Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
Governance to Governance Session North West Local Health Integration Network
January 30, 2013
Planning Session Objectives
To continue the education of the Boards on the Health Services Blueprint
To identify progress made to-date on the Health Services Blueprint
To understand the role of the Health Service Providers and North West LHIN in moving the Health Services Blueprint framework forward
To develop a common understanding of the establishment of Health Links in Ontario
To engage in discussion regarding the sense of urgency and bold leadership required to move forward with transformational change
2
Time Topic Speaker/Facilitator/ Participant(s)
8:00 - 8:30 Breakfast
8:30 - 8:45 Welcome and ‘Housekeeping’ Joy Warkentin
8:45 - 9:30 Transforming the Health System in the North West LHIN Reg Jones Dianne Miller
Laura Kokocinski
9:30 - 10:30 Health Links Initiative Plan Helen Angus
10:30 - 10:45 Networking Break
10:45 - 12:15 Exercise #1 KPMG/All
12:15 - 1:00 Lunch
1:00 - 2:00 Transforming the System: Sense of Urgency and Bold Leadership
Janet Davidson
2:00 - 3:30 Exercise #2
Break KPMG/All
3:30 - 4:15 Pulling it All Together: Summary of Action Items for the Day KPMG
4:15 - 4:30 Closing Remarks Joy Warkentin Laura Kokocinski
4:30 Session Closure
Agenda
3
Welcome and ‘Housekeeping’ Joy Warkentin
4
Transforming the Health System in the North West LHIN
G2G Survey Summary – Reg Jones & Dianne Miller Health Services Blueprint Update – Laura Kokocinski and Team
5
Governance to Governance Survey Summary
January 30, 2013
6
Governance to Governance Surveys
In April 2012, the North West LHIN Board of Governors met with 266 Board Governors from LHIN-funded health service provider organizations.
At these sessions the Governors were informed that they will be asked to participate in a survey to gather information for the next Governance to Governance sessions with Health Service Provider Boards.
The surveys focused on the following: − Checklist for Board/Council Review of Strategic Plan Alignment
(10 questions); − Checklist for Board/Council Accountability for Voluntary Integration
Initiatives (11 questions); and, − Health Service Utilization.
7
G2G Survey Results
Board/Council Strategic Plan Alignment (24 responses): − 19/24 = aligns with North
West LHIN Strategic Directions
− 23/24 = reflects common principles
− 11/24 = using Integration tools
8
G2G Survey Results
Where in Local Health Hub could integration take place? − 13/24 = Back office – IT − 10/24 = Back office – Finance − 13/24 = Back office – Quality − 12/24 = Back office – Safety − 10/24 = Back office – Human
Resources − 8/24 = Services - Clinical − 6/24 = Services - Medical − 7/24 = Services – Physicians − 7/24 = Administration -
Management
9
G2G Survey Results Voluntary Integration Initiatives
(24 responses): − 24/24 = fully briefed on LHSIA
and the LHINs Integrated Health Services Plan
− 19/24 = receive regular updates on LHIN policies and activities
− 9/24 = established a Board/Council policy on voluntary integration
− 13/24 = have designated a member of Board/Council to liaise with LHIN
10
G2G Survey Results
Health Service Utilization (26 responses): − 9/26 = circulatory − 9/26 = neoplasms − 9/26 = external causes − 11/26 = digestive − 9/26 = endocrine − 2/26 = homemaking − 4/26 = respite
11
G2G Survey Results
Voluntary Integration Initiatives (24 responses): − 16/24 = Board/Council
provides direction to CEO regarding integration and reflect in CEO performance agreement
− 7/24 = Board/Council proposes an integration plan that is consistent with the LHIN Strategic Plan
− 17/24 = Have a “no surprise” policy
12
G2G Survey Results
Health Service Utilization (26 responses): − 4/26 = long-term care − 26/26 = mental health − 24/2 = addictions − 2/26 = primary care − 9/26 = supportive housing − 18/26 Have a wait list for
their services − Length of stay for service is
variable depending on the service
13
Health Service Providers Feedback on the Survey
Difficult to understand the survey questions and how they applied to the organization.
Focus seemed more hospital-based than community based. Didn’t understand what the top 1% and top 5% utilization meant
to their respective organization. Difficult to obtain the data on top 1% and top 5%. Challenging to complete the data request when offering multiple
services/programs within or across one organization (e.g. which option to choose to respond to on the survey).
