Public sector/stakeholder collaboration - moving beyond

1
Public sector/stakeholder collaboration - moving
beyond the clenched fist

• Strategies for Public Sector Transformation 2002
• - October 16, 2002

2
Agenda

• introduction
• Physician Office System Program
• a case study
• challenges solutions

You cannot shake hands with a clenched
fist - Indira Gandhi
3
Introduction

• lessons learned from walking in the other guys
  moccasins
• experience is the best teacher or how I got the
  scars on my back
• Alberta Wellnet
• CYNCH
• Western Health Information Collaborative
• Alberta One Window
• Common opportunities
• Western Canadian Continuing Care EHR Initiative
• Physician Office System Program
• the usual disclaimer

4
The Physician Office System Program
A case study
5
Physician Office System Program

• joint initiative of the Alberta Medical
  Association and Alberta Health Wellness
• negotiated under the AMA/AHW master agreement
• a contractual relationship
• provides three types of assistance to the
  physician
• financial assistance to defray the cost of
  hardware/software
• information technology services
• change management services
• targets improvement in physician office systems,
  services and business models (e.g., ASP)

6
POSP vision
to establish a physician office information
infrastructure that is integrated with the health
information system
7
EHR a longitudinal record of a patients
health healthcare, from cradle to grave
Electronic health record
Physician office system Electronic medical
record Integrated decision support Billing Sch
eduling Office productivity tools
Stand-alone information sources Labs Pharmacies R
adiologists
Regional clinical systems - acute MPI/ADT Lab Pha
rmacy ER Radiology Home care Immunization Speech
Pathology
Regional clinical systems sub-acute and
continuing care Continuing care delivery
systems, including case management, care
protocols, clinical data and reports Client/patien
t surveys
Interface
8
Physician Office System Program
AMA
AHW
Finance Cttee.
POSP Subcommittee
Evaluation Howard Research
Program Management Office
Program Director Program Support Admin. Assistant
Operations (AMA)
Communications (AMA/AHW)
IT Delivery (alberta we//net)
Change Management
9
Delivery of change management services
POSP Program Director Program Support Admin.
Assistant
Operations
IT Delivery
Communications
Change Management Manager Karen Shimko
Advisor Nancy Stewart
Advisor South
Sub-contracted Expert Field Resources
Sub-contracted Expert Field Resources
Sub-contracted Expert Field Resources
Sub-contracted Expert Field Resources
Expert Field Resources
Expert Field Resources
Expert Field Resources
Expert Field Resources
10
POSP results to date...

• 1,212 physician participants to date target
  2,138
• standing offers for physician office system
  vendors developed (1st in Canada) 2nd round of
  requirements definition underway
• physician led 5 stakeholder groups
• national and regional participation
• POS to POS interface feasibility study in process
• support for electronic reporting of lab results
• standing offers for Microsoft and Dell negotiated

11
POSP results to date

• first of its kind change management program
• web-based tools (POSP Software Lab, electronic
  doctors lounge), communication and knowledge
  products, workshops (computer literacy, decision
  support, change management, privacy impact
  assessments) on-site consultations
• communications strategy and products developed
• external evaluation ongoing, first reports issued
• operational, change management and groupware IT
  systems implemented

12
POSP results to date

• cited as the premier physician program in
  Alberta
• seen as a successful collaboration by the Program
  sponsors
• proposed for renewal by both sponsors

13
IT services

• POSP developed standing offers with vendors for
  the delivery of hardware and software that will
  support achievement of physicians program
  outcomes
• standing offers published April, 2002
• first time in Canada comprehensive physician
  office system requirements articulated

14
Learning as we go

• significant learnings through standing offer
  process
• external evaluation conducted and results shared
  with stakeholders
• process was fair
• no need to issue another RFP
• POSP should develop and maintain standards
• independent evaluation agency should evaluate
  applications against standards

15
Benefits of this approach

• consultation with stakeholders will
• ensure requirements carry weight
• address vendors business issues
• result in increased alignment between physicians
  other stakeholder needs and vendor offerings
• allows time for vendors to meet any new
  requirements
• vendors who already meet VCUR can market by
  reference to these requirements, as soon as
  requirements published

16
Public sector/stakeholder collaboration
Lessons learned
17
Barriers to successful collaboration

• absence of shared vision, commitment
• inappropriate governance model
• lack of specificity re outcomes targets
• lack of clarity re roles responsibilities
• misunderstanding the nature of the relationship
• inadequate resourcing of the collaborative effort
• positional stereotyping mistrust
• dogmatic adherence to past decisions

18
Strategies that work

• you cant outsource strategic planning
• business owners need to own the vision and
  define/approve key strategies
• environmental scan helps clarify the larger
  picture
• listen with an empty teacup

19
Strategies that work

• give careful thought to your governance structure
  and respect it once its in place
• appropriate to the task
• terms of reference
• if youve delegated authoritydont meddle! but
  hold parties accountable with respect to
  agreed-upon outcomes
• consider orientation to ensure governance level
  and operating level are clear on respective roles
  and responsibilities

20
Strategies that work

• collaboration requires dedicated resources
• consider implementing an appropriately resourced
  program management structure, accountable to the
  project sponsors
• keeping sponsors, stakeholders informed is key

21
Strategies that work

• articulate and communicate expected outcomes,
  targets
• link to strategies
• assign owners to strategies
• monitor and report on performance relative to
  these outcomes
• linkage with related initiatives?

22
Outcomes/targets example
23
Linking outcomes to strategies
24
Strategies that work

• dont confuse the way you treat people with the
  nature of the business relationship
• partnership?
• contractual relationship?
• dont expect a vendor to act like the owner of
  the initiativetheir primary focus is their own
  bottom line
• dont let suspicion based on different agendas
  taint the relationship

25
Strategies that work

• do your best not to fall back on stereotypes
• encourage a climate of continuous improvementits
  okay not to get it perfect the first time!
• formal evaluation function or periodic external
  reviews are just good practice
• dont get trapped sticking with decisions that
  time circumstances have proven sub-optimal
• change what you can on the fly schedule reviews
  when more substantive policy changes can be
  implemented
• invite the stakeholders in at the earliest
  opportunitydoesnt have to be perfect

26
Getting beyond the clenched fist
The law of win/win says lets not do it your
way or my waylets do it the best way
- Greg Anderson The 22 Non-negotiable Ways of
Wellness