agile health systems: aligning financial, operating and prioritization processes in real-time to...
TRANSCRIPT
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Imagine Tomorrow- Act Today Agile Health Systems: Aligning Financial, Operating and Prioritization Processes in Real-time to Drive
Performance
Thursday, March 2, 2017 from 1430-1530
Karin Olson and Duncan Campbell
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Declaration of Conflicts
• Karin Olson – Vancouver Coastal Health COO Coastal Community of Care
– No conflicts
• Duncan Campbell – Principal Consultant Craigavon Enterprises Limited
– Former CFO at Vancouver Coastal Health and Alberta Health Services
– Led research on Agile Performance for Canadian Institute
– Independent consultant working in partnership with software vendors to implement agile performance, integrated operations centres and predictive analytics
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Unhappy Healthcare Headlines... Any Options or Solutions?
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What You Will Hear Today
• Demand is highly predictable – 98% overall
– Why is every day a surprise?
• VCH used predictive analytics as a key strategy to turnaround operational and financial performance
• The Coastal COC journey is still in progress – and share their learning’s from a difficult 2016 Christmas
• Imagine tomorrow will share CIHI/ AHS research which I led and learning’s from New Zealand, Israel etc.
– Includes an aha moment
– My aha moment -Air New Zealand became the best airline in the world using Integrated Operations Centre
• Conclusion and questions
Imagine tomorrow – Act today is real today and in action in well run health systems
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What You Will Hear Today
• Imagine tomorrow – Act today
– Imagine if you could predict the future, and plan accordingly?
– Imagine if all your patients had sufficient staffing and care?
– Imagine if front line staff can plan their life, and not fear being called back on overtime
– Imagine if you can predict demand crunches and can plan discharges ahead of time
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What You Will Hear Today
• Demand is very predictable
– Scarily accurate at approx. 98%
– Share Lions Gate time of day graphs over past 3 years
– If so predictable, why is every day a surprise?
• VCH Journey as part of its quality and financial turnaround
– Predictive analytics
– Visible leadership
– Managing patient flow is a team sport
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What You Will Hear Today
• The Coastal COC Journey
– Initial roll-out
– Heading to the dark side- and flying blind
– Back at Coastal – this time as COO
– Crisis Christmas and lessons learned • Burning platform
• Process support – Icare
• Real-time predictive analytics
• Team effort
• Trial and error
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Imagine Tomorrow- Act Today Agile Health Systems: Aligning Financial, Operating and Prioritization Processes in Real-time to Drive
Performance
The Vancouver Coastal Story
Thursday, March 2, 2017 from 1430-1530
Karin Olson and Duncan Campbell
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Fiscal Crisis in 2008
$42m Operating deficit
•95% of funding received committed to collective bargaining
•Cash less than 1 weeks payroll - $10m
•High admin and support costs (13%)
•Staff growth twice as high as population growth
$1 Billion Infrastructure Deficit (excluding hospitals)
Outdated technology – on fire pc’s Obsolete equipment Aging and fiscally starved maintenance budgets
•$50m capital projects in flight without a funding source
•ED congestion and hallway patients
•Long wait times, and cancelled elective surgery
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Before Predictive Analytics: Decision in Real-Time
24
1 2 3 4 5 6 7
6
*
Overtime
Day
Open additional beds
7
28
Beds FTEs
24
6
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Utilizing Predictive Analytics to Support Decisions 3 Days in Advance
1 2 3 4 5 6 7
*
Straight time
Open additional beds 28
7
Beds FTEs
Day
6
24 * Decision
24
6
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Utilizing Predictive Analytics To Create Capacity & Plan Ahead To Exceed Discharge Targets
1 2 3 4 5 6 7
24
6
Baseline staffing
No additional beds 28
7
Beds FTEs
Day
28
7
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• Updated every 15 minutes
• Provides web-based real-time daily visibility
• Worm graph shows 3 days of information – retrospectively, today and tomorrow
