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Forum Workbook The Challenge Dialogue System TM

Central LHIN – Health Integration Forum: Applying Outcome Mapping for

Systemic Change

Forum Sponsored by—

The Central Local Health Integration Network in Partnership with the Faculty of Health, York University (Longitudinal Evaluation Initiative)

Organizing Team —

Hy Eliasoph, CEO Central LHIN

Kim Baker, Senior Director, Planning, Integration and Community Engagement, Central LHIN

Harvey Skinner, Dean, Faculty of Health, York University

Keith Jones, David Forrest & Don Juzwishin, Innovation Expedition Consulting Ltd. and as associates of the Faculty of Health, York University

March 5, 2009

Holiday Inn–Markham, Ontario

Central LHIN – Health Integration Forum: Applying Outcome Mapping for Systemic Change March 5, 2009 / Holiday Inn, Markham Page i

Welcome and Thank You!

Dear Colleague,

We are delighted to welcome you to the Forum on Applying Outcome Mapping for Systemic Change. Over the course of this one-day workshop we will be learning about and exploring the results of an exciting Outcome Mapping project. This work was conducted in the spring and summer of 2008. A number of you contributed to its development by way of interviews and participation in the Outcome Mapping Steering Committee. We appreciate the input you provided.

This somewhat new approach helps us to visualize and express more explicitly our shared strategic intentions for improving the performance of heath care across the Central LHIN. We think you will find the results interesting and, more importantly, useful as a tool to understand and think through the many challenges and opportunities we must address together.

The Outcome Mapping project represents the first product of a partnership between the Central LHIN and the Faculty of Heath at York University. One aspect of this partnership is focused on undertaking a longitudinal evaluation of the Central LHIN’s progress towards its vision. This work looks at the Central LHIN systemically.

While the Outcome Map provides a framework for the longitudinal evaluation work, we think it also serves as a form of road map for our strategies and actions. In November 2008, the Outcome Map was presented to the Central LHIN Board. The Board encouraged the staff to move forward and start to use it. They have used it to map out existing projects and initiatives, assess gaps (e.g., the Service Needs Assessment and Gap Analysis project) and evaluate priorities. A few health service providers have also started to explore the application of the Outcome Map from their own organizational and stakeholder perspective. You will hear about these developments today.

Based on what we learn today, our plan is to engage a wider set of Central LHIN health service providers and stakeholders in similar discussions. We look forward to hearing your ideas about how we might accomplish this most effectively.

In addition to thanking those who contributed to the development of the Outcome Map last year, we would also like to acknowledge those who have provided very helpful ideas for the design of this forum. Lastly, we wish to thank those who agreed to share some of their ideas in the brief presentations today — Cheryl Avrich, Aura Kegan and Karen O’Connor.

I hope you will find today’s sessions interactive, informative, innovative, practical and fun. Thanks for taking the time out of your busy schedules to be here. Let’s see if the Outcome Map helps us to better “connect the dots” .

Kind regards,

Hy Eliasoph

CEO, Central LHIN

Harvey Skinner

Dean, Faculty of Health, York University

Central LHIN – Health Integration Forum: Applying Outcome Mapping for Systemic Change March 5, 2009 / Holiday Inn, Markham Page ii

Agenda

THURSDAY, MARCH 5, 2009 — Holiday Inn – Markham

8:30 am Assemble—Coffee, Tea and Refreshments

9:00 am

Session 1: Welcome, Introductions & Setting Context and the Stage for a Productive, Collaborative Workshop

Hy Eliasoph, Central LHIN, Harvey Skinner, York University and Keith Jones, Innovation Expedition Consulting Ltd. – York University

9:30 am

Session 2: Results of the Outcome Mapping Project & Learning How to Read, Navigate and Interpret the Outcome Map

David Forrest and Keith Jones; Scavenger Hunt by participants

10:30 am Refreshment Break

10:45 am

Session 3: Initial Application of the Outcome Map by the Central LHIN – Distribution of Existing Projects, Priority-Setting and Decision- Making (always keeping in focus the desired systemic outcomes)

Kim Baker, Sr. Dir. Planning, Integration and Community Engagement, Central LHIN

11:30 am

Session 4: Health Service Provider Perspectives on Applying the Outcome Map (to help guide their efforts internally and among their key partners); Spotlights and Discussion

Cheryl Avrich, Dir. Planning and Decision Support, York Central Hospital (and Outcome Mapping Steering Committee)

Aura Kagan, Exec. Dir., Aphasia Institute North York Hospital (and Outcome Mapping Steering Committee)

Karen O’Connor, Dir. Specialized Services and Research, Canadian Mental Health Association

12:00 am Lunch

12:45 am

Session 5: Starting to Act on the Central LHIN’s Top Priority Areas by Applying the Outcome Map

Self-selected table group assignment on addressing priority areas informed by the Outcome Map

2:30 pm Refreshments

2:45 pm

Session 6: Engaging Others in the Central LHIN about the Outcome Map and its Application

Plenary brainstorming of ideas that would most effectively engage others in the LHIN about the Outcome Map and its application

3:30 pm Session 7: Next Steps and Wrap-up

Hy Eliasoph and Harvey Skinner

Central LHIN – Health Integration Forum: Applying Outcome Mapping for Systemic Change March 5, 2009 / Holiday Inn, Markham Page iii

