Public sector/stakeholder collaboration - moving beyond “the clenched fist”

Strategies for Public Sector Transformation 2002

- October 16, 2002

Agenda introduction Physician Office System Program

– a case study

challenges & solutions

“You cannot shake hands with a clenched fist”

- Indira Gandhi

Introduction lessons learned from walking in the other guy’s moccasins experience is the best teacher or “how I got the scars on my

back” Alberta Wellnet CYNCH Western Health Information Collaborative Alberta “One Window” Common opportunities Western Canadian Continuing Care EHR Initiative Physician Office System Program

the usual disclaimer

The Physician Office System Program

A case study…

Physician Office System ProgramPhysician Office System Program

joint initiative of the Alberta Medical Association and Alberta Health & Wellness negotiated under the AMA/AH&W master agreement a contractual relationship

provides three types of assistance to the physician: financial assistance to defray the cost of hardware/software information technology services change management services

targets improvement in physician office systems, services and business models (e.g., ASP)

POSP visionPOSP vision

“to establish a physician office information infrastructure that is integrated with the health information system”

Electronic health record

Physician office system:

Electronic medical recordIntegrated decision support

BillingSchedulingOffice productivity tools

Stand-alone information sources:

Labs

Pharmacies

Radiologists

= Interface

Regional clinical systems - acute:

MPI/ADT

Lab

Pharmacy

ER

Radiology

Home care

Immunization

Speech Pathology

““EHR” – a longitudinal record of a patient’s EHR” – a longitudinal record of a patient’s health & healthcare, from cradle to grave…health & healthcare, from cradle to grave…

Regional clinical systems – sub-acute and continuing care:

Continuing care delivery systems, including case management, care protocols, clinical data and reports

Client/patient surveys

Physician Office System ProgramPhysician Office System Program

EvaluationHoward ResearchEvaluation

Howard Research

POSPSubcommittee

POSPSubcommittee

Program DirectorProgram SupportAdmin. Assistant

Program DirectorProgram SupportAdmin. Assistant

Operations(AMA)

Operations(AMA)

Communications(AMA/AH&W)

Communications(AMA/AH&W)

IT Delivery(alberta we//net)

IT Delivery(alberta we//net)

Change Management

Change Management

AMAAMA AH&WAH&W

Program Management Office

Finance Cttee.

Delivery of change management Delivery of change management services…services…

POSP Program DirectorProgram SupportAdmin. Assistant

POSP Program DirectorProgram SupportAdmin. Assistant

OperationsOperations IT DeliveryIT Delivery CommunicationsCommunicationsChange ManagementManager

Karen Shimko

Change ManagementManager

Karen Shimko

AdvisorNancy Stewart

AdvisorNancy Stewart

Expert Field ResourcesExpert Field Resources

Expert Field ResourcesExpert Field Resources

Expert Field ResourcesExpert Field Resources

Expert Field ResourcesExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Advisor South

POSP results to date...POSP results to date...

1,212 physician participants to date; target 2,138 standing offers for physician office system vendors

developed (1st in Canada); “2nd round” of requirements definition underway physician led; 5 stakeholder groups national and regional participation

POS to POS interface feasibility study in process support for electronic reporting of lab results standing offers for Microsoft and Dell negotiated

POSP results to date…POSP results to date…

“first of its kind” change management program web-based tools (POSP Software Lab, electronic “doctors’

lounge”), communication and knowledge products, workshops (computer literacy, decision support, change management, privacy impact assessments…) & on-site consultations

communications strategy and products developed external evaluation ongoing, first reports issued operational, change management and groupware IT

systems implemented

POSP results to date…POSP results to date…

cited as the “premier” physician program in Alberta seen as a successful collaboration by the Program

sponsors proposed for renewal by both sponsors

POSP developed “standing offers” with vendors for the delivery of hardware and software that will support achievement of physicians’ program outcomes

standing offers published April, 2002 first time in Canada comprehensive physician

office system requirements articulated

IT servicesIT services

Learning as we go…Learning as we go…

significant learnings through standing offer process external evaluation conducted and results

shared with stakeholders process was fair no need to issue another RFP POSP should develop and maintain standards independent evaluation agency should evaluate

applications against standards

Benefits of this approachBenefits of this approach

consultation with stakeholders will: ensure requirements carry weight address vendors’ business issues result in increased alignment between physicians’ & other

stakeholder needs and vendor offerings allows time for vendors to meet any new

requirements vendors who already meet VCUR can market by

reference to these requirements, as soon as requirements published

Public sector/stakeholder collaboration

Lessons learned…

Barriers to successful collaboration absence of shared vision, commitment inappropriate governance model lack of specificity re: outcomes & targets lack of clarity re: roles & responsibilities misunderstanding the nature of the relationship inadequate resourcing of the collaborative effort positional stereotyping & mistrust dogmatic adherence to past decisions