14
North West LHIN Health Services Blueprint
Governance to Governance Session January 30, 2013
15
Desired Outcomes
1. Strong focus on population health and improving health outcomes
2. Improving the patient care experience—right care, right time, right place
3. High quality care 4. Increased accountability and transparency 5. Increased communication, partnerships and integration 6. System sustainability 7. Value for money
16
INTERPRETING THE BLUEPRINT RECOMMENDATIONS
17
Recommendations 1-8 R1 to R8: Implement an integrated health system model to organize services and delivery of care at the local, district and regional level
Local Health Hub (LHH): • Plan and provide health care
services to local community • Improve access to care for stable
patients including: • Chronic conditions • Mental Health and Addictions
• Communities with hospitals
District Health Campus (DHC): • One hospital in each District • Secondary care for District population Integrated District Network (IDN): • Five IDNs in North West LHIN • Formalized network within each district
comprised of all LHIN HSPs • Coordinate services for district
population across local, district, regional levels
Regional Program (RP): • High cost, high complexity, high
impact services • Education, research, knowledge
exchange, adoption of evidence-based practice, and system navigation
LOCAL HEALTH HUB INTEGRATED DISTRICT NETWORK REGIONAL PROGRAM
18
The Local Level • Local Health Hubs will plan and provide health
care services to the local community • Local Health Hubs will focus on improved
access to care for stable patients, including those with chronic conditions and mental health and addictions issues
• Services at the local level will include: o Primary care o Community support services o Community mental health and addictions o Acute care o Post-acute care (rehab, complex
continuing care, transitional care) o Long-term care
19
The District Level • One hospital in each District will be a District
Health Campus • The District Health Campus will provide more
specialized, secondary care to the population • District Hospital site • Visiting clinics in local health hubs • Technology-based services (e.g. telemedicine,
tele-psychiatry) • The District Health Campus may host regional
programs and CCAC satellite office • Integrated District Networks will be made up of all
LHIN-funded HSPs that deliver health services within the District
• The Integrated District Network will arrange a coordinated continuum of services for the District population across local, district and regional levels
• The Integrated District Network doesn’t provide “services”
20
The Regional Level • Regional Programs will focus on high cost, high
complexity, high impact services • Regional Programs will enable the provision of
highly specialized care within the North West LHIN • Regional Programs will deliver some services at
the local level; more specialized services delivered at a District or Regional level
• Regional Programs will include components of education, research, knowledge exchange, adoption of evidence-based practice and system navigation
• Regional or LHIN-wide Programs and services will incorporate leading practice evidence-based care and will set the standards of care across the LHIN
• Regional Programs will be disease-based (e.g. cancer), population-based (e.g. Seniors), or will enable delivery of key services across the LHIN (e.g. back office solutions)
21
How It All Works Together • Local Health Hubs deliver primary care close to home
• There is one designated District Health Campus within each District
• The District Health Campus will provide more specialized care within the District
• Local Health Hubs can make referrals to specialty programs at the District Health Campus and Regional Program levels
• The Local Health Hubs and the District Health Campus is part of the Integrated District Network
• The Integrated District Network will act like a steering committee, overseeing the coordination of care across the District, facilitating the link with highly specialized regional programs
• Regional Programs will work closely with and support the Districts to spread best practices and deliver specialty programs and services to all populations across the LHIN
22
Recommendation 9
• The integrated health system model will be comprised of five Integrated District Networks that will work across the entire North West LHIN: • District of Thunder Bay IDN • City of Thunder Bay IDN • District of Kenora IDN • District of Rainy River IDN • Northern IDN
23
• Integrated District Networks will reduce the reliance on acute inpatient hospital use by developing a comprehensive continuum of care for each of the following programs:
Thunder Bay District
Rainy River District
Kenora District
City of Thunder Bay
Northern District
North West LHIN
Circulatory Circulatory Circulatory Circulatory Circulatory Circulatory
Neoplasms External Causes
External Causes Neoplasms External Causes Neoplasms
Respiratory Neoplasms Neoplasms External Causes Neoplasms External Causes
External Causes Respiratory Respiratory Respiratory Respiratory Respiratory
Digestive Digestive Digestive Digestive Digestive Digestive
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Recommendation 10
24
Sector District of Thunder Bay IDN
Rainy River IDN Kenora IDN Northern IDN City of Thunder Bay IDN
Mental Health Improve access to services across the continuum for Mental Health and Addictions patients Improve coordination/delivery of community and hospital services
Implement substance misuse programs
Improve access to designated MH beds Home Care and Long Term Care
