Digitalisation with a Human Touch by SCAN Health

DIGITALISATION WITH A HUMAN TOUCH Value proposition to the Government of Canada Team: The Healthy chain Max Bust Janne Hesen Stephany Ly

SWOT ANALYSIS CANADIAN HEALTHCARE AND IMPACT COVID-19 Strengths

Weaknesses

Quick response to the pandemic when the WHO announced Enough financial resources: high buying power but low bargaining power Universal healthcare system: accessibility for everyone Large network resulting in telemedicine (i.e. Dashboard, Multi-supplier award) Large number of hospitals Resources such as the supply dashboard and multi-supplier award

Power division (Federal-Provincial-Territorial) - Decentralised vs centralised governments - Discrepancies via lack of communication and silo-forming, therefore slow response to pandemic Lack of digital infrastructure due to lack of knowledge and standardisation Universal Healthcare system: political decision making results in a lack of decision making and slow responses to critical situations which also cause long waiting times Overreliance on one supplier

Opportunities Digitalisation -Improvements on intra- and inter-collaboration - Increased unity of communication - Increased data accessibility - Increased market competition between suppliers Diversification of suppliers Learning from best-practices

Threats Not achieving the full needs capacity - Suppliers unable to ramp-up production - No alternative supply - Lots of competition over PPE Increased uncertainty Lack of digitalisation Negative economic impact

ADVICES BASED ON CHALLENGES AND THREATS SWOT ANALYSIS Standardization among all jurisdictions Decentralize when: - Customisation is desired - Fast (local) decision making is required

Centralize when: - You aim for lower costs - Greater procurement power - Eliminate duplicates - Knowledge sharing is crucial

Diversification supplier base Multi-supplier award strategy Also, look at factories that could transform their production to produce PPE’s. Auping (bed producer) started making face masks to compensate for the shortages (Geleen, 2020). Supply dashboard Use the existing dashboard as a base and create a more real time dashboard that stimulates transparency and creates a better flow between the jurisdictions.

Create an agile supply chain Make it as agile as possible - Strengthening risk management capabilities - Improving transparency - Building redundancy in supplier and transportation networks - Reducing product complexity - Creating the capacity to flex production across sites. Improving the financial and operational capacity to respond to shocks and recover quickly

In-practice Integrate in-house production

Set up contingency plans. Decentralise to the jurisdictions in normal times, whilst setting up a crisis team transitioning healthcare to (temporary) centralised control in times of crisis.

China is the most dominant exporter of PPE (+60%) with India as the world’s leading provider of generic drugs. However, 38 to 60 percent of the pharmaceutical supply chain could shift geographically. In order for Canada to play a part in this shift, high digitization and automation is required (Lund et al., 2020). This also includes the transformation of existing factories to produce PPE’s.

- Use segmentation and regionalization (Chopra & Sodhi, 2014) - Use the real time dashboard for transparency on location of PPE’s - Increase supplier base in combination with in-house production - Find components that require less complex infrastructure - Build stock on PPE - Install an overarching system that takes over in times of crises

Integrate performance measurements in the real-time dashboard Adapt the performance measurement frame of Lega et al. (2013) to move towards a transformational approach: - Includes elements that are relevant to the health care sector in comparison to traditional frameworks - Overview of performance: enables faster responses if low performances are spotted - Fast discovery and response to variability linked to uncertainty (e.g. COVID-19, sudden supply disruptions and shortages) - Provides benchmarks

ANALYSIS CANADIAN PROVINCES BEST CASE Alberta Highly digitized supply chain infrastructure Capable of tracking every product, location and utilization rates Source PPE before any other jurisdiction Only 8.1% COVID-19 infection rate among health workers (very low) Currently sending supplies to other provinces.

Best-practice used as guideline for other provinces

WORST CASE

Main goals Low death rates Low infection rates High patient value

Quebec & Ontario No supply chain capacity Highest infection and death rates among seniors No provincial data infrastructure capable of tracking COVID-19 outcomes among key populations (e.g., seniors, vulnerable populations), tracking workforce prevalence of COVID-19 or identifying the availability or location of PPE supplies across the health system High rates of worker absenteeism resulting from fear for their personal safety and high prevalence of COVID-19 cases among care providers.

