APOYO A REGIONES Apoyo de medallas:

Lord Darzi researched the different healthcare delivery models for the NHS London region (Darzi, 2007). He identified six different types: home care, polyclinic, local hospital, elective centre, major acute hospital and the specialist hospital (Table 6.5). Table 6.5 Delivery models NHS London (Darzi, 2007)

Name Description

Home care There is increasing potential to provide care in people’s homes, including ons

specialist care, rehabilitation and support for long-term conditi

Polyclinic ovide the infrastructure to shift hospital-based care into a

Local hospital

Major acute hospital

Specialist hospital

Polyclinics pr

more local setting and improve existing GP and community care and social services

Local hospitals provide non-complex inpatient and day case care in the local setting, ensuring patient access and convenience without sacrificing quality of care

Elective centre Elective centres focus on specific types of activity and exclude emergency work to be more productive and produce better clinical outcomes

Major acute hospitals enable co-location and critical mass of specialist services to maximise clinical quality and efficiency, some being a hub for teaching and R&D

Specialist hospitals retain established infrastructure, expertise and focus to deliver leading-edge complex services in a specific area

ue of the app delivery models is by individual organizati

healthcare system. E al

ype of ca borders of the tra organizations than ho

Models such as Da idering what the value

roposition and subsequent elements of a hospital business model should be. Healthcare

intaining a competitive position. Even with a The val roach that Darzi has taken towards the rethinking of the healthcare research systemic development as a whole, rather than focusing on ons. He identifies complementary models that together form a

xample of this is the identification of home care as an addition important t re delivery. This makes clear that we may need to think beyond the

ditional hospital, because there are needs for other types of spitals.

rzi’s can be useful in different ways cons p

delivery is a point which is most visible in the business model with the element of strategic position: where does the organization fit in “the system” with respect to other organizations. This research makes it clear that we cannot go about defining a single organization without placing it in the realm of the system. We can try, but that obliterates any chance we have at obtaining or ma

6.6 Conclusion

Looking at the six elements of the business model (value proposition, market segment, strategic position, value chain, competitive strategy, cost structure/revenue potential) we can conclude that there is mostly focus on the elements of strategic position and value hain – resembling the long tradition of hospitals with reasoning inside out. There is less g estions like “what do we want to whom”. This e long tradition of hospital reasoning from the inside-

can we, w their ultimate custom Lacking in any of th

absent from the strategic conversations amongst hospital executives for several reasons. n can

different ways that

completely paid for by a government to direct payment structures. But when viewing this ss m

structure/revenue po er will

a comp be done if a

mi

throughout the orga naging resources

olio, (re)bundling resources and leveraging

ness model links strategic domains to offer c

reference to the value position of the hospital askin qu

be for illustrates th

out (where hat can we deliver) instead of looking at the starting point of what er would want.

e overviews is a reference to value appropriation. This might be The first reaso be the diversity of cost structures around the world. There are many healthcare organizations can get reimbursed, ranging from being from a busine odel perspective there is a clear link between the possible cost

tential of a model and the other elements, because they togeth have to form

can only

rehensive logic. Defining different cost structure/revenue potential ll strategic elements are aligned and logically connected.

Another reason ght be the absence of a mindset of strategic entrepreneurship nization. Strategic entrepreneurship (SE) means ma

strategically: structuring the resource portf

those capabilities (flowing from financial, human and social capital) to simultaneously enact opportunity- and advantage-seeking behavior to deliver value (Ireland, Hitt, & Sirmon, 2003; Hagel III & Singer, 1999). SE must not be practiced only at the level of strategic management, but through the whole organization.

The last conclusion from this analysis is the absence of a structured way (model) to group the models and analysis we reviewed. They focus on parts of a strategic decision,

hensiveness. The busi but do not offer compre

more inclusive ways of framing problems and challenges that permit us to consider the

7

usiness model theory focuses on comprehensiveness and a concise approach to

7.1

“We need

inherent complexity of the issues in a meaningful way.” -- SHORTELL ET AL. (2000)

Value of business model theory for hospitals

building strategy. The six elements of the business model all add up to sound business logic (value proposition, market segment, strategic position, value chain, competitive strategy and cost structure/revenue potential).

