this delivery approach requires under pressure to deliver greater value: better outcomes at providers to offer a wide range of services to a wide range lower cost. We believe that significant progress along the of patients. This demands flexibility in multi-disciplinary road to better value can be made by retaining a sharp focus settings and constant preparation for challenging, unex- on a few basic goals and strategies. One corresponding pected cases. strategy is optimizing clinical operations. It is available to III) Go to your patient: A third option is to establish all providers, large and small, in all healthcare settings. low-acuity centers, which simplify procedures to attract patients – going to them rather than waiting for them to Hamburg’s Martini-Klinik has been extraordinarily effective come to you. This approach requires the expansion of at this, undertaking the task with passion and precision. service offerings at remote low-volume centers and is Their clinical operations are one of the key determinants of made economically viable through the establishment of the remarkable success and reputation they enjoy. This universal standards and – when required – access to paper examines their operating philosophy as well as the specialists through hub-and-spoke models. practical ways in which they apply this philosophy. More importantly, this paper identifies the crucial decisions and Direct your patients tactics – the building blocks – of optimizing clinical Qualify and guide patients through quick assessment for operations. These can serve as an implementation referral to the best possible care delivery archetype or care blueprint for healthcare practitioners. provider. Gain insights on patients’ histories and behavior patterns, assess symptoms and identify root causes This blueprint can be summarized as follows: robustly to guide patients. Improve your competitive position If these steps are followed, we believe that clinical opera- Define your clinical portfolio: what type and level of care tions can be effectively optimized, resulting in tangible and do you want to provide? Understand market opportunities, meaningful benefits for patients, caregivers, and all other map out future scenarios and understand the importance stakeholders. of measuring patient outcomes and performance against KPIs. Decide on your care delivery archetype(s) I) Specialization and high volumes: (In this paper we characterize this approach as ‘go deep,’ the route chosen by the Martini-Klinik). Success with this approach requires intense specialization combined with high volumes and a continuous flow of work. Successful implementation of 16 Siemens Healthcare GmbH, 2020 Suggested follow up on siemens-healthineers.com/transforming-care-delivery • Siemens Healthineers Insights series, issue 4: Achieve twice as much but only work half as hard • Siemens Healthineers Insights series, issue 2: Culture of diversity, respect and inclusion • Harvard Business Review: Transforming care delivery to increase value References 1 Bitzer, EM et al. 2012. BARMER GEK 6 Vickers, A et al. 2010. The Learning Report Krankenhaus 2012. Schwäbisch Curve for Surgical Margins After Open Gmünd: BARMER GEK, 214p. Radical Prostatectomy: Implications 2 The National Prostate Cancer Register of for Margin Status as an Oncological Sweden (NPCR). 2013. National quality End Point. Journal of Urology, 183 (4), report for the year of diagnosis 2012. p1360–1365. 7 Trinh, QD et al. 2012. Variations in the 3 Martini-Klinik. 2013. Martini-Klinik quality of care at radical prostatectomy. Outcome Measurement database. Hamburg. Therapeutic Advances in Urology, 4 (2), p61–75. 4 Huland, H et al. 2018. Das Martini- 8 Prinzip: Spitzenmedizin durch Huland, H. 2017. ICHOM. Localized Prostate Cancer. Data Collection Spezialisierung, Ergebnistransparenz Reference Guide. und Patientenorientierung, 1st ed. Berlin: Medizinisch Wissenschaftliche 9 Huland, H. 2019. The winning Verlagsgesellschaft. formula for state-of-the-art medicine. Bray, F et al. 2018. Global cancer Siemens Healthineers Talk, [Online] URL 5 [Accessed: December 03, 2019]. 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68 (6), p394–424. Siemens Healthcare GmbH, 2020 17 Insights series, issue 7 About the authors Professor Hartwig Huland Dr. Herbert Staehr Co-founder, Physician-in-Chief Vice President of the Martini-Klinik at University Global Head of Transforming Care Hospital Hamburg-Eppendorf Delivery at Siemens Healthineers Professor Hartwig Huland is widely recognized as a lead- Herbert Staehr is passionate about healthcare and, as ing authority on prostate surgery and as a creative and global head of Transforming Care Delivery, drives activities successful trailblazer in making medical care more trans- to equip healthcare providers to deliver higher-value parent, patient-centered, and outcome-driven. Under his care. Prior to this position, he led Portfolio Development leadership, the Martini-Klinik has become the world’s lead- and Marketing within the Enterprise Services and Solutions ing center for prostate surgery, performing more surgical business of Siemens Healthineers. Before joining Siemens procedures than any other hospital or clinic worldwide, and Healthineers, Herbert Staehr worked with a major private consistently achieving superior outcomes. hospital group in Germany in senior leadership roles Prof. Huland received his medical training at a number of including serving as managing director of an acute care leading universities including Stanford University (Califor- and a post-acute care hospital. Earlier, he led the group’s nia), and received his medical degree from the University of Corporate Development department. He was employed for Hamburg in 1968. In 1988 he became professor at the Free several years in the Healthcare Consulting practice of University of Berlin. Three years later he moved to the Uni- McKinsey & Company on various European and interna- versity Hospital Hamburg-Eppendorf, where until 2008 he tional assignments. Herbert Staehr holds a PhD in Health- served as full professor and director of the Department of care Economics from the University of Hohenheim, Urology and its Polyclinic. From 1997 to 1998, Prof. Huland Germany. He obtained a dual degree (Bachelor of Arts and served as president of the German Society of Urology Diplom-Betriebswirt) in International Business and Finance (DGU). He co-founded the Martini-Klinik with Prof. Graefen from the European School of Business, Germany, and in 2005 and was appointed physician-in-chief. Prof. Huland Dublin City University, Republic of Ireland. has published more than 500 academic and scholarly arti- cles as well as books. He speaks frequently at conferences and academic gatherings around the world, is the recipi- ent of numerous awards, and continues to perform surgery three or four times a week. 18 Siemens Healthcare GmbH, 2020 At Siemens Healthineers, our purpose is to enable health- care providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experi- ence, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We are a leading medical technology company with over 120 years of experience and 18,500 patents globally. With about 50,000 dedicated colleagues in over 70 countries, we will continue to innovate and shape the future of healthcare. 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