Transforming the patient experience at the hospital

Prof. Dr. Dr. h.c. Frederik Wenz is Chief Medical Officer, CEO of the Medical Center – University of Freiburg. He spoke to us about challenges in the modern hospital environment and how technology is helping to solve them and make healthcare more patient centric.¹

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The university hospital here in Freiburg provides healthcare services to a catchment area of some two million people in the southwest of Germany. We have 15,000 employees who take care of around 100,000 inpatients per year. We also provide care for some 800,000 outpatients.

I often get asked what the CEO of a university hospital does. In essence, I plan and deliver the strategy for the hospital together with my team. This means looking at future challenges in healthcare at the local, regional, national and even international levels. We design strategies to meet these challenges and provide healthcare for the population in this part of the country.

We first have to define the term sustainability in the healthcare context. In general, it refers to ecological sustainability. But in healthcare, it also has economic and social dimensions.

From the ecological perspective, it means we need to cut down energy consumption. Right now, our hospital produces 104,000 tonnes of CO₂ per year, so we have a program in place to eventually reduce this by 20,000 tonnes per year. We believe this will be achievable in the near future.

When we talk about economic sustainability, we mean taking care of our expensive equipment in order to reduce waste. Providing quality care is also part of economic sustainability, in that it means providing the right amount of care for the patient – not too much, and not too little.

The third part is social sustainability, which is mainly about taking care of the hospital’s most precious resource: our employees. We have to make sure that the members of our team are healthy and that they stay in the profession.

It's always difficult to make predictions about the future, but it’s interesting that in some ways we’re returning to the initial idea of healthcare. When we look back 200 years, there were no hospitals. Healthcare was delivered to the home, with physicians visiting patients there. This was at least the case for wealthy people – the poor had no access to healthcare.

Florence Nightingale and others then started the development of hospitals – mainly for the poor – and during the past century healthcare has become concentrated in hospitals. Over the past 25 years or so, we have learned that acute care in the hospital is only one aspect, and we now see that outpatient care for chronic conditions is becoming more and more important.

In the future there will be more focus on prevention – on keeping people healthy – and healthcare delivery will go outside of the hospital into the home-care setting, where assistance devices will monitor and support patients. This is really interesting, in that it basically goes back 300 years to a time when home care was the standard. Now, it may again be a key aspect of healthcare when we look 30 or 40 years into the future.

Until now we have been building hospitals around the physicians, but in the future it will be patients at the center of the hospital. What I mean by this is that we’ll see a shift to designing our hospitals in a customer-centric manner, where the patient journey is seamless.

Patients are used to this one-stop process from sitting on their couch in front of the TV, and ordering something on their phone or tablet that arrives the next day. But then they visit the hospital and must stand in queues and fill in lots of paper forms. This will change within the next couple of years as we see the introduction of digital onboarding processes, much like you use an app on your phone to board an airplane.

Yes. We currently have an app-based digital assistant that we call “Meine Uniklinik App,” which helps to guide patients through the days they spend in the hospital. The patients want this. It’s something they have requested and are used to, so we need to deliver it to them. It’s all about patient empowerment and improving their customer journey.

When we talk about the future of quality and medicine, digitalization is the tool that will establish what we call “quality in real time.”

The traditional way to perform quality management is to treat the patient and then document it in the afternoon or the next day. It could even be in the days after the patient has left the hospital. Then at the end of the quarter or even the end of the year, the quality management team comes in to look at the data and discuss the results. For example, we may see a six percent rate of wound infection – which is not good – so we know to do something differently in the future.

But when we talk about quality in real time – and the use of digitalization – then we have sensors that constantly monitor the process. So when something goes wrong, we immediately get a red flag, and the patients get the treatment they need.

When it comes to cancer treatment, we will start to see more and more technical devices in use, including robotic assistants for surgery. We will also increase the use of data-driven medicine, which is an area where we can still do a lot. Right now we are basically blind to what happens to the patient before and after the hospital stay, yet there is a lot of data out there on the patient's behavior – including parameters relevant to their condition.

When the patient leaves the hospital, we talk about their outcome measurements. This is where we have to change our approach, especially when it comes to cancer medicine. Sometimes we see a patient on a fixed schedule – every six weeks, or every three months – and we are blind to what happens between these visits. The fact is that some of these patients would need to come more often, and some would need to come less often.

With monitoring devices and sensor systems, we can move from this one-size-fits-all follow-up approach to an adaptive one. Then the patient who needs to see a physician can do so, and patients who don't need treatment do not need to come for an in-person visit.

This is the future of cancer treatment, where digital and other technological developments are used to improve outcomes.