• Displays key metrics with applicable traffic light on the current status within the hospital
• Can display the details of each nursing unit under each planning group
Real-Time Predictive Analytics
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Real Productivity Gain- Staffing Flat, Volumes increased 2%. Savings over $60m
FTE' Analysis
16000
17000
18000
19000
20000
FT
E's
Actual Projected
Actual 16083 16683 17452 18043 17932 17932
Projected 16083 16683 17452 18063 18695 19349
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11
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Predictive Analytics are 98% Accurate & Avoid Over And Under Staffing
waste
Safely issue
The Goal Is To Have The Right Staffing For The Right Census And Acuity… Not Elevated (Waste)
And Not Insufficient (Safety)
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Financial Sustainability $110m turnaround in financial performance
•$80m surplus in 2012/13
•$42m deficit 2007/8
• Admin and support costs down from 14% to 9.2%
•Headcount flat since 2008 saving $60m per year Working capital ratio ..93 vs.50
Bank balance $320m and growing at $5m per month
$ 500 million Infrastructure Deficit (excluding hospitals) Improved risk profile from extreme to moderate Reinvested $40m pa in infrastructure refresh (IT and
equipment)
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Imagine Tomorrow- Act Today Agile Health Systems: Aligning Financial, Operating and Prioritization Processes in Real-time to Drive
Performance
The Coastal COC Story
Thursday, March 2, 2017 from 1430-1530
Karin Olson and Duncan Campbell
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The Coastal Community Of Care Journey
• The Early Years
– Turnaround VCH -2008
– Lions Gate’s turn- 2011
– The Theta Care executive visit and burning platform
– Leadership and management changes • Karin Olson heads to Ontario
• Flying blind in Ontario without predictive analytics
• Less leadership focus on predictive analytics
• Slipping performance – admissions within 10 hours 65% to 30%
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The Coastal Community Of Care Journey
• Modern day 2017 – Happy days – Appointment as COO
– Christmas crisis
– Learning from Christmas crisis - Don’t waste a good crisis
– Improved admissions within 10 hours from 30% to 50% - still work to do
• Future 2017 onward • Future plans – roll out to other acute sites and home and community
care
• Implement Community of Care Integrated Operations Centre
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Steadily Declining Admits within 10 hours. Lowest point 30%
0%
10%
20%
30%
40%
50%
60%
70%
80%
20
12
/13
-P0
1
20
12
/13
-P0
3
20
12
/13
-P0
5
20
12
/13
-P0
7
20
12
/13
-P0
9
20
12
/13
-P1
1
20
12
/13
-P1
3
20
13
/14
-P0
2
20
13
/14
-P0
4
20
13
/14
-P0
6
20
13
/14
-P0
8
20
13
/14
-P1
0
20
13
/14
-P1
2
20
14
/15
-P0
1
20
14
/15
-P0
3
20
14
/15
-P0
5
20
14
/15
-P0
7
20
14
/15
-P0
9
20
14
/15
-P1
1
20
14
/15
-P1
3
20
15
/16
-P0
2
20
15
/16
-P0
4
20
15
/16
-P0
6
20
15
/16
-P0
8
20
15
/16
-P1
0
20
15
/16
-P1
2
20
16
/17
-P0
1
20
16
/17
-P0
3
20
16
/17
-P0
5
20
16
/17
-P0
7
20
16
/17
-P0
9
20
16
/17
-P1
1
%<10hrs by period 12/13-16/17FY
%<10…
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Demand is 98% Predictable
21
Increased Y/Y ED Visits and Admissions
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Demand Forecast OK, Discharges and Staffing not alligned
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Christmas Learning’s Applied to Family Day Long Weekend
Weekly Plan to Operational Forecast
Projected Discharges vs. Actual
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Spring Break/Easter Forecast Patient Flow Update
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Identical Spring Break Discharge Pattern Over Past 3 Years
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ED Visit Surge Analysis
26
SPRING BREAK/EASTER FORECAST (OCCUPANCY)
Opportunities decreasing staffing
Opportunities increasing staffing
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Leadership, Teamwork, and Real time Forecasting in Action From <40% to 78% in 2 Months
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
%<10hrs by period 15/16-16/17FY
%<10hrs
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Key Learning’s
• Christmas issues highlighted the need to re-energized the use of Predictive analytics in bed meetings
• Worked very well for February Family Day weekend – Staffing inside and outside hospital to move discharge over weekends
– Pay for Performance improved from low of 30% to 50%
