Ministry of Health OLIS Adoption Strategy

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Transformational Change Achieving Performance
and Accountability through Behavioural
Change Liz Buller, Senior VP Patient Services,
William Osler Health System Barbara Pitts,
Associate Partner, PricewaterhouseCoopers June
10, 2010
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Agenda
Slide 1

• Background
• Oslers Requirements
• Methodology (Process Management) Governance
• Project Management
• Current State Assessment
• Key Considerations for Implementation Planning
• Tools and Techniques for Improving Accountability
  and Performance
• Key Success Factors
• Questions

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Background

• William Osler Health System (WOHS) is one the
  largest community hospitals in Ontario
• Serves one of the fastest growing, culturally
  diverse populations in Canada
• Amalgamated in 1998, WOHS has three sites two
  hospitals providing acute care services, and one
  (currently under re-development) that will
  provide ambulatory services
• New Brampton Civic Site opened Fall 2007

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Background (continued)

• The Health System Plan developed within the
  Central West Local Health Integration Network
  identified three key areas
• Mandate for the Health System A strong
  foundation of integrated community-based health
  services which is fully supported by an acute
  care system. The health service providers
  collectively deliver consistent, high-quality
  services at the most effective location for the
  citizens of the LHIN.

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Background (continued)

• Mandate for Community-based Health Services
  Community-based health services are the first
  point of contact for residents of the Central
  West LHIN. The goal is to provide more services
  which support health and well-being closer to
  where people live. The health service providers
  need to deliver services locally but manage in an
  integrated regional model.
• Mandate for Acute Care A fully integrated
  hospital system which provides a comprehensive
  range of services to meet the needs of LHIN
  residents and support the community-based service
  providers.

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Oslers Requirements

• Osler required transformational change designed
  to achieve the following objectives
• Improve patient access and flow
• Enhance care management
• Design regional health systems and
• Implement a financial improvement plan for Q4 of
  2009-10.

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Oslers Requirements (Continued)

• Identify a consulting firm with whom partner to
  support
• Current state assessment
• Detailed design
• Implementation planning and
• Full-scale execution.
• Utilize strong process and project management.
• Provide knowledge transfer and capacity building.

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Methodology to Support Process

• PwCs Health System Integration Methodology
• Five-step methodology that spans the gap from the
  awareness of the need to change to developing
  innovative solutions for the change to successful
  implementation.
• A "deliverables based methodology with gated
  review points.

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Governance Structure
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Project Management

• Transformation Management Office (TMO) a
  project management office established to provide
  oversight and guidance across all work streams to
  ensure consistency, continuity in applying
  standards of best practice and coordination of
  change management and communications.
• Project Management Tools and Processes An array
  of tools and techniques from the HSIM toolkit
  were employed by, such as
• Standardized Project Charters
• Standardized Status Reports
• Implementation Metrics

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Current State Assessment

• The organization-wide current state assessment
  resulted in the creation of 27 performance
  improvement projects that included both Quick
  Wins and longer term Design and Redesign
  projects.
• The projects spanned a wide range of focus,
  including
• The redesign of processes, policies and
  procedures and roles and responsibilities to
  improve patient access and flow from ER to
  discharge
• The design of regional health systems for cancer,
  seniors care, cardiovascular, mental health
  additions, and women children

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Current State Assessment (continued)

• Optimization of perioperative services including
  scheduling, OR blocks, turnaround times and CSR
• Surfacing and executing financial improvement
  initiatives to leverage opportunities for
  additional revenue generation or cost savings
  across the organization and
• The development of business cases for
  opportunities with a return on investment which
  contributed to the achievement of the goals.

