Sher orb co n pres draft 3
-
Upload
cdnbloodservices -
Category
Health & Medicine
-
view
277 -
download
0
description
Transcript of Sher orb co n pres draft 3
From crisis to trusted partner in healthcare delivery:
The transformation of Canada’s blood supply system – past, present, and future
ORBCoN Spring SymposiumToronto, March 24, 2012
Dr. Graham D. Sher, MB BCh, PhDChief Executive Officer
Canadian Blood Services
Outline• Legacy• Picking up the pieces• A journey of transformation• Building for the future – an integrated blood system• Strategic shift• Challenges and opportunities• A trusted partner in healthcare delivery
2
Legacy
3
• Tainted blood: greatest public health crisis in Canadian history
• 2,000 HIV infections• 30,000 HCV infections• C$ 2.7 billion in
compensation
Legacy
• Pockets of excellence and compassionate care overshadowed by systemic failure– Poor decision-making– Inadequate funding– Insufficient governance oversight– Lack of accountability– Inability to respond in a timely manner
4
Legacy – Krever Inquiry
• Federal government determines need for a commission of inquiry
• Justice Horace Krever, appointed by Order in Council, October 4th 1993– to review/report on mandate, organization,
management, operations, financing and regulation of all activities of the blood system in Canada
5
Krever’s gift to Canada and the world
• Krever recommendations are foundation for today’s blood system in Canada, and elsewhere
• Remains the single most important prescription for modernization of blood systems internationally
6
Justice Horace Krever, recipient of Lifetime Achievement Award, Honouring our Lifeblood 2008
Krever’s recommendations
7
Picking up the pieces
• New “National Blood Authority” created via Memorandum of Understanding
• Roles of CRCS and CBA in the blood system are terminated• Canadian Blood Services (and Héma-Québec) assume
ownership and responsibility September 28, 1998
• Not-for-profit, charitable organization• Funded by provinces, regulated by Health Canada
8
Picking up the pieces
9
The system today
10
Canadian Blood Services at a glance
Governance
A journey of transformation
13
So, how did we get here?
Explicit transformation of purpose
1414
Transformation journey
15
Building for the future - an integrated blood system for Canada
16
Progress report
17
Safety
18
2007Bacterial detection 2007Bacterial detection
Safety remains paramount
Investment in safety goes beyond protection from TTHAs
automation, process control, quality culture, surveillance, knowledge, innovation etc.
Safety remains paramount
Investment in safety goes beyond protection from TTHAs
automation, process control, quality culture, surveillance, knowledge, innovation etc.
Future challenge of increasing costs of safety initiatives for increasingly small safety gain
cost benefit analyses essential
“acceptable risk” rather than “zero risk” paradigm
Future challenge of increasing costs of safety initiatives for increasingly small safety gain
cost benefit analyses essential
“acceptable risk” rather than “zero risk” paradigm
Security of supply
19
Demand for fresh components volatile
Demand for derivative products continues to increase unabated
Multi-pronged approach focusing on recruitment, retention, loyalty, product wastage, diversity of supply
Real time demand forecasting
“Collect what the system needs, not what we can”
Service Delivery Model
20
Silo modelIslands of duplicationLimited integrationLimited redundancy, backup or business continuity
National integrated supply chainSingle inventoryShared services modelConsolidation of key functionsHigh level of business continuity and redundancy
Productivity & Efficiency
21
At transition, significant under investment in core systems, processes, people and infrastructure
necessitating steep increases in revenue in early years
cost of reasonably “affordable” system unknown
At transition, significant under investment in core systems, processes, people and infrastructure
necessitating steep increases in revenue in early years
cost of reasonably “affordable” system unknown
Year-over-year increases in funding have steadily declined below the general healthcare rate
Major operational efficiencies: Collections / employee – compound annual improvement of almost 12% since 2000
Operational effectiveness has increased. Collections have a compound annual growth rate of more than 24% since 2000
Year-over-year increases in funding have steadily declined below the general healthcare rate
Major operational efficiencies: Collections / employee – compound annual improvement of almost 12% since 2000
Operational effectiveness has increased. Collections have a compound annual growth rate of more than 24% since 2000
