Public sector/stakeholder collaboration - moving beyond “the clenched fist”
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Transcript of Public sector/stakeholder collaboration - moving beyond “the clenched fist”
Public sector/stakeholder collaboration - moving beyond “the clenched fist”
Strategies for Public Sector Transformation 2002
- October 16, 2002
Agenda introduction Physician Office System Program
– a case study
challenges & solutions
“You cannot shake hands with a clenched fist”
- Indira Gandhi
Introduction lessons learned from walking in the other guy’s moccasins experience is the best teacher or “how I got the scars on my
back” Alberta Wellnet CYNCH Western Health Information Collaborative Alberta “One Window” Common opportunities Western Canadian Continuing Care EHR Initiative Physician Office System Program
the usual disclaimer
The Physician Office System Program
A case study…
Physician Office System ProgramPhysician Office System Program
joint initiative of the Alberta Medical Association and Alberta Health & Wellness negotiated under the AMA/AH&W master agreement a contractual relationship
provides three types of assistance to the physician: financial assistance to defray the cost of hardware/software information technology services change management services
targets improvement in physician office systems, services and business models (e.g., ASP)
POSP visionPOSP vision
“to establish a physician office information infrastructure that is integrated with the health information system”
Electronic health record
Physician office system:
Electronic medical recordIntegrated decision support
BillingSchedulingOffice productivity tools
Stand-alone information sources:
Labs
Pharmacies
Radiologists
= Interface
Regional clinical systems - acute:
MPI/ADT
Lab
Pharmacy
ER
Radiology
Home care
Immunization
Speech Pathology
““EHR” – a longitudinal record of a patient’s EHR” – a longitudinal record of a patient’s health & healthcare, from cradle to grave…health & healthcare, from cradle to grave…
Regional clinical systems – sub-acute and continuing care:
Continuing care delivery systems, including case management, care protocols, clinical data and reports
Client/patient surveys
Physician Office System ProgramPhysician Office System Program
EvaluationHoward ResearchEvaluation
Howard Research
POSPSubcommittee
POSPSubcommittee
Program DirectorProgram SupportAdmin. Assistant
Program DirectorProgram SupportAdmin. Assistant
Operations(AMA)
Operations(AMA)
Communications(AMA/AH&W)
Communications(AMA/AH&W)
IT Delivery(alberta we//net)
IT Delivery(alberta we//net)
Change Management
Change Management
AMAAMA AH&WAH&W
Program Management Office
Finance Cttee.
Delivery of change management Delivery of change management services…services…
POSP Program DirectorProgram SupportAdmin. Assistant
POSP Program DirectorProgram SupportAdmin. Assistant
OperationsOperations IT DeliveryIT Delivery CommunicationsCommunicationsChange ManagementManager
Karen Shimko
Change ManagementManager
Karen Shimko
AdvisorNancy Stewart
AdvisorNancy Stewart
Expert Field ResourcesExpert Field Resources
Expert Field ResourcesExpert Field Resources
Expert Field ResourcesExpert Field Resources
Expert Field ResourcesExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Sub-contractedExpert Field Resources
Advisor South
POSP results to date...POSP results to date...