Increase access to home care services Increase access to home care services
Increase access to long term care services Post Acute Care
Increase access to post acute care services, including transitional care beds that promote reactivation and independence
Realign inpatient/ outpatient rehab
Ambulatory Care
Implement community based programs for high impact clinical programs (see recommendation 10)
Other MYWHC lead • culturally
appropriate care across the region
• regional approach to addiction issues in obstetrics/ maternity care
Continue to evolve relationship between SJCG and TBRHSC SJCG lead regional post-acute care (rehab, LTC, palliative)
Recommendations 11-40 by IDN
25
Sector District of Thunder Bay IDN
Rainy River IDN Kenora IDN Northern IDN City of Thunder Bay IDN
Information Management /Information Technology
Implementation of Connecting Northern and Eastern Ontario (cNEO) across the LHIN Expansion of tele-homecare and tele-medicine
Back Office Integration
Integrated back office s across all health service providers including: • Heath Human Resources • Finance • Procurement • Supply Chain • Learning and Development • Information Technology
Health Human Resources
Develop consolidated 10 year plan for Health Human Resources to help manage accessibility of HHR in rural and remote regions
Recommendations 41-44 by IDN
26
Alignment to Provincial Initiatives Support to become
healthier
Faster access and a stronger link to family
health care
The right care, at the right time, in the right
place Childhood Obesity
Strategy
Smoke-Free Ontario
Expanded Cancer Screening
Family Health Care at the Centre of the System
Faster Access
House Calls
Local Integration of Family Health Care
A Focus on Quality in Family Health Care
High Quality Care
Timely, Proactive Care
Care as Close to Home as Possible
Seniors Strategy
Moving Procedures into the Community
Funding Reform
Family Health Care at the Centre of the System
Local Integration of Family Health Care
High Quality Care
Timely, Proactive Care
Care as Close to Home as Possible
Seniors Strategy
Moving Procedures into the Community
Funding Reform
Faster Access
27
Context: North West LHIN High Users
28 2/1/2013
• 1.5% of provincial high users live in the
City of Thunder Bay – this is the largest proportion of high users in a city in the province
• 59% of the LHIN’s high users in our LHIN reside in Thunder Bay
• 52% of the LHIN’s population resides in Thunder Bay City
• 98.3% of the high user expenses for the North West LHIN were incurred within the LHIN boundaries, offering a unique opportunity to change this pattern of hospital use
# of Patients
Total Expenses for Patients
Number of Events
Avg. Expense per Client
Total % ALC for this population
% total NW LHIN ALC
top 1% 1,145 people $123m 11,830 $108,000 65.7% ALC 44.9%
top 5% 5,075 people $230m 44,335 $45,500 49.6% ALC 73.4%
top 10%
9,880 people $279m 72,685 $28,000 39.9% ALC 83.1%
All Users
105,740 people $372m 279,845 $3,500 8.4% ALC
Overview: North West LHIN High User System Impact
29 2/1/2013 Source: Health Analytics Branch, Analysis of High Users of Health System 2009/10, Analysis of 'High Users' of Health Care Services, Ontario, 2009/10, Table 1.1 Distribution of patients and expenses; events and expenses by LHIN of service for all care types, 2009/10
IMPLEMENTING THE BLUEPRINT
30
High-Level Implementation Plan
Year 1 – Year 2 Phase 1: Planning and Pilot
Implementation
Year 3 - Year 4 Phase 2: Phased Implementation
Year 5 – Year 10 Phase 3: Full
Implementation
• Communication, Education, Training and Capacity Building
• Planning for Local Health Hubs, IDNs, and District Hospitals
• Financial Planning by sector • Early-adopter
implementation, including Regional Programs
• Ongoing analysis, evaluation and refinement
• Phased implementation of Local Health Hubs, District Hospitals and IDNs across LHIN
• Continued Implementation of Regional Programs
• Ongoing communication • Ongoing analysis,
evaluation and refinement
• Full Implementation • All IDNs • All Local Health Hubs • TBRH as Regional
Healthcare Centre • Regional Programs
• Ongoing communication • Ongoing evaluation,
analysis and refinement
31
Work Underway Year 1
19 recommendations
we’ve already started work on
R1: Organize services at regional, district and local levels
R2: Collaboration across all HSPs at the Local Level
R7: Designate TBRHSC as the tertiary hospital
R8: Establish regional programs
R12: DoTB IDN to increase access to home care services
R16: DoRR IDN to increase access to home care services
R19: DoK IDN to improve access to designated MHA beds
R22: DoK IDN to increase access to home care services
R23: DoK IDN to increase access to post acute/ transitional care beds
R26: CoTB IDN to continue to evolve SJCG role in post-acute care
R29: CoTB to increase access to home care services
R30: CoTB IDN will investigate CCC and LTC settings for post-acute care
R25: CoTB IDN evolve relationship between TBRHSC & SJCG
R38: Northern IDN to ensure access to long term care services
R39: Northern IDN to increase access to post acute/transitional care beds
R41: Implementation of cNEO
R42: Expand tele-homecare and telemedicine
CCC: Complex Continuing Care cNEO: Connecting Northern and Eastern Ontario COTB: City of Thunder Bay DoK:: District of Kenora D0RR: District of Rainy River
DoTB: District of Thunder Bay HSP: Health Service Provider IDN: Integrated District Network LTC: Long Term Care SJCG: Saint Joseph’s Care Group TBRHSC: Thunder Bay Regional Health Sciences Centre
R9: Define District IDN Geographies
R44: Develop Health Human Resources Plan
32
Anticipated Activity Year 2
11 recommendations
In addition to the work started in Year 1, we expect Year 2 will focus on another