Table of Contents

WELCOME AND THANK YOU! ...................................................................................................... I

AGENDA ................................................................................................................................. II

PURPOSE OF THIS WORKBOOK................................................................................................. 1

SESSION 1: WELCOME – INTRODUCTIONS & SETTING THE CONTEXT AND STAGE FOR A PRODUCTIVE COLLABORATIVE FORUM........................................................ 1

1.1 PURPOSE ................................................................................................................................ 1 1.2 RESOURCES............................................................................................................................ 2 1.3 OUTCOME MAPPING STEERING COMMITTEE .......................................................................... 2 1.4 OUTCOME MAPPING INFORMANTS ......................................................................................... 2 1.5 FORUM DESIGN INFORMANTS ................................................................................................ 3 1.6 SUGGESTED RULES OF THE ROAD FOR NURTURING COLLABORATION ................................... 4 1.7 EXPECTED OUTCOMES FOR THE WORKSHOP .......................................................................... 7 1.8 TASKS FOR SESSION 1 ............................................................................................................ 7

SESSION 2: RESULTS OF THE OUTCOME MAPPING PROJECT AND LEARNING HOW TO READ, NAVIGATE AND INTERPRET THE MAP................................................... 8

2.1 PURPOSE ................................................................................................................................ 8 2.2 RESOURCES............................................................................................................................ 8 2.3 OVERVIEW OF OUTCOME MAPPING........................................................................................ 8 2.4 OUTCOME MAPPING RESULTS.............................................................................................. 15 2.5 TASKS FOR SESSION 2 — OUTCOME MAPPING SCAVENGER HUNT ...................................... 16

SESSION 3: INITIAL APPLICATION OF THE OUTCOME MAP BY THE CENTRAL LHIN .... 18 3.1 PURPOSE .............................................................................................................................. 18 3.2 RESOURCES.......................................................................................................................... 18 3.3 TASKS FOR SESSION 3 .......................................................................................................... 18 3.4 INTEGRATED HEALTH SERVICES PLAN 2 – CONCEPTUAL FIGURE ........................................ 19

SESSION 4: HEALTH SERVICE PROVIDER PERSPECTIVES ON APPLYING THE OUTCOME MAP.................................................................................................... 20

4.1 PURPOSE .............................................................................................................................. 20 4.2 RESOURCES.......................................................................................................................... 20 4.3 TASKS FOR SESSION 4 .......................................................................................................... 20

SESSION 5: STARTING TO ACT ON THE CENTRAL LHIN’S TOP PRIORITY AREAS BY APPLYING THE OUTCOME MAP ........................................................................ 21

5.1 PURPOSE .............................................................................................................................. 21 5.2 RESOURCES.......................................................................................................................... 21 5.3 DRAFT CENTRAL LHIN PRIORITY AREAS............................................................................ 21 5.4 OPEN SPACE PROTOCOL....................................................................................................... 22 5.5 TASKS FOR SESSION 5 .......................................................................................................... 23

Central LHIN – Health Integration Forum: Applying Outcome Mapping for Systemic Change March 5, 2009 / Holiday Inn, Markham Page iv

SESSION 6: ENGAGING OTHERS IN THE CENTRAL LHIN ABOUT THE OUTCOME MAP AND ITS APPLICATION ....................................................................................... 24

6.1 PURPOSE OF THIS SESSION.................................................................................................... 24 6.2 RESOURCES.......................................................................................................................... 24 6.3 TASKS FOR SESSION 6 .......................................................................................................... 24

SESSION 7: NEXT STEPS AND WRAP-UP............................................................................... 25 7.1 PURPOSE OF THIS SESSION.................................................................................................... 25 7.2 RESOURCES.......................................................................................................................... 25 7.3 TASKS FOR SESSION 7 .......................................................................................................... 25

APPENDIX 1: LIST OF PUBLICATIONS THAT INSPIRED THE DEVELOPMENT OF OUTCOME MAPPING........................................................................................... 26

APPENDIX 2: FORUM PARTICIPANTS ...................................................................................... 27

The constraints we feel are holding us back are often self-imposed.

Central LHIN – Health Integration Forum: Applying Outcome Mapping for Systemic Change March 5, 2009 / Holiday Inn, Markham Page 1

Purpose of this Workbook

The purpose of this Workbook1 is:

To provide a guiding framework for the Forum participants to understand and start to apply the Outcome Mapping tool.

To set the scene for a Forum that is intended to be interactive, informative, innovative, practical and fun.

To provide take away reference material for participants to use in follow-up discussions with their colleagues, including those that were unable to attend this Forum. Please feel free to share it. An electronic version has been posted on the Central LHIN’s website — http://www.centrallhin.on.ca/.

Session 1: Welcome – Introductions & Setting the Context and Stage for a Productive Collaborative Forum

1.1 Purpose • To provide Hy Eliasoph, CEO, Central LHIN and Harvey Skinner, Dean,

Faculty of Health, York University, with an opportunity to welcome and thank the participants to the workshop and make a few introductory remarks to set the context for the Outcome Mapping work that was done and their expectations for the Forum.

• To thank the people that freely provided their initial thoughts and ideas that were used to help shape the Outcome Map; that provided the guidance and refinements of the Steering Committee; and that most recently offered ideas for the design of this Forum.