– Heavy planning for spring break and Easter close
• Still on the improvement journey
• Takes consistent and visible leadership
• It’s a team effort that makes flow happen
• – Admits within 10 hours now 78% - Wow
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Imagine Tomorrow- Act Today Agile Health Systems: Aligning Financial, Operating and Prioritization Processes in Real-time to Drive
Performance
Imagine Tomorrow – Findings from CIHI/AHS Agile Performance Research
Thursday, March 2, 2017 from 1430-1530
Karin Olson and Duncan Campbell
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Agile Performance
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Imagine Tomorrow- Act Today Key Findings from CIHI Research
• Real-time predictive analytics is the foundation for patient-centred care
• Using predictive data to plan care, staffing and patient flow is key to better quality, planning and efficiency
• New Zealand is a leader in Integrated Operations • Air New Zealand story • Will become common in Canadian Healthcare
• Significant opportunity for Canada to simultaneously improve
care and lower costs - $3bn
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$3bn Opportunity –Agility Low Rated High
77%
66% 85%
97%
Rated their health system’s agility as low to very low
Rated the applicability of the model as high to very high
Rated predictive analytics as the element with the most value and budgeting and month-end
close the least valuable elements
Rated having an agile health system high to very high
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Siloes Kill – Quality, Productivity, Efficiency … and even Patients
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• Financial distress
• Turnaround- Siloes and lack of analytic were killing performance
• “The Hub”
• Visible Real time analytics – Co-locating functions
– All responsible for uptimes and performance
• Breaking down the siloes with real- time decision making
• Mission accomplished – top airline in the world 4 years in a row
My AHA Moment- The Air New Zealand Story
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Funding “Rules of the
game”
Strategic imperatives and targets
Predictive Model
Scenario plan
Disinvest/ reinvest
Revenue P4P
Staffing
Wait times Volumes
Quality metrics
OR and supplies
Non Case Mix Funding
Forecast weekly
Based on real time Predictive model
Monthly
Financial ME +1 Disinvest/ reinvest
Admin and overhead
Other Revenue/ Costs/Innovation
Agile Performance Management Model Tested by Project
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Strategic imperatives and targets
Funding “Rules of the
game”
Wait times Volumes
Quality metrics
Predictive Model
Scenario plan
Disinvest/ reinvest
Forecast weekly
Based on real time Predictive model
Monthly
Financial ME +1 Disinvest/ reinvest
Agile Performance Management Model Tested by Project
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Integrated Operations Centre
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Mackenzie Health Day Surgery Unit- Family Waiting Area
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Integrated Operation Centres Middlemore: Wait for Bed. Discharge Delays. Housekeeping.
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Integrated Operation Centres Middlemore: Location. Status. Alerts.
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Integrated Operation Centre Middlemore
Demand Forecast. Occupancy. Staffing.
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Imagine Tomorrow– Act Today
• Agile performance is standard
– Predictive analytics engine
– Integrated Operations Centre
– Real-time information and decision making
– Rapid prioritization to invest/ disinvest to align to strategies
– Budget replaced by rolling forecasts using predictive analytics
• Improved access and positive news headlines
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Imagine Tomorrow– Act Today
• The near future: 3 to 5 years
– AI and Machine learning – improve prediction ability
– Humans for caring and problem solving and decision making
– Redesigned care processes
• Monitored in real time, alerts drive action
• AI improves diagnosis and
– Real-time information and IOC’s blows up siloes and command and control structures
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Questions?
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Thank you
• Contacts
• Karin Olson – Chief Operating Officer Coastal Community of Care
– email - [email protected]
• Duncan Campbell – Principal Consultant Craigavon Enterprises
– email– [email protected]
– Twitter - @CraigavonEnt