A6 Duncan Campbell - Improving System Performance: Making the Most of our Resources at Vancouver...
Transcript of A6 Duncan Campbell - Improving System Performance: Making the Most of our Resources at Vancouver...
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Improving System Performance: Making the Most of our Resources at
Vancouver Coastal Health
Quality Forum 2013
Duncan Campbell C.F.O. and V.P. Systems Development &
Performance
February 28, 2013
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Making Most of Our Resources Agenda
• Just imagine if….. • Vision • Background and context • Fiscal crisis in 2008 • Workforce optimization • Results • Where to from here
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Just Imagine if…. • You know how many patients you will receive each and
every minute of the day • You know what staffing is required to perform on straight
time • Your staff can plan their lives outside work, without the
risk of being called back • You have the correct number and mix of staff to safely
support the workload demand. • You could use information to reduce adverse drug
events • You can use information to optimize OR’s, staffing
surgeon availability and beds to drive down wait times
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Vision: Create Agile Financial And Operation Processes
1. Real time information updated every 15 minutes – ED visits and Pay for Performance metrics, census and bed maps, staff scheduling and availability, discharges and targets.
2. Forecasting and scheduling software that predicts census, volume mix, physician and clinical staffing, operating room and acuity
3. Using analytics to make decisions in real time e.g. whether to flex beds up or down, use overtime understanding PFF revenue and costs.
4. Very little time spent wondering what happened as part of decisions when they did happen
5. Have sufficient notice based on forecasts to staff plan at straight time
…to support quality care
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Vision: Create Agile Financial And Operation Processes
1. Manage wait times through complex scenario analysis
– Real time based on forecast models and simulation the optimum balance of scheduled and unscheduled surgeries against wait time targets, bed capacity, physician and clinical staffing, and diagnostics
2. Forecasting revenue based on RIW, Volumes, and capacity constraints
3. Budgeting is simple – driven by forecasts, revenue, staffing and efficiency assumptions
4. Pay for Performance agency pays for all growth (could be subject to a cap)
– Block funding becomes a smaller and smaller part of funding
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Fiscal Crisis in 2008 $42m Operating deficit •95% of funding received committed to collective bargaining •Cash less than 1 weeks payroll - $10m •High admin and support costs (15%) •Staff growth higher than volume growth
$1 Billion Infrastructure Deficit (excluding hospitals)
Outdated technology – on fire pc’s Obsolete equipment Aging and not well maintained facilty
•$50m capital projects in flight without a funding source •ED congestion and hallway patients •Long wait times, and cancelled elective surgery
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Turnaround Plan • Take control of cash and stop in flight projects • Get admin and support costs into line – $26m and 200 staff
reduction –reduce from 13% to 9.2% • Invest in ED Pay for Performance • Get control over headcount – Senior team approves all new hires
and replacements • Focus on workforce optimization to get control over the biggest cost
item –over 70% • Invest in staff scheduling, forecasting,decision support tools and
portals • Invest in Greencare sustainability initiatives
I will focus my discussions today on workforce and resource
optimization and developing agile financial processes
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Key Elements of Our Resource Optimization Journey
Scheduling Deploy staff effectively
Data Warehouse Standardized data
increased data quality for decision making
Care Management Understand patient acuity
and care needs
Bed Management Maximize utilization of beds
Business Intelligence Integrated portal improves and Simplifies reporting capabilities
Forecasting Project demand and staffing requirements
Resource Optimization
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Average Variable StaffingGFS Rehab MedicineOct 03-Nov 13, 2008
0
5
10
15
20
25
30
35
40
F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13
Ave
rag
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um
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of
Sta
ff
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54
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Cen
sus
RN LPNAide CensusBudget
Staff Forecasting and Staff Scheduling
• Lower fixed levels of staffing and increase flexibility of variable staffing
Average Variable Staffing
Staff Forecasting Solution will allow the
ability to forecast demand & the
associated staff requirements
Optimizing Variable Staffing Levels
Staff Scheduling Efficient & effective deployment of staff to match expected
activity patterns
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Pre-Cap Plan: Decision in real time
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1 2 3 4 5 6 7
6
*
Overtime
Day
Open additional beds
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28
Beds FTEs
24
6
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Utilizing Cap Plan to make decision 3 days in advance
1 2 3 4 5 6 7
*
Straight time
