埃森哲提供给香港医管局用于为公私合营研究的建议书.doc

3.0 PROJECT METHODOLOGY AND ORGANISATION SUPPORT3.1 Our Understanding of Hospital Authoritys ObjectivesThe purpose of this tender is to collaborate with a consultancy partner to conduct a business case study to explore the feasibility of developing a Public Private Partnership (PPP) operating model for North Lantau Hospital Phase Two, with the goal of encouraging greater private sector involvement in providing healthcare services at the Lantau facility. The Broader HA ObjectivesAccenture believes HA has a broader objective to achieve behind this study, which is to investigate how PPP can be leveraged to build a sustainable healthcare system in Hong Kong. A sustainable healthcare system should be cost efficient and well equipped to offer quality heath services to the community, at the same time promote healthy competition and collaboration between the public and private health sectors. With reference to the Hong Kong Healthcare Reform Consultation Document, the major challenges facing the Hong Kong Government to attain a sustainable healthcare system in Hong Kong are the growing healthcare needs due to rapidly ageing population and increasing occurrence of lifestyle related illness, imbalance provision of hospital services between public and private sectors, rising medical cost due to medical advancement and publics expectation of the Government to keep up with the quality of medical services, healthcare expenditure is growing faster than the Hong Kong economy and an increasing burden for the future generation if the Hong Kong Government maintains the present financing arrangements of the healthcare system.Greater Public-Private collaboration is required to bring about a sustainable healthcare system.Public Private Partnership (PPP) is defined as a contractual arrangement involving the private sector in the delivery of public services, where the responsibility for the delivery of services is shared between the public and private sectors, both of which bring their complementary skills to the enterprise. In healthcare, PPP has the potential of being a useful tool in increasing the private sector involvement, facilitating collaboration and sharing of expertise and experience, and promote healthy competition between the public and private sectors for service quality and professional standards. Patients could have more choice of services, and cost and price transparency could be enhanced to the benefit of patients, which is in line with NLHs strategic goal to allow the provision of private healthcare services in public hospital facilities (i.e. NLH Phase Two). A successful implementation of PPP model at NLH will allow HA to roll out the PPP concept to other hospitals in Hong Kong. It is expected that through PPP, a more efficient and cost-effective services within the healthcare industry will become the benchmarks for both the public and private sectors. The overall capacity of the health care system can also be enhanced. All these factors contribute to improving service quality, efficiency and in turn the sustainability of Hong Kongs health care system. Project RequirementsTo achieve NLH Phase Two goals, HA is pursuing a business case study within 12 months to scientifically evaluate potential PPP models in a procedural and structured approach. The study will begin with leading PPP Hospital practice research, followed by NLH current planned operations/capabilities and local hospital industry investigation, to develop NLHs PPP requirements which set the stage for a non-committal Expression of Interest (EOI) process to gather PPP proposals and feedback from interested PPP vendors. This is followed by an in-depth feasibility study of viable PPP options in terms of costs, benefits and implementation risks, to identify the optimal PPP option for NLH, and develop a high level implementation plan for the recommended option.The business case study will hold into account the fact that the Government and the HA envisage that the PPP model to be developed under North Lantau Hospital Phase Two project would possibly take the form of co-location of public and private facilities, either within the same building (vertical co-location) or in separate buildings on adjacent sites (horizontal co-location). HA has already ruled out private financing, shared ownership of buildings and operation of public hospital facilities and public clinical services by private providers.However, apart from the options above that have been ruled out, HA are open-minded about the possible PPP models that may be developed and that may be operated by the private provider on a profit-making or non profit-making basis. The study will address the specific request of the HA to advice on a most feasible PPP model for NLH that is designed with reference to: · Land arrangements· Role of Government and private sector in design construction