Regional Shared Services: Aligning the stars for success in a scattered IT universe

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Regional Shared Services Aligning the stars for
success in a scattered IT universe

• Stéphane Ouellet, Marg Kampers, David Veeneman
• London Health Sciences Centre
• Malcolm Hopkins
• St Thomas Elgin General Hospital

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Agenda

• Overview Regional Shared Services
• Present Key Concepts
• Star Model for Organizational Design
• Balanced Scorecard
• Case Studies
• Duplicate PINs
• Regional Compliance to Privacy Standards
• Key Learnings

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Overview Regional Shared Services

• The Regional Shared Service (RSS) provides
  direction and support for implementing a shared
  IT solution at sites throughout Southwestern
  Ontario.
• Housed at London Health Sciences Centre (LHSC)
• Governed through a Memorandum of Understanding
• Annual budget 8M (07/08)
• Funded through a shared cost recovery model for
  purchased services covering
• PACS/DI (11 sites, set to double by 09/10)
• EPR (7 sites, with an 8th site looking to join)
• Business Systems (Peoplesoft) (3 sites)

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RSS in Southwestern Ontario (LHIN 1 2)
PACS Active
PACS SWO Repository (in progress)
EPR Active
EPR Planning phase
Business Systems
Max. distance between sites 450 km
North-South 250 km East-West
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RSS in Central/Southern part of LHIN 2
PACS Active
PACS SWO Repository (in progress)
EPR Active
EPR in planning
Business Systems
Max. distance between sites 150 km
North-South 120 km East-West
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Star Model

• Galbraith (1995) proposed an organizational
  design framework (a five-point star model) to
  evaluate and improve infrastructure effectiveness
• RSS adopted this process to align and reinforce
  the organization, all the while considering the
  underlying culture differences which naturally
  exist between partner hospitals.

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RSS Framework

• STRATEGY
• LHINs
• E-Health (MOHLTC)
• Growth (new sites)

CULTURE

• PROCESSES
• Financial
• Communications
• Requests
• Project Mgmt

• PERFORMANCE
• Service Level Agreements
• Balanced Scorecard

• PEOPLE
• RSS Staff
• Regional Hospital Partners
• Vendors
• LHSC Corporate (IT, Finance)

• STRUCTURE
• MOU (3)
• JMC
• User Groups

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Evolution of Star Model
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Balanced Scorecard (BSC)

• Developed by Kaplan and Norton in 1992, BSC is a
  performance measurement tool that measures the
  implementation of a strategic plan through the
  use of indicators grouped in 4 categories
• Customer (operations, reliability and service)
• Financial
• Quality (project mgmt, internal processes)
• Learning/ Innovation/ Growth

10/24/2009
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Measuring Performance

• As RSS evolves, it was deemed critical to
• Continually show value for investment
• Demonstrate sound stewardship of invested funds
• A Balanced Scorecard tool increases
  accountability
• Communicate progress to stakeholders
• Promote focus and dialogue
• Facilitate operational decision-making
• Assist in the prioritization of projects
• Provide guidance to staff in defining benchmarks

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Customer
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Financial
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Quality
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Learning and Innovation

• Early findings
• No clear, robust indicators have emerged
  preference to focus on other three quadrants
• Easier to demonstrate quick wins for use of BSC
• Reflective of startup nature of RSS
• Preliminary ideas on future indicators
• Leverage regional systems in place to provide
  rapid value add reports and assist in regional
  planning
• Cerner EPR/Surginet OR utilization?
• GE PACS/Radnet CT/MRI wait times?
• EPR/PACS utilization Hospital market share by
  patients postal code?

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Case study 1 Duplicate PINs in EPR

• 169,000 historical duplicates on regional EPR
• Staff workload in auditing CPI
• 1 FTE (Comm. Hospitals) 4 FTE (London
  Hospitals)
• Reconcile 5,000 duplicates each month
• With no added resources
• could take approximately 3.5 years to eliminate
  most duplicate records from the CPI
• 700 1,000 new duplicates added monthly
• Clearly a process that needs scorecard
  monitoring!

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Impact of Duplicate Records

• Patient safety issue
• Full record not accessible
• Cost to reconcile
• Decrease integrity of Provincial EMPI
• Regional records can not be properly linked
• No longer one patient, one record

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Duplicate PINs Action Plan

• Strategies to reduce occurrences
• Regional CEO awareness (via BSC)
• Engage Health Information Group
• Educate users on proper patient search (road
  shows)
• Provide error feedback to users
• Promote patient Naming Convention standard
• Require accurate complete information from
  referral sources
• Early results From 8 to 6 in 8 months

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Case study 2 Regional Compliance to Privacy
Standards

• EPR MOU contains a Privacy Addendum with roughly
  40 items covering
• Accountability and Openness
• Privacy Education
• System Access Policy
• Restrictions to paper PHI and requests to correct
  PHI
• Auditing and Breach policy/procedures
• Contracts/MOA's Data Share Agreements
• While partner hospitals signed, compliance was
  low (20), especially in approving/documenting
  policies.
• Clearly another process that needs scorecard
  monitoring!

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Privacy (non-) compliance Impact

• Only as good as the weakest link in preventing
  privacy breaches
• As clinical users can access records of other
  organizations ? trust becomes a factor
• Employees often work in multiple organizations ?
  requires the need for consistency amongst sites

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Privacy Compliance Action Plan

• Strategies to increase compliance
• Regional CEO awareness (via BSC)
• Engaged regional privacy officers
• Leveraged regional project to enhance access
• 80 compliance had to be achieved before each
  site could go live
• Early results
• From 20 to 85 of compliance in 8 months

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Key Learnings

• Combining elements of the star model and the
  balanced scorecard forms an effective approach
  developing a high-performing regional IT
  infrastructure.
• Regional relationships are enhanced by improving
  
• Performance
• Accountability
• Collaboration and Communication
• Trust and Respect

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The process does not end

• Star Model
• When making changes to strategy, review impact on
  other points of the star for alignment
• Balanced Scorecard
• Regularly review indicators
• Develop and Benchmark
• Measure Collect (Designated individual)
• Interpret (Management Team comments Action
  Plan)
• Share (Communication Plan to stakeholders)
• Evaluate the process

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Thank you!
For more information, contact stephane.ouellet_at_lh
sc.on.ca
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Additional readings

• Healthcare Quarterly, 7(4) 2004 34-42 Aligning
  the Stars Using Systems Thinking to (Re)Design
  Canadian Healthcare Brian R. Golden and Roger L.
  Martin
• Designing Organizations by J. Galbraith,
  Jossey-Bass Publishers, San Francisco, 1995
• Kaplan R S and Norton D P (1996) Balanced
  Scorecard Translating Strategy into Action
  Harvard Business School Press