S6 EP5: Lou O'Connor on the Future of Health

Lou is the CEO of Adeney Private Hospital a new joint venture private hospital between 40+ doctors and Medibank Private, challenging the way healthcare is delivered in Australia.

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

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[00:00:00] David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host David Cummins, and today we're speaking to Lou O'Connor.

[00:00:24] With a background in nursing, Lou has worked in health services and clinical services management for over 24 years. Lou is an absolute powerhouse in the world of health. Lou has helped lead multiple large scale health developments and is currently pioneering a new hospital from scratch.

[00:00:41] Helping lead her team with everything from design to policies and procedures, compliance, governance, and resourcing for Adeney Private in Melbourne. As a CEO, Lou is helping lead a joint venture private hospital between 40 plus doctors and Medibank Private. This is an exciting project aiming to achieve zero out-of-pocket expenses for all patients. 

[00:01:01] Welcome Lou. Thank you for your time to be here. 

[00:01:04] Lou O'Connor: Hi Dave. It's great to be here. Thank you so much for having me. 

[00:01:07] David Cummins: That's okay.

[00:01:07] I do mention your name a few times around Australia in the world of health design, and when I mention to people that you are literally creating a hospital from scratch, most people can't believe it, but then it's followed up very quickly by, "if anyone could do it, Lou O'Connor could do it".

[00:01:25] Lou O'Connor: Well, that's very nice feedback. So possibly another word is determined and never give up and happy to disrupt the market and perhaps show a different way of doing things. I think we should always never get complacent that it will stay the same. And I think the pandemic absolutely created instability, but also gave us an opportunity to innovate and change.

[00:01:45] So that's what drives me. 

[00:01:47] David Cummins: So what do you think is that driving force? Obviously you've been in the industry for over 20 plus years and will no doubt be there for 20 plus more years, and you've obviously seen a big change there. 

[00:01:55] What's this driving force that's driving you to actually create this change of create in Australia's first gap-free hospital.

[00:02:04] Lou O'Connor: Yeah. Look, I think Dave, I was very fortunate to be working with a group of doctors over the past sort of eight to 10 years who believed in the same things that I believed, that if we stayed the same in how we created and run our hospitals that the system is unlikely to survive in its current form.

[00:02:20] So to have that those like-minded medical professionals to talk about it was absolutely amazing. And indeed, five of them were the ones that originally came to me and said " maybe this is something that we can do". 

[00:02:31] Fortuitously, at the time, Medibank was also looking at these sort of opportunities. So it was one of those situations where everything kind of falls in place. And indeed, we were looking at a concept like this in 2018, but it never went anywhere because you need the right people to be able to put themselves out there and really completely. 

[00:02:49] Completely flip what you're doing, and that includes your model of care, it includes how long people stay in hospital, it includes understanding truly how doctors run their private businesses and truly partnering with them, not just as a visiting medical officer. 

[00:03:02] So, certainly a lot to do in this space and obviously the no out-of-pocket model is something that the industry is crying out for and, we're seeing unprecedented demand on public hospitals. 

[00:03:13] Indeed, a lot of private hospitals are undertaking the surgery for the public system, so in and of itself, the status quo can't stay that way. And the system to not change something has to be done differently. So hence at a new private hospital. 

[00:03:28] We are a little bit of a Guinea pig, I suppose, in showing a different way and I'm sure many people are looking at what we're doing and talking about it. 

[00:03:35] It's not without its challenges and I would certainly not sit here and go, it's a walk in the park. It's absolutely not. The health design or building the building, you think that's an easy part of this but it certainly hasn't been, and that's been reflected in really understanding the importance of how we design something to meet a model of care. 

[00:03:53] And I think too often we just look at the compliance pieces, the AusHFG Guidelines, what are all the accrediting bodies saying we must have... and we lose sight of the fact that we're people caring for people, for the betterment of their lives. So in and of itself, you have to look at how are you going to do that? 

[00:04:11] And there's the resource element as well. So, many hospitals have large footprints, lots of steps, but lots of steps mean lots of people, right? So in my mind that doesn't work at the moment either given workforce shortages. 

[00:04:24] We need to reduce the steps so that we can be more efficient, so that we can reduce the human load on how we operate. So just little things like that. 

[00:04:33] Patient flow.. my Medical Director, Sherryl Wagstaff and myself nearly turned ourselves inside out trying to understand the patient flow of the hospital. And we had one very important brief in mind, and that was psychologically as a patient, let's acknowledge, no one wants to be in hospital. 

[00:04:49] It's not a David Jones sale, you're not knocking on the door saying, "please, can I have my hip replaced today"? So there is an element of stress when they come in. 