Open additional beds 28
7
Beds FTEs
Day
6
24 * Decision
24
6
12
Utilizing Cap Plan to Create Capacity and plan ahead to exceed discharge targets
1 2 3 4 5 6 7
24
6
Baseline staffing
No additional beds 28
7
Beds FTEs
Day
28
7
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CapPlan Dashboard
• Updated every 15 minutes
• Provides web-based real-time daily visibility
• Worm graph shows 3 days of information – retrospectively, today and tomorrow
• Displays key metrics with applicable traffic light on the current status within the hospital
• Can display the details of each nursing unit under each planning group
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0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2011
-01
2011
-02
2011
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2011
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2011
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2011
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2011
-07
2011
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2011
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2011
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2011
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2011
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2011
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2012
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2012
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2012
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2012
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2012
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2012
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2012
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2012
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2012
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2013
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2013
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2013
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2013
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2013
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2013
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2013
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2013
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2013
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2013
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2013
-11
Perc
ent o
f 4-h
our s
hift
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Staffing Implications Example - Richmond 2 West Psychiatry
Elevated (>1 over)
Balanced (-1 to 1)
Insufficient (<-1 under)
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ED Performance
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Results
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Hand Hygiene Up
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
08/09Q4
09/10Q1
09/10Q2
09/10Q3
09/10Q4
10/11Q1
10/11Q2
10/11Q3
10/11Q4
11/12Q1
11/12Q2
11/12Q3
11/12Q4
12/13Q1
12/13Q2
12/13Q3
Hand Hygiene Percent Compliance (VGH, LGH and RH for consistent four-year trend)
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MRSA Down
0.00
2.00
4.00
6.00
8.00
10.00
12.00
MRSA Rate per 10,000 Acute Patient Days (in VCH facilities excluding PHC for consistent long term trend)
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Workforce Optimization Efforts
FTE' Analysis
1600017000180001900020000
FTE'
s
Actual Projected
Actual 16083 16683 17452 18043 17932 17932
Projected 16083 16683 17452 18063 18695 19349
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11
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Improvements in Insufficient Notice
Key Findings:
Year over year reductions in insufficient notice are projecting annualized savings of $724k in 2011/12
Insufficient Notice Premiums
$-
$100,000$200,000
$300,000$400,000
$500,000
$600,000$700,000
$800,000$900,000
$1,000,000
2008 2009 2010 2011 2012
Insu
ffic
ien
t N
oti
ce (
$)
Pilot, A and B
• Reduced scheduling errors
• Shift to proactive scheduling processes
• Standard Interpretation of Insufficient notice contract language
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The Bottom Line • Quality improved and costs reduced
– Improved quality, Mortality, Infection, wait times and access, Adverse drug events etc
• Reinvested operating surpluses in infrastructure to support front line staff – bed –pan decontaminators, replaced 10000 pc’s, invested in quality initiatives
• $120m turnaround –now $70m surplus • Set aside $100m for Clinical Systems transformation across
continuum, including decision support • Increased cash from $10m to $250m • Paid off all long term debt including $50m to Health Benefit trust
liabilities • Investment in decision support tools less than $15m • Real productivity gains 2% volume growth with the same level of
staffing – previously staff growth twice volume growth
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Where to From Here?
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Real Time ED Dashboard
INTERNAL DASHBOARD BCAmbulance DASHBOARD
PUBLIC WEBSITE
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Data Linkages across the Patient Continuum
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http://www.information-management.com/news/Vancouver-Coastal-Healths-Patient-Continuum-Increases-Insights-10023644-1.html
What is a Patient Continuum? • Facilitates longitudinal patient tracking across the
entire health authority according to criteria and measurements such as time, space, visits, facilities and type of care.