(Snowdon & Forest, 2021) (Tikkanen et al., 2020)

VALUE PROPOSITION Our value proposition to the Canadian federal government is to upgrade the current digitized platform through “high tech and high touch”. Its aim is to create a connected network to make Canada smaller through collaboration and engagement. This would improve supply chain capacity, create higher visibility, and enable faster and enhanced decision making, which in turn would lead to higher quality and safety to those affected in times of crisis.

Gain creators

Solution Digital platform characterised as "High Tech and High Touch"

Increased supply chain visibility and mapping Network perspective: best practice sharing and gives every stakeholder a voice Increased quality of service Knowledge

Transparancy Safety and quality Accessibility Ability to provide high quality health care

Pain relievers

Pains

Data accessibility and forecasts for better demand anticipation Better and faster decision making Collaborative arrangements Risk diversification Improved capacity and inventory management of critical materials Structure

Needs

Who? 1. Frontliners - doctors, nurses, medical professionals 2. Hospital managers, purchasers, supply chain managers 3. Patients, citizens

Lack of visibility High risk exposure Time consuming tasks Lack of collaboration and accessibility

Supply chain visibility

The digital platform PILOT VERSION

Home

About

Obtain real-time insights at the inventory levels of the healthcare supply chain. Real-time track and trace of critical materials.

Functionalities

Contact

HIGH TECH, HIGH TOUCH The digital transformation of the healthcare supply chain stems from technologies inspired from other successful industries. Besides high tech, our platform offers a sense of community through high touch with an emphasis on collaboration, trust, and personal interaction

bottlenecking Look into the capacity utilization of neighboring jurisdictions.

Community platform

Short term forecasts for systematic de-

Efficient patient allocation

Standardized procurement policies and identification systems. Overview of production sites and potential faciltieis to be transformed Crisis management

Collaborative arrangements: Encourage transferable best-practices learning Network perspective by determining value together and accelerate adoption (Prada, 2016) Stimulate co-opetition

Performance measurement

Supply chain and procurement

Supply chain mapping

Emphasize community practice

Benchmark performance with other jurisdictions, and discover variability due to uncertainty more easily Balanced scorecard: track impact and savings of the digital transformation

The digital platform Home PILOT VERSION

About

Participants Contact Functionalities Supply chain visibility

Real-time track and trace Stimulate transparency and

Insights

create a better flow between the jurisdictions Match supply with demand more efficiently

Improved inventory management Improved and faster decision making as data becomes available Increased safety for workers as critical materials are available Determine utilization rates of materials Improved sourcing process

Inventory

Infrastructure

Knowledge

The digital platform Home PILOT VERSION

Supply chain mapping

About

Participants

Functionalities

Contact

Forecasting Engage in systematic de-bottlenecking. Focus should be on both identified bottlenecks and potential ones (Bohmer et al., 2020). Supply and demand forecasting; Supply forecasting with information about inventory and capacity across the chain to identify shortages before they become acute (Bohmer et al., 2020) Inter-operability of data

Capacity mapping and patient allocation Make the supply chain as agile as possible Improving the financial and operational capacity to respond to shocks and recover quickly Creating the capacity to flex production across sites Look into the utilization of capacities in other jurisdictions. Release pressure of health care workers from a crowded hospital by transferring patients to less occupied hospitals

The digital platform Home PILOT VERSION

About

SupplyFunctionalities chain and Contact procurement

Participants

Reporting environment Adopt global identification systems and standards for scannable materials (Snowdon, 2016) Eliminate duplicates Insights into procurement processes helps determining value and better anticipation of demand Greater procurement power Centralized overview Inter-operability of data

Crisis management Available contingency plans in times of crisis Assign a central crisis structure Overview with opportunities for production expansion

The digital platform Home PILOT VERSION

About

Community platform Participants

Functionalities

Contact

Collaborative arrangements

Community practice A group of clinicians, doctors and stakeholders who

Transferable best-practices learning (Bhakoo,

share the common goal of providing high quality health

Singh, & Sohal, 2011)

care

Sharing information

Create a connected network where everyone can share

Improve inventory management (engage in

information

vendor managed inventory e.g.)