• To provide time for the Forum participants to:

o Introduce themselves at their Table Groups and affirm why they are here today.

o Review the Rules for the Road.

o Review and seek alignment on the Expected Outcomes for the Forum.

1 This Workbook is one of a number of tools developed by the Innovation Expedition Inc. for its Challenge Dialogue SystemTM — a disciplined process that engages diverse groups on discovering collaborative and innovative solutions to complex challenges. www.innovationexpedition.com.


• To outline the Agenda, processes and approximate timeframes, Workbook content, other support resources and logistics.

1.2 Resources • “Welcome and thank you” note from Hy Eliasoph and Harvey Skinner – see

Workbook page i.

• Outcome Mapping Steering Committee – see section 1.3, this page.

• Outcome Mapping Informants – see section 1.4, this page.

• Forum Design Informants – see section 1.5, page 3.

• List of Forum participants – see Appendix 2, page 4.

• Rules for the Road – section 1.6, page 4.

• Expected Outcomes for the Workshop – section 1.7, page 7.

• Workshop Agenda on page ii and Workbook Table of Contents on page iii – iv.

1.3 Outcome Mapping Steering Committee The Outcome Mapping initiative was initiated in April 2008. The development of the map was guided by a Steering Committee comprising:

• Kim Baker, Senior Director, Planning and Integration and Community Engagement, CLHIN

• Aura Kagan, Executive Director, Aphasia Institute

• Cheryl Avrich, Director, Planning and Decision Support, York Central Hospital

• Joel Moody, Epidemiologist, CLHIN

• Harvey Skinner, Dean Faculty of Health, York University

• Elaine Walsh, CLHIN Board member

• Mary Wiktorowicz, Chair, School of Health Policy and Management, Faculty of Health, York University

• Peter Tsasis, Asst. Professor, School of Health Policy and Management, Faculty of Health, York University

1.4 Outcome Mapping Informants In addition to individual interviews conducted with the Steering Committee members, conversations were also held with a cross-section of Central LHIN health service providers:

• Hy Eliasoph, CEO, Central LHIN

• Paul Barker, (formerly) Performance, Contracts and Allocations, Central LHIN


• Simon Cheng, (formerly) Director, Human Services Planning Branch, Regional Municipality of York

• Perry Doody, Senior Director, Performance Management & Accountability, Central CCAC

• Peter Finkle, Chief Operating Officer, South Lake Regional Health Centre

• Francesca Fiumara, Project Manager eHealth, Central LHIN

• Larry Grossman, Chief of Staff, York Central Hospital

• Kathleen Heslin, Chief Nurse Executive & Chief Practice Officer, York Central Hospital

• Nancy Hunter, (formerly) Senior Consultant, Decision Support, Central LHIN

• Mendel Janowski, Community Development Coordinator, York Central Hospital

• Aura Kagan, Executive Director, Aphasia Institute

• Bill Krever, President and CEO, Better Living Health and Community Services

• Nancy Kula, President and CEO, Unionville Home Society

• Rakesh Kumar, Chief of Emergency Services, Humber River Regional Hospital

• Nizar Ladak, Chief Information Officer, North York General Hospital

• Steve Lurie, Executive Director, Canadian Mental Health Association – Toronto Branch

• Jo-Anne Marr, Vice President, Programs, York Central Hospital

• Donna McRitchie, Director of Critical Care, North York General Hospital

• Nancy Merrow, Chief of Staff, South Lake Regional Health Centre

• Patti Reed, Consultant, Distance Learning Group

• Gary Ryan, President and Chief Executive Officer, Stevenson Memorial Hospital

• Diane Salios-Swallow, Chief Information and Privacy Officer, York Central Hospital

• Neil Walker, Chief Operating Officer, Markham Stouffville Hospital

• Terry Winston, Executive Director, Hospice Thornhill

1.5 Forum Design Informants The following people provided helpful input to the design of this Forum:

• Hy Eliasoph, CEO, Central LHIN

• Kim Baker, Senior Director, Planning and Integration and Community Engagement, Central LHIN

• Elaine Walsh, Central LHIN Board member


• Francesca Fiumara, Project Manager eHealth, Central LHIN

• Cheryl Avrich, Director, Planning and Decision Support, York Central Hospital

• Larry Grossman, Chief of Staff, York Central Hospital

• Jo-Anne Marr, Vice President, Programs, York Central Hospital

• Kathleen Heslin, Chief Nurse Executive & Chief Practice Officer, York Central Hospital

• Rochelle Cohen Schneider, Program Director: Pat Arato Aphasia Centre and Coordinator of On-site Training, Aphasia Institute

• Michelle Christian, Executive Assistant and Manager of Communications, Aphasia Institute

• Steve Lurie, Executive Director, Canadian Mental Health Association – Toronto Branch

• Karen O’Connor, Director Specialized Services and Research, Canadian Mental Health Association – Toronto Branch

• Perry Doody, Senior Director, Performance Management & Accountability, Central CCAC


• Nancy Kula, President and CEO, Unionville Home Society

• Rakesh Kumar, Chief of Emergency Services, Humber River Regional Hospital


• Nancy Merrow, Chief of Staff, South Lake Regional Health Centre

• Terry Winston, Executive Director, Hospice Thornhill

• Nizar Ladak, Chief Information Officer, North York General Hospital

1.6 Suggested Rules of the Road for Nurturing Collaboration

1. We commit to do everything we can to learn how to work together efficiently and effectively to accomplish our tasks. Among other things this means making every effort to honour and respect the diversity of experience and of learning and decision-making styles in our group.

