Time to reinvent the wheel

David Sweetnam FRCS Orth. June 2019

Private Healthcare Summit

Who am I ?

JOINT REPLACEMENT

Surgery

Soft Tissue and Ligament

Reconstruction

BIOLOGICAL SOLUTIONS

David Sweetnam FRCSHead of department

The Schoen ClinicLondon

The new kid on the Block Opened at 66 Wigmore Street on 14 th August 2018

In The Beginning ….

There was The Word…

And the Word was Good…

( Well for a while anyway)

We should be rightly proud

The Middlesex Hospital, London

The Bone Tumor Tumour Firm

How did that happen ?

It was Flattened in 2007

The grade 2 Star listed chapel was spared

So, what about the ethos of private practice?

Paul Aichroth set up the first ever Unit in Private Practice

The Knee surgery Unit in 1991

Time to re invent the wheel ?

We need to take the best from the past and combine it with achieving the best outcomes at the lowest cost

Rediscover the power of team work …

All pulling together ….

It’s time for a change from the same old ,

same old

We are going to have to prove that we can achieve better outcomes at lower cost

Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians.

The need to move away from a supply-driven health care system organised around what we clinicians do and move toward a patient-centred system organized solely around what patients need..

WHY?.....Because it will be required of us.

“Schoen Clinic London will be the first private hospital in the UK, offering world class outcome management to patients, consultants and insurers”Quality measurementProf. Michael E. Porter

Integration of careHBS-study case about Schön Klinik

“Schön Klinik is playing a leading role at the use of clinical data for a full measurement of result quality”

In 2006, Michael Porter and Elizabeth Teisberg introduced the value agenda in their book Redefining Health Care.

Where are you on the curve?

I want to be treated by “The Best…”

? ?

“Because GIRFT is led by clinicians, frontline medics in the specialties being reviewedwelcome the programme because they can share both their best practice and their challenges

with people that understand clinical service. We now need more clinicians to roll out that approach

to more specialties.

The orthopaedic pilot has already helped deliver efficiencies and savings of up to £30 million,

with another £20 million forecast for 2015/16. But importantly, good patient outcomes and safety

have remained paramount throughout the programme.”Professor Tim Briggs, Chair of GIRFT and National Director of Clinical Quality and Efficiency at NHS Improvement

Mr Sam Rajaratnam FRCS(Tr&Orth)

.

Mr David Sweetnam FRCS(Tr&Orth) Mr Hugh Apthorp FRCS (Tr & Orth)

Orthopaedic and Spinal Heads of Department

Mr Stuart Tucker Mr Peter Hamlyn Mr Colin Natali

What makes Schoen Clinic different?

SPECIALISATION QUALITY OUTCOMESCLINICAL ENGAGEMENT

• Statistical analyses are performed on a quarterly basis and …

• benchmarks are available online company-wide

Internal benchmarks and external reports

• 33 expert groups consisting of medical staff and quality managers …

• define relevant quality indicators for important treatments, that are …

specific, significant & science-based

• For every patient administrative and clinical data is documented …

• with the use of clinical information systems Standardized and comparable

documentation

Documentation2

Analysis & Reporting3

Definition of indicators1

• Expert groups discuss the results in regular meetings and …

• initiate improvement activities • Improvement of outcomes is the major

goal Clinical Management

Continuous improvements4

At Schoen Clinic medical outcomes are continuously measured and comparedThe process of outcome measurement is called QED – ‚Quality Empowered by Documentation‘

We have decided to use Amplitude as a system that allows us to not only collect patient and expert data, but also submit it to the individual registries

. . .

• Expert data• Clinical

Assessment• Procedure• …

• Patient data• PROMs1)

Data Registries

(1) Patient Reported Outcome Measures

The whole data collection process is electronic and an interface to SAP I-SH allows a transfer of patient demographics

NATIONAL JOINT REGISTRY Data -1st September 2018

So what’s so special about The Schoen Clinic?

• First ever totally private Orthopaedic and Spinal hospital in the UK . ( RNOH )

• Working as a World Class Team of Professionals, MDT working

• 24 Hour RESIDENT Ward Care by CONSULTANT ANAESTHETISTS who are INTENSIVISTS

• Working with Allied Professionals eg. Sports Medicine Consultants, Pain Specialists

• Outcome measure collection to improve each patient pathway (eg. Knee – 137 measures)

• Heritage of Transparency and Value based Healthcare

Cumulative Marginal Gains

Our Aim:

• To make the Schoen Clinic London The “Destination of Choice” for Private OrthopaedicCare in the UK

Thank you