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WorldConnex Summit 2008 April 28 – May 1, 2008 Hilton Head Island, SC, USA Paul Faguy Executive Vice President Hamilton Health Sciences Disruptive Technology, Convergence & the Purpose of Being

“ Vision without action is a daydream. Action without vision is a nightmare.” Japanese Proverb

“ Information technology and business are becoming inextricably interwoven, I don’t think anybody can talk meaningful about one without the talking about the other.” Bill Gates

Points for Consideration Where am I coming from? Current reality of large multi sited academic health sciences centre Disruptive Technology Convergence Hospital’s purpose for being

“ Technology is meaningless except in how it can assist you, and then it should disappear and be invisible. It allows you to think of things you couldn’t think of, it doesn’t think of them itself.” Richard Saul Wurman

HHS is a Family of 5 Unique Hospitals and a Cancer Centre McMaster University Medical Centre McMaster Children’s Hospital Hamilton General Hospital Henderson General Hospital Chedoke Hospital Juravinski Cancer Centre

Our Mission To provide excellent health care for the people and communities we serve and to advance health care through education and research. Our Vision Leaders in exemplary care, innovation and academic excellence. Our Values Respect - In all interactions, we will treat every person with dignity and courtesy. Caring - At all times we will act in a way as to be concerned with the interests and well being of others. Innovation - We will be creative and open to new ideas and opportunities. Accountability - We will create value in our activities and accept responsibility for our actions.

Hamilton Health Sciences More than 1,000 beds and 24 bassinettes Over 108,000 emergency visits a year 45,000 inpatients 50,000 surgeries 650,000 clinic visits $1.1 billion annual budget 11,000 employees

2007 Portfolio Data - A Statistical View 12,611 Devices Processed (biomed) 18,058 Work Orders (biomed) 3325 Number of Inventory Items *47,160 Purchase Order Lines 287,489 L Sharps Waste all sites 44,749.5 kg Pharmaceutical Waste all sites 383,168 kg Biomedical Waste all sites 2,458.75 tonnes General Waste all sites 3,465,205 Kilos used (Linen) $389,250 Postage (includes (FHS) 15,563,629 Photocopies 20,800 # of pages processed per day 3,934 Pagers in Service 1,750,522 Total calls processed 5,373 Fire Safety Training 60,591 Security Occurrences 930 Codes Dispatched Total 5989 Parking Spaces 41,428 Other 233,417 X-ray 74,930 Ultrasound 23,152 MRI 42,159 CT (DS) exams 38,363 Electronic Purchase Orders 329,090 Annual Patient Meals 26,679 OR Cases 71,640 Disinfected Loads 28,439 Sterilized Loads $18.7 million Revenue - Outpatient Pharmacy 55,644 Prescriptions Filled (outpatient) 6,366,946 Drug Doses Filled (inpatient) 765,513 Prescriptions Filled (inpatient) $32.0 million Drug Expenses

Who Am I? Professionally trained as a labour negotiator 20+ years senior hospital management experience 5 hospitals – 6 mergers and integrations President and CEO Shared Services organization

MSS Organizational Chart Operating Committee Operating Committee CEO Mohawk Hospital Laundry Services FOHSCI Supply Chain Services IT Human Resources Finance Hurst Place Operating Committee DI R Mohawk Shared Services, Inc. Board of Directors Operating Committee

Clinical Support and Hospital Services Human Resources Organizational Development Labour Relations Volunteer Services Core and Clinical Housekeeping Waste Management Portering Supply Replenishment Shipping / Receiving Service Response Centre Room Bookings Laundry and Linen Telecommunications Security Parking Audiovisual Transportation Printing Mail Diagnostic Imaging Computed Tomography Ultrasound MRI Nuclear Medicine PET/Cyclotron Radiopharmacy Forms Clinical Chemistry Immunology, Genetics Haematology Transfusion Medicine Microbiology Anatomical Pathology Biomedical Technology Patient Equipment Reprocessing (CPD) Nutrition Services Pharmaceutical Services Purchasing Warehouse and Logistics Hospital Retail Services

“ Opportunity ideas do not lie around waiting to be discovered. Such ideas need to be produced.” Edward de Bono

Talk about three concepts; disruptive technology convergence the purpose of being for hospitals

Disruptive technology is a term coined by Harvard Business School professor Clayton M. Christensen to describe a new technology that unexpectedly displaces an established technology. In his 1997 best-selling book, "The Innovator's Dilemma," Christensen separates new technology into two categories: sustaining and disruptive. Sustaining technology relies on incremental improvements to an already established technology. Disruptive technology lacks refinement, often has performance problems because it is new, appeals to a limited audience, and may not yet have a proven practical application. (Such was the case with Alexander Graham Bell's "electrical speech machine," which we now call the telephone.)

