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Regional Shared Services: Aligning the stars for success in a scattered IT universe

Regional Shared Services: Aligning the stars for success in a scattered IT universe. Stéphane Ouellet, Marg Kampers, David Veeneman London Health Sciences Centre Malcolm Hopkins St Thomas Elgin General Hospital. Agenda. Overview – Regional Shared Services Present Key Concepts

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Regional Shared Services: Aligning the stars for success in a scattered IT universe

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  1. Regional Shared Services: Aligning the stars for success in a scattered IT universe Stéphane Ouellet, Marg Kampers, David Veeneman London Health Sciences Centre Malcolm Hopkins St Thomas Elgin General Hospital

  2. Agenda Overview – Regional Shared Services Present Key Concepts Star Model for Organizational Design Balanced Scorecard Case Studies Duplicate PINs Regional Compliance to Privacy Standards Key Learnings

  3. Overview – Regional Shared Services The Regional Shared Service (RSS) provides direction and support for implementing a shared IT solution at sites throughout Southwestern Ontario. Housed at London Health Sciences Centre (LHSC) Governed through a Memorandum of Understanding Annual budget $8M (07/08) Funded through a shared cost recovery model for purchased services covering: PACS/DI (11 sites, set to double by 09/10) EPR (7 sites, with an 8th site looking to join) Business Systems (Peoplesoft) (3 sites)

  4. RSS in Southwestern Ontario (LHIN 1 & 2) PACS – Active PACS – SWO Repository (in progress) EPR – Active EPR – Planning phase Business Systems Max. distance between sites 450 km North-South 250 km East-West

  5. RSS in Central/Southern part of LHIN 2 PACS – Active PACS – SWO Repository (in progress) EPR – Active EPR – in planning Business