R3: Development of District Networks
R4: Establish District IDN Steering Committee with Early Adopter(s)
R6: Designate District Health Campus Sites
R11: DoTB IDN to reduce MHA reliance on Emergency Departments
R20: DoK IDN to reduce MHA reliance on Emergency Departments
R21: DoK To implement models for substance misuse
R27: CoTB IDN to reduce MHA reliance on EDs
R28: CoTB IDN to implement models for substance misuse
R31 CoTB IDN increase access to rehab services
R43: Investigate Back Office Integration opportunities
R32: CoTB IDN implement alternatives to ED/inpatient for high impact programs
CCC: Complex Continuing Care cNEO: Connecting Northern and Eastern Ontario COTB: City of Thunder Bay DoK:: District of Kenora D0RR: District of Rainy River
DoTB: District of Thunder Bay HSP: Health Service Provider IDN: Integrated District Network LTC: Long Term Care MHA: Mental Health and Addictions SJCG: Saint Joseph’s Care Group TBRHSC: Thunder Bay Regional Health Sciences Centre 33
• Develop Clinical Service Delivery Model Decision Making Framework to align services to Local, District and Regional levels
• Incorporate leading practice care delivery approaches • Implement consistent approach to programming/costing
• Value Stream Mapping to improve transitions in care
• Align financial allocation to clinical services at Local, District and Regional levels
• Identify opportunities for improving value for money • Implement standardized costings
• Reflect expectations in Service Accountability Agreements
Implementing the Service Delivery Model: Approach
34
Year 2 – Implementation • Early Adopter Implementation will commence Year 2 with implementation
across two Integrated District Networks • Align Integrated District Network Level with Health Links
• Introduce new model of care at the clinical level • All providers in a community or district will be included in the planning
network, and this will encompass primary care involvement, hospital, home and community care. The providers will be responsible for coordinating plans at the patient/client level.
Both the Blueprint and Health Links identify and respond to the need for and importance of local partnership across providers to: • Deliver better value for money • Ensure higher quality of care • Improve access to care.
35
Year 2 - Measurement and Monitoring
Improved health outcomes
Access, as close to home as possible
Continuous quality improvement
Well managed resources
Reduce ALC Rate
Reduce 30 day readmission to hospital
Reduce avoidable ED visits for patients with
conditions best managed elsewhere
Reduce average cost of delivery of health services without compromising the
quality of care
Primary care follow up within 7 days of discharge
Reduce unnecessary admissions to hospital
All complex patients have coordinated care plans
Reduce time from referral to home care visit
Enhance experience that patients with the greatest health care needs have
with the system
Reduce time from a primary care referral to specialist consultation
Increase the number of complex patients and seniors with access to
primary care
36
Year 2 – Preliminary High Level Timelines for Early Adopters
Key Activity Q4 12/13
Q1 13/14
Q2 13/14
Q3 13/14
Q4 13/14
Readiness Assessment Business Case Implementation IDN/Health Link 1 Implementation IDN/Health Link 2 Ongoing Collaboration Ongoing Evaluation and Monitoring Value Stream Mapping Knowledge Exchange
37
WHERE WE NEED YOUR HELP
38
We Need You To…
Be visible, vocal,
champions of the
Blueprint
Encourage participation
in LHIN activities
Hold Senior Leadership
accountable to be visible, active change agents
Advocate change to achieve common
goals Pursue
innovative partnership
opportunities
Break from traditional ways of
doing things
39
Equipping Your Organizations
• How to become increasingly more strategic as an organization
• How and why to align strategic plans with the Blueprint
• Accountability at a leadership level
• This isn’t just about your organization or clients - shift thinking to a community-based, integrated leadership perspective
Help to identify other Blueprint Champions, and work with them to: • Develop synergistic
partnerships; share best practice, identify opportunities for integration
• Prepare their respective organizations and communities for new ways of working
• The Blueprint, the burning platform and our goal of an integrated service delivery model
• What we mean by integration and the opportunities it presents
• Transformational change – what it is, how it’s different, and how to position it for success
Educate Coach Connect
40
Your Leadership is Needed
This is exciting, it’s cutting edge and it’s absolutely necessary for health system sustainability
This is an opportunity to create a health care system that provides better access to health care than ever before
We need Board members to lead the transformation to a health care system for the future – not just for us, but for our children and
grandchildren
This is an opportunity to do something for your community, today and in the future
This is our opportunity to shape our local system – together – to create a
leading health care system
We’re the first LHIN to do this, and Board Members can play a
key role in making it happen This system change will help your
organization function more effectively through integrated care delivery - this
means improved client experiences and, ultimately, improved health for your client
population
41
Questions
? 42
Health Links Initiative Plan Helen Angus
43
Networking Break
44
Exercise #1
KPMG/All
45
Exercise #1
Representatives will be divided into discussion tables.
