Keynote Speakers:


John Toussaint   

CEO – Catalysis (formerly ThedaCare Center for Healthcare Value) 

John is one of the foremost figures in the adoption of lean principles in healthcare. Under his leadership, Catalysis has launched peer-to-peer learning networks, developed in-depth workshops, and created many products – including books, DVDs and webinars. Catalysis sponsors the Lean Healthcare Transformation Summit each year – both in the U.S. and in Europe. The Catalysis team has built C-suite coaching capability and partners with many organizations throughout the world advancing the idea of healthcare value through delivery redesign using lean, transparency of healthcare performance data, and payment reform.

He was the founding chair of the Wisconsin Collaborative for Healthcare Quality and of the Wisconsin Health Information Organization, as well as the non-executive leader of the Partnership for Healthcare Payment Reform in Wisconsin. He has participated in many Institute of Medicine subcommittees and has directly worked with CMS leaders to broaden their understanding of lean for government.

Dr. Toussaint’s healthcare improvement work using Toyota Production System principles has been well documented in articles published in Mayo Clinic ProceedingsHealth AffairsThe Journal of Patient SafetyThe Journal of Healthcare ManagementHealthcare: The Journal of Delivery Science and InnovationHarvard Business Review and Frontiers in Health Services Management. His work on payment reform and the transparency of provider performance data has been featured in The American Journal of Managed CareThe Journal of the American Medical AssociationHealth Affairs, and the Commonwealth Fund publications.  News publications such as TIMEThe Wall Street Journal, the CNBC BlogThe Milwaukee Journal Sentinel and Healthcare Finance News have featured articles about Dr. Toussaint’s work.

Dr. Toussaint has been recognized for his work in transforming healthcare by organizations such as The Business Healthcare Group of Wisconsin, which awarded him the “Driving Meaningful Change” award in 2014, The Association of Manufacturing Excellence (AME), which inducted him into its 2012 Hall of Fame, and the Jon M. Huntsman School of Business at Utah State University, which hosts the Shingo Prize for Operational Excellence. Dr. Toussaint was named a lifetime member of the Shingo Academy in 2011. Wisconsin Governor Jim Doyle also honored Dr. Toussaint with a Certificate of Commendation for Innovation from the State of Wisconsin in 2005.



Patrick De Coster 



After a training in internal medicine, cardiology and nuclear medicine and a two-year stay in Hammersmiths Hospital in London (mainly for research), Patrick De Coster took in 1986 the leadership of the nuclear medicine department in one of the two University Hospital of the Catholic University of Louvain (UCL).

Interested in inter-hospital collaborations, he has chaired since 1993 the Réseau Santé Louvain (RSL), which groups thirty hospitals affiliated to UCL.
Between 2005 and 2009 he was Dean of the Faculty of Public Health that he reorganized fundamentally.

He is an active director of 17 associations in the medico-social world. Since 1991 he occupies the position of CEO at the CHU Namur Hospital, since then merged with the hospital of Dinant in  2012 and merged with the hospital of Sainte Elisabeth in Namur in 2016. He initiated and completed several strategic considerations. 

Since 2009 he has seen in LEAN a managerial framework extolling the values ​​it has always defended and therefore decided, in close collaboration with its Management Committee, to implement a fundamentaly LEAN transformation at the institutional level.

Moreover, after a master in hospital management, he was appointed professor at the UCL where he teaches several courses and is he promoter of several theses. He is also co-owner of a teaching programme on LEAN management at the public health faculty of the UCL, at the “Ecole des Hautes Etudes en Santé Publique” in France and the School of Management in Strasbourg.


Johnny Van der Straeten

CEO – Antwerp University Hospital

Johnny Van der Straeten is the CEO of the Antwerp University Hospital.  He obtained his master degree in Political and Social Sciences for the University of Antwerp, a postgraduate degree in Managerial Economics and an Executive MBA from the University of Antwerp Management School. He is also an alumnus of the European Health Leadership Programme at Insead.


Daniel Jones photo

Daniel T. Jones

Founding Chairman - Lean Enterprise Academy

A management thought leader and advisor on applying lean, process thinking to all kinds of businesses across the world.