2. We will focus on using the principles of Dialogue as opposed to Debate in exploring issues and options (section 1.6.2, pages 6-7).

3. We will use the concept of Alignment as opposed to Agreement in order to improve our capacity to make quick, quality, team decisions. Alignment here describes the state of group agreement in a specific context. It does not mean, necessarily, complete agreement. It means that, while a suggestion may not be your top priority, you are prepared to recognize it as one of the team’s priorities and you will allow the dialogue to move forward in order to achieve the objectives of the meeting.


We will pledge in our discussions to:

help maximize participation by all group members

ensure that the focus remains on the task assigned

ensure the capture the key ideas of the group on flip charts

help the group accomplish each task in the allotted time

4. We will use the flip charts as our main way of documenting and sharing input and for capturing the results of the dialogue.

5. We acknowledge that the operating culture will be that of an informal but serious conversation.

6. While bun fights are not encouraged, we will only use underhand throws.

7. We will honour these rules governing our session today until we decide to change them.

1.6.1 The Alignment Tool for Quick, Quality Team Decision Making

Purpose: To help people make quick, quality team decisions.

Alignment — What is it? A tool for quick quality team decisions.

Describes a state of group commitment in a specific context.

Not necessarily complete agreement.

If proposed action remains a priority, then all team members will support the action. The action is seen as a high priority worth supporting though it may not have been their individual top priority.

1.6.2 Distinguishing Between Dialogue and Debate

While there is considerable recognition now of the importance of collaboration, network building and co-creation, too often our old instincts drive our action and turn our conversations into struggles over proving the position of others is wrong, that we are right, and that our approach should be embraced.

To stimulate one’s thinking about the tools for nurturing high level, collaborative conversations aimed at developing breakthrough solutions to complex tasks we offer the following distinctions between Dialogue and Debate.


Dialogue Debate

• Dialogue is collaborative: two or more sides work together toward common understanding.

• Debate is oppositional: two sides oppose each other and attempt to prove each other wrong.

• In dialogue, finding common ground is the goal.

• In debate, winning is the goal.

• In dialogue, one listens to the other side(s) in order to understand, find meaning, and find agreement.

• In debate, one listens to the other side in order to find flaws and to counter its arguments.

• Dialogue enlarges and possibly changes a participant's point of view.

• Debate affirms a participant's own point of view.

• Dialogue reveals assumptions for re-evaluation.

• Debate defends assumptions as truth.

• Dialogue causes introspection on one's own position.

• Debate causes critique of the other position.

• Dialogue opens the possibility of reaching a better solution than any of the original solutions.

• Debate defends one's own positions as the best solution and excludes other solutions.

• Dialogue creates an open-minded attitude: openness to being wrong and an openness to change.

• Debate creates a closed-minded attitude, a determination to be right.

• In dialogue, one submits one's best thinking, knowing that other people's reflections will help improve it rather than destroy it.

• In debate, one submits one's best thinking and defends it against challenge to show that it is right.

• Dialogue calls for temporarily suspending one's beliefs.

• Debate calls for investing wholeheartedly in one's beliefs.

• In dialogue, one searches for basic agreements

• In debate, one searches for glaring differences.

• In dialogue, one searches for strengths in the other positions.

• In debate, one searches for flaws and weaknesses in the other positions.

• Dialogue involves a real concern for the other person and seeks to not alienate or offend.

• Debate involves a countering of the other position without focusing on feelings or relationship and often belittles or deprecates the other person

• Dialogue assumes that many people have pieces of the answer and that together they can put them into a workable solution.

• Debate assumes that there is a right answer and that someone has it.


1.7 Expected Outcomes for the Workshop Drawing on ideas expressed by the design team and the design interviews, we advance the following expected outcomes for your consideration.

1. Report back on the results of the Outcome Mapping project.

2. Learn how to read, navigate and interpret the Outcome Map.

3. Learn about how the Outcome Map is starting to be used by the Central LHIN and some health service providers.

4. Gain some initial experience in applying the Outcome Map to address some Central LHIN priorities collaboratively.

5. Provide input to a plan aimed at engaging others in the Central LHIN about Outcome Mapping and its application.

1.8 Tasks for Session 1 • At your Table Groups please introduce yourselves sharing with one another why

you decided to attend this Forum and what your expectations are of it.

• Please review the Rules for the Road on page 4– can you accept these as the group’s operating principles for the day?

• Please review the Expected Outcomes for the Forum above — are you aligned with these? What adjustments would you like to see? What expectations would you like to add, recognizing that we only have a short time together today?

Notes


Session 2: Results of the Outcome Mapping Project and Learning How to Read, Navigate and Interpret the Map

2.1 Purpose To provide some background information on Outcome Mapping. Note –

much of this material is provided for later reference.

To briefly outline the process that was used to create the Outcome Map.

To share and explain the results of the Outcome Mapping project.

To learn how to read, navigate and interpret the Outcome Map.

2.2 Resources Overview of Outcome Mapping – section 2.3, page 8-14.

Results of Outcome Mapping – section 2.4, page 15-16.