Why Build a Patient Continuum? • Standardizes joins between fact tables • Provides a means of analyzing patient movement • Improves data quality • Enables easier data mining Award • Winner of the 2012 Innovation Solution Award for
BI/Analytics
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Agile Processes: Armour vs. Fly by Wire
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Questions?
http://www.vch.ca
Thank You
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Appendix: Full Deck
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About Vancouver Coastal Health
VCH delivers acute, residential and community healthcare services directly to more than one million residents
• $3.0 billion annual funding • 22,000 staff • 2,500 physicians • 5,000 volunteers • 556 locations including: – 13 hospitals – 3 diagnostic and treatment centres – 15 community health centres
• 3 million+ patient days of care • 308,000+ annual emergency department visits • 640,000+ annual clinic visits • 116,000+ annual surgeries • 79,000+ inpatient discharges • 2.3 million+ residential care days • 1.9 million+ home support hours • 199,000+ home nursing visits
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About Vancouver Coastal Health
Geographic area:
• 54,165 square kms • Richmond • Vancouver • North Shore • Sunshine Coast • Powell River • Sea to Sky • Bella Bella/Bella Coola
One of BC’s top 55 employers
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Who we serve at VCH Vancouver
• Urban centre with inner city challenges • Highest and lowest socio-economic status in
one geographic area • 40% of our patients in acute care are from
outside Vancouver • 640,000 Vancouver residents:
– 1 in 4 live in poverty – 1 in 5 are under 19 – 1 in 8 are 65+ – 1 in 3 live alone – 1 in 6 families annual income below $20,000 – 1 in 2 speak English at home
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Innovate For Sustainability
Workforce Optimization Initiatives
Program Budget Marginal Analysis, Pay for Performance
Food Waste and Recycling Programs
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Fiscal Crisis in 2008
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Fiscal Crisis in 2008 $42m Operating deficit •95% of funding received committed to collective bargaining •Cash less than 1 weeks payroll - $10m •ED congestion and hallway patients •High admin and support costs (15%) •Staff growth higher than volume growth
$1 Billion Infrastructure Deficit (excluding hospitals)
Outdated technology – on fire pc’s Obsolete equipment Aging and not well maintained facilty
•$50m capital projects in flight without a funding source
35
Turnaround Plan • Take control of cash and stop in flight projects • Get admin and support costs into line – $26m and 200 staff
reduction –reduce from 13% to 9.2% • Invest in ED Pay for Performance • Get control over headcount – Senior team approves all new hires
and replacements • Focus on workforce optimization to get control over the biggest cost
item –over 70% • Invest in staff scheduling, forecasting,decision support tools and
portals
I will focus my discussions today on workforce and resource optimization and developing agile financial processes
36
Key Elements of Our Resource Optimization Journey
Scheduling Deploy staff effectively
Data Warehouse Standardized data
increased data quality for decision making
Care Management Understand patient acuity
and care needs
Bed Management Maximize utilization of beds
Business Intelligence Integrated portal improves and Simplifies reporting capabilities
Forecasting Project demand and staffing requirements
Resource Optimization
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Workforce Optimization Objectives
• Optimize resource utilization through alignment of staffing to predicted
patient volumes / activities:
– Reduce productive hours per patient day
– Reduce cost per patient day
– Optimize variable staffing
• Improve patient flow:
– Optimize discharges to create capacity
– Decrease ALOS
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LGH Pilot LGH, VC, VA