After studying at the Universities of Sussex and Manchester he joined the National Institute for Economic and Social Research (NIESR) in 1973 researching innovation in the energy industries and comparative industrial performance. In 1977 he joined the Sussex European Research Centre and the Science Policy Research Unit at the University of Sussex researching European industrial policy and performance.

In 1979 he became the European Director of MIT’s Future of the Automobile and International Motor Vehicle Programmes. In 1989 he became Professor of Manufacturing Management and founder of the Lean Enterprise Research Centre at Cardiff University Business School. He left Cardiff in 2004 to establish the Lean Enterprise Academy.

He co-authored several best–selling management books, including The Future of  the Automobile, The Machine that Changed the World, Lean Thinking and Lean Solutions, which summarized the lean management systems pioneered by Toyota, as well as three articles in the Harvard BusinessReview.

This led to the establishment of a network of non-profit institutes to carry  out research and education in lean management practices with pioneering organisations across the world. He is the founding Chairman of the Lean Enterprise Academy (www.leanuk.org) in the UK and of the Lean Global Network (www.lean- global.org). LGN organises Lean Summits and publishes books in the USA, UK, Australia, Brazil, China, France, Denmark, India, Israel, Italy, Netherlands, Poland, South Africa, Spain, and Turkey,

 He has been part of many initiatives to spread lean thinking to many different  sectors. He organized the first Global Lean Healthcare Summit, wrote the Lean Thinking for the NHS report and published the Making Hospitals Work guide to using lean to improve hospital performance. He was a member of the UK Government’s Rethinking Construction, Manufacturing Futures, Automotive Innovation and Growth and Skills for Sustainable Communities task forces. He helped establish the first Company University in the UK at Unipart and the International Car Distribution Programme (ICDP). He was an advisor to the grocery industry’s Efficient Consumer Response (ECR Europe) movement and Editor in Chief of the International Commerce Review. He continues to advise leading organisations across the world on lean management.


Benjamin Garel                                                                                                

Project Manager – AP HP

Benjamin Garel is an engineer. He made the Ecole Polytechnique and an MBA. He started his lean journey in industry. He became a civil servant and has used lean approached to improve customer satisfaction in healthcare and in court. He has been working in healthcare for 9 years. He is now working in AP HP as project manager and leads several lean transformations in AP HP (Greater Paris University Hospitals) hospitals.



Marianne Griffiths 

Chief Executive – Western Sussex Hospitals NHS Foundation Trust

Marianne Griffiths is the Chief Executive of Western Sussex Hospitals NHS Foundation Trust – the only CQC rated “Outstanding” hospital trust on the south coast and one of only four in England.

Marianne has led the organisation since its formation from a merger in 2009 and has overseen continuous quality improvement ever since. She is passionate about empowering her 6,500 colleagues to make good decisions and has introduced a trust-wide transformation programme called “Patient First” to ensure that services are continually enhanced and improved.

The trust runs St Richard’s in Chichester and Worthing Hospital, both with full A&E, maternity and paediatric departments, as well as Southlands Hospital in Shoreham, which provides outpatient care.

Marianne’s previous roles include Deputy Chief Executive and Director of Commissioning and Delivery at NHS South East Coast and Chief Executive at Kent and Medway Strategic Health Authority.



Martin Lund

CEO – Mental Health Services, Capital Region of Denmark

For almost 30 years, Martin Lund has worked in various parts of the Danish health care system, primarily in mental health. In administration, he has worked with national and European health and health care planning, decease prevention and health promotion, research and health registries as well as the establishment of comparable European health data. In health care delivery and management, he was responsible for long-term rehabilitation of people with mental illness and treatment of substance abuse. For the last 15 years, Martin has been responsible for mental health in the greater Copenhagen region. The organization has a staff of 4800 and treated 50,000 patients in 2015.

Seeing that it becomes increasingly difficult to provide sufficient health care to a growing number of people with mental illness and a need to improve quality seen from the patient’s point of view, Martin has over the last 6-7 years been increasingly committed to building a system based on waste removal and continuous improvement. He and his organization feel a special obligation to ensure high quality services delivered by a professionally driven organization with a view to getting as much value for money as possible as they serve the weakest groups in society.  Therefore, they are striving to become a lean- hospital.



