Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006


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Health System, Health System, Performance, Operations Research, Value, Michelle Goulbourne

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Enhancing Health System Performance Creating Value with Operations Research M Goulbourne 2006

  1. 1. 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
  2. 2. 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.
  3. 3. Certainty The only certainty is that nothing is certain. Pliny the Elder Sam Savage 2000, http://analycorp.com/uncertainty
  4. 4. 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.
  5. 5. 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).
  6. 6. Health System Performance and Operations Management Performance Management Strategy* Dynamic Collaborative Multi-Level Relationships Structure 3 Levels of Policies Tools Operation Ministry Goals and Health System Innovation for 1. System Government Priorities Scorecard Sustainability 2. LHINS Formalized macro- Performance Creation of programs, 3. Providers structural policy measurement system and operational framework that that consists of health processes that informs evidence care and quality enhance our ability to Hospitals Cancer based planning indicators whose achieve health system Centres and accountability measures may be goals and sustain processes. tracked and compared them temporally and over time. spatially. *Revised Strategy Diagram – Original in Veillard, J., Ardal, S. and Gilbart, E. 2006.
  7. 7. Health System Performance and Operations Management Health System Strategy Map “Strategy fundamentally reflects a statement about what you are doing and what you hope to achieve. “ 5. CREATE “TRUE VALUE “ Edited Strategy Map From: Veillard, J., Ardal, S. and Gilbart, E. 2006.
  8. 8. Health System Performance and Operations Management 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)
  9. 9. Health System Performance and Operations Management Getting There Involves Provider Level Change Provider System Processes • Timely access to the right treatment • Accurate patient assessment and follow-up Patient Level Processes • Patient satisfaction along the trajectory of care Medical Care Process Factors • Guideline based clinical care paths at point of care Organizational Processes • Resource utilization, efficiency and cost effectiveness • Standardization of patient care • Manage costs Technological Processes • Integrated clinical system supporting the trajectory of care
  10. 10. Health System Performance and Operations Management Planning, Performance and Success* System Goal Attainment Regional Innovations - Technology Concerned (Electronic Health Regional Performance Project Evaluation, about local Record, Patient Network Determine Priority Knowledge Transfer compliance, Portal, etc.) Projects and Programs Procedures & Integration innovation, dissemination - Clinical Decision and quality Support Tools *Extension of diagram created by Veillard, J., Ardal, S. and Gilbart, E. 2006.
  11. 11. Health System Performance and Operations Management Regional Performance Networks 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. Knowledge Transfer and Regional System Integration 1. Innovative practice that is tested and then transferred to sites of parallel practice over time. 2. Implement high impact changes across the region. 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?
  12. 12. Health System Performance and Operations Management Regional Technological Integration Regional Vision • 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. Integrated Electronic Health Record • 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.
  13. 13. Health System Performance and Operations Management Staff Readiness Vision + Leadership Success • 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 Capacity Building = Long Term 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”. Capacity building at the individual level creates the foundation for future local level innovation.
  14. 14. 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.
  15. 15. Thank You
  16. 16. Contact Michelle Goulbourne mgoulbourne@diamindhealth.com