Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006

Enhancing System Performance and

Operations Management:Using Research and Technology to

Reduce Uncertainty and Enhance Value

Originally presented March 21, 2006

(Revised July 26, 2006)

Michelle Goulbourne

Health System Performance and Operations Management

Strategic Drivers of Change

Concerns:

1. Increase in health care costs – projected to reach $142 billion in 2005

7.7% over previous year (CIHI 2005).

2. Our efforts have enhanced patient outcomes but the strategies have

not been cost effective (Veillard, J., Ardal, S. and Gilbart, E. 2006).

3. Variations in outcomes reflect spatial and sociocultural factors.

4. Access issues such as wait times and variation in utilization rates

remain.

5. Aging of baby boomers and concerns about the burden of care weigh

heavily on all stakeholders.

6. Patient evaluations of care.

7. Limited systematic technology integration in the health care sector.

Certainty

The only certainty is

that nothing is certain. Pliny the Elder

Sam Savage 2000, http://analycorp.com/uncertainty


System Planning for Change Management

• Abandon averages and face uncertainty squarely.

• Harness the best of the “New World” of management tools

such as simulation, decision trees, portfolio theory and real

options.

• Develop collaborative and long-term knowledge building

relationships between health care stakeholders,

government and academia.

• Create principled strategies for dealing with competing

healthcare priorities that include decisions about health

care operations and clinical practice.


Strategic Goals Identified

Health Results Agenda is to:

1. Strengthen accountability in health care.

2. Actively manage health system performance.

3. Target better health system outcomes. (Veillard, J., Ardal, S. and Gilbart, E. 2006).

Towards this end a macro-structural framework has been established

with agreed upon performance indicators associated with each level

(LHIN, sector and provider).


Policies StructureTools

Formalized macro-

structural policy

framework that

informs evidence

based planning

and accountability

processes.

Performance

measurement system

that consists of health

care and quality

indicators whose

measures may be

tracked and compared

over time.

Creation of programs,

and operational

processes that

enhance our ability to

achieve health system

goals and sustain

them temporally and

spatially.

Dynamic Collaborative Multi-Level Relationships

3 Levels of

Operation

1. System

2. LHINS

3. Providers

Ministry Goals and

Government Priorities

Health System

Scorecard

Innovation for

Sustainability

Hospitals Cancer

Centres

*Revised Strategy Diagram – Original in Veillard, J., Ardal, S. and Gilbart, E. 2006.

Performance Management Strategy*


Health System Strategy Map

Edited Strategy Map From: Veillard, J., Ardal, S. and Gilbart, E. 2006.

“Strategy fundamentally reflects a statement about

what you are doing and what you hope to achieve. “

5. CREATE “TRUE VALUE “

True Value at the Local Level

“…should occur in the prevention, diagnosis, and treatment of

individual health conditions. It is at this level that true value

is created – or destroyed – disease by disease and patient

by patient. It is here where huge differences in cost and

quality persist. And it is here where competition would

drive improvements in efficiency and effectiveness, reduce

errors and spark innovation.”

(Porter and Olmsted Teisberg 2004)


• Resource utilization, efficiency and cost effectiveness

• Standardization of patient care

• Manage costs

Getting There Involves Provider Level Change

Organizational Processes

• Patient satisfaction along the trajectory of care

Patient Level Processes

• Guideline based clinical care paths at point of care

Medical Care Process Factors

• Timely access to the right treatment

• Accurate patient assessment and follow-up

Provider System Processes


• Integrated clinical system supporting the trajectory of care

Technological Processes

Planning, Performance and Success*


System Goal

Attainment

*Extension of diagram created by Veillard, J., Ardal, S. and Gilbart, E. 2006.

Regional

Innovations

- Technology

(Electronic Health

Record, Patient

Portal, etc.)

- Clinical Decision

Support Tools

Project Evaluation,

Knowledge Transfer

Procedures & Integration

Regional Performance

Network Determine Priority

Projects and Programs

Concerned

about local

compliance,

innovation,

dissemination

and quality

Regional Performance Networks

What are we doing as a team to achieve our long term goals?

How can we work together better to increase the effectiveness of our efforts regionally?


Reflecting from a Systems Perspective

• Learning and Growth – professional skills, capabilities and the accessibility

of integrated information systems and extent of innovation.

• Internal Processes – intermediate functional, clinical and financial

outcomes such as length of stay, price per unit of service.

• Customer Outcomes – health related quality of life, patient and employee

satisfaction.

• Financial Outcomes – goals, return on investment.

1. Innovative practice that is tested and then transferred to sites of

parallel practice over time.

2. Implement high impact changes across the region.

Knowledge Transfer and Regional System Integration

• Regional frameworks have the volumes that can encourage local

specialization which often enhances expertise, efficiency and reduces

errors and costs.

• Local providers within regional frameworks are motivated to improve

due to accountability agreements and patient choice.

Regional Technological IntegrationRegional Vision

• Regional deployment of integrative technologies that support

evidence based care of all diseases and patient types from oncology

to oral surgery.

• Patients have greater access to their health histories and use it to make informed appraisals about local care.

• Patients can freely choose among care options with their electronic health record supporting their care regardless of the provider.

Integrated Electronic Health Record


• Need informed technologically ready staff.

• Staff that are “ready” fully understand the vision and support it.

• Ready staff have the skills and resources for goal attainment.

Staff Readiness

Vision + Leadership Success

• Staff readiness is assessed as part of the planning process.

• Training and access to resources (software/computers/space) need to be negotiated so staff can make substantive contributions to the team and the project over the long term. Working smarter not harder.

• Once this foundation is laid quality improvement innovation and implementation can become “business as usual”.

Staff Capacity Building = Long Term Success

Capacity building at the individual level creates the foundation

for future local level innovation.


System Performance Success

• Share the regional vision and ensure that staff have the integrative technology, data, tools and other supports they need to achieve local goals.

• Develop a team of expert facilitators and clinical champions to implement and sustain initiatives over time and space.

• Implement high impact sustainable initiatives that enhance evidence availability and use, provision of care, health status and outcomes and health system sustainability and equity.

• Increase capacity at the local level to replicate and sustain these successes across the region.

Thank You

Contact

Michelle Goulbourne

[email protected]

mailto:[email protected]

Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006

Health & Medicine

Transcript of Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006