Miquel Sánchez

Director of the Emergency Department - Hospital Clínic of Barcelona


Miquel Sánchez, MD, PhD. After completing his training in Internal Medicine, he started to work as Emergency Medicine Physician in the Hospital Clínic of Barcelona in 1994. Since 2010, he has been the Director of the Emergency Department (ED).

Master on Hospital Administration (1998) and postgraduate diploma on “Leadership of Healthcare Organizations” (2009). In his different positions, he has been highly interested in process management and quality initiatives that improve ED performance and quality markers. In this field he has carried out a good piece of clinical research and published more than 100 originals articles in medical journals. Because of that, he has often participated as a speaker in medical conferences and meetings, and as a teacher in courses, diplomas, and masters. In 2014, he completed the Lean Practitioner Program for the Lean Enterprise Institute in Spain. Since then, he has attempted and led a lean transformation in the Emergency Department. It is not being that easy and there is still a long way to go.

Learning Session Speakers

Jake Raymer photo

Jake  Raymer   

The Institute for Enterprise Excellence


Jacob Raymer is an internationally recognized speaker addressing corporate and public audiences on the subjects of leadership roles & responsibilities, cultural transformation, and how to achieve enterprise excellence with the right behavior and sustainable long-term results.

As the former Shingo Prize Director of Education at the Jon M. Huntsman School of Business, Jacob co-created the Shingo Model from key insights gained through partnerships with Steven Covey and Ritsuo Shingo (Former CEO of Toyota China).  The Shingo Prize is regarded as the premier operational excellence award and recognition program in the world with Business Week dubbing The Shingo Prize as “the Nobel Prize of Manufacturing.”  For over 10 years Jacob has developed and trained Shingo Examiners and 1000’s of individuals worldwide on how to assess and implement lean transformation by applying the Shingo Model and its principles. He continues to lecture at the Huntsman School of Business at Utah State University in graduate courses such as “Leadership and Operational Excellence in a Global Context”, and “Principles of Operational Excellence” – where he brings practical application to the theoretical philosophy of excellence.

 As a lean motivational speaker, Mr. Raymer shows organizations that true innovation is not achieved by superficial imitation or the isolated, random use of lean tools & techniques and systems (“know how”), but instead requires the “know why” — i.e., an understanding of underlying Principles.  By blending his real-life stories and 5 years of Shingo Prize site-visits, Mr. Raymer educates, motivates, and entertains—delivering solutions audiences can use right away.

Mr. Raymer is a member of the National Oversight and Appeals Committee for the Lean Certification program that was created by the Shingo Prize, AME, and SME.  At this capacity he actively participates in the development of the certification program and review of candidates.

The Institute for Enterprise Excellence (IEX), founded by Jacob Raymer in 2013, is a research, education and coaching institution that focuses on helping organizations build principle-based architecture to achieve world-class results. 




Mark Graban



Mark Graban is an internationally-recognized consultant, author, keynote speaker, and blogger in the world of “Lean Healthcare.” Mark also serves as the VP of Improvement and Innovation Services for the technology company KaiNexus.

He is the author of the book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (Productivity Press), which was selected for a 2009 Shingo Research and Professional Publication Award and has been translated into eight languages. A 3rd revised edition will be released in June, 2016. Mark has also co-authored a new book, titled Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, released in June 2012. He is the founder and lead blogger and podcaster at LeanBlog.org, started in January 2005.

Mark earned a BS in Industrial Engineering from Northwestern University as well as an MS in Mechanical Engineering and an MBA from the MIT Sloan Leaders for Global Operations Program (previously known as Leaders for Manufacturing). Mark has worked in automotive (General Motors), the PC industry (Dell), and industrial products (Honeywell). At Honeywell, Mark was certified as a “Lean Expert” (Lean Black Belt).

Since August 2005, Mark has worked exclusively in healthcare, where he has coached lean teams at client sites in North America and the United Kingdom, including medical laboratories, hospitals, and primary care clinics. From 2005 to 2009, Mark was a senior consultant with ValuMetrix Services, a division of Johnson & Johnson, where he led projects in the United States, Canada, and England. He currently consults independently through his company, Constancy, Inc.

Mark’s motivation is to apply Lean and Toyota Production System principles to improve quality of care and patient safety, to improve the customer/patient experience, to help the development of medical professionals and employees, and to help build strong organizations for the long term.