Body of knowledge and practices

Co-opetition

Network perspective Engage hospitals and clinicians to voice their opinions

Tapping into horizontal ties

Determine value together and accelerate adoption

Knowledge sharing across competitors while achieving

(Prada, 2016)

mutual benefits together (Marques, Martins, & Araújo,

Map the differences across every type of flows within the

2019).

network and assess how practices in one flow, could improve the processes in another flow (Marques et al., 2019)

The digital platform Home PILOT VERSION

Performance measurement

About

Participants

Functionalities

Contact

A Balanced scorecard will be used to determine the performance of the platform. It provides a holistic overview of what is happening within the healthy chain and translates the measures directly to the government's strategy. CUSTOMER

Waiting time for patients Patient satisfaction scores Patient safety: number of incidents happening in the facility Increase in qaly

FINANCIAL ROI = the numerator should equate the savings and benefits whereas the denominator equals the investment costs of this project. The savings combines the KPI's of patient and employee safety.

INTERNAL PROCESSES

Proportion of systems and policies that are standardized Time of shortage for critical materials Critical materials utilization rate Savings in shortage costs

SAFETY AND EMPLOYEES

Employee safety: number of incidents happening in the facility Number of critical materials stockouts

(Jackson, n.d.)

STAKEHOLDER MAPPING Before establishing communication and engagement plans, the stakeholders need to be mapped

High

Keep satisfied

Stakeholder's influence on project

Research and development organisations: Involves companies in charge of developing the platform Policy makers

Monitor The media Other industries/countries

Low Low

Manage closely

Hospitals and clinicians: the goal is to create a connected network , and participation of all hospitals across provinces are required to make this platform a success. Jurisdictions: one way to make the platform work is to align all digital infrastructures

Keep informed

Wholesalers: they may perceive the platform as a threat due to the sensitivity of data Procurement managers Supply chain managers Pharmaceutical companies: less errors are made due to identification systems Patients

Project's impact on stakeholder

High

STAKEHOLDER ENGAGEMENT AND COMMUNICATION PLANS (LEMOS, 2017) Full compliance is required to make the digitized platform a success

Monitor

Monitor the patients and their point of views on social media Pay attention to other industries/countries for improvement opportunities or collaborations

Message

Target supply chain parties in your messages and inform on the changes Send invitations for the tender process to developers

Advocate

Find support from jurisdictions in general assemblies Obtain buy-in from jurisdictions and policy makers for centralized approach in times of crisis and the standardification of policies

Consult

Solicit explicit feedback on the platform from clinicians and supply chain managers

Dialogue

Collaborate

Initiate conversations with hospitals, clinicians and jurisdctions. Emphasis on community practice and mutual benefits Multi-stakeholder dialogues

STRATEGIC ACTION PLAN - STEPS AND TIME LINE

Provide access to all relevant stakeholders and measure

Apply a centralized

LAUNCH NATIONAL ACTION PLAN

performance and impact of the

approach to establish

Create an environment

platform on the supply chain

digitial systems for

that is easy to report and

through feedback loops and

each province.

communicate.

balanced scorecard

ALIGN DIGITAL INFRASTRUCTURE 6-12 MONTHS

6 MONTHS

MANDATE GLOBAL

CREATE A

DEVELOPMENT

STANDARDS AND

REPORTING

OF THE

LAUNCH AND

ENVIRONMENT

PLATFORM

EVALUATION

6-12 MONTHS

12-18 MONTHS

IDENTIFICATION SYSTEMS 3-6 MONTHS

Data collection: Identify factors that can be applied

Apply this for all scannable materials

to all provinces and how we can align all provinces

Ensure that everyone has similar

with the same digital infrastructure.

infrastructures which enables inter-

Anounce the action plan to transform the

operability

healthcare supply chain and stimulate

Prepare tendering process and set

collaboration to increase data availability

selection criteria (competence in

Focus on best-practices such as Alberta and

stakeholder management and change

existing digital (reporting) systems (nationwide

management through dialogue)

registries in Sweden, cancer registries e.g.)