VGH/VC
Scope & Timeline: Staff Scheduling and Staff Forecasting
Jun 2009
Oct 2009
Mar 2010
RHS and Community
Jun 2010
Jan 2011
PHC Upgrade
Feb 2011
May 2011
PR, Corp, Regional
Feb 2012
VA Amb, HR, MI, Comms
LMI – MI July 2012 VC, Corp,
NS Com
STS and SC
Dec 2012
RH Pilot
Apr 2009
RH & LGH
Feb 2011
SP & MSJ
Jun 2011
VGH & UBCH
Mar 2012
2009 Apr
2009 Jun
2009 Oct
2010 Mar
2010 Jun
2011 Jan - Feb
2011 May - Jun
2012 Feb - Mar
2012 Jul
2012 Dec
Staff Scheduling
Staff Forecasting
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Average Variable StaffingGFS Rehab MedicineOct 03-Nov 13, 2008
0
5
10
15
20
25
30
35
40
F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13
Ave
rag
e N
um
ber
of
Sta
ff
52
54
56
58
60
62
64
66
68
70
72
Cen
sus
RN LPNAide CensusBudget
Staff Forecasting and Staff Scheduling
• Lower fixed levels of staffing and increase flexibility of variable staffing
Average Variable Staffing
Staff Forecasting Solution will allow the
ability to forecast demand & the
associated staff requirements
Optimizing Variable Staffing Levels
Staff Scheduling Efficient & effective deployment of staff to match expected
activity patterns
40
Predicting Demand An integrated approach to optimal resource utilization
..and
How will I know… How will I know…
CapPlan
..and
How many patients can I expect? How many staff will I need?
What beds are available to place patients?
(Access and Flow)
What staff are available to fill shifts?
(Staffing Service) Beds Staff
Patient Volume
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Workforce Optimization through Capacity Planning
Capacity Planning for Hospital Care (CapPlan), an operational management system and a toolkit for decision-making:
• Providing integrated information • Enabling staffing and bed utilization decisions on long-term and short-
term basis • With an easily accessible and visual web-based dashboard displaying
key performance indicators (i.e., discharges, occupancy) • Matching staffing levels to patient volumes:
– Optimize productive hours per patient day – Reduce overtime by planning for fluctuations in demand – Optimize relief staffing – Optimize bed utilization and flow
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Workforce Optimization through Electronic Staff Scheduling & Timekeeping Maximizing workforce capacity and effectively deploying clinical staff through the provision of efficient scheduling tools and real time staffing data for managers:
• Improved consistency and efficiency in workforce productivity • A regional view of staff resources • Real-time data access for analysis • Improved decision making • More effective deployment of staff to baseline • Decreased overtime, insufficient notice premiums and payroll errors • Significant reduction in hours per patient day • Improved daily and weekly planning • Standardized processes and procedures • Increased support for frontline and operations staff with improved
reporting processes made available through online reporting portals
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Bed Management - TeleTracking™ Capacity Management
TeleTracking™ enables patient placement and flow management redesign through:
• Pre-Admit Tracking • Bed Tracking • Transport Tracking
Successes – Technology and Process Redesign • Enhanced ability to create and manage capacity and throughput • Automated processes to improve efficiency • Reduction in “idle” bed time • Enhanced ability for proactive vs. reactive decision-making • Accurate and real-time reporting
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Managing Patient Flow through Effective Bed Utilization
• Enhanced ability to create and manage capacity
and throughput
• Enhanced ability for proactive vs. reactive
decision-making
• Automated processes to improve efficiency
• Accurate and real-time reporting
• Reduction in “idle” bed time
45
Management Reporting Through Portals (SharePoint)
Online Portals Provide: • A “one stop shop”
• Managers with real-time
tools and data to guide
decisions
• Improved productivity
• Improved data quality