22
Sustained drive for efficiency
22
Other major changes
23
Trust
24
• System transformation and “walking the talk” on safety has regained trust
• Trust is fragile, and must continuously be earned
Strategic shift
• Leveraging our capabilities to solve other healthcare challenges:
– National umbilical cord blood bank– Organ and Tissue Donation and Transplantation (OTDT):
• Registries• Leading practice • National strategy
25
Not just blood anymore…
2626
current
new
Prior to launching OTDT, we had independently determined we needed to transition to business line management to better serve the customers of each business line
New horizons
• The case for cord blood:– Canada one of few industrialized nations
without national public cord blood bank– Growing utilization - >900 Cdn patients
currently waiting for stem cell transplant– Better respond to Canadian patient needs
• ethnic diversity (aboriginal, mixed ethnicity, etc)
– Reduce reliance on imports, reduce costs to Canadian healthcare
New horizons
• The case for change in OTDT– Despite pockets of excellence, Canada as a country is not
realizing its full OTDT potential– Canadians are supportive of organ and tissue donation,
but the system is failing them– The system has inefficiencies, lacks equity, transparency,
and sustainable funding to drive break-through performance
New horizons
• Donation rates nationally have stagnated for a decade
• Organ donor rates are less than half of the world’s top performing countries (Canada ranks just behind Lithuania)
• Reliance on imports for tissue• Provincial service delivery model is “shackling” the
good work of healthcare professionals in the field
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Key Indicators
Waiting List Transplants Donors
Donation and transplantation performance have not been improving. In 2009, 249 Canadians died waiting for an organ transplant.
Performance data - organs
30
Sources: Canada: CORR e-statistics; International: iRodat
There has been no improvement in preventing deaths on waitlists for any organs for the last three years.
31
32.1
*ONT (Spain), UNOS (US), NHSBT (UK), Donatelife (Aus), CIHI/CORR (Canada)
15.3
International experienceDeceased donors per million population (2010)
Reducing wait times
32
Call to Action Targets:An increase of 50% in donations, resulting
in over 900 new transplants annually by Year 5 of the plan.
Call to Action Targets:An increase of 50% in the supply of corneas
resulting in an additional 1,100 transplants annually by Year 5 of the plan
Current State — Canada vs. USA
33
*Data estimated from 2007 to 2009 EBAA, AATB, and CBS statistics)
Attempts to improve performance
34
Volpe Report
DM Report/ ACHS
CCDT merges with CBS
CCDT established
NationalCoordinatingCommittee
Alberta Framework for
Action
Citizens Panel (ON)
CDM Report/ CCDT
QC Minister/ CEST
New horizons – some early advances
• Organ registries:– Living Donor Paired Exchange
• partnership between transplant centres and Canadian Blood Services
• Pan-Canadian• 100+ transplants facilitated in past 2 years
– National Organ Waitlist– Highly Sensitized Patients
New horizons
• OTDT national strategy:– Call To Action delivered 25 recommendations on how to
significantly improve performance– 3 years worth of consultation, dialogue, and planning with
experts (domestic and international), professional associations, patients and patient groups, governments and other stakeholders
– Delivered to FPT governments April 2011– Impact assessments ongoing , decision
pending in 2012
Challenges and Opportunities
37
Challenges and opportunities
38
International trends in blood systems
39
A trusted partner in healthcare delivery
40
A trusted healthcare partner
• Viewing the blood system as an integral part of the healthcare system
• Our value proposition is partnership in healthcare delivery
• Over a decade of experience in complex health system transformation:o Leverage the lessons learned:
service delivery integration healthcare sustainability national pharmacare in micro
41
A trusted healthcare partner
• We have a lot to offer when it comes to being part of national health policy discussions.
• Proven and unique experience in operating a nationally integrated system, best practices and learnings to share with others.
• Real opportunity for Canadian Blood Services to leverage its national, pan-Canadian, integrated, delivery expertise
Conclusion
Paradigm shift:•From crisis to confidence•From single-focus to multiple business lines•From risk aversion to risk-based decision making•From monopoly, to stewardship – continually earning the right to serve•From service provider to trusted partner in patient care
43
44
Questions