This chapter compares what the value of each element versus the current situation of how it is defined by hospitals (7.1 - 7.6). We base our analysis on the literature review in the previous chapter as well as the field research detailed in chapter 5. This is followed by an analysis of the benefits and limitations of the business model approach in the last paragraph (7.7).

What we do not do here is claiming exclusivity and focusing on concrete examples of how each element can be defined. We focus on the inclusive ways of approaching each element and listing how it currently is used versus how it can be used. This aligns with the nature of the business model of inclusiveness by asking questions, rather than exclusiveness by giving (pre-defined) answers.

Value proposition

The value proposition is about the core functions of the organization (H. E. Roosendaal

to define the outcome, but it is possible to define the attributes that need to be addressed to build a relevant value proposition. With the list of guiding questions used for the second discussion session (Box 5.4) we have already introduced several themes that can be included in the definition of the value proposition. We here give the summary of the attributes to be addressed when building a valid value proposition based on the essential strategic question: what (and for who), where, how and when. The value proposition is “at the & Geurts, 1997). And when the value proposition is defined this is based on the value preferences of the customer (Figure 4.1). Therefore the value proposition always must include the notion of whom the core functions are offered to. When determining a value proposition with business model theory it is not possible

must b

can oft ations, such as “Mayo Clinic: The

eeds of linic Heart and Vascular Institute: Treating heart,

vascular and thoracic conditions for patients from around the world”.

Field research indicated that hospitals define as their core offering providing specialized

We can clarify this with an example from literature about scientific communication (H

etwork, which can be described as four main forces and their interplay. he forces are actors (author/reader pair), accessibility, content, and applicability.

actors, such as customers or end-users. It is precisely these two outcomes that are n hospital value propositions. Hospital decision makers, when e appealing to the customer. Less comprehensive versions of a value proposition

en be spotted as slogans or taglines for organiz n the patient come first” or “Cleveland C

As identified the value proposition starts with the core function of the offering. medical services (5.4.1). But can this be described as the real core offering of the organization or are there possible deeper and more fundamental functions the hospital wishes to fulfill – from which providing specialized medical services can be one?

. E. Roosendaal & Geurts, 1997). What is the core function of a publishing company (focused on scientific communication)? One the surface one might say that the core function of the publishing company is to publish scientific journals. But digging deeper the core functions of the publishing company leads to the focus on the scientific communication n

T

Scientific communication is described as providing registration, awareness, certification and archive.

The example above indicates two important issues: (1) the value proposition is not automatically related to a concrete product or service offering and (2) has to be linked to currently ill provided i

asked to define their core business, almost often define it as “offering specialized medical services”. This is not wrong, but the same as with the scientific publishing company, the real value might be elsewhere. Examples of such “deeper core” functions can be “keeping people healthy” or “making people feel well”. When the hospitals views it value proposition in such a way, it might just as with the publishing company, result in a shift in focus where other service are provided that are beneficial to the deeper core functions. The other outcome was that the value proposition is linked to actors such as customers or end-users. The end-user of the hospital can be defined as the patient - not always the customer, though. But as we found out through our field research – hospitals often not base their strategic decisions on the demand-side (5.4.2) and also not always consider patients as the end-consumer (5.4.8). Thus in order to build a solid value proposition and answer the strategic questions of what (and for who), hospitals need to venture out and define their core functions instead of only their (current) offerings.

least, if one wants to build a olid value proposition, it is needed to consider each of these elements. The question of

ress the sues of scale and scope that we have identified in the field research (5.4.3), but it

o one hospital that bases its business model on things as friendliness or formation provided. There are currently new models emerging, such as the Planetree