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Key Considerations for Implementation Planning

1. What is the magnitude of change for the key
   stakeholders? What is the duration of the change?
2. What are the goals for execution? (i.e., What do
   we need to accomplish?)
3. What are the critical barriers and risks to
   successful implementation? How will they be
   managed / mitigated?
4. What resources are required for successful
   implementation? (e.g., people IT equipment
   space)

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Key Considerations for Implementation Planning

1. What indicators will need to be tracked during
   transition to ensure the changes are being
   adopted?
2. How are you going to communicate the benefits and
   success to the impacted stake holders (e.g.,
   patients, staff, physicians, management,
   partners)?
3. How is tracking and monitoring of success during
   transition going to be handled efficiently?
4. How will you use the information tracked during
   transition to support any course corrections if
   targets are not met?

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Tools and Techniques for Improving Accountability
and Performance Stake Holder Analysis and
Change Strategies
Early Adopters Late Adopters Resistors
list the stake holders here list the stake holders here list the stake holders here
Describe the mitigation strategies to be employed to optimize adoption by this stake holder group Describe any opportunity to leverage this group to influence the opinion of late adopters and resistors Describe the mitigation strategies to be employed to optimize adoption by this stake holder group Describe the mitigation strategies proposed to overcome resistance by this stake holder group
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Tools and Techniques for Improving Accountability
and Performance Implementation Reporting
Framework
Detailed Design (Phase 2a)
Implementation Planning (Phase 2b)
Phase 3 Implementation (Phase 3)
Sustainability

• No degradation of performance improvement
• Active responses to evolving changes in internal
  and external environment (continuous improvement
• Transition indicators
• Outcome indicators
• Permanent measurement systems in place for
  ongoing monitoring
• Transition indicators trending and exception
  reporting
• Senior Leadership dashboard

• Launch and execution
• Monitoring and reporting of performance
  improvements
• Adjustments based on feedback (primarily metrics)
• Transition indicators that reflect demonstration
  of real improvement (i.e. outputs of change)
• Temporary measurement systems in place
• Leverage existing systems where possible (via
  Fin, DSS)
• Transition reporting to SC via ACTION project
  Office
• SC presentations

Focus

• Design and development
• Alignment to project objectives
• Engagement of leadership and stake holders
• Progress and achievements of key milestones,
  deliverables in Phase 2
• Project management updates at project meetings
  (core extended PM)
• Status Reports
• SC presentations

Metrics
Data Collection
Reporting
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Tools and Techniques for Improving Accountability
and Performance ER Quick Win Registration
Triage

• Implementation Start Date January 4, 2010
• Baseline Average Unknown March 13 28
  Collection Began
• Narrative
• Over time the greet nurse attendance at the greet
  desk has been increasing, although last week the
  compliance trended down.
• This likely happened because we had a higher than
  average number of sick calls, and the ER was
  short staffed, and the greet nurse desk was not
  staffed during breaks.
• A suggestion was made to get the resource nurses
  to cover breaks when the ER experiences staffing
  shortages.

• 65

• 60

Better/Same as Previous Week
Worse Than Previous Week
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Key Success Factors

• Highly Engaged Leadership
• Executive Sponsors, Steering Committee members,
  Project Leaders, Project Managers and Physician
  Champions have
• led and advocated the importance of the project
  to physicians, administration and staff
• provided support to the teams when working
  through challenges and risks and approving or
  proposing innovative solutions.

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Key Success Factors (continued)

• Rigorous Project Management Structures and
  Processes
• Standardized project management and gated reviews
  facilitated
• The coordination of project activities in a
  consistent manner that adhered to the principles
  embedded in transformation (i.e., high quality
  patient-centred evidence-based supportive of
  the LHIN, etc.)
• Consistent monitoring of progress and risk and
• Reporting genuine performance improvement in a
  measureable manner and making course corrections
  in real time.

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Key Success Factors (continued)

• Knowledge Transfer
• Osler staff and the PwC team worked in a highly
  collaborative manner to develop and improve
  capacity.
• All Project Leaders were Osler management staff
  to ensure decisions were made locally and
  supported by the PwC project managers.
• A number of Osler employees were seconded
  specifically to lead work streams in order to
  maximize the knowledge transfer during the
  engagement so future initiatives can be executed
  effectively by the hospital.

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Slide 20
Questions Comments