Dr Rollie Nichol, Calgary Health RegionSandra MacDonald Goy, Calgary Health Region

Nicholas Tait, Social Sector Metrics IncCatherine Keenan, Calgary Health Region

Medical Affairs:Innovations in the Calgary Health Region

Calgary Health Region Context

• One of the largest fully integrated, publicly funded health systems in Canada

• $2.8 billion budget

• Population of 1.2 million people, some of the fastest growing communities in the country

• Over 29,000 employees, 3,000 physicians

• Over 100 health care locations, including

• 12 acute hospitals

• 4 comprehensive health centres

• 41 care centres

• variety of community and continuing care settings

Calgary Health Region

Population Growth in the Calgary Health Region 2004 - 2008

1,000,000

1,050,000

1,100,000

1,150,000

1,200,000

1,250,000

1,300,000

2004 2005 2006 2007 2008

Po

pu

lati

on

Population Growth

11.0% increase (n=125,448) in the

population of the Calgary Health Region between

2004 - 2008

Physicians working in the Calgary Health Region 2004 - 2008

2000

2200

2400

2600

2800

3000

3200

Apr-0

4Ju

l-04

Oct

-04

Jan-

05Apr

-05

Jul-0

5O

ct-0

5Ja

n-06

Apr-0

6Ju

l-06

Oct

-06

Jan-

07Apr

-07

Jul-0

7O

ct-0

7Ja

n-08

Apr-0

8N

um

be

r o

f P

hy

sic

ian

s

Physician Growth

23% increase (n=575) in the number of physicians practicing in the Calgary Health Region between April 2004 -April 2008

Panel Presentation

• A Systematic Approach to Regional Physician Workforce Planning

• e-Partners Project

• Future Physician Workspace Project

A Systematic Approach to Regional Physician Workforce Planning

Dr. Rollie Nichol, Calgary Health RegionMr. Nicholas Tait, Social Sector Metrics Inc.

Purpose

Support Rational Decision Making

• Internal

• Meeting patient need

• Aligning with infrastructure development and evolving service delivery models

• External

• Funding UGME/PGME expansion and mix

• Increased provincial funding of APPs

Methodology Research

1. Adjusted Needs Models estimate the current and projected supply of physicians required for the perceived burden of disease. Based on an understanding of current and projected prevalence of disease and capacity of specific specialties to care for that disease burden e.g. GMENAC (Graduate Medical Education National Advisory Committee) 1979 and 1991;� Complex, data intensive

2. Demand-Utilization Models project supply of physicians required to provide health care services at current utilization levels. Projects future use based on forecast changes in demography & productivity;� Baseline is current utilization rates, identify current supply deficit (if any), project future need

based on demography (adjusted) & programs – Calgary Health Region Adopted Modified Version;

3. Requirements Models are based on current Health Maintenance Organization staffing patterns;� Not applicable in Canadian context

4. Socio-Demographic Models project the effects of socioeconomic and demographic factors on the availability of future practice opportunities for physicians;� Market opportunity approach

5. A Physician Human Resource Strategy for Canada (03/2006) – incorporate “needs-based” factors;

� Conceptual only

6. Comparative Ratios & Benchmarking is a fifth model that is an alternative to the four quantitativemodels above. This method uses physician to population ratio’s e.g. CIHI (not intended for PWP);� Simplistic

Integration

Need Assessment

Assessment, Forecasting,

Planning

Supply Assessment

• Balance Hours of Work & Lifestyle“@ 50 hour work week”

• Sustainable Call Rotation“1:4 Guideline”

• Alternate Care Providers“right time, right place”

• Balancing the “need” forappropriate access with the

“demand” for immediate access

Evidence-based Needs

Assessment

• Current Demand plus Future NeedNot

• Current Demand plus Future Demand• Defining an “FTE”@50 hours plus Hrs on Call

Policy Framework

Integration

Supply Assessment

Current Roster

FutureSupply

ApplyVariables

Assessment, Forecasting,

Planning

Need Assessment

Forecast Population

ForecastPrograms

ApplyVariables

CurrentUtilization

Summary Model

Supply Assessment

Build Current Roster

Assess FutureSupply

ApplyVariables

Undergraduate (Medical Schools)

Postgraduate (Residency Pgrms)

Matching (CaRMS)

Fellows

IMGs (CaRMS, CAPERS)

Foreign

Life Style/Work Week(survey, T&M study)

Migration(CIHI, Roster Analysis)

AgeGender

Departure

Time/Motion Studies

Base Roster

Surveys (CMA, CFPC, etc.)