Outcome Maps, Logic Models and Scrapbooks – available at the Table Groups.

List of publications that inspired the development of Outcome Mapping – Appendix 1, page 26.

2.3 Overview of Outcome Mapping Outcome mapping is a new approach for defining and managing complex, multi-stakeholder strategic initiatives. It clarifies the outcomes that must be achieved to realize strategy, and identifies all of the necessary and sufficient actions required to achieve them. When completed, the map becomes a detailed “roadmap” for execution, and provides a framework for performance measurement to confirm that the intended outcomes are actually being achieved.

By thinking through the strategy we create a roadmap for execution and performance measurement. Accountability is assigned for every action, and implementation is actively managed by monitoring outcomes. Each stakeholder can see exactly where their own contributions complement the contributions of others in achieving the intended strategic goals.

A Modelling Technique

Outcome mapping is a modelling technique that creates a visual representation of strategy on a single page. The desired strategic outcomes are located typically on the right-hand side of the map. Projects and enabling outcomes that


Legend

Strategic outcome

Outcome

Project

Assumption

Contribution

contribute to achieving these strategic outcomes are positioned throughout the map. Arrows show how the enabling outcomes contribute to the end result.

Clusters of actions and outcomes in the map relate to the creation or enhancement of capabilities required to implement the strategy.

Symbols

The symbols used in outcome mapping represent strategic outcomes, enabling outcomes, projects or actions, assumptions, and contributions.

Strategic outcomes are the ultimate strategic goals.

Enabling outcomes are stepping stones to achieving the targeted strategic goals. They are usually expressed in a way that is measurable or verifiable.

Projects are formalized work activities designed to produce specific and measurable outcomes.

Assumptions describe special conditions under which an outcome will be achieved – where there is uncertainty that these conditions will exist and that the desired outcome will be realized. Assumptions highlight risks to successful implementation of the strategy.

Contributions explicitly show the relationship between actions and outcomes. Collectively, they define the logic for implementing a strategy.

Chains of Enabling Outcomes

Strategic outcomes are created through chains of enabling outcomes. Each chain starts with an action that creates an initial outcome. This outcome – combined with others -- supports the achievement of higher-level outcomes downstream (see figure next page).


Figure: Chains of Enabling Outcomes

ACTION - Translate strategy into individual stakeholder action plans

STRATEGIC OUTCOME - Caring communities, healthier people, and health system sustainability

ENABLINGOUTCOMES


A Tool for Successful Implementation

Outcome mapping provides a strong foundation for the successful implementation of strategy. Many strategies fail due to a variety of risks.

How do we define success?

IncreasedBusiness

Value

FragmentedVision

PoorStrategic

Alignment

IncompleteSponsorship

WeakCommitment

PoorlyDefinedRoles

IneffectiveProgram

Mgmt

Poorly Defined

Outcomes

EXPECTED OUTCOMESMAY NOT BE

ACHIEVED

Are we doing what we need to do to get there?

What are we trying to accomplish?

Are we getting the results we intended?

Are stakeholders committed?

Does everyone know what they need to do?

Is there strong leadership?

How do we define success?

IncreasedBusiness

Value

FragmentedVision

PoorStrategic

Alignment


WeakCommitment

PoorlyDefinedRoles

IneffectiveProgram

Mgmt

Poorly Defined

Outcomes


ACHIEVED







IncreasedBusiness

Value

FragmentedVision

PoorStrategic

Alignment


WeakCommitment

PoorlyDefinedRoles

IneffectiveProgram

Mgmt

Poorly Defined

Outcomes


ACHIEVED

IncreasedBusiness

Value

FragmentedVision

PoorStrategic

Alignment


WeakCommitment

PoorlyDefinedRoles

IneffectiveProgram

Mgmt

Poorly Defined

Outcomes


ACHIEVED


ACHIEVED













Shared vision

• communicates the logic and rationale for getting results;

• shows how each action contributes to outcomes;

• identifies required necessary and sufficient actions;

• surfaces key assumptions; and

• provides an effective way of communicating with stakeholders.

Increased strategic alignment

• ensures that actions produce outcomes that are aligned with strategic objectives;

• provides a high-level view of the required change;

• identifies targeted results; and

• explicitly links actions to outcomes.

Well-defined outcomes

• clarifies expected strategic outcomes;

• identifies specific outcome streams;


• establishes metrics to measure the achievement of results; and

• creates an action plan for implementation that has a much higher likelihood of delivering the anticipated results.

Complete sponsorship

• shows the full scope of required activity; and

• surfaces sponsorship issues and assumptions.

Clear commitment

• establishes a process for involvement and buy-in at all levels.

Well-defined roles

• defines accountability and responsibility for actions and outcomes in a measurable way.

More effective program management

• provides a roadmap for executing the strategy and monitoring results;

• shows the complete scope and effort required to implement the strategy;

• integrates all of the required enabling capabilities (process, technology, organization, people, product, and assets);

• identifies sources of risk and defines mitigating actions;

• documents major assumptions that may impact program delivery; and

• shows the downstream impact of issues encountered during delivery.


A Bridge Between Planning and Execution

The outcome map creates a bridge between planning and execution: encouraging clear thinking when developing strategy, and providing a framework that can be used during implementation to assign accountability, monitor progress, and measure performance.