1,212 physician participants to date; target 2,138 standing offers for physician office system vendors
developed (1st in Canada); “2nd round” of requirements definition underway physician led; 5 stakeholder groups national and regional participation
POS to POS interface feasibility study in process support for electronic reporting of lab results standing offers for Microsoft and Dell negotiated
POSP results to date…POSP results to date…
“first of its kind” change management program web-based tools (POSP Software Lab, electronic “doctors’
lounge”), communication and knowledge products, workshops (computer literacy, decision support, change management, privacy impact assessments…) & on-site consultations
communications strategy and products developed external evaluation ongoing, first reports issued operational, change management and groupware IT
systems implemented
POSP results to date…POSP results to date…
cited as the “premier” physician program in Alberta seen as a successful collaboration by the Program
sponsors proposed for renewal by both sponsors
POSP developed “standing offers” with vendors for the delivery of hardware and software that will support achievement of physicians’ program outcomes
standing offers published April, 2002 first time in Canada comprehensive physician
office system requirements articulated
IT servicesIT services
Learning as we go…Learning as we go…
significant learnings through standing offer process external evaluation conducted and results
shared with stakeholders process was fair no need to issue another RFP POSP should develop and maintain standards independent evaluation agency should evaluate
applications against standards
Benefits of this approachBenefits of this approach
consultation with stakeholders will: ensure requirements carry weight address vendors’ business issues result in increased alignment between physicians’ & other
stakeholder needs and vendor offerings allows time for vendors to meet any new
requirements vendors who already meet VCUR can market by
reference to these requirements, as soon as requirements published
Public sector/stakeholder collaboration
Lessons learned…
Barriers to successful collaboration absence of shared vision, commitment inappropriate governance model lack of specificity re: outcomes & targets lack of clarity re: roles & responsibilities misunderstanding the nature of the relationship inadequate resourcing of the collaborative effort positional stereotyping & mistrust dogmatic adherence to past decisions
Strategies that work… you can’t outsource strategic planning
business owners need to “own” the vision and define/approve key strategies environmental scan helps clarify the “larger picture”
listen with an “empty teacup”
Strategies that work… give careful thought to your governance structure
and respect it once its in place appropriate to the task terms of reference if you’ve delegated authority…don’t meddle! but hold
parties accountable with respect to agreed-upon outcomes consider “orientation” to ensure governance level
and operating level are clear on respective roles and responsibilities
Strategies that work… collaboration requires dedicated resources consider implementing an appropriately
resourced program management structure, accountable to the project sponsors
keeping sponsors, stakeholders informed is key
Strategies that work… articulate and communicate expected outcomes,
targets… link to strategies assign owners to strategies monitor and report on performance relative to these
outcomes linkage with related initiatives?
Outcomes/targets example Program outcome: Technology is delivered
Outcome
(statement of Program result)
Target
(when/quantitative/qualitative)
Means of Verification
Verification
Responsibility
1. The competitive multi-vendor market place for
physician office systems has been improved (more vendors, who meet defined requirements, are offering products and services to Alberta physicians).
By March 2003: 100% of SO vendors and 80% of non-SO vendors providing EMRs to POSP physicians indicate they understand requirements as per the SO. The number of physician office system vendors who meet or plan to meet the technical/privacy/security and EMR functional requirements has increased since Program launch. By June 2003 vendors and POSP are working together in a constructive and mutually satisfactory way. By March 2005: 80% non-SO vendors providing EMRs to POSP physicians indicate they have or will (in the next year) adopt technical/security/privacy and EMR requirements as specified by POSP. The majority of vendors selling physician office systems in Alberta have adopted peer-to-peer (POS to POS)
Vendor survey Quantitative analysis Vendor survey Vendor audit Vendor survey Vendor focus group Qualitative assessment – IT Delivery Vendor survey Vendor survey
HowardResarch
IT Delivery HowardResearch
IT Delivery
HowardResearch IT Delivery Team IT Delivery Team
HowardResearch
IT Delivery (?)
Program outcom e: T echnology is delivered
O utcom e
S trategies
O w n er
(Subcom m ittee/D elivery T eam )
1. T he com petitive m ulti-vendor
m arket place for ph ysician office system s has been im proved (m ore vendors, w ho m eet defined requirem ents, are offering p roducts and services to A lberta physicians).
S trateg y # 9 – R enew the S tanding O ffer process. S trateg y #18 – Identify vendor s trategies used b y w e//net and R H A s, harm onize w here desirable and ex plore concept of a vendor association . O ngoing vendor m anagem ent through IT D elivery
D eb K ./IT D elivery
IT D elivery
IT D elivery
2 . P hysician o ffice system
requirem ents (technical/privacy/security, E M R , business/general and usability) are understood and valued by the physician com m unity.
S trateg y # 9 – R enew the S tanding O ffer process.
D eb . K /IT D elivery
Linking outcomes to strategies…
Strategies that work… don’t confuse the way you treat people with
the nature of the business relationship partnership? contractual relationship?
don’t expect a vendor to act like the owner of the initiative…their primary focus is their own bottom line
don’t let suspicion based on different agendas taint the relationship
Strategies that work…
do your best not to fall back on stereotypes encourage a climate of continuous improvement…its
okay not to get it perfect the first time! formal evaluation function or periodic external reviews are
just good practice don’t get trapped “sticking with” decisions that time &
circumstances have proven sub-optimal change what you can on the fly… schedule reviews when
more substantive policy changes can be implemented invite the stakeholders in at the earliest
opportunity…doesn’t have to be perfect
Getting beyond the clenched fist…
The law of “win/win” says “let’s not do it your way or my way…let’s do it the best way”
- Greg AndersonThe 22 Non-negotiable Ways of Wellness