From June 2009 to June 2011, Mark was a Senior Fellow with the Lean Enterprise Institute, a not-for-profit educational organization that is a leading voice in the Lean world. Mark served as the LEI’s “Chief Engineer” for healthcare activities, including workshops, web & social media, and other publications. Mark also served as the Director of Communication & Technology for the Healthcare Value Network, a collaboration of healthcare organizations from across North America, a partnership between LEI and the ThedaCare Center for Healthcare Value. Mark continues as an LEI faculty member.

Mark is a popular speaker at conferences and private healthcare meetings. He has guest lectured at schools including MIT and Wharton and has served as a faculty member for the Institute for Healthcare Improvement. He has been quoted and interviewed in many publications, including Health Affairs and the New York Times.

Mark and his wife live in Texas.




Paul  DeChant, MD, MBA, FAAFP

Simpler Consulting


Dr. Paul DeChant joined Simpler in 2014 as a physician executive with more than 25 years of clinical and management experience in all aspects of medical group governance, with an emphasis on quality improvement, strategic planning, financial growth, acquisitions and Lean workflow redesign.

From 2009 - 2014 he served as CEO of Sutter Gould Medical Foundation (SGMF), a not-for-profit health care organization dedicated to providing the highest level of patient care. Under his tenure, through implementation of Lean process philosophy, the organization's more than 300 primary and specialty care physicians achieved significant improvements to efficiency, cost and quality of care. Highlights of his contributions include:

  •          Implementing an organization-wide Lean management system and culture, empowering providers and staff in continuous daily improvement, resulting in the highest levels of provider and patient satisfaction in Sutter Health;
  •          Improving physician satisfaction from the 45th to 87th percentile
  •          Increasing profitability while reducing costs
  •          Achieving recognition for SGMF and its affiliated medical group as the highest rated in overall care among 170 California medical groups two years in a row (Consumer Reports, February 2014 and 2015).

During his tenure with Sutter Health, Dr. DeChant also served as President of the Palomares Division of Palo Alto Medical Foundation (PAMF) and served 4 years as Chair of ACME, Sutter's Administrative Council of Medical Executives. In those roles DeChant launched programs to drive quality and service improvements and cost reductions throughout the system. He has also held leadership roles at Geisinger Health System, High Country Health Care and P.C./Breckenridge Primary Care.

Dr. DeChant has been an active member of prominent national organizations, including the American Academy of Family Physicians, American College of Physician Executives, American Medical Group Association and the Group Practice Improvement Network. He has maintained a high level of civic contributions and community service throughout his career, including founding a free medical clinic for homeless shelter clients, developing a primary care education program and volunteerism in undeveloped countries.

Dr. DeChant graduated from the University of Oregon with a Bachelor of Science degree. He received his medical degree from the Oregon Health and Science University School of Medicine and earned his Master of Business Administration from the University of Colorado-Denver.


Eric Daneau

CHU de Québec – Université Laval


Adjoint au directeur à la direction de l’évaluation, de la qualité et de la planification stratégique au CHU de Québec – Université Laval, biochimiste de formation, accrédité par le Project Management Institute et finissant à la maîtrise en gestion de projet de l’Université du Québec à Rimouski, monsieur Daneau possède plus de 16 ans d’expérience en gestion de projet dont 12 ans dans l’industrie pharmaceutique. En poste depuis janvier 2011 au CHU de Québec, il travaille à développer la culture Lean et l’amélioration continue au sein de cet établissement.

Élisabeth Morin

CHU de Québec – Université Laval


Mme Morin œuvre dans le domaine du développement organisationnel depuis plus de 15 ans. Actuellement, elle est Adjointe au directeur des Ressources Humaines pour le Service du développement des personnes et du soutien à la transformation du CHU de Québec-Université Laval. Elle a également évolué comme consultante et chef de pratique dans une firme conseil en gestion pendant 10 ans. Détentrice d’une maîtrise en psychologie organisationnelle de l’Université de Sherbrooke, ses champs d’intervention concernent l’accompagnement d’équipe de gestion et la gestion du changement. Elle participe activement au développement de la culture d’amélioration continue au sein de son établissement.