Each group will work together to take the insights gained from the presentation by the North West LHIN and Ministry to respond to a series of questions regarding the implementation of the Health Services Blueprint recommendations.
Each group will be co-chaired by a Health Service Provider representative and LHIN Board member. In addition, a LHIN staff will be assigned as a recorder for each table.
Each group will report back to the plenary.
46
Exercise #1 Question 1:
How will the Local Health Hubs and the Integrated District Network (IDN) work collectively with the regional programs to address population health needs? Identify the action steps with timelines to make this happy over the next 2 years.
47
Exercise #1 Question 2:
As part of our governance deliberation we have confirmed many desired outcomes to be achieved over the next 10 years which include: • Strong focus on population health and improving health outcomes • Improving the patient care experience—right care, right time, right place • High quality care • Increased accountability and transparency • Increased communication, partnerships and integration • System sustainability • Value for money How will the Local Health Hubs and Integrated District Network (IDN) collaborate to meet the desired outcomes? Identify action steps that need to be taken by Health Service Provider boards and executive teams with timelines to initiate this in 2013/14.
48
Lunch
49
Transforming the System: Sense of Urgency and Bold Leadership
Janet Davidson
50
Transforming the System: Sense of Urgency and Bold Leadership
Setting the stage: What factors are creating urgency for system transformation?
Provincial
National
Global
51
Source: KPMG ‘Succeeding in a Changing World’ 2012
Transforming the System: Global Forces
Changing business operations to realize cost efficiencies
Improving cash and working capital management
Exploiting growth opportunities through successful transactions
Preparing your organization for major business model changes
Managing and retaining the right people within the organization
Addressing risk throughout the organization
Looking for growth in emerging markets
Innovation through product development
Adapting to take into account changing customer and stakeholder behavior
Using information to forecast response to uncertain times
Refinancing or seeking capital
Using technology as a strategic enabler, not just an operational facilitator
Embedding sustainability in the business model
Responding to regulatory change
Seizing opportunities offered by increasing public/private sector interaction
43%
32%
30%
25%
24%
21%
21%
20%
18%
15%
13%
12%
10%
10%
6%
3,000 CEOs from all industries can see the importance of transformational change but focus their attention on short term transactional efficiency.
Note: (a) Due to rounding up and down total figure may vary from 300%
Total adds up to 300% all
respondents had three votes(a)
52
Globally, transaction trumps transformation.
Source: KPMG ‘Succeeding in a Changing World’ 2012
27%
50%
15%
33%
15%
18%
18%
17%
20%
10%
12%
27%
17%
17%
5%
32%
43%
21%
30%
15%
25%
4%
21%
18%
12%
10%
24%
13%
20%
10% Healthcare Total
Healthcare
Improving cash and working capital management
Changing business operations to realize cost efficiencies
Addressing risk throughout the organization
Exploiting growth opportunities through successful transactions
Using information to forecast response to uncertain times
Preparing your organization for major business model changes
Seizing opportunities offered by increasing public/private sector interaction
Looking for growth in emerging markets
Adapting to take into account changing customer and stakeholder behavior
Using technology as a strategic enabler, not just an operational facilitator
Embedding sustainability in the business model
Managing and retaining the right people within the organization
Refinancing or seeking capital
Innovation through product development
Responding to regulatory change
Note: (a) Due to rounding up and down total figure may vary from 300%
Total adds up to 300% all
respondents had three votes(a)
53
Active strategies to cope are transactional.
• Question - Which strategies are providers likely to adopt to respond to these changes?
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
Major cost reduction
Lean and improvement methods
More focus and specialization
Investment in Health IT
New workforce models
85%
81%
82%
78%
74%
Extra income from existing payers 74%
54
Active strategies to cope are transactional.
• Question - Which strategies are providers likely to adopt to respond to these changes?
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
Domestic new markets
International new markets
Vertical integration
Acquisitions in primary care
Acquisitions
22%
30%
30%
44%
52%
Mergers 56%
55
While payment systems are expected to focus more on quality, value and risk (but not cost!)