works· Role of Government and private sector in clinical service delivery scope and mode of delivery· Arrangements for the delivery of non-clinical and ancillary service· Facility maintenance · Staffing arrangements3.2 Our Project ApproachAccenture, with its global experience in consulting and participation of PPP related projects, brings to HA a well defined and proven methodology to conduct the business case study.Our MethodologyAccentures Business Integration Methodology (BIM) provides a framework for driving and sustaining change in an organization in order to create value. Figure 3.1 Business Integration Methodology DiagramAt the highest level, the Methodology has four phases that together depict the entire life cycle of a change initiative. These phases are: Planning, Delivering, Managing, and Operating. Given our understanding of HAs scope of study, we propose to drive the HA PPP project using the Planning Phase and Managing Phase Methodologies of BIM to build out the Business Case Study Approach and Project Management respectively.Business Case Study ApproachThe Planning component provides a proven structured method to conduct a feasibility study, identification of the most valuable opportunities, formulating the plans to realize those opportunities and develop an implementation plan for the proposed solution aligned with the intended consultancy scope for the HA PPP project. The methodology serves as the guiding principle and was used to build out the business case study activities of the HA PPP project work plan. PlanningFigure 3.2 Planning Phase Major Phases OverviewThe Planning phase includes four stages of work: Phase I: Business DiagnosisPhase II: Strategic DirectionPhase III: Operating StrategyPhase IV: Business ArchitecturePhase I: Business Diagnosis HA: Requirements AnalysisThe project kickoffs with a visioning workshop to clarify and define the NLHs vision for Phase Two and expectations for the PPP study. (We believe HA would have an existing (or planned) hospital operating model for NLH Phase One. It would be important for us to understand what this planned operating model for Phase One is and take this "existing" model as a baseline of Phase Two and determine how much they need to transform themselves (in the areas of organisation, process and technology) to the selected PPP models. This would give HA an indication of how much effort is required (and not just financially) to make the PPP leap.) A workplan will be put in place, beginning with a leading PPP Hospitals research, followed by a local hospital industry and NLH study to define NLHs PPP requirements for the EOI exercise. PPP proposals gathered from interested private vendors and their profiles will be evaluated to identify PPP options for business case development.Phase II: Strategic Direction HA: Options AnalysisThe project team and leadership will refine the strategic vision and objectives based on research study findings and EOI feedback. The team will begin the evaluation of viable PPP options by stating the value propositions, gaps and implementation risk for each option. Phase III: Operating Strategy HA: Options AnalysisThe next step for the business case is focused on running the Public Sector Comparator (PSC) to evaluate Government costs for each PPP option. Operational Impact (e.g. Clinical Outcomes, Access to Care, Clinical Adjacencies and Patient Flow, Impact on Research and Teaching etc.) will also be analysed for each option. There will be a final evaluation of aggregated business case results, and the recommended PPP option(s) for NLH will be delivered.Phase IV: Business Architecture HA: Implementation PlanningThe project team will develop implementation outline for the recommended option(s).Note: The Managing component provides the continuous guidance needed to keep an project on track and to ensure that it delivers value. It will serve as the guiding principles to build out the Project Management activities for the HA PPP project. Project Management details will be further discussed in the last part of this section.3.2.1 Phase I: Business Diagnosis HA: Requirements Analysis (Month 1 through Month 5)Objectives· Develop a high level understanding of North Lantau Hospitals strategic goals and vision· Define project scope and work plan· Define possible PPP model outcomes aligned to the strategic goals and vision of the hospital· Understand how leading overseas PPP Hospitals set up their partnership for areas that is relevant to HAs requirements stated in the RFP· Identify NLHs PPP requirements for the EOI· Conduct non-committal public EOI to gather PPP model options and gauge local and overseas PPP health industry groups interestsApproachStep 1: Conduct Visioning Workshop· Accenture will conduct a visioning workshop with HA Leadership Team to define:o Strategic goals and vision for North Lantau Hospital Phase Twoo Based on the