Clinical Integration: Capital Health’s Journey and Early Lessons Presentation.pdf ·...

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Clinical Integration:

Capital Health’s Journey and Early Lessons

Dr. Jodi Abbott

Vice President Operational Policy & Integration

Capital Health, Edmonton, Alberta

National Healthcare Leadership Conference

June 2, 2008


Capital Health’s Journey


Capital Health

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Red Deer


Capital Health

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Regional Health Services Planning Framework


Focus = The Patient/Client


Where we began - Integration projects

• Bone and Joint (Winter 2006)

• Neurosciences (Winter 2006)

• Cancer (Winter 2006)

• Emergency Services and System Capacity (Winter 2006)

• Chronic Disease Management (Winter 2006)

• Ambulatory Care (Fall 2006)

• Wellness (Spring 2007)

• Cardiac Sciences (Summer 2007)


THE JOURNEY: Lessons for Leaders

• Setting the stage

• Establishing a vision

• Standardized approach

• Common strategies

• Successes to date

• Key learnings


Setting the stage

Hospitals & Health Networks Magazine, January 2008


Setting the stage

• The ink blot - no ‘one way’ or model appropriate for all organizations

• Bottom up clinical integration has more impact on patient outcomes than top down structural integration

• Combination of strategies are more effective than single approaches and system thinking required


Setting the stage

• Create a shared vision – point to the burning platform!

• Look at integration drivers

– Lip service to the centrality of consumers and patients

– Emerging patterns of aging, chronic illness and disability

– Unbalanced ‘balance of care’

– Service fragmentation, gaps and redundancies

– Coordination and continuity problems

– Inefficient use of resources


Establishing a vision

Capital Health’s Integrating Services Initiative is building

stronger connections between health services, people and

providers to better support people in their care journey and

realize all the benefits of a regional health system.


Standardized Approach – Road Map

CurrentState

Assessment

Best PracticeReview

Implementation

of Service Delivery Plan

What are we

doing?

What should we be doing?

How do we get there?

Are we doing it?

Gap/Fit Analysis

What are the gaps and fits?

Design of Integrated

Service Delivery

Plan

How can we improve?

Monitoring and

Evaluation

Future State Design

Where do we need to

go?


Standardized approach


• Strong and visible leadership with authority

• Champions and change agents at all levels

• Accountability

• Administrative/medical leadership dyads

• Standardized governance structures




• Process just as important as strategy

• Adopt business methodologies – stage gated process, project management, benefits realization, system reengineering through Six Sigma, Lean

• “Integrate the integration”



• Courage for culture, process and organizational change

• Adaptive change methods – where solutions are not known

• Engagement strategies and communication



• Information management and knowledge translation strategies

• Demonstrate and report results continuously

– What difference does this make?

• Comprehensive evaluation framework and dashboards


Four common change strategies

• Providing people centred care

• Reducing clinical variance

• Organizing the care continuum

• Improving process management


Results: Ambulatory Care

• Two streams:

– Gold Standard Patient Experience - principles

– eCLINICIAN/Electronic Medical Record


Results: Bone and Joint Health

• Hip and Knee Arthroplasty

• Orthopedic Trauma

• Regional Inflammatory Arthritis

• Alternative service provider roles

• Best practice/standardized care plans

• Back and Spine


Cancer

Significant integration of services within and between regions, provincial organizations and sectors

• Breast

• Prostate


Results: Cardiac Sciences

• Services provided throughout central/northern Alberta and beyond

• Significant development within the region: Alberta Mazankowski Heart Institute

• Linking with province-wide Alberta Cardiac Access Collaborative

• Initiatives include:

– 1-800 line to patient navigators

– Heart failure clinics closer to patients

– Improved EMS response


Results: Chronic Disease Management

• Involved 6 areas: Asthma, COPD, Diabetes, Obesity, Heart Failure, Cardiovascular Risk

• Document the burden of disease - registries

• System flow and best practice between primary and tertiary care

• Managing co-morbidities and service links


Results: Emergency Services & System Capacity

• 15 design solutions in 4 major areas

– Emergency Departments

– Bed Management

– Care Management

– Community Care Services


Results: Neurosciences

• Stroke

• Multiple Sclerosis

• Neurosurgery – Back and Spine

• Neuromuscular Disease


Wellness

• 2 streams – external and internal to Capital Health

– A leader in wellness for the community

– Organizational wellness


Key Learnings

• Identify champions and commit long term – people, time and funding

• Clear structures, roles and expectations

• Establish – and RE-establish priorities

• Utilize business management methods, extensive information management and knowledge transfer strategies

• “Integrate the integration” - adopt enterprise wide approach to accelerate change


Regionalization and Integration

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Regional Planning

Regional Planning

Regional Planning


Taking the road less traveled!


Acknowledgements

• Michele Lahey, former Executive VP and COO Health Services

• VP/COOs and Medical Leads of sites/sectors

• Michele Zielinski, Director, Regional Initiatives and Health Systems Design, and all the Operational Policy and Integration Division staff

• Directors, Regional Initiatives, Integration Projects

Clinical Integration: Capital Health’s Journey and Early Lessons Presentation.pdf ·...

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