4-5 year plan Start tendering process for the development of the platform Integrate reporting infrastructure within the platform Integrate real-time track and trace feature

Enable short-term forecasting

STRATEGIC ACTION PLAN Implementation plan Enablement phase & Authorative leadership style LAUNCH NATIONAL ACTION PLAN

ALIGN DIGITAL INFRASTRUCTURE 6-12 MONTHS

6 MONTHS

Level: Provincial government Engagement strategy: Message and advocate Change management: Create awareness of current problems and address the need for change

MANDATE GLOBAL

CREATE A

DEVELOPMENT

STANDARDS AND

REPORTING

OF THE

LAUNCH AND

ENVIRONMENT

PLATFORM

EVALUATION

6-12 MONTHS

12-18 MONTHS

IDENTIFICATION SYSTEMS 3-6 MONTHS

Level: Municipal level Engagement strategy: Message and advocate Change management: Include jurisdictions in dialogues to deal with resistance to change. Build trust

Engagement phase & Democratic/ affiliative leadership style

Level: Federal and provincial level Engagement strategy: Advocate Change management: Employ action plan and engage jurisdictions to stimulate collaboration

Level: Provincial and municipal level Engagement strategy: Dialogue and collaboration Change management: Share information and train

Level: Federal level Engagement strategy: Dialogue and message Change management: Seek feedback from others and learn from it

Level: All levels Engagement strategy: Collaboration and dialogue Change management: Ask for feedback

ARCHITECTURE REQUIREMENTS AND PROJECT COSTS An approximation was made based on past investments in e-health in Europe (eHealth Hub, 2019). It is approximated that the project will cost around $4.66 Billion per year and $23.3 Billion in total (5 year investment). This is a 6.5% increase in spendings for the coming five years. The breakdown of these costs are estimated and depicted below. Item Item 1 20%

Item 1 26.1 %

30% Item 2 73.9 %

Cloud components and infrastructure

Integrated services and components

15%

20%

20% Item 2 80%

Item 1 15%

Item 2 85%

Data storage

Item 2 85%

FTE

Security engineers, database analysts, network engineers, storage engineers

Item 1 5%

1 10%

10% Item 2 90%

5% Item 2 95%

Training Maintenance workforce due to digitalisation

This investment will be in addition to the government's spending of $74.4 billion* on hospitals and healthcare (EPHPP, 2020). The financing of this project will be done through public procurement (+/- 70%) and the private funds (+/- 30%) *calculations are on a yearly basis (=264 billion * 0.283)

THE DIGITAL PLATFORM AND ITS TECHNOLOGY The main source of inspiration for our platform stems from the SaaS technology of Uber which yield substantial benefits by effectively matching supply with demand in real-time (Zhong et al., 2019). The creation of visibility and transparancy through technology and cloud computing brought us to our current platform. The benefits of using cloud-based platforms are its scalability and transferability to other industries as no big investments in hardware needs to be made

DATA VIRTUALIZATION -

DATA FEDERATION

SOFTWARE-AS-A-SERVICE (SAAS)

Provides stakeholders the opportunity to

Our

Allows to make use of

request data from

proposal:

innovation to improve

multiple sources to expand data availability across the supply chain (Haas et al., 2002)

Digital platform

services and care. Enables data acquisition and connectivity to support enhanced clinical workflows.

CHANGE MANAGEMENT - DEALING WITH PRIVACY CONCERNS

Data sensitivity: The concern among stakeholders is the exchange of sensitive information. To address these concerns, the platform will distinguish two groups of users. The sensitive data such as supplier base and procurement processes are available to those responsible and making decisions based on these data, whereas the community platform will be more publicly available.