[00:04:57] Now, if you're continuing to walk in a forward journey, 'cause walking forward is positive, I'm moving through my care, that's really important psychologically for a patient as well. 

[00:05:07] If you continue to move to one desk, then back to the seat that you're in, moving to another person, then back to the seat that you're in, you're not feeling a part of the care or a part of the flow, so that leads to increased anxiety, not really sure what's going on.

[00:05:22] So when you think about patient flow just in on a theatre floor, for example, it was really important to us that we matched that journey and understood how the patient was going to move through that floor. 

[00:05:32] And we kept them moving forward and then we complimented the staff on that journey as well, so they walked it together. 

[00:05:39] But that took a lot of thinking because we tend to focus on where are the staff going to be and prioritise that instead of where does the patient need to be. So there's sort of two aspects of some of the things that have come out of just designing this hospital.

[00:05:53] And then the other big part of it is, the technology element, you know I have been talking to a lot of software vendors and normally you might be running a hospital and you might add a theatre or renovate an era, whatever, and you're stuck with legacy systems because no one ever has the luxury of actually designing something from scratch.

[00:06:12] And once you have that ability, you suddenly realise that you can look at your technology differently. Our brief was, and certainly to the other two members of our team at the moment, has been around how do we use technology. This is really important as an enabler for people to give their best and be their best.

[00:06:32] It's not the technology driving the staff, it's the other way round. So we look at things with that lens, and if it doesn't enable us to do something better with a better outcome, to collect better data, to make better decisions, then we are not going to go with it. 

[00:06:47] And that in and of itself is a massive piece of work, but as I said, it's something that is exciting to all of us. 

[00:06:52] And the other big part was investing time in partnering with the doctors. A lot of them have worked in hospitals for a long time and they come in and out, right? They're a consumer of the service to operate or medically treat their patients. 

[00:07:04] But we haven't spent enough time in truly partnering with them to understand the intersection of their business, my business running or building a hospital, the patient and how do they receive information, get care before they come in, during this day and after. And when you sit and have these conversations, you realise that. 

[00:07:23] And your health insurance funds are no different. Everyone's coming with a different lens. Now, that's powerful. Feedback is a gift, and it should always be thought of that way, but, when you start to do that, you realise that there's a lot of gaps that you've got to fill and that takes time and that takes communication.

[00:07:39] So we have spent a lot of time doing that as well. So that's a little bit of an overview, Dave. 

[00:07:43] David Cummins: How hard was it to design a hospital on such a small footprint, but literally in capture all that, plus more into such a small design while maintaining patient safety and staff safety? 

[00:07:56] Lou O'Connor: Yeah, look it was difficult.

[00:07:58] Often you have this plethora of space and you can have 50,000 floors and whatever else. We didn't have the luxury of that, but in actual fact, it made us realise that often we create these big spaces that we don't actually need. 

[00:08:11] I think the pandemic has also taught us that where people started working from home, we suddenly realised that you could have operable walls, so you could have multi-use spaces that someone doesn't need to sit in an office five days a week because the nature of their role is that they are a patient facing person for a majority of the time.

[00:08:28] So how do we multi-use spaces and share them, how do we look at our model of care in our food services. How do we prioritise the nutrition of the patients, the quality of the food versus this, I suppose, factory line of food coming out. 

[00:08:44] So we've tried to look at that differently as well and you know, Jacques Ramonde, we're very lucky that he's certainly provided us some advice on how to run that part of our business and look at it differently as well. So we've really pulled every part of it apart. 

[00:08:57] Even if I think about my administration area where I've got my office, it is an open plan, there is ability to have little breakout spaces because we're all there to serve a purpose, so people don't have these discreet departments everywhere. 

[00:09:11] David Cummins: Yeah. It's very much throwing the baby out with the bath water. I've been working on health design for years and even just a few of those principles haven't been applied anywhere in any other hospital in Australia that I've heard of.

[00:09:22] So how important is it to be partnering with someone like Medibank to share that vision? How important is it to have someone like Medibank to literally help pave the way for the future of healthcare? 

[00:09:34] Lou O'Connor: Yeah, look, it's been really important for us and it was certainly really important for the medical staff.

[00:09:38] Over my 20 something year career, I've seen many doctor ventures where they've bought their own hospitals and started to run them and they haven't worked. 

[00:09:46] And they haven't worked for a myriad of of reasons, but partly due to that, that's not their bread and butter running hospitals, but also not being able to tap into larger resources such as Medibank and they've certainly been a fantastic partner in enabling us to tap into some of their senior team whether that be, finance, whether that be it, et cetera. 