Notes


15

This represents a fundamental shift in thinking, from just doing projects

to delivering value…

A fundamental shift in thinking

GETTING RESULTS

© Global Vision Consulting Ltd., 2005-2007

Focus on completing

PROJECTS

Focus on completing

PROJECTS

Focus on delivering

VALUE

Focus on delivering

VALUE

© Innovation Expedition Consulting Ltd. 200815

47 47

From concept to completion

THE OUTCOME MAPPING LIFE-CYCLE

• The outcome map documents the program in terms of the intended outcomes and required actions

• Building the model helps to improve program design to maximize value and minimize risk

Programdelivery

Programcommitment

Programdesign

• The outcome map is used to develop a detailed program implementation plan

• Priorities, timelines and accountabilities are defined and a performance measurement framework is put in place

• The outcome map is used as a roadmap to manage delivery and communicate the achievement of results

• Performance is measured as projects are completed• Early outcomes serve as leading indicators to

validate that the program is on track in delivering the intended value

• Project and environmental changes are assessed to see if they impact the outcome logic and program value

© Innovation Expedition Consulting Ltd. 200847


2.4 Outcome Mapping Results The Outcome Mapping project produced four deliverables:

1. The Outcome Map (best viewed from a print with dimensions no less than around 34 x 22”).

2. A companion report which describes the Outcome Map in general terms and in more detail by Capability area.

3. Two simplified expressions of the Outcome Map in the form of Logic Model:

• Simple Logic Model in standard 8.5 x 11” format.

• Detailed Logic Model in tabloid format (11 x 17”).


4. Outcome Map – Scrapbook: Integrated Health Service Plan and Other Themes & Linkages to the Service Needs Assessment and Gap Analysis Project

2.5 Tasks for Session 2 — Outcome Mapping Scavenger Hunt • In your Table Groups please reflect on and discuss the Outcome

Mapping overview presentation and note on your flip chart any further questions your group may have. Please use the Outcome Map and the Scrapbook to accomplish these tasks.

• Scavenger Hunt – the following questions are aimed at helping you to read, navigate and interpret the map.

1. Identify, count and note the statements in the strategic outcomes.

2. Identify, count and note the statements in the enabling outcomes.

3. What action realizes the outcome at map coordinate F-G/09?

4. What outcome occurs at map coordinate F/07? … and at C-D/11?

5. What two outcomes contribute to the enabling outcome “The health system is better able to respond to growing pressures”?

6. How many capability areas are there?

7. Note and count how many contributing outcomes were necessary and sufficient to achieve the outcome at: a) map coordinate H/06? … and, b) map coordinate C/05?


8. Starting with action “Increase collaboration with regional planning authorities” (in the Breadth of Service capability area), through what outcomes does that contribute to the strategic outcome “Caring communities, healthier people and health system sustainability”?

9. What would be the affect of progress not being made on outcome D/10?

10. What outcome relates to “transportation” challenges?

11. What actions and outcomes related to “equity”?

12. What outcomes relate to data “accessibility”?

13. What outcomes affect the length of stay of a patient?

14. What area in the map is most focused on “efficiency”?

15. What area in the map is most focused on “quality”?

16. What two areas in the map are most focused on “policy” and “governance”?

17. What two areas in the map are most related to “performance”?

Notes


Session 3: Initial Application of the Outcome Map by the Central LHIN

3.1 Purpose To learn about how staff in the Central LHIN are starting to apply the

Outcome Map to map out existing projects and initiatives, assess gaps (e.g., the Service Needs Assessment and Gap Analysis project) and evaluate priorities.

3.2 Resources Outcome Map (front of room) annotated with “Post-its” for existing projects.

Outcome Map, Logic Models and Scrapbooks provided at the Table Groups.

Integrated Health Services Plan 2 – Conceptual Figure – section 3.4, page 19.

3.3 Tasks for Session 3 • Kim Baker of the Central LHIN will make a brief presentation.

• In your Table Groups please reflect on what Kim has presented regarding applications of the Outcome Map by the Central LHIN. In your Table Groups please note on the flip chart 2-3 key questions, comments or observations and be prepared bring them forward for discussion in plenary.

Notes


3.4 Integrated Health Services Plan 2 – Conceptual Figure

10

IHSP 2 Conceptual Framework

IHSP 10/11-12/13

IHSP 06/07-08/09

Provincial Health Strategy

and Priorities

SNAGA

Quality

Aging at Home

Outcome MapPriorities & Strategies• Develop• Rank• Timelines• Resources• Assign Responsibilities• Measurement

•Integration, Coordination & Information Access

•Service•Sustainability

•Adaptation


Session 4: Health Service Provider Perspectives on Applying the Outcome Map

4.1 Purpose To learn about and discuss how the Outcome Map can be used by

individual health service providers and groups of providers to help guide their efforts internally and among their key partners.

4.2 Resources Outcome Map, Logic Models and Scrapbooks provided at the Table

Groups.

4.3 Tasks for Session 4 • Cheryl Avrich, York Central Hospital; Aura Kegan, Aphasia Institute; and

Karen O’Connor will make brief “spotlight” presentations on their thoughts at this early stage.

• This will be followed by an open plenary discussion prior to having lunch.