• Question - I expect payment systems to:
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
Become more integrated
Contain more quality incentives
Focus more on patient value
Share more risk with providers
Reduce prices & cap volumes
78%
78%
74%
74%
55%
Remain largely the same 11%
56
But they are still not yet fully ready for the change.
• Question - Providers are well equipped to respond to these changes:
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
Bundled payments
Increased risk sharing
Value based purchasing
Price reductions
26%
30%
52%
52%
Shifting care to new channels 58%
57
We are well aware of the challenges…
Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012
• Aging • Multi-morbidity • Rising expectations • Lifestyle diseases • Technology and devices
People and Products
Process
• Poor system and process design • Specialization • Organizational culture • Problems with economic model • Growing complexity
58
How Canada compares, globally.
Increasing obesity rates among the adult population in OECD countries, 1990, 2000 and 2009 (or nearest years)
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
59
How Canada compares, globally.
Health expenditure as a share of GDP, 1960-2009, selected OECD countries
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
60
How Canada compares, globally.
Infant mortality rates, 2009 and decline 1970-2009 (or nearest year)
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
61
How Canada compares, globally.
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
62
How Canada compares, globally.
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
63
How Canada compares, globally.
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
64
Transforming the System: National Forces
65
A Review of the 2004 Health Accord
Many of the factors that influence the health outcomes of Canadians lie beyond health care systems and are located in the social determinants of health
Reflected in the poorer health status of Aboriginal peoples and the challenges children and youth face with respect to mental health and obesity
Source: Time for Transformative Change: A Review of the 2004 Health Accord. Standing Committee on Social Affairs, Science Technology. March 2012. . 66
A Review of the 2004 Health Accord
Systemic change has stalled
When compared internationally, Canada is no longer seen as a model of innovation in health care delivery and financing
Need for specific mechanisms to promote the implementation of new practices in health care systems across the country
Health care reform can only be achieved by breaking down silos within health care systems Different health care sectors such as primary, acute, continuing
care and mental health services be integrated through common governance structures and funding arrangements and supported by seamless information systems
Source: Time for Transformative Change: A Review of the 2004 Health Accord. Standing Committee on Social Affairs, Science Technology. March 2012. . 67
How long can we enjoy B-player status?
Highest rating was a B+
Source: How Long Can We Enjoy B-Player Status? Brown, A.D. & Sullivan, T. Healthcare Quarterly. Vol 15 No.2, 2012 68
How long can we enjoy B-player status?
Worry that this B grade may seem good enough and discourage serious efforts to improve
Position as ‘B-player’ on quality risks encouraging an attitude of complacency, rather than motivating a leadership imperative to strive for excellence
B-player status will persist until we set improvement goals and link them to measures for our system, coast to coast
Time to set better goals for quality
Source: How Long Can We Enjoy B-Player Status? Brown, A.D. & Sullivan, T. Healthcare Quarterly. Vol 15 No.2, 2012 69
Measuring and reporting on health system performance in Canada: Opportunities for improvement
Health Council of Canada Improved performance reporting to enhance
accountability is a potential tool as governments and their health system planners look forward
Source: Measuring and reporting on health system performance in Canada: Opportunities for improvement. Heath Council of Canada. May 2012.
“The debate on health should no longer be about
structure and processes, but about principles and progress in health improvement for all”
- Equity and excellence: Liberating the NHS [England’s National Health Service], 2010
70
Towards a more rigorous approach to health system performance reporting in Canada.
