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Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
Building a Business Case
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Building a Business Case

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This was presented in session F6 at the Quality Forum 2014 by: …

This was presented in session F6 at the Quality Forum 2014 by:

Rizwan Damji
Director, Financial Planning and Business Support
Vancouver Coastal Health

Sydney Scharf
Project Manager, Infection Control
Vancouver Coastal Health

Published in: Health & Medicine
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  • 1. Developing a Business Case for Quality Dr. Elizabeth Bryce Linda Dempster Sydney Scharf Rizwan Damji Vancouver Coastal Health Authority February 28, 2014
  • 2. Traditional Business Case 1. Background –current state, problem/opportunity 2. Project Description – Objectives, scope, deliverables, operational impacts, strategic alignment 3. Cost and Benefit analysis – resource requirements, costs and benefits and assumptions 4. Risk Assessment – project risks and risk of not proceeding with project 5. Evaluation – how will we know the impacts 6. Alternative Analysis – what other options are there 7. High Level Implementation plan –what will be done by when
  • 3. Our areas of focus 1. 2. 3. 4. 5. 6. 7. Apply framework to assess situation Clearly define the problem Develop a plan; identifying options Engage the team – think partnerships Identify measurable deliverables Share results early and often Remember the PDSA cycle
  • 4. 1. The framework Health Economic Evaluation • • • • Competition between resource scarcity and providing the best possible care Economic outcome measurement, efficient use of resources Patient focused Long-term evaluation Cost-Benefit Analysis • • • Evaluation of costs and consequences in monetary units Opportunity Costs Cost Avoidance System Access • Translate results into improved access to the system, e.g. • Bed days / Patient days • Wait times • Patient Volume Projection Analysis • Assess the potential of a quality improvement initiative before implementation  Is an intervention worthwhile? 4
  • 5. Our emphasis was on 1. 2. Productivity & Efficiency Quality Outcomes • Patient/Employee Satisfaction and Experiences • Adverse Events / Occurrences • Healthcare Acquired Infections • Mortality & Morbidity • Length of Stay • Admissions / Readmissions • Work Flow / Direct Care Time • Employee Turnover and Staff Absence • Reducing Waste /Clutter-Free Environment Making Cents 4. Program Costs / Investments 3. Health Economics • Operational Costs • Implementation Costs • Training and Education • Consultancy Support • Cost-Benefit Analysis • Return-on-Investment • Cost Avoidance • Access (e.g. additional patient days, beds freed) 5
  • 6. Assess the situation The health economic framework is useful in building a business case as it takes into consideration multiple factors and it can be applied to evaluate a number of different programs
  • 7. Economic Burden of Adverse Events* The rate of AE 7.5 % The total number of discharges per year 84,043 (VCHA) Economic burden of preventable AE $ 15,329,475 Additional attributable acute care days per AE 6 days** Of which 37 % are preventable Median cost per acute care day $ 1,100 Economic burden of AE $ 41,601,285 Resources: * Baker, N. et al.: The Canadian Adverse Events Study. CMAJ. 2004. Vol. 170(11): 1678-86. **Etchells, E. et al.: The Economics of Patient Safety in Acute Care. Canadian Patient Safety Institute. 2012. 7
  • 8. Money, Money, Money… …is not the only deliverable
  • 9. 2. Clearly define the problem Healthcare-associated infections (particularly C.difficile) need to be improved Roles/Responsibilities for cleaning of portable equipment have never been assigned (ward clutter, hoarding, mixing clean and dirty) Cleaning of surfaces impeded by clutter, out-dated tools (e.g. cleaning carts, rags), inadequate instructional aids and logistical issues Minimal antimicrobial stewardship program, limited accountability for antimicrobial resistance rates, prescribing practices and drug utilization contributes to the problem 9
  • 10. 3. Develop the plan • • • • • What are you trying to improve? How will you get there? What resources do you need? What is the ROI? How long do you need?
  • 11. What did we want to improve Standardize equipment cleaning and reducing C. difficile rates Need to identify: • All the elements • Clear direction • Who is accountable
  • 12. Elements of our plan • • • • Environmental de-cluttering to improve overall surface cleanliness on the wards An environmental management program to improve clinical equipment surface cleanliness Antimicrobial stewardship program to ensure appropriate, cost effective use of antibiotics on the clinical units within our hospitals Implementation of a risk-managed approach to the isolation of VRE clients in an effort to support patient flow and reduce unit supply costs 12