Data Sources (College, HA, etc.)

Counts

FTEs

Practice Entry (CAPERS)

Practice Profiles

Supply Assessment Model

Supply Assessment

Operationalizing““Model delivers Model delivers ““BaselineBaseline””

““Department addresses other parametersDepartment addresses other parameters””

e.g. Colon screening 50+e.g. Colon screening 50+

e.g. Teaching modele.g. Teaching model

NeedAssessment

Population Programs

ApplyVariables

Infrastructure

Access

Capacity

Education

Research

Technology

GrowthAge

GenderMigration

Multi-cultural

SustainabilityExpansionPriorities

Morbidity

Demographic

Referral Patterns

Data Sources

Health Status

Socio-Economic

Services

Needs Assessment Model

Need Assessment

Operationalizing““Model delivers Model delivers ““BaselineBaseline””

““Department addresses other parametersDepartment addresses other parameters””

e.g. minimally invasive surgery e.g. minimally invasive surgery

e.g. new hospital e.g. new hospital

Less: [population growth] Less: [population growth]

e.g. diabetese.g. diabetes

e.g. deficit indicator or 1x catch up indicatore.g. deficit indicator or 1x catch up indicator

e.g. Fulle.g. Full--time academic funded position 50% protected timetime academic funded position 50% protected time

e.g. core services in remote arease.g. core services in remote areas

e.g. Expansion of Undergraduate & Poste.g. Expansion of Undergraduate & Post--Graduate Graduate

Automating

Baseline Plan

Modelling

Scenario Planning & Sensitivity Analysis

ePartners Project

Sandra MacDonald Goy, Calgary Health Region

Purpose

The ePartners Project will deliver:

• Business process and customer service improvements

• A Medical Staff appointments solution (replacement of the existing Medical Staff database)

• An authoritative, integrated source of information for the Provider Registry

• Integration with the Oracle Financial system

ePartners will not deliver:

• Technology and information related to patient/client care

• Duplication of Oracle Financial systems

Physicians&

Allied Health

Communications

Demographics

Medical StaffAppointments

&Credentialing

Contracts&

Finance

e-Partners

Portal

Finance

Regional Medical Staff

Office

Chief Medical Officer

Communications

PhysicianRelations

Regional Clinical

Departments

Applications

Contract Review

Demographics

Account Status

Invoice Entry

ApplicationsRecruitment

ContractsReports

ARPsWorkforce Plans

Workflow Notifications

ePartners Concept Diagram

ePartners Project Timeline• Defined business requirements & issued RFP Jan – Dec. 2006

• Contract negotiations completed January 2007

• Oracle selected as product

• Impac selected as the vendor for implementation

• Approved separate Operating Org configuration Oct 2007

• User acceptance testing/regression testing June 2008

• Configure for Production July 2008

• Limited production access September 2008

• Data migration/data entry

• Passive feed to Regional Provider Registry

• Implementation with governing offices October 2008

• Begin rollout to regional departments 2009

ePartners Project Status

Appointments & Credentialing

• Configuration complete May 2008

• Automated workflow development deferred

Finance & Contracts

• Configuration complete May 2008

• Automated workflow development deferred

Communications

• Implementation deferred until regional delivery channels in place (eg. Enterprise fax upgrade, paging system replacement)

Self Service (Portal)

• Roll out deferred in order to ensure data integrity and system functionality established

Business Process Redesign

Example – Physician Contact Information (Risk Management)

“AS IS” and “TO BE” mapping completed

• Regional Medical Staff Office (RMSO)

• Health Records Services (HRS) - Transcription Services

• IT Access Office

Business Roles Confirmed

• Data entry responsibilities for internal providers – ePartners Governing Offices – Regional Medical Staff Office (RMSO),

– Medical Education Office (MEO)

– Allied Health Office

• Data entry responsibilities for external providers – ePartners (HRS)

• Data integrity (back end validation) - HRS

Risks

• Project timelines

• Managing risks

• Managing expectations

• Communications

• Transition to business & service owners

Rewards• Medical Affairs

• One database shared by 14 clinical departments for 3,000 physicians

• Financial Accountability• Automated business processes for $200million in annual physician payments

• Risk Management• Standard business processes and templates for physician contracts

• eRecord• Source of truth for the information about healthcare providers to support role-

based access to health information

• Communication• Single point of contact for physician updates• Physician have identified as preferred route for communication

Future Physician Workspace Project

Catherine Keenan, Calgary Health Region

Purpose

• To provide standard processes and guidelines to enable consistent and transparent decisions concerning physician office space requirements in the Calgary Health Region.