[00:10:07] You know, You can't underestimate the power of partnerships. So for us it's healthcare is, is an affordability question as well. The value of, of the healthcare that we provide and the how is becoming more important than ever.

[00:10:20] And, it's been absolutely vital. 

[00:10:23] David Cummins: So what do you think is going to happen to the public system in Australia at the moment?

[00:10:27] I think you're a hundred percent right if it continues the way it's going to go, something's got to give. 

[00:10:31] The resources alone is a huge issue. The number of aging population and the demand for healthcare is going to be huge over the next 10 plus years. What do you think is going to happen there, not everyone's going to be changing their models of care to suit you so how do we survive that over the next 10, 15 plus years? 

[00:10:46] Lou O'Connor: Yeah, look, it's going to be interesting and the workforce shortages are compounding that as well. I mean, every hospital's experiencing that at the moment. So the traditional concept of we will build more beds and we will employ more staff is a bit of a naive view to have, because that's not going to work. 

[00:11:02] There are not the people to pull off the side of the road to come and work and certainly care for those patients in all of these beds.

[00:11:08] So that's why looking at things like your model of care and your length of stay can certainly yield a massive increase in the ability to surgically assist patients, et cetera, just by nature of not having people sitting in beds for seven days.

[00:11:23] We're starting to look at every single specialty that we'll have, every single procedure and indeed, we've mapped out every single DRG with the sole focus of understanding the current continuum of care for each one of those. 

[00:11:36] And we meet with each of the specialists, so with the urologists, the colorectal surgeons, et cetera. And we look at each of the cases that they do and understand the average length of stay in the state.

[00:11:45] And we have access to state average data and outcome data, et cetera. And we are trying to challenge the norm around, okay, can we do this better? And a good example is really partnering with their businesses to know about these patients as early as possible. 

[00:12:00] If we do more, and this is certainly for us in private, if we do more around frailty scores, readiness for admission, suitability for surgery, and really invest time into what I see as almost like a health coach type role then we've got a better opportunity of reducing the length of stay and being as efficient as we can to meet the needs of the future with no extra resource.

[00:12:21] It's not about churn and burn or anything like that. It's really about understanding the continuum of care and what goes with that is also primary care. So we're starting to meet with our local GPS around what information do you truly need, how do we get that to you, how do we find out what the issues are of concern for that patient and not leave things till the last minute. 

[00:12:41] The earlier you know things, the better chance you have of improving what you're doing. And I think everybody could learn from that. It's not saying it's easy, it's not at all but also respectfully learning from our colleagues in other countries. 

[00:12:53] So the US has certainly paved the way around shorter stay models of care. How do we get people home, how do we have the right care guides or profiles for how we manage pain when people go home, constipation, understanding our readmissions, all that sort of stuff. 

[00:13:07] So it's been a big piece of work. 

[00:13:10] David Cummins: Obviously being the first comes with pros and cons. I think it's very obvious what the advantages are of this new model of care in Australia.

[00:13:19] I'm always positive more will follow but what are some of the disadvantages for this and how do you plan on de-risking some of these disadvantages being not only a pioneer, but also having such short stay for patients? 

[00:13:32] Lou O'Connor: Yeah. Well look, that question can be answered under each of our key areas of work from how do we do payroll, how do we run human resources what do we do about work health and safety to meet the legislation there? Biomedical engineering, and again, we don't want to have to replicate every service.

[00:13:48] We don't need to so we do look at partners for a lot of those things and we are very careful around who those partners are because it's about a long-term partnership. We're not creating teams to do payroll, we're not creating teams to do accounts payroll. So there's a whole lot of operational stuff in that space that we've had to really pull apart because it's too easy just to add another five people to do that task.

[00:14:11] And that's where Medibank has been instrumental in us talking to them about some of their big service lines and how do they run them. Again, how do you use technology partners to help you with that? So looking at cloud technology, looking at how staff use their mobile phones rather than having someone there that's data entering something or whatever.

[00:14:31] They're the biggest disadvantages because once we do it, once, whoever does it next, they've almost got the profile or the recipe ready to go. And really all they have to concentrate on is the specific clinical specialties that they're running and how they're going to do that.

[00:14:45] David Cummins: Is there any disadvantage or greater risk for a patient not being in a healthcare acute care environment for, for more than 24 hours? 

[00:14:55] Lou O'Connor: No, because we are very clear around our risk profiles. So obviously everyone will go through clinical pre-admission process. They have their ASA score done, their fitness for surgery is looked at their entire comorbid state is looked at their medications, et cetera.

[00:15:12] We'll have the services to compliment that regarding our preadmission or health coaches and certainly our physicians and GPs. That all has to be documented and that all has to be approved. So, we're certainly not cutting any corners, but for a lot of people, they would rather be at home with the support services.