  • 13. Environmental Program • • • • • De-cluttering Introduction of color coded microfiber cleaning cloths and color coded buckets Equipment management includes cleaning, preventative maintenance, establishing par levels, and ensuring that the right piece of equipment is available and is clean at all times. Labeling/tagging Introduction of PPE carts
  • 14. Antimicrobial Stewardship Program • • • • • • Right drug Right time Right route Most focused therapy Least invasive therapy Optimal duration of therapy
  • 15. 4. Engaging the Team • Thinking win – win • According to Steven Covey it is one of the seven habits of highly effective people • It is the habit of EFFECTIVE INTERPERSONAL LEADERSHIP • Take the time to consider the other persons perspective and engage them with that in mind
  • 16. Leadership support is the key • When we think of leadership we need to think of in context of the layers within the organization – Senior Leadership – Project Leadership – Front Line Leadership
  • 17. Project Leadership • • • • • • Regular updates Working groups Continuous engagement Culture shift Project influences were reported routinely Updates for senior leaders and what was the goal.
  • 18. About working together • • • • • Goals have to resonate with the team Acknowledge and recognize team effort Thank team members Report on successes Share successes
  • 19. Our partners • • • • • • • • • • • • • Aramark Biomedical Engineering BISS CDI Working Group at VGH, Goldie Luong Clinical Services FMO HSSBC IMIS Infection Control Leslie Forrester & Epidemiology Team Medical Microbiology Pharmacy Professional Practice
  • 20. Speaking the same language
  • 21. Be Flexible • You may have to change your plan along the way • You may have to play many different roles: bookkeeper, labour lawyer, coach and expert stay calm and REMAIN FOCUSED!
  • 22. 5. Measureable deliverables • Identify indicators for each projected benefit • This comes from being able define and link each benefit “cause” to an “effect” – Environmental cleaning will show a change in UV audit results – Switching to less costly generic drugs that have the same efficacy will overall drug costs
  • 23. Metric Our deliverables ↓ Equipment management ↓Isolation Management Costs 1 2 Isolation Cost Avoidance Implement an environmental program to improve equipment and surface cleanliness Product Replacement Establish a VCH antimicrobial stewardship program to ensure appropriate, cost effective antibiotic use Environmental Improve use of antibiotics Program Decrease costs of antimicrobials Antibiotic resistance Antimicrobial 3 4 Decrease healthcare-associated infections following implementation of the two programs Implement a risk-managed approach to the isolation of VRE Stewardship Decreased rates of: UTIs, MRSA, Hand VRE, VAP, BSI, SSI Hygiene Standardized Staff Satisfaction Protocols ↓ Lab costs 23
  • 24. 6. Share the results early and often 1. Regular reporting and updates to leadership team(s) 2. Show them the results early 3. Look for low hanging fruit early 4. Remain focused 5. No surprises – if something goes sideways, must report 6. Spend the money early!
  • 25. De-cluttering Before After 26
  • 26. Yellow gowns Before
  • 27. Yellow gowns After
  • 28. Savings -- Environmental Achieved Soap-Swap Out $65,490.00 Lab Savings $64,830.00 Yellow Gowns $154,170.00 Decreased FTE Equipment Program $480,000.00 Total for 1 year $764,490.00
  • 29. Patients isolated for VRE at VGH Before After 32 beds/day 7 beds/day
  • 30. Four Cornerstones VGH: Pre and Post Implementation Total CDI Acquired at VGH (Pre & Post Implementation) 400 350 375 ↓ 30% Total Number of Cases 300 250 263 200 150 100 50 Jun 2011 - Aug 2012 Sep 2012 - Dec 2013 0 Pre Post
  • 31.  Dollars saved  Bed Days saved  Patients protected from CDI
  • 32. ASPIRES Antimicrobial Stewardship Program – Innovation, Research and Education for Safety Clinical Care Education Excellence Research Collaboration
  • 33. IV to PO Step-Down IV Anti-Infective Utilization (DDDs per 100 Patient Days) RH IV Anti-Infective Utilization (DDDs per 100 Patient Days) VGH 8 7 6 5 4 3 2 1 0 7.3 5.6 Pre Post DDDs per 100 Patient Days DDDs per 100 Patient Days Interventions: •Stepping down from IV to PO anti-infectives when patients can tolerate PO Outcomes: •Reduced utilization of IV anti-infectives with PO bio-equivalence at VGH and RH 16 14 12 10 8 6 4 2 0 13.8 10.7 Pre Post
  • 34. Financials -- ASPIRES Run Rate for Imipenem to Generic Meropenem Substitution VGH: $144,524* Audit and Feedback - Reduction in Antibiotic Utilization VGH, CTU: $34,812 IV to PO Step-down : VGH: $22,901 RH: $4,448 Total Cost Savings (FY 2013/14 Periods 1- 8): $199, 538 * In collaboration with pharmacy
  • 35. 7. Remember the PDSA cycle Plan (operationalize) Act Do (Trial) (adjust) Study (assess/review)
  • 36. Questions
  • 37. IHI Calculator • http://www.ihi.org/knowledge/Pages/Tools/ AdverseEventsPreventedCalculator.aspx Adverse Events Prevented Calculator

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