Sher orb co n pres draft 3
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  • We have a gone from a source of outrage to an pan-Canadian institution worthy of the trust of the public, donors and hospitals New mandate: rebuild the blood system in Canada regain the trust of Canadians in their blood supply create risk management programs aimed at preventing future catastrophes
  • Before: No system based approach to the business No big picture of problems and solutions Process and structural duplication Error-prone manual systems Obsolete IT infrastructure Lack of operating metrics No consistent operational look and feel After: Fully integrated national system Capacity for rapid response (e.g. WNV) Flexibility and scalability to manage demand shifts (e.g. 9/11, labour disruptions) Comprehensive use of information technology to improve safety and quality e.g. MAK Progesa, advanced modular testing Single national inventory improved supply-demand alignment
  • The provincial and territorial ministers of health (excluding Québec*) approved the total estimated cost of $48 million to establish and operate a national, public cord blood bank with the goal of obtaining 20,000 ethnically diverse cord blood units over eight years. Canadian Blood Services agreed to raise $12.5 million in the first three years to help cover the $48 million total cost. The Canadian Blood Services’ OneMatch Public Cord Blood Bank will consist of collection sites (hospitals) in Ottawa, Toronto, Edmonton and Vancouver, with processing and storage sites at our two existing stem cell laboratories in Ottawa and Edmonton. Phase 1 of the cord blood bank is estimated to be operational in Ottawa by April 2013, and in the remaining sites, Phase 2, by the fall of 2014, giving even more Canadians the opportunity to donate cord blood stem cells. Mention funding for cord blood
  • Organs 101 Organs that can be transplanted include kidneys, heart, liver, lungs, bowels, pancreas. Organs must be transplanted within 4 – 48 hours of recovery, depending on organ type For patients suffering from end-state organ failure, organ transplantation is generally the best long-term treatment option, and in many cases the only therapeutic choice available to patients. For some organ transplantation, notably kidneys, there is significant economic benefit as well With the exception of lungs, the situation is deteriorating. Key Indicators: Wait time issue: in previous graphs it looked like wait times were improving but we know there has not been a substantial increase in transplants. This issue with CORR data—Alberta—mis-reporting of data in 2009. In 2008 (427) in 2009 (283—should it be 483?) and then 2010 (526)—checking. Ontario—waitlist is slowly going down but Trillium data confirms that CORR data not correct—it’s not crashing down. Trillium reports in 2008 (1683), 2009 (1631), 2010 (1525)…as opposed to CORR in 2008 (1739), in 2009 (1229) and 2010 (865). Also important to note—how different the Trillium data is from CORR…(wait lists and transplants) Depending on age, 30-40% of Cdns who need an organ transplant will not receive one and will get removed from transplant waitlists as a result of death or further disability. Patients with transplant eligible organ failure do not just suffer and die. They do so while consuming substantial resources on expensive life-sustaining machines such as dialysis and mechanical hearts.
  • As international experience shows, performance improvements happen when multiple, interwoven initiatives, collaboration and national leadership converge. Spain and the U.S. are international leaders in OTDT performance, consistently reaching high performance. Their experiences and methods have been successfully applied in other countries to improve performance. While ON’s performance exceeds the national average, we are headed in the wrong direction and have much opportunity for improvement. In January 2008 the OTDT taskforces reported in UK. Key recommendations to increase donation rates 50% in 5 years included: 100 extra donor transplant coordinators employed centrally by NHS Blood and Transplant Almost 200 Donation Physicians (known as Clinical Leads for Organ Donation in the UK) Dedicated organ retrieval teams available 24/7 Funding (per donor ) hospitals to reduce disincentives associated with costs of donation (equivalent of about $3,300 CAD/donor) From 2008/09 to 2012/2013, the UK has invested or plans to invest over £150 million to implement their recommendations. These investments are proving successful. In January 2011, NHSBT reported 28% increase in donation rates since initiating implementation of their package of recommendations. As of July 2011, the UK was close to achieving a 40% increase in donor numbers over 4 years. In July 2008, an OTDT reform package was announced in Australia to establish a nationally consistent and coordinated system. Some of the key elements of the $151.1 m (Aus) funding package include: $67 m over 4 years to fund donation specialists and other staff $17 m over 4 years for staff, beds and infrastructure costs for hospital donation activities $13.4 m over 4 years for public awareness and education $46 m to establish nationally consistent approach, of which $24.4 m over 4 years will fund the Authority’s operation and infrastructure It is still early in the implementation of their plans, but both the UK and Australia are reaping the benefits of their investments and seeing increases in their donation rates: UK – from 14.7 dpmp (2008) to 15.3 (2010) Aus- from 12.1 dpmp (2008) to 13.8 (2008) Canada has failed to achieve sustainable performance improvement 2010 data from each countries national org: ONT (Spain), UNOS (US), NHSBT (UK), Donatelife (Aus), CIHI/CORR (Canada)
  • Governments have had some success in reducing wait times for various procedures: cancer, heart, diagnostic imaging, joint replacement and sight restoration (cataracts); however, wait times for organs and corneas continue to be among the longest and most variable across the country.   Organs For patients suffering from end-stage organ failure, organ transplantation is generally the best long-term treatment option, and in many cases is the only option available for patients. Yet, too many patients die waiting for an organ transplant. The statistics are alarming: In 2009, 249 Canadians died waiting for an organ transplant. Depending on age, 30-40% of Canadians who need an organ transplant will not receive one. There has been no improvement in preventing deaths on waitlists for any organs for the last three years. In fact, t here has been no significant improvement in performance over the past 15 years. Canada’s donation rates are in the lower half of developed countries. Donation rates vary across the country and though some provinces are doing better than others, none match world leaders such as Spain or United States. The implementation of Call to Action recommendation swill result in an increase of 50% in donations and in transplantations, or 900 new transplants by year 5. We can’t predict specifically how far our wait times will go down – we’re not sure our current wait time numbers are accurate, we expect many people who are not on the list should be on the list, we expect wait lists will expand with increased supply – however, we do expect that deaths on wait lists will decrease, and that the variability that currently exists between provinces will be reduced. Tissues We know that many patients wait for as long as three years for cornea transplants to restore or improve their vision, and an estimated 2000 Canadians are waiting for a transplant. Our plan will increase the supply of corneas by 50%, allowing for an additional 1100 transplants annually by Year 5. In the United States cornea transplantation is scheduled electively, and there are enough corneas available to allow some to be exported abroad. We believe Canadians should have equitable access to cornea transplants, and there is no reason why this cannot be an elective procedure in Canada as well. For other tissues, we import what we can’t produce. For surgical use we import 53% of what we need, and when you include the tissues used in dental practice, we import 80% of all the tissue we need. In addition to the wait time issue for corneas and tendons, surgeons do not have enough skin for burn patients, heart valves for children.