defined strategic goals and vision, develop desired high-level PPP model outcomeso Discuss potential benefits and cost savings for the government using the PPP modelDefining the strategic and operating goals for NLH is a critical step to set the direction and guiding principles for all downstream project activities:· Define EOI scope and criteria (i.e. aspects of PPP arrangements that is of greatest interest to NLH e.g. land arrangement, maintenance etc., and HAs initial thoughts and requirements for these PPP components)· EOI vendor evaluation marking scheme· Define business case analysis criteria (i.e. other then focusing only on evaluating the benefits, risks and financial implications of PPP options, we should also investigate the operational impact that will be brought about by each of the options e.g. clinical outcomes, access to care, patient flow etc.)· Components to focus on during the development of the implementation workplan and deployment considerationsStep 2: Conduct Project Scoping Session· The project team will conduct PPP project scoping session to:o Define project objectives and how they will address the strategic goals and visiono Develop work plan. We suggest reviewing the EOI process logistics with private PPP health industry groups to ensure we have factored in adequate amount of time in the process to allow them to inquiry about NLHs PPP requirements and respond accordingly. This is a good time to engage private sector groups for feedback.o Confirm deliverables and its specifications (i.e. detailed requirements for the PPP feasibility study report, signoff criteria etc.)Step 3: Research on Leading PPP Hospitals· The project team will conduct extensive research to identify leading PPP Hospitals (e.g. from the countries known for their PPP Hospital experience: UK, Canada, Spain etc.). It is critical for us to clarify the term “leading PPP Hospital” (as mentioned in the RFP) with HA before we commence this research.o We can also coordinate PPP hospital site visit(s) to help HA visualise some implemented PPP concepts and exchange ideas with site managementStep 4: Investigate PPP Arrangements from Leading Hospitals Relevant to HAs Initial Requirements· The team will drill into selected PPP Hospital case studies to futher understand how the Hospitals execute their PPP model, especially how they set up their PPP arrangements with the private sectors· Where the PPP Hospital case studies provides us with insights on their PPP arrangements for the following HA requested PPP components, we will include their best practices as reference options:o Land arrangemento Respective Role of the Government and the private provider in relation to design and construction workso Scope of clinical services to be provided by the public and private providers and the mode of service deliveryo Arrangements for provision of non-clinical and ancillary serviceso Maintenance responsibilitieso Staff arrangementPlease see below an illustrative diagram to help HA conceptualise our proposed way of performing a leading PPP arrangement study. The collated viable PPP arrangement options will serve as guiding principles to help EOI vendors develop their response back to HA. EOI vendors should also feel free to respond with PPP arrangements not mentioned in the EOI Invitation Document.Figure 3.3 Leading PPP Hospitals - PPP ArrangementsStep 5: Understand NLHs Current Planned Operations and Capabilites, its Macro Environment, Opportunities and Challenges· As explained previously, taking the existing/planned operating model for NLH Phase One (as the baseline for Phase Two), the team will perform an in-depth study of NLHs current planned operations and capabilities, opportunities and challenges, the local Hong Kong hospital industry (both public and private sector), the marco environment to identify NLHs Phase Two requirements for the EOI Invitation Document. The following list is an example of study areas we will cover in this effort:o Current NLHs planned operations and capabilities (people, process, technology)§ People: Hospital Organisation and Governance, Staffing, Recruiting, Orientation, Training etc.§ Process: Facility Planning, Business Plans and Financials, Revenue Cycle, Construction, Visiting Physicians, Management of Operations, Policy, Clinical Service Lines, Clinical Research & Trials etc.§ Technology: ERP, CIS, Medical Equipment, IT infrastructure, Clinician End User Devices, HVAC/Security/Fire etc., and interfaceso Current public and private hospital operations in Hong Kongo Current competition/relationships between the public and private sectorso Existing legislative and regulatory system for public and private hospitalso Current health care standards and performance monitoring of the two sectorsStep 6: Conduct EOI Process· The project team will conduct a non-commital EOI process, which include the following steps:o Define