Digital Transformation of Andernach State Hospital using Hosp.Do.IT's Generic Strategy Template

Andernach State Hospital, in collaboration with Hosp.Do.IT, developed a comprehensive digital agenda aligned with the Hospital Future Act. This initiative focused on integrating digital strategy into corporate goals, fostering user-oriented IT processes and implementing structured project management. Key outcomes include enhanced digital platform structures, streamlined processes and improved compliance monitoring through KPIs, addressing the challenges of healthcare digitalisation.

Key Points

• Andernach State Hospital partnered with Hosp.Do.IT for digital transformation.
• The Digital Agenda aligned IT strategies with corporate goals and HFA requirements.
• The initiative prioritised user-oriented IT processes and structured project management.
• Key performance indicators monitored progress and ensured regulatory compliance.
• The approach emphasised innovation despite challenges in the healthcare system.

 
Problem & Challenges

Andernach State Hospital had a technically oriented IT strategy, primarily geared towards the necessary systems and the requirements for operation and security. User requirements were identified through working groups and process teams and then implemented by the IT department. The aforementioned process teams, primarily medicine and nursing, were the only ones that aligned with the corporate objectives and the strategic thrusts of the individual facilities. From the users' perspective, many work tasks were seen as "the responsibility of IT", leading to a lack of joint prioritisation and task definition, which was often fragmentary at best.

In 2019, management recognised the need to more closely align the digital strategy with the corporate strategy. Requirements were formulated in management committees that already made it clear that a deeper penetration of digitalised processes was imminent. Collaborative efforts within the hospital community, along with the availability of a "toolbox" for establishing and implementing a digital agenda, appeared to be a logical step towards professionalisation.

As is well known, the central challenge of digitalisation is not simply the existence of such tools as a well-formulated IT operating strategy for the secure operation of hardware and software (Meier 2023). Rather, it lies in the recognition that established and functional business processes, whether analogue or digital, must be deconstructed during the digital transformation to establish new business models. In this context, the term "disruption" is used to describe business models that swiftly wipe out the established competition. In cases where the success of the business model is less fundamental, it is referred to as transformation or even evolution. The core of digitalisation consists of understanding the value of existing data and information for one's business model, which involves effective data or information management. In the healthcare industry, this specifically pertains to strategic health data or information management (HDM or HIM).

Figure 1 illustrates the digital landscape of health information management that all players need to navigate. In order to survive in the market in the long term, these players must successfully manage the "HIM triangle" (Meier 2019). New competitors are emerging in the field of psychological treatment, which traditionally seems rather insensitive to digitalisation, especially in the core aspects of providing therapeutic services. Numerous digital health applications (DIGA), which can be prescribed by general practitioners and are covered by statutory health insurance, could challenge the previous necessity of physical consultations between doctors and patients for certain episodes of illness. The Federal Institute for Drugs and Medical Devices (BfArM) provides a list of currently approved digital applications, categorised by disease type, on its website diga.bfarm.de. For a specialist hospital focused on psychiatry and neurology, the strategic question will be whether and how the state hospital will participate in this development.

Objectives

In 2019, the hospital decided to join the hospital community, leading to the development of key elements for a future digital agenda. This was accomplished during a joint workshop that took place prior to the implementation of the Hospital Future Act (HFA or Krankenhauszukunftsgesetz, KHZG). The workshop included the directorate of the Rhein-Mosel-Fachklinik and Corporate Development team, with moderation provided by the hospital community (Meier 2019). The management then deemed the resulting aspects relevant for the entire state hospital.

A comparison with the topics of the HFA (BAS 2021) showed that most of the issues were also addressed there, which led the Supervisory Board to approve the hospital's digital agenda. The integrated approach, which emphasised digital strategy, digital business, digital patient relationship management and a focus on employees in digital work (Meier 2022), received strong support.

Initially, all focus areas were developed with equal importance and urgency, followed by a structured internal prioritisation. The HFA then prioritised mapping the digital strategy to align it with the HFA funding elements. However, the fundamental classification of the Digital Agenda as an essential component of the overall orientation of the state hospital company remained unaffected by this shift in priorities. Only the timeline ("when") was adjusted, but not the essential decision ("if").

The Digital Agenda (Fig. 2) resulted in a much stronger focus on the benefits of digitalisation in achieving strategic goals in terms of business alignment. As a result, it is not surprising that the management conference adopted user-oriented IT processes as an independent strategic goal for the five-year period from 2023 to 2028.
 