Strategies that work… you can’t outsource strategic planning

business owners need to “own” the vision and define/approve key strategies environmental scan helps clarify the “larger picture”

listen with an “empty teacup”

Strategies that work… give careful thought to your governance structure

and respect it once its in place appropriate to the task terms of reference if you’ve delegated authority…don’t meddle! but hold

parties accountable with respect to agreed-upon outcomes consider “orientation” to ensure governance level

and operating level are clear on respective roles and responsibilities

Strategies that work… collaboration requires dedicated resources consider implementing an appropriately

resourced program management structure, accountable to the project sponsors

keeping sponsors, stakeholders informed is key

Strategies that work… articulate and communicate expected outcomes,

targets… link to strategies assign owners to strategies monitor and report on performance relative to these

outcomes linkage with related initiatives?

Outcomes/targets example Program outcome: Technology is delivered

Outcome

(statement of Program result)

Target

(when/quantitative/qualitative)

Means of Verification

Verification

Responsibility

1. The competitive multi-vendor market place for

physician office systems has been improved (more vendors, who meet defined requirements, are offering products and services to Alberta physicians).

By March 2003: 100% of SO vendors and 80% of non-SO vendors providing EMRs to POSP physicians indicate they understand requirements as per the SO. The number of physician office system vendors who meet or plan to meet the technical/privacy/security and EMR functional requirements has increased since Program launch. By June 2003 vendors and POSP are working together in a constructive and mutually satisfactory way. By March 2005: 80% non-SO vendors providing EMRs to POSP physicians indicate they have or will (in the next year) adopt technical/security/privacy and EMR requirements as specified by POSP. The majority of vendors selling physician office systems in Alberta have adopted peer-to-peer (POS to POS)

Vendor survey Quantitative analysis Vendor survey Vendor audit Vendor survey Vendor focus group Qualitative assessment – IT Delivery Vendor survey Vendor survey

HowardResarch

IT Delivery HowardResearch

IT Delivery

HowardResearch IT Delivery Team IT Delivery Team

HowardResearch

IT Delivery (?)

Program outcom e: T echnology is delivered

O utcom e

S trategies

O w n er

(Subcom m ittee/D elivery T eam )

1. T he com petitive m ulti-vendor

m arket place for ph ysician office system s has been im proved (m ore vendors, w ho m eet defined requirem ents, are offering p roducts and services to A lberta physicians).

S trateg y # 9 – R enew the S tanding O ffer process. S trateg y #18 – Identify vendor s trategies used b y w e//net and R H A s, harm onize w here desirable and ex plore concept of a vendor association . O ngoing vendor m anagem ent through IT D elivery

D eb K ./IT D elivery

IT D elivery

IT D elivery

2 . P hysician o ffice system

requirem ents (technical/privacy/security, E M R , business/general and usability) are understood and valued by the physician com m unity.

S trateg y # 9 – R enew the S tanding O ffer process.

D eb . K /IT D elivery

Linking outcomes to strategies…

Strategies that work… don’t confuse the way you treat people with

the nature of the business relationship partnership? contractual relationship?

don’t expect a vendor to act like the owner of the initiative…their primary focus is their own bottom line

don’t let suspicion based on different agendas taint the relationship

Strategies that work…

do your best not to fall back on stereotypes encourage a climate of continuous improvement…its

okay not to get it perfect the first time! formal evaluation function or periodic external reviews are

just good practice don’t get trapped “sticking with” decisions that time &

circumstances have proven sub-optimal change what you can on the fly… schedule reviews when

more substantive policy changes can be implemented invite the stakeholders in at the earliest

opportunity…doesn’t have to be perfect

Getting beyond the clenched fist…

The law of “win/win” says “let’s not do it your way or my way…let’s do it the best way”

- Greg AndersonThe 22 Non-negotiable Ways of Wellness