Now that the participation model does not seem to take hold, the following question arises: what can we as hospital and MSB do to join forces? “To date, the introduction of integrated funding has not meant that the hospital and MSB jointly manage healthcare in a smarter and more efficient manner”, is one of the conclusions from the ‘Integrated Fidelity Monitor’ recently published by the NZa. Three concrete opportunities in this article.

Why is it so difficult? An important reason why this objective does not get off the ground is the calculation system between hospital and MSB, which in many cases is primarily driven by volume. In some cases there are additional agreements about quality outcomes that are included in the settlement. Whatever the case, doctors who work for the MSB, are not affected by the incurring costs related to their choices – for example medicines, length of stay and diagnosis. The smart and efficient organization of healthcare in times of staff shortages remains the main concern of the managers and directors of the hospital organization.

Professional interlocutor. With the arrival of the MSB, a single point of contact has arisen for the hospital management, in which there is a joint sense of responsibility and a certain alignment of interests. This offers potential when it comes to joint performance management. How to redeem this potential as a hospital organization?

  1. Starting point: shared and concrete future vision.
    The healthcare landscape is changing, it’s clear that the role and position of the hospital is changing too. What the healthcare landscape looks like and what this actually means for the hospital and the different departments within the MSB, is to be agreed upon. It’s easy to see that directors are already on a different planet, while the MSB are occupied with production ceilings, internal calculation models and distribution of medical specialist capacity. By jointly exploring the strategic scenarios, a shared view of the urgency arises: the considerations and the opportunities that this offers.For example, in some regional hospitals together with the MSB we have experienced in practice what the different scenarios mean, also for the departments in the MSB: which healthcare do we no longer provide, which partnerships are important and which investments in technology and (ICT) infrastructure are needed? And which form of healthcare is being shifted internally to a specialist nurse?
  2. Maintaining a uniform working method: the right steering information.
    Medical and business manager form a crucial team in realizing the strategy and the clever organization of healthcare. In addition to formal authority for the medical manager, it is important that both maintain a uniform working method when it comes to steering. ‘Are we seeing the right patients? Do we provide healthcare in line with our chosen healthcare model (eg, do/do not perform surgery, e-consult versus screening, hospital stay)? Do we use our critical resources properly and how happy is our scarce staff actually?”In order to reach the right steering information, we are able to point out three success factors in practice: – Conducting the conversation about “when are you doing it right” and what do you want to know to get there, or even better; what do you want to know to stay there. – Developing together with the person in charge: making a semi-finished product better through good consultation. Only then does responsibility arise to also improve the quality of source information, after all ‘garbage in = garbage out’. – Transparency and the ability to down drill information to patient or employee level.
  3. From volume incentive to risk sharing and creating space to invest.
    It is not fair to jump to conclusions by saying that medical specialists at the MSB with the current incentives are only driven to make revenue and to monitor their own trade. However, in the current cooperation model, the MSB hardly bears any entrepreneurial risk. In the field of management accounting, sufficient research has been done to state that steering the performance is less effective without the right incentives.The path that has been taken to outcome steering offers opportunities. Let the medical and business manager themselves make a proposal for the results on which performance agreements can be made and which remuneration structure fits. Thus, with the space that has been created, a buffer for investments needed in technology and innovation can be supplied. So that the focus is no longer on distributing the proceeds, but on the transition to the right healthcare in the right place.
Rozan Gilles

Author Rozan Gilles

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