  • Message One We’re not the first to try to improve OTDT in Canada. Message Two In the past 10 or 15 years, there have been numerous papers, recommendations and changes, at the federal and provincial levels, targeting improvements in the Organs and Tissues systems. Message Three But as you can see, and this graph is just one example, we have not achieved substantial improvements in key donation and transplant metrics. 02/28/12
  • Since 1998, Canadian Blood Services has introduced significant and important changes to the blood system, each designed to restore public trust, increase the security of supply, and maximize safety. This is our time to ‘pay it forward’ No other organization has experienced the lessons learned or developed best practices in relatively short period of time
  • While working diligently to improve the blood system – never deviating from this focus – Canadian Blood Services is at a point in its evolution where its national delivery model, operational capabilities and governance model can be leveraged to provide solutions and services in other parts of the healthcare system. – not only based on its experiences with the transformation of the Canadian blood system, but also with mandates such as the development of the Organ and Tissue Donation and Transplantation national strategy, the creation of a national public cord blood bank and plasma protein product bulk purchasing expertise on behalf of the provinces and territories.

Sher orb co n pres draft 3 Presentation Transcript

  • 1. From crisis to trusted partner in healthcare delivery: The transformation of Canada’s blood supply system – past, present, and future ORBCoN Spring Symposium Toronto, March 24, 2012 Dr. Graham D. Sher, MB BCh, PhD Chief Executive Officer Canadian Blood Services
  • 2. 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
  • 3. Legacy
    • Tainted blood: greatest public health crisis in Canadian history
    • 2,000 HIV infections
    • 30,000 HCV infections
    • C$ 2.7 billion in compensation
  • 4. 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
  • 5. Legacy – Krever Inquiry
    • Federal government determines need for a commission of inquiry
    • Justice Horace Krever, appointed by Order in Council, October 4 th 1993
      • to review/report on mandate, organization, management, operations, financing and regulation of all activities of the blood system in Canada
  • 6. 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
    Justice Horace Krever, recipient of Lifetime Achievement Award, Honouring our Lifeblood 2008
  • 7. Krever’s recommendations
  • 8. 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
  • 9. Picking up the pieces
  • 10. The system today
  • 11. Canadian Blood Services at a glance
  • 12. Governance
  • 13. A journey of transformation So, how did we get here?
  • 14. Explicit transformation of purpose
  • 15. Transformation journey
  • 16. Building for the future - an integrated blood system for Canada
  • 17. Progress report
  • 18. Safety
    • 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
  • 19. Security of supply 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”
  • 20. Service Delivery Model Silo model Islands of duplication Limited integration Limited redundancy, backup or business continuity National integrated supply chain Single inventory Shared services model Consolidation of key functions High level of business continuity and redundancy
  • 21. Productivity & Efficiency
    • 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
  • 22. Sustained drive for efficiency
  • 23. Other major changes
  • 24. Trust
    • System transformation and “walking the talk” on safety has regained trust
    • Trust is fragile, and must continuously be earned
  • 25. 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
  • 26. Not just blood anymore… 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
  • 27. 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
  • 28. 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
  • 29. 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
  • 30. Performance data - organs Donation and transplantation performance have not been improving. In 2009, 249 Canadians died waiting for an organ transplant. 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. International experience Deceased donors per million population (2010) 32.1 *ONT (Spain), UNOS (US), NHSBT (UK), Donatelife (Aus), CIHI/CORR (Canada) 15.3
  • 32. Reducing wait times 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 
  • 33. Current State — Canada vs. USA * Data estimated from 2007 to 2009 EBAA, AATB, and CBS statistics )
  • 34. Attempts to improve performance Volpe Report DM Report/ ACHS CCDT merges with CBS CCDT established National Coordinating Committee Alberta Framework for Action Citizens Panel (ON) CDM Report/ CCDT QC Minister/ CEST
  • 35. 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
  • 36. 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
  • 37. Challenges and Opportunities
  • 38. Challenges and opportunities
  • 39. International trends in blood systems
  • 40. A trusted partner in healthcare delivery
  • 41. 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:
      • Leverage the lessons learned:
          • service delivery integration
          • healthcare sustainability
          • national pharmacare in micro
  • 42. 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
  • 43. 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
  • 44. Questions