Data privacy and ownership concerns: One concern relates to privacy due to the public nature of the platform. The application of the data federation model in our platform prevents the data of stakeholders from being duplicated and manipulated. The platform simply provides the opportunity to request and obtain insights into the data of other parties within the supply chain. By doing such, the privacy of all parties will be guaranteed.

REFERENCES - Bhakoo, V., Singh, P. and Sohal, A., 2012. Collaborative management of inventory in Australian hospital supply chains: practices and issues. Supply Chain Management: An International Journal, 17(2), pp.217-230. - Bhomer, R.M.J., Pisano, G.P., Sadun, R., Tsai, T.C. (2020, April 03). How Hospitals Can Manage Supply Shortages as Demand Surges. Harvard Business Review. Retrieved February 2, 2021 from https://hbr.org/2020/04/how-hospitals-can-manage-supply-shortages-as-demand-surges - Chopra, S., & Sodhi, M. (2014). Reducing the risk of supply chain disruptions. MIT Sloan management review, 55(3), 72-80. - Effective Public Healthcare Panacea Project. (2020, March 10). How Much Does Canada Spend on Health Care? Retrieved February 2, 2021, from https://www.ephpp.ca/healthcare-funding-policy-incanada/ - Geleen. (2020, April 28). Dutch consortium begins production of millions of medical face masks for healthcare professionals in the Netherlands I DSM. Retrieved November 25, 2020, from https://www.dsm.com/corporate/news/news-archive/2020/2020-04-28-production-in-the-netherlands-of-millions-of-medical-facemasks-for-healthcare-professionals-has-started.html - Haas, L. M., Lin, E. T., & Roth, M. A. (2002). Data integration through database federation. IBM Systems Journal, 41(4), 578-596. - Lega, F., Marsilio, M., & Villa, S. (2013). An evaluation framework for measuring supply chain performance in the public healthcare sector: evidence from the Italian NHS. Production Planning & Control, 24(10-11), 931-947. - Lemos, M. (2017). A Guide to Stakeholder Engagement for Healthier Communities. Retrieved February 2, 2021, from https://www.bsr.org/en/our-insights/blog-view/a-guide-to-stakeholder-engagementfor-healthier-communities - Lund, S., Manyika, J., Woetzel, J., Barriball, E., Krishnan, M., Alicke, K., … Hutzler, K. (2020, August). Risk, resilience, and rebalancing in global supply chains. McKinsey Global Institute. Retrieved from https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Operations/Our%20Insights/Risk%20resilience%20and%20rebalancing%20in%20global%20value%20chains/Risk-resilience-andrebalancing-in-global-value-chains-exec-summary-vF.pdf - Marques, L., Martins, M. and Araújo, C., 2019. The healthcare supply network: current state of the literature and research opportunities. Production Planning & Control, 31(7), pp.590-609. - Prada, G., 2016. Value-based procurement. Healthcare Management Forum, 29(4), pp.162-164.Marques, L., Martins, M. and Araújo, C., 2019. The healthcare supply network: current state of the literature and research opportunities. Production Planning & Control, 31(7), pp.590-609. - Snowdon, A. W., & Forest, P.-G. (2021, January 4). Flying Blind: Canada s Supply Chain Infrastructure and the covid-19 pandemic. Retrieved January 28, 2021, from https://www.longwoods.com/content/26386/healthcare-quarterly/-flying-blind-canada-s-supply-chain-infrastructure-and-the-covid-19-pandemic - Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). Canada | Commonwealth Fund. Retrieved January 28, 2021, from https://www.commonwealthfund.org/internationalhealth-policy-center/countries/canada - Zhong, Y., Lin Z., Zhou Y.W., Cheng, T.C.E., Lin X., 2019. Matching supply and demand on ride-sharing platforms with permanent agents and competition, International Journal of Production Economics, Volume 218, Pages 363-374. https://doi.org/10.1016/j.ijpe.2019.07.009