• Increased accessibility,
usability, and accountability
46
CapPlan Dashboard
• Provides web-based real-time daily visibility
• Worm graph shows 3 days of information – retrospectively, today and tomorrow
• Displays key metrics with applicable traffic light on the current status within the hospital
• Can display the details of each nursing unit under each planning group
47
Pre-Cap Plan: Decision in real time
24
1 2 3 4 5 6 7
6
*
Overtime
Day
Open additional beds
7
28
Beds FTEs
24
6
48
Utilizing Cap Plan to make decision 3 days in advance
1 2 3 4 5 6 7
*
Straight time
Open additional beds 28
7
Beds FTEs
Day
6
24 * Decision
24
6
49
Utilizing Cap Plan to Create Capacity and plan ahead to exceed discharge targets
1 2 3 4 5 6 7
24
6
Baseline staffing
No additional beds 28
7
Beds FTEs
Day
28
7
50
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2011
-01
2011
-02
2011
-03
2011
-04
2011
-05
2011
-06
2011
-07
2011
-08
2011
- 09
2011
-10
2011
-11
2011
-12
2011
-13
2012
-01
2012
-02
2012
-03
2012
-04
2012
-05
2012
-06
2012
-07
2012
-08
2012
-09
2012
-10
2012
-11
2012
-12
2012
-13
2013
-01
2013
-02
2013
-03
2013
-04
2013
-05
2013
-06
2013
-07
2013
-08
2013
-09
2013
-10
2013
-11
Perc
ent o
f 4-h
our s
hift
s
Staffing Implications Example - Richmond 2 West Psychiatry
Elevated (>1 over)
Balanced (-1 to 1)
Insufficient (<-1 under)
51
Supporting Systems
Home Care
Home ED Home
Residential
Acute
Community
Real time decision support tools for agile decisions • Forecasting – staffing, census, Operating Rooms • Kronos Scheduling and timekeeping • Acuity • ED Performance monitoring • Bed management • Portals and decision support metrics • Management practices and bed meetings
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Results
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Hand Hygiene Up
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
08/09Q4
09/10Q1
09/10Q2
09/10Q3
09/10Q4
10/11Q1
10/11Q2
10/11Q3
10/11Q4
11/12Q1
11/12Q2
11/12Q3
11/12Q4
12/13Q1
12/13Q2
12/13Q3
Hand Hygiene Percent Compliance (VGH, LGH and RH for consistent four-year trend)
54
MRSA Down
0.00
2.00
4.00
6.00
8.00
10.00
12.00
MRSA Rate per 10,000 Acute Patient Days (in VCH facilities excluding PHC for consistent long term trend)
55
Workforce Optimization Efforts
FTE' Analysis
1600017000180001900020000
FTE'
s
Actual Projected
Actual 16083 16683 17452 18043 17932 17932
Projected 16083 16683 17452 18063 18695 19349
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11
56
Improvements in Insufficient Notice
Key Findings:
Year over year reductions in insufficient notice are projecting annualized savings of $724k in 2011/12
Insufficient Notice Premiums
$-
$100,000$200,000
$300,000$400,000
$500,000
$600,000$700,000
$800,000$900,000
$1,000,000
2008 2009 2010 2011 2012
Insu
ffic
ien
t N
oti
ce (
$)
Pilot, A and B
• Reduced scheduling errors
• Shift to proactive scheduling processes
• Standard Interpretation of Insufficient notice contract language
57
The Bottom Line • $120m turnaround • $10m to $250m in cash • Investment in decision support tools less than
$15m • Invest in infrastructure out of operating funds • Improved quality, Mortality, Infection, wait times
and access, Adverse drug events • Real productivity gains 2% volume growth with
the same level of staffing
58
Where to From Here?
59
Real Time ED Dashboard
INTERNAL DASHBOARD BCAmbulance DASHBOARD
PUBLIC WEBSITE
60
Data Linkages across the Patient Continuum
60
http://www.information-management.com/news/Vancouver-Coastal-Healths-Patient-Continuum-Increases-Insights-10023644-1.html
What is a Patient Continuum? • Facilitates longitudinal patient tracking across the
entire health authority according to criteria and measurements such as time, space, visits, facilities and type of care.
Why Build a Patient Continuum? • Standardizes joins between fact tables • Provides a means of analyzing patient movement • Improves data quality • Enables easier data mining Award • Winner of the 2012 Innovation Solution Award for
BI/Analytics
61
Agile Processes: Armour vs. Fly by Wire
62
Questions?
http://www.vch.ca
Thank You