Railways Digital cameras Personal computer Voice data convergence Collaborative software Federated systems Nanotechnology

What are the disruptive technologies we don’t yet know about and how might they benefit us tomorrow?

“ Just because something doesn’t do what you planned it to do doesn’t mean it’s useless.” Thomas A. Edison

Technology convergence is the modern presence of a vast array of different types of technology to perform very similar tasks.

Why is convergence important in healthcare? We always start in the middle Compel and empower interoperability Speed of change in technology Soft land disruptive technology Technology and suppliers converging Leveraging and harvesting sunk costs Lack of warm bodies – need to reduce the need for labour, it will not be there!

You’ve got to be very careful if you don’t know where you’re going, because you might not get there.” Yogi Berra

“ If you don’t know where you’re going, any road will take you there.” George Harrison

“ If you don’t know where you’re going, you will probably end up somewhere else.” Laurence J. Peter

Convergence Nurse call systems Fire alarms Multiple phone switches Bed boards Tracking systems

Many new mobile e-health products and services are available or emerging which can, not only put diagnosis and treatment management into the hands of the provider but the patient as well. blood pressure, heart rate and blood glucose monitoring CPOE and e-prescribing mobile MRSA detection systems tagging systems to ensure medical staff use hand washing stations or prescribe appropriate medications. send critical results or information (and eliminate non-critical or unimportant information) to PC’s, PDA’s or Smart phones. Point of Care / Mobility

Enabling Themes To achieve the core themes substantial infrastructure and other enabling investments & resources are needed; Project Management / Business Analysis Wireless Data Quality / Data Retention Business Continuity Security & Privacy Technology Education

What’s possible on our horizon? Rfid and wireless disruption External and patient driven portals Critical-to-flow test results

Effective leadership is putting first things first. Effective management is discipline, carrying it out. Stephen Covey

Let’s ask ourselves, what is the purpose of a hospital?

Is it “our hospital exists to help make our community and surrounding areas a healthier place to live by working with individuals to maintain, improve, and/or cope with their health status.”

Or “a hospital exists to provide the most amount of necessary services to the greatest amount of people with the most effectiveness and efficiency.”

“ Most people spend more time and energy going around problems than in trying to solve them.” Henry Ford

Lack of access relates directly to the serious inability to manage the flow of patients to and through our hospitals!

“ The crisis in hospital emergency departments (EDs) across Canada, which has led to strikes, walkouts, investigations and finger-pointing, is directly linked to shortages of hospital beds, says emergency physicians.” …” The correct approach to solving overcrowding is in fact to increase acute care bed capacity and increase bed flexibility and appropriate utilization of beds. That’s really what it comes down to, “ says Drummond, who practices emergency medicine in Perth, Ont. …” Over the past decade there has been a 40% decrease in hospital bed capacity in Canada. Closing beds translates into more patients being “warehoused” on stretchers and treated in corridors in hospital EDs when they need to be admitted.” ED Problems Result of Bed Shortages, Doctors Contend

Overproduction Producing too much or too soon Transportation Any unnecessary movement of materials or Work In Progress Inventory Any more than the minimum to get the job done Waiting Waiting on parts, waiting for information Processing Over-processing Process Variability Over Handling due to defects Rework/Defects Any repair, defect or rework, doesn’t conform to Critical Quality Standards Motion Any motion of the worker that does not add value Intellect Any failure to fully utilize the time and talents of people Identify and Eliminate the 8 Types of Waste

Question to continually ask ourselves is how can we use existing and new technology to eliminate waste, and destroy the current barriers of time and space.

… if all I have is a hammer, all I see are nails…if all you see are nails all you reach for is a hammer.

Questions / Comments Find me, I love to chat about our business [email_address]

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