Jyrki Perttunen

Hospital District of Helsinki and Uusimaa (HUS) 


Jyrki Perttunen joined the Hospital Director of Helsinki and Uusimaa (HUS) in April 2015 as their Lean Projects Director. He is responsible for advising HUS management in lean transformation and for coaching and leading HUS’s lean coaches. Prior to joining HUS Jyrki Perttunen worked as a president of one of the Danaher companies. Before working for Danaher Jyrki Perttunen worked as CEO of medium sized private equity owned companies. Jyrki Perttunen has Masters degrees in industrial management and in law.


René  Aernoudts

Lean Management Institute


René has a background in Business Economics, Sociology and Organizational Behavior (Erasmus University Rotterdam, graduated in 1993) and a Postgraduate Diploma (Master Black Belt) from UPC Barcelona Tech (2014).

Before founding the Lean Management Institute in 2004 he was a managing partner of a renowned consulting firm in The Netherlands. His other work experience includes lecturing at two business schools (HES Rotterdam and HvU Utrecht) in the Netherlands. He is an experienced leader: he managed departments in operations, marketing, sales and finance for a variety of organizations. Since the founding of the Lean Global Network (1999), he is one of the board members of this non-profit organization (HQ in Boston, USA) founded by Professor Daniel T. Jones and Dr. James P. Womack, authors of Lean Solutions (2005), Lean Thinking (1996) and The Machine That Changed The World (1990).

René is founder of Planet Lean (www.planet-lean.com), a web-based magazine on Lean and publishing 3 articles a week. He is a guest lecturer at universities and professional educational institutes. He translates and publishes books in the field of Lean. In 2005 he (co-)created the first Lean Certification Program in the Netherlands and has been evolving this since then. He initiated and co-developed the Lean Postgraduate Certification Program in close cooperation with UPC in Barcelona and this program is being delivered worldwide.

René is a well-respected consultant and trainer who has been working as a consultant for over 20 years, in a wide variety of organizations. Main focus since 1998: designing and implementing over 120 transformations worldwide, both in healthcare, government and service industries. His particular expertise includes the change management strategies that can be used in implementing lean in an organization. He has worked in the healthcare sector since 1998 (in a wide range of hospitals, senior care, youth support, child protection).

René has a strong relationship with the educational field: from his early years onwards he has been active as a Judo teacher for youth and mentally impaired people, later as a (guest) Lecturer at several universities and business schools. In 2009 he was appointed a visiting professor at Virginia Tech, Blacksburg, USA. Since 2012 he regularly teaches in MBA programs. René speaks Dutch, English and German.




Fabrice Deprez, MD, MSM, EBIR

CHU UCL Namur, Godinne


Dr. Fabrice Deprez is an interventional radiologist (IR) at the CHU UCL Namur since 2013. In addition to his training in Medicine, Radiology (Catholic University of Louvain - UCL) and Interventional Radiology (EBIR – European Board of Interventional Radiology, CIRSE), he obtained his master degree in Sciences of Management from the Leuven School of Management (LSM, UCL) and a certification in Hospital Management from the Public Health Faculty of the UCL.


Concurrently with his clinical and scientific activities, he was highly involved in the “lean transformation” of his IR unit. He also has teaching and professional representation activities, as president of the IR section of the Belgian Society of Radiology.


Renaud Vander Stricht

CHU UCL Namur, Godinne


Renaud Vander Stricht is a technologist in radiology at the CHU UCL Namur since 2008. He has been working in interventional radiology since 2013. He highly involved in the “lean transformation” of the interventional radiology.

Kjeld Aij

VU University Medical Center


Kjeld Aij is a business administrator and registered nurse with an MBA, Master Black Belt and over fifteen years of experience in the health care industry. He worked as the head of Anesthesiology & Operative Care at the VU University Medical Center from 2010 to mid-2015. In April 2015, he became the Director of Business Administration for the Acute Care Division at VUmc. Kjeld has implemented various projects in the areas of quality and patient safety and spearheaded, among other projects, the introduction of lean thinking and lean processes in the operating rooms.

Kjeld has previously conducted research into leadership and successful change in organizations, with a special focus on the role of middle management. Since 2010, he has served as a member of the project committee for the Dutch Operating Room Benchmarking Collaborative, whose objective is to improve operating room performance through mutual learning from best practices. In 2010, he was appointed as a research member of the Lean Healthcare Research Consortium of Stanford University in Palo Alto, California, USA. He got his PhD in 2015, investigating the leadership behaviors essential to the successful, sustainable implementation of lean principles in hospitals. He also teaches at VU University and is a popular speaker at conferences and is author of the books Practical Lean Leadership for Healthcare Managers and The New Leadership.