Notes


Session 5: Starting to Act on the Central LHIN’s Top Priority Areas by Applying the Outcome Map

5.1 Purpose Using an Open Space approach, to gain some initial experience in applying

the Outcome Map to address collaboratively some of the Central LHIN’s draft priority areas.

5.2 Resources Open Space Protocol: Principles, Law and Convenor’s Responsibility – see

section 5.4, this page.

Bulletin Board in the workshop room indicating the Table Group location for each discussion theme (CLHIN priority area).

Outcome Map, Logic Models and Scrapbooks provided at the Table Groups.

Draft Central LHIN Priority Areas – section 5.3.

Outcome Map graphic in legal size format (paper and one transparency per Table Group) – to be used for annotating your key points.

5.3 Draft Central LHIN Priority Areas 1. Emergency Room and Alternate Level of Care

• Improve access to emergency department care by reducing the amount of time the patients spend in the emergency room

• Improve access to hospital care by reducing the amount of time that patients spend in alternative level of care beds

2. Diabetes Care

• Improve access to integrated diabetes care by supporting the roll-out of the current diabetes strategy

3. Population Health – Reducing Inequities through Primary Care and Community Health Centre’s

4. Population Health- Reducing Inequities for high risk populations through improving access/capacity for appropriate care for Mental Health Services.

5. Integration

• Regional Programs

• Planning Area Service Networks


• eHealth

5.4 Open Space Protocol We will spend a few moments immediately after lunch getting ourselves organized for the remaining sessions. For this session we will use an Open Space approach. The Open Space session is aimed at stimulating a high level conversation in which sharing, listening and learning are the operative values.

Principles:

1. Whoever comes is the right people – whoever turns up at your group represents the people who should be there at that moment.

2. Whatever happens is the only thing that could happen.

3. Whenever it starts is the right time (although we do need to consider this fitting-in with other planned sessions).

4. Whenever it is over it is over (again there are some timetable considerations here).

The Law of Two Feet:

If you find yourself in a situation where you aren't learning or contributing, go somewhere else.

Every individual has two feet, and must be prepared to use them. Responsibility for a successful outcome in any Open Space Event resides with exactly one person – each participant.

Convener's Responsibility:

Those who have volunteered to be convenors or have put forward a priority issue or opportunity "offering" of their own have some responsibilities. You are asked to show up at the Table Group location posted. Your job is to convene the group. You are not there to lecture to people. Your main task is to initiate and support a focused, high level conversation and to ensure that the key insights, key questions and key suggestions arising from the group are captured (so they can be shared by the larger group). You are also asked to be responsible for seeing that the results of your conversation or activity are recorded on the flip charts.

Notes


5.5 Tasks for Session 5 • If you are not a convenor, please select what Table Group challenge you

would like to (start to) contribute to.

• We only have 1 ¾ hours for this session so please organize yourselves at the Table Groups as efficiently as possible, ensuring that someone is charged with capturing the key discussion points.

• The intent with this task is to examine the priority area in relation to using the Outcome Map to inform the discussion in a manner similar to how some themes have been explored in the Scrapbook.

• We suggest that you start by choosing one or two capability areas (clusters of allied outcomes) you feel are particularly relevant to advancing affirmative action on this priority area. Put a priority area “lens” on the map with your thinking. Consider:

o How do these outcomes express themselves from the perspective of this priority area?

o Can you identify any outcomes that are particularly relevant?

o Can you identify some existing or candidate projects that will help achieve the enabling outcome for the capability areas you are focusing on?

o What indicators would you use to measure success?

• In addition to capturing the discussion points on the flip chart, use the legal size format (8.5 x 14”) Outcome Map graphic to sketch-out some of the key points in relation to the map (similar to what was done in the Scrapbook for some themes). Convenors: Please use the transparency of the Outcome Map graphic so your Table Group’s thoughts can be shared on an overhead in the plenary session.

• We hope to have time for every group to provide a brief 2-3 minute report on their discussions.

• Convenors please note: at just after 2 pm could you please start to assemble the key discussion points so they can be shared efficiently in plenary which will start at 2:10 pm.

Notes


Session 6: Engaging Others in the Central LHIN About the Outcome Map and its Application

6.1 Purpose of this Session To brainstorm some ideas on what would be most effective for engaging

others in the Central LHIN about Outcome Mapping and its application.

Note – this session in many ways also serves as an evaluation of this Forum exploration – how did we all do; what did we all learn; what can be take away from this?

6.2 Resources Materials, experience and related thoughts derived over the course of this

Forum.

6.3 Tasks for Session 6 Today has been an exploration where we have learnt about a somewhat new approach to portraying and understanding the strategic intentions of the Central LHIN. Consider:

• Has the Outcome Map been helpful in understanding our intent to effect systemic change?

• What potential does it offer the LHIN, the health service providers and their partners as we move forward with existing and new priorities, programs and initiatives?

• If we want to extend this approach more broadly across the Central LHIN to engage other health service providers, what is the best approach?

• What did we learn from the Forum today about what worked and what didn’t?

• What should be our plan for moving forward?

Please take a few moments to reflect on this and write down a few key points. We will then share our thoughts in a plenary discussion.


Session 7: Next Steps and Wrap-up

7.1 Purpose of this Session To review our accomplishments for the day and what we have learned.

To discuss what some of the important next steps should be.

To re-visit the Expected Outcomes to measure our collective performance.