[00:15:30] But again, we've got to provide that connection. So we're also looking at at home care services and how do we make sure that we link in because for a patient, they see us as all the same. If you're come in to Adeney Private and someone might meet with you about physio in the home, they think that that's us.

[00:15:47] So the onus is on us to create those partnerships and ensure everybody understands each person's part of the continuum. We use words like continuum of care, but do we really know what they mean? And you don't really understand what they mean until you start mapping every single type of procedure and type of patient, et cetera. That might come across your path. 

[00:16:06] The other part that's been really important in what we've done is also involve our community, our consumers. Our So being in queue, we have access to certainly a lot of people who are able to talk to us and and indeed, I remember when I first started, one of the first things we did was invited all the neighbours.

[00:16:22] There are about 50 of them that came, and we all sat in a room and we just looked at the plans and they came up with some great ideas of things that needed to change. Now, normally you don't invest as much time into that, but given where we are in a residential area, it was certainly a very important thing that we had to do.

[00:16:38] So we do now have a consumer advisory committee. We have some very invested people that guide us and everything that we look at and do we check with them? Does this make sense? Have we got it right? So, which is important. 

[00:16:51] David Cummins: There's a constant theme pretty much of every sentence you talk about it's a human element.

[00:16:55] It's the patient element, the patient care, which is a lot of people use that patient-centred care word, but I don't think they actually live by it. 

[00:17:02] It is very obvious that that is one of the Adeney's values or certainly culture that's coming from the top. So one of your important values. 

[00:17:08] How important is it to ensure healthcare, especially healthcare of the future, to understand our patients, understand our patient needs, especially when it comes to design?

[00:17:18] Lou O'Connor: Probably the most important things thing consumers are driving how we do things now. They're more fully informed. They do Dr google, they look up every single thing that anyone says to them, right? So you can't underestimate the power of the patient's experience, let alone the fact that the patient's experience helps them to heal. 

[00:17:36] Conversely the better the patient experience, the better it recruits your high performers. So there's a direct complement between the patient and their experience and the staff and their engagement. The two go hand in hand and they should never be looked at separately.

[00:17:51] And that's the same with our doctor engagement as well. So the positive feedback from the patients about the food or about the staff that cared for them, also rere recruits them on the journey. 

[00:18:01] And I fundamentally don't believe that you can have the best outcomes. If you don't ensure that you have an exceptional patient experience and exceptionally engaged staff and our values at the hospital have tried to reflect that.

[00:18:13] So to finish up, it is connect, unifying challenge. 

[00:18:16] The connect is about you must connect with the patients and we'll do a lot of work around that. Unify is that we are a unified team. No one is better than anybody else. It doesn't matter what role you have, you are a carer. A person cleaning a room cleans that room well to stop the patient getting an infection, they're a carer.

[00:18:34] The final one, which is my favorite as well, is challenge. That we want our staff and our patients to challenge how we're doing things to give us that feedback, to present different opportunities if we continue to have the blinkers on, I don't believe you can grow and be the best that you want to be.

[00:18:50] David Cummins: A hundred percent agree.

[00:18:51] Just before we finish, for a lot of people who are in healthcare, they do like to challenge and they do like to change, but a lot of people in public health are certainly more restricted to not having these opportunities.

[00:19:01] So what can people in public systems, or architects or builders or designers or services people do to challenge the norm for us to have a more sustainable healthcare future over the next 20 years? What do we need to think about? How do we need to challenge ourselves or challenge the system?

[00:19:17] Lou O'Connor: Well, I think something like Adeney Private Hospital hopefully provides that first step for people. And I think it's like anything. The more you talk about it, the more you look at perhaps overseas or add any different ways of doing things, the more opportunity you have of it coming up.

[00:19:31] And look, we will look at what research we can do as well around our model of care, around the hospital, et cetera to try and provide some further validation that that we think it's the right way to go. But People just have to keep going, keep trying. 

[00:19:46] David Cummins: Absolutely love. I think you are absolutely phenomenal.

[00:19:49] You are not in the word of health in Australia, but pretty much the world, like every person I speak to in Australia, that when your name comes up, talks so highly of you and I think it's a credit to you and your background and thank you so much for literally challenging the healthcare industry because without people like you, I don't think we'll survive the next 20 plus years. 

[00:20:08] So thank you so much for your tireless effort and I look forward to adding the opening soon and look forward to going through it with you. 

[00:20:14] So thank you very much. 

[00:20:15] Lou O'Connor: Thanks Dave. Take care. 

[00:20:17] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the go.

[00:20:22] To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:20:26] Thank you for listening.