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Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006
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Transcript of 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
Health System Performance and Operations Management
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.
Health System Performance and Operations Management
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).
Health System Performance and Operations Management
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 Performance and Operations Management
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)
Health System Performance and Operations Management
• 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
Health System Performance and Operations Management
• Integrated clinical system supporting the trajectory of care
Technological Processes
Planning, Performance and Success*
Health System Performance and Operations Management
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?
Health System Performance and Operations Management
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
Health System Performance and Operations Management
• 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.
Health System Performance and Operations Management
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