To adjourn the Forum thanking the participants for their time and valued input.

7.2 Resources The “evaluation” perspectives identified in Session 6.

Expected Outcomes from Session 1 – page 7.

7.3 Tasks for Session 7 Hy Eliasoph and Harvey Skinner will reflect on the activities of the day and

what has been accomplished and what the next steps should be. In plenary, we will identify some of the immediate actions and what contributions the participants might be able to provide to help the LHIN.

Harvey Skinner will ask the participants to return to the Expected Outcomes (page 7) set at the beginning of the Forum so, with the participants input, we can evaluate how well we met these objectives:

• 4 Stars **** expected outcomes exceeded

• 3 Stars *** expected outcomes met

• 2 Stars** expected outcomes partially met

• 1 Star * expected outcomes not met but perhaps some useful conversation occurred

Hy Eliasoph and Harvey Skinner will close the Forum off thanking the participants for their valued input today and for the Outcome Mapping project overall.


Appendix 1: List of Publications that Inspired the Development of Outcome Mapping

Outcome mapping is one of a number of techniques used to develop causal models of change:

DMR Consulting’s Benefits Realization™ approach, and the Results Chain™ method described in The Information Paradox: Realizing the Business Benefits of Information Technology (McGraw-Hill, 1999);

Cranfield University’s Benefits Realisation approach, and the Benefits Dependency Network™ method described in Strategic Planning for Information Systems (John Wiley & Sons, 2002);

The Strategy Map developed by Kaplan and Norton to support the Balanced Scorecard, described in The Strategy-Focused Organization (Harvard Business School Press, 2000) and Strategy Maps: Converting Intangible Assets into Tangible Outcomes (Harvard Business School Press, 2003); and

The Theory of Constraints developed by Eliyahu Goldratt, described in The Theory of Constraints (North River Press Publishing Corporation, 1999) and Goldratt's Theory of Constraints (American Society for Quality, 1997).


Appendix 2: Forum Participants

Ms. Cheryl Avrich Director, Planning and Decision Support York Central Hospital

Dr. Rakesh Kumar Chief of Emergency Services Humber River Regional Hospital - Church Site

Ms. Trish Barbato President & CEO COTA Health

Ms. Sue Lantz Project Manager Doorways to Care

Mr. Simon Cheng Executive Director Carefirst Family Health Team & Project Development

Ms. Helen Leung Chief Executive Officer Carefirst Seniors & Community Services Association

Ms. Wyn Chivers Executive Director Community Home Assistance to Seniors (CHATS)

Ms. Carol Lever Director, Integration and Quality Improvement Canadian Mental Health Association - York Region Branch

Mr. Perry Doody Senior Director, Performance Management & Accountability Central CCAC

Ms. Carolyn MacLeod Senior Manager, Organizational Development Central CCAC

Ms. Francesca Fiumara Manager, Joint eHealth Office Central /Toronto Central LHIN

Ms. Donna McRitchie Director of Critical Care North York General Hospital

Mr. David Forrest Consultant Innovation Expedition Consulting Ltd.

Dr. Nancy Merrow Chief of Staff Southlake Regional Health Centre

Mr. Bruce Harber President & CEO York Central Hospital

Mr. Malcolm Moffat President & CEO St. John's Rehab Hospital

Mr. Keith Jones Consultant Innovation Expedition Consulting Ltd.

Mr. Danny Mui Executive Director Carefirst Seniors & Community Services Association

Mr. Don Juzwishin Consultant Innovation Expedition Consulting Ltd.

Dr. Bill Newton Markham Stouffville Hospital

Dr. Aura Kagan Executive Director Aphasia Institute

Ms. Karen O'Connor Director, Specialized Services & Research Canadian Mental Health Association - Toronto Branch

Ms. Nancy Kula President & CEO Union Villa Home For The Aged

Ms. Sonia Pagliaroli Manager, Clinical Informatics North York General Hospital


Ms. Sylvia Patterson General Manager Regional Municipality of York

From Central LHIN Hy Eliasoph CEO

Ms. Rhonda Schwartz Director, Quality, Patient Safety & Risk Management North York General Hospital

Kim Baker Senior Director, Planning, Integration and Community Engagement

Mr. Harvey Skinner Dean, Faculty of Health York University

Shaukat Moloo Senior Director, Performance, Contract and Allocation

Mr. Jasbir Sunner Project Manager, Sunner Consulting Services Ltd.

Anne Lessio Senior Planner, CDMP, Planning, Integration and Community Engagement

Ms. Deb Tregunno School of Nursing York University

Joel Moody Epidemiologist, Planning, Integration and Community Engagement

Mr. Peter Tsasis Assistant Professor, School of Health Policy and Management, Faculty of Health York University

John Montagnese Project Lead, Emergency Room/Alternate Level of Care, Planning, Integration and Community Engagement

Mr. Neil Walker Chief Operating Officer Markham Stouffville Hospital

Robyn Saccon Senior Coordinator, Planning, Integration and Community Engagement

Ms. Mary Wiktorowicz Chair, School of Health Policy and Management, Faculty of Health York University


Notes

Documents

CLHIN Outcome Mapping Forum Workbook-03-05-09-final/media/sites/central/uploaded... · SystemTM — a disciplined process that engages diverse groups on discovering collaborative