All provinces and territories are actively developing strategic plans which include health system performance goals and objectives
The challenge remains to see if we can achieve the same, if not better, results in performance measurement and improved accountability at the pan-Canadian level
Globally, England: National Health Services Outcomes
Framework Australia: Council of Australia Governments
Agreements
Source: Measuring and reporting on health system performance in Canada: Opportunities for improvement. Heath Council of Canada. May 2012. 71
Measuring What Matters in Health Care: Cost vs. Value
Clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded
Recommendation 1: Align health system values with Canadians’ values
Recommendation 2: Align health system performance metrics and funding models with Canadian values
Recommendation 3: Re-examine health workforce values relative to the needs and values of Canadians
Source: Measuring What Matters: Cost vs. Values of Health Care. Snowdon, A., Schnarr, K., Hussein, A. & Alessi, C. Ivey Centre for Health Innovation. November 2012. 72
Fiscal Sustainability & The Transformation of Canada’s Healthcare System
Transformative action will require a shift in how policy makers think about and respond to changes in the healthcare system
This shift can be achieved through four concepts: 1. Use disruptive innovation as a framework
to understand changes in technology and service delivery
2. Recognize Moore’s Law – which suggests declining costs over time – applies to healthcare and recover productivity gains
3. Focus on improving quality and access as costs decline
4. Treat healthcare as a high-tech industry
Source: Fiscal Sustainability & the Transformation of Canada’s Healthcare System: A Shifting Gears Report. Falk, W., Mendelsohn, M. & Hjartarson, J. 2012. 73
Fiscal Sustainability & The Transformation of Canada’s Healthcare System
Five Transformative Reforms:
1. Modernize the organization of hospitals by disrupting clinical business models
2. Use virtualization to develop new roles for providers and patients
3. Widely deploy digitization in the second decade of Infoway
4. Devolve decision-making selectively and where appropriate
5. Reform the way health services are purchased
Source: Fiscal Sustainability & the Transformation of Canada’s Healthcare System: A Shifting Gears Report. Falk, W., Mendelsohn, M. & Hjartarson, J. 2012. 74
Transforming the System: Provincial Forces
Ministry of Health & Long-Term Care: Healthy Change: Ontario’s Action Plan for Health Care
Keeping Ontario Healthy Faster Access to Stronger Family Health Care Right Care, Right Time, Right Place
Excellent Care for All Act
Health System Funding Reform
Health Human Resources Planning
75
Transforming the System: Provincial Forces
Health Quality Ontario: Measuring Attributes of a High Quality Health System
Accessible
Patient Centred
Appropriately resources Integrated
Equitable
Effective Safe
Efficient
Focused on population
health
76
Transforming the System: Sense of Urgency and Bold Leadership
System challenges…
Aging population
Misalignment with values
Risk of complacency
Fiscal restraint
Rising expectations
Chronic disease management
Poor system and process
design
Technology
Aboriginal health
77
Transforming the System: Sense of Urgency and Bold Leadership
Now what?
Aging population
Misalignment with values
Risk of complacency
Fiscal restraint
Rising expectations
Chronic disease management
Poor system and process
design
Technology
Aboriginal health
78
Transforming the System: Sense of Urgency and Bold Leadership
79
Transforming the System: Sense of Urgency and Bold Leadership
Given this sense of urgency, how do we motivate radical change?
80
There are some ideas about what to do:
• Accountability for a defined population.
• Value based reimbursement.
• A rigorous focus on quality and safety.
• Reduce variation.
• Empower patients and carers.
• Focus on wellness.
• Work to reduce inequalities.
• Segmentation, stratification and personalization.
• Systemic, coordinated and evidence-based care.
• Underpin with information systems, measurement and feedback.
81
Providers responses: Four general strategies for change.
Continuing to grow the current model
Improving operations and
delivery
New approaches built on existing
models
Developing new models for new or current markets
82
Success requires tactical improvement simultaneously with strategic transformation.
Implementation and skills transfer
Clinical engagement
Financial and operational
grip
Tactical savings
acceleration
Strategic transformational
planning
83
Five propositions to address Health System Transformation.
Board Grip
Care System Redesign
Health IT Quality and
Margin Improvement
Strategy, Transactions & Financing
84
The leadership and governance mechanisms to address all these problems are poorly developed.
The problems with the organizational culture:
The dominance of professional autonomy: the tendency to reject
mechanisms of accountability. A reluctance to give or receive feedback or to share information
about performance. Emphasis on individual judgment and knowledge rather than on the
value of teams. Reluctance to accept the idea that clinical decisions have resource
consequences. A paternalist approach to care an inadequate involvement of patients
in their own care. Undervaluing and under investment in management and a divide between
clinicians and managers.
Leadership, not just better management
85
Transforming the System: Sense of Urgency and Bold Leadership
Health System Governance Challenges Identified by The Center for Healthcare Governance
1. Monitoring both collective and individual entity’s operating performance and accountability
2. Coordinating system and local boards to achieve system performance targets
3. Aligning strategy throughout the system 4. Clinical integration 5. Establishing system wide standards of care 6. Setting and overseeing accountability measures for subsidiary boards 7. Ensuring coordination among system level and local management 8. Putting in place infrastructure to support governance across multiple
entities.
86
1. Establishing a Sense of Urgency
2. Forming a Powerful Guiding Coalition
3. Creating a Vision
4. Communicating the Vision
5. Empowering Others to Act on the Vision
6. Planning for and Creating Short-Term Wins
7. Consolidating Improvements & Producing Still More Change
8. Institutionalizing New Approaches
Eight Steps to Transforming Your Organization
87
1. Establishing a Sense of Urgency
Examining market and competitive realities
Identifying and discussing crises, potential crisis, or major
opportunities
Eight Steps to Transforming Your Organization
“Make the status quo more dangerous than launching into the unknown”
“When is the urgency rate high enough? When about 75% of a company’s management is honestly convinced that business as usual is totally
unacceptable.”