• To support regional clinical departments, site administrators, capital planning and space management teams in the strategic allocation of physician office space in current and future facilities owned, leased and/or operated by the Calgary Health Region.

• To provide the tools and resources that physicians and regional teams will use to explore innovative and creative solutions to physician office space issues across the Region, including options that explore off-site and community-based physician office space.

Change Drivers

• Aging and changing physician workforce

• Changing economic environment in Calgary

• Issues highlighted by Family Medicine

• Historical and current practices, agreements and relationships

• Stakeholder expectations

• Changing practice

• Limited space and capacity for physician offices

Progress and Deliverables

Completed Tasks (June 2007 – June 2008)

• Project management structure

• Physician office data collection

• Framework document

• Assessment toolkit

• Innovative physician office space models

• Support and implementation service

Project Resources

• Project Management and Governance

• 12 months from start to finish (June 2007 – June 2008)

– 12 senior-level steering committee meetings

– 40 hours – Associate Chief Medical Officer

– 40 hours – Executive Director, Physician Leadership

– 1500 hours – project management, tools and documentation

• Data Collection and Analysis• 5 months from start to finish (July 2007 – December 2008)

– 500 hours – summer students

– 500 hours – management/analysis

– 140 hours – Regional Clinical Departments

Data Collection and Analysis

• Lack of a common understanding of the current physician office space situation

• Baseline data collected at July 20, 2007 from sources:

• Medical Staff Office Database

• UofC Faulty Academic Appointments Database

• CMO Contracts for Administrative Roles Database

• Regional Clinical Department physician office location data

• Significant variation among regional clinical departments

• in how physician offices are allocated and managed

• in the number of physicians who have been allocated offices

• More information on physicians with offices in the community is required

Physician Office Space Toolkit

Policy and Process Map• outlines the overview of policies and processes relating to physician workspace

Physician Practice Profile Tool• allows physicians to assess their tolerance for change and appetite for risk

Situational Analysis and Problem Definition• helps physician determine their office space problems

Proposed Support Models• matches results of the situational analysis with support models

Business Case Tool• provides guidance on creating a business case (when required) with strategic,

economic, financial, commercial and management dimensions

Provide time-limited “incubator” space for physicians new to practiceIncubator Model19

Match new physicians with more experienced physicians for coaching and mentoringMentorship Model18

Use advances in AT to allow physicians to have a mobile, virtual officesMobile/Virtual Working Model17

Create a process to use short-term space that is temporarily vacated by physicians (e.g. sabbatical)Short-term Space Model16

Ensure there is a uniform formula for physician overhead costs in Calgary Health Region facilitiesOnsite Physician Model15

Create a clear process with University of Calgary to maximize space for academic physiciansAcademic Partnership Model14

Space on or near a “health campus” is designated for targeted physician office spaceSatellite Office Model13

Lease spare capacity in Calgary Health Region facilities to physiciansCHR Revenue Model12

Several physicians can use one workspace, scheduled to meet individual requirementsShared Workspace Model11

Provide support or incentives to physicians who are will to provide targeted servicesTargeted Services Model10

Support physician revenue and capital costs through grants, reimbursements, or incentivesRegional Grant Model9

Support renovation process of existing physician space with expertise and planning support Renovation Support Model8

Physicians partner with Private Sector investors to provide clinic spaceP3 (Public Private Partnership)7

Match physician who want to share business risk with other physicians or partnersBusiness Broker Model6

Calgary Health Region provides a full service health centre with multi-disciplinary teamCHR Health Centre Model5

Calgary Health Region holds head lease on office space, sub-leases to physicians.CHR Sub-Lease Model4

Match physicians with excess capacity in owned/leased space with physicians in need of office

space.

Capacity Broker Model3

Use Calgary Health Region resources and leverage to support physicians’ lease negotiations.Lease Negotiation Model2

Match physician requirements with existing services (e.g. practice development)Service Broker Model1

DescriptionModel

Guide to Future Physician Workspace Support Models

Risks

• Stakeholder expectations

• Resistance to change

• Commitment to new models

• Limited resources

• Adaptability of models

• Exit strategies

Rewards

• Robust project management

• Validated data on current state

• Targeted stakeholder engagement

• Effective decision support tools

• Innovative physician office space solutions

• Leverage of strengths, resources, capacity

• Clear concept of “value exchange”