Description of Concept and Solution

The digital strategy has been developed based on the management focus shown in Fig. 1, the digital agenda presented in Fig. 2 and the associated mission statement that encompasses the vision, mission and code of values formulated for this purpose. This strategy includes the associated overall objectives according to standard strategy principles as shown in Fig. 3.

In the usual way, the rather general goals were translated into objectives and sub-objectives for the digital strategy of the Hosp.Do.IT hospital community. These objectives can be categorised into eight main pillars represented as a thematic grouping in Figure 4:

Based on the digital agenda that complements its corporate strategy and digital strategy, the state hospital in Andernach has undertaken an organisational realignment. This realignment included the establishment of a Chief Digital Officer (CDO) position and a stringent project management framework to implement the HFA projects. Ultimately, the goals of all pillars are reflected in this initiative, which spans digital platform structures, optimised processes for closed-loop medication and the necessary security architecture to maintain operational safety.

Management committees of the hospital receive regular progress updates. The diverse, interprofessional and cross-hierarchical composition of project and sub-project groups ensures early and comprehensive engagement. The success of digitalisation efforts in the hospital depends on the participation of internal stakeholders. Due to the broad spectrum of services—ranging from outpatient to inpatient care, from acute care to rehabilitation, from residential and support services to outreach psychiatric care—having a tailored approach to tools and methods introduced is a success factor.

From the beginning, these projects have been regularly viewed as organisational projects rather than mere IT projects. In this context, IT serves as a business partner responsible for providing secure, stable and high-performance systems. However, it is not the systems themselves that generate added value, but the use cases created and implemented based on real-world requirements.

Benefits/added Value and Shortcomings of the Solution

The advantages of the current system were evident for the state hospital in Andernach, as well as for the other members of the hospital community. Each member has a detailed digitalisation and IT plan for 3–5 years which is reviewed quarterly. This includes ongoing quarterly strategy evaluations and a straightforward alignment with the HFA funding criteria (BAS 2021).

At the state hospital in Andernach, this mapping was implemented accordingly, and the funding HFA Eligibility criteria outlined in §19 (1) nos. 2–6, 9 (hospital-wide), 9 (cross-hospital) and 10 were applied for and approved. The benefits of the jointly developed control documents became particularly evident. The standardisation significantly simplified the overall project, and clear, transparent joint solutions were reached through discussions among the members regarding various open questions.

Conclusion and Outlook

The digital agenda system developed within the hospital community serves as a further dimension of the corporate strategy, closely linked with a digital strategy. This approach not only provides a sustainable method for institutionalising these topics within the hospital but has also proven well-suited to implementing the HFA and supporting its ongoing execution over the years. Almost en passant, the members benefit from an elaborated monitoring process that tracks compliance with mandatory criteria through jointly established key performance indicators (KPIs). This serves as a control mechanism to address impending revenue deductions. The KPIs are collaboratively developed and continuously refined in accordance with the agreements at both federal and state levels. The aim is to operationalise the legally mandated provision and ensure compliance with the mandatory criteria.

However, the intense pressure to innovate that has been placed on the market by the Hospital Future Act, in conjunction with the current crises (eg coronavirus pandemic, war in Ukraine, inflation and shortage of skilled workers), shows that even industry partners often struggle to develop and implement solutions at the pace required by service providers. The complexity of the healthcare system, which can create non-standard case constellations due to the rights of representation of legal guardians and their influence on patient decision-making, necessitates standardised solutions.

Moreover, the limitations faced by vulnerable groups, particularly in psychiatric and geriatric care, require user interfaces to be designed to be barrier-free or at least low-barrier. Ensuring data protection and information security for highly sensitive health data, along with upholding the right to informational self-determination, are additional challenges that can hinder the digital implementation of even simple service processes.

Despite these challenges, the state hospital's digital agenda has a positive effect on the situation. It assists service providers in clearly articulating their requirements in alignment with their organisational goals. In cooperation with the control system being developed by the hospital community, the necessary conditions for achieving these targets have thus been established.

Conflict of Interest

Dr. Thorsten Junkermann: none
Prof. Dr. Pierre-Michael Meier: the author is the CEO of the Hospital Community Hosp.Do.IT. He also developed the Digital-, Data- & IT-Strategy.