88
2. Forming a Powerful Guiding Coalition
Assembling a group with enough power to lead the change effort
Encouraging the group to work together as a team
Eight Steps to Transforming Your Organization
“Efforts that don’t have a powerful enough guiding coalition can make apparent progress for a while. But sooner or later, the opposition gathers itself together
and stops the change.”
89
3. Creating a Vision
Creating a vision to help direct the change effort
Developing strategies for achieving that vision
Eight Steps to Transforming Your Organization
“Without a sensible vision, a transformation effort can easily dissolve into a list of confusing and incompatible projects that can take the organization in the
wrong direction or nowhere at all.”
90
4. Communicating the Vision
Using every vehicle possible to communicate the new vision and
strategies
Teaching new behaviors by the example of the guiding coalition
Eight Steps to Transforming Your Organization
“Use every possible channel, especially those that are being wasted on nonessential information”
“Learn to walk the talk – consciously attempt to become the living symbol of the
new corporate culture”
91
5. Empowering Others to Act on the Vision
Getting rid of obstacles to change
Changing systems and structures that seriously undermine the vision
Encouraging risk taking and nontraditional ideas, activities and actions
Eight Steps to Transforming Your Organization
“In the first half of the transformation, no organization has the momentum, power or time to get rid of all obstacles. But the big ones must be confronted
and removed.”
92
6. Planning for and Creating Short-Term Wins
Planning for visible performance improvements
Creating those improvements
Recognizing and rewarding employees involved in those improvements
Eight Steps to Transforming Your Organization
“Real transformation takes time, and a renewal effort risks losing momentum if there are no short-term goals to meet and celebrate.”
“Commitments to produce short-term wins help keep the urgency level up and
force detailed analytical thinking that can clarify or revise visions.”
93
7. Consolidating Improvements: Produce Still More Change
Using increased credibility to change systems, structures and policies
that don’t fit vision
Hiring, promoting, and developing employees who can implement the
vision
Reinvigorating the process with new projects, themes and change
agents
Eight Steps to Transforming Your Organization
“Until changes sink deeply into a company's culture, a process that can take five to ten years, new approaches are fragile and subject to regression.”
“It is the premature victory celebration that kills momentum.”
94
8. Institutionalizing New Approaches
Articulating the connections between new behaviors and corporate
success
Developing the means to ensure leadership development and
succession
Eight Steps to Transforming Your Organization
“Change sticks when it becomes “the way we do things around here.”
95
Health System Transformation requires Board Accountability and Board Leadership
• Difficult decisions are
ahead!
• Courage and bold leadership are required
• Focus on: the consumer and value for money.
• Embrace what you need to do …
Be visible, vocal,
champions of the
Blueprint
Encourage participation
in LHIN activities
Hold Senior Leadership
accountable to be visible, active change agents
Advocate change to achieve common
goals Pursue
innovative partnership
opportunities
Break from traditional ways of
doing things
96
Questions? Comments?
97
Exercise #2
KPMG/All
98
Exercise #2
The representatives will return to their respective discussion tables to address a series of questions regarding their role as health system leaders in moving forward transformational change.
Each group will be co-chaired by a Health Service Provider representative and LHIN Board member. In addition, a LHIN staff will be assigned as a recorder for each table.
Each group will report back to the plenary.
99
Exercise #2 Question 3:
Within the G2G survey, you identified the steps/changes that your organization has taken towards system transformation to ensure alignment with the North West LHIN strategic plan/directions. Identify the enablers and the barriers to these transformational steps. What can be learned from the enablers and how did you mitigate the barriers?
100
Exercise #2 Question 4:
Within the Pre-reading #2: Leading Change: Why Transformation Efforts Fail, Harvard Business Review (Kotter, 2007), you have considered the 8 change leadership steps. As a governor or executive leader, identify the 3-4 steps that you can take within the next 6-12 months to lead transformational change within your Integrated District Network (IDN).
101
Exercise #2 Question 5:
Other comments or suggestions for transformational leadership in the North West LHIN:
102
Pulling it All Together: Summary of Action Items for the Day
KPMG
103
2012/13 Q4
2013/14 Q1/2
2013/14 Q3/4
2014/15 Q1/2
2014/15 Q3/4
2015/16 Q1/2
2015/16 Q3/4
• Summary of Steps Year 1 • Summary of Steps Year 2 • Summary of Steps Year 3
Pulling it All Together: Summary of Action Items for the Day
104
Closing Remarks Joy Warkentin and Laura Kokocinski
105
Thank you
106