Anne-Sophie Marsin 

Saint-Luc University Hospital


Anne-Sophie Marsin, PhD, is Chief Strategy Officer at Saint Luc University Hospital in Brussels, Belgium. She has a 5-years degree in pharmaceutical sciences (UCL, Brussels) and holds a PhD in Medical Sciences from the Christian de Duve Institute (Belgium). Before joining Saint-Luc University Hospital, she worked 10 years at McKinsey&Company where she led projects and development initiatives for the Pharmaceutical and healthcare industry throughout Europe and abroad. She has specialized primarily in the areas of strategy, sales and marketing –with a subspike in customer insights- and capability building/ transformation program. At Saint-Luc, Anne-Sophie is responsible to develop, upgrade, and ensure the implementation of the strategic plan, one of the strategic axes being the transformation of the hospital. 


Olivier Ykman

Saint-Luc University Hospital


Olivier Ykman, is the head of OR administration at Saint Luc University Hospital in Brussels, Belgium for the last 8 years. He has a bachelor degree in nursing and a postgraduate education in Tropical Medecine; he also holds a master in Public Health and Healthcare Institution Management.

Oliver has been working at Saint-Luc university hospital since 1995 where he has covered many different areas: 4 years in abdominal surgery care units, 8 years as Clinical Research Coordinator and Oncology Care Coordinator and 2 years in the OR administration.

Now, Olivier is responsible for all organizational, administrative, financial and infrastructure-related matters within the OR.

Olivier has been largely involved in the last OR 360° transformation and has led several optimization waves.

Carine Hens 

Saint-Luc University Hospital


Carine Hens, is the OR nurse Director at Saint Luc University Hospital in Brussels, Belgium for the last four years. She has a bachelor degree in nursing and a postgraduate education in perioperative care. Carine holds a master's degree in Public Health and Healthcare Institution Management. Before joining Saint Luc University Hospital, she worked 16 years at Saint-Pierre hospital (Belgium) where she led the operating room nursing team.

As OR nurse Director, Carine is responsible for the management of the whole OR nursing team, from both traditional and day care surgery, as well as the sterilization unit. Over the past three years, she has led a significant amount of optimization projects within the OR. She also manages many day-to-day issues and elaborates with the Strategy team, amongst others, new ways of working and improvement ideas.

Jens W. Krombach, MD

Zuckerberg San Francisco General Hospital


Dr. J. Krombach attended medical school in Frankfurt/Germany and completed anesthesia residency training and a fellowship in transfusion medicine in Frankfurt and Cologne. In 2002, he became a faculty member at the University of California San Francisco. Dr. Krombach served as the clinical director of anesthesia from 2006-2009, before becoming the medical perioperative director at Zuckerberg San Francisco General Hospital.


Dr. Krombach’s research interest focuses on patient safety and quality improvement projects, especially in implementing clinical health care checklists. He has been involved in lean improvement projects within the operating room for over 4 years.


Viviane Malet

Hôpitaux Universitaires de Genève


Infirmière spécialisée en soins intensifs de formation, est engagée dans la réflexion sur l’optimisation des processus depuis 2008. S’implique dans les démarches Lean à partir de 2010. Lean manager, formée en gestion de projet et gestion du changement, elle mène à bien plusieurs projets dans le domaine médical et à la pharmacie des HUG. Elle accompagne depuis 2015, la mise en place d’une démarche Lean à la Direction des finances tout en soutenant d’autres départements dans leur projets.



Philippe Garnerin photo

Philippe Garnerin

Hôpitaux Universitaires de Genève


Formé à l'informatique et l'analyse des données, s'intéresse depuis de nombreuses années à l'amélioration des processus cliniques notamment du point de vue de la sécurité des soins, de l'analyse rétrospective ou prospective des flux ainsi que de l'aide à leur conduite. Il a débuté ses travaux dans les domaines de l'anesthésiologie, du bloc opératoire, de la transfusion sanguine et du médicament. Depuis 2013, il étend le champ de ses interventions aux processus administratifs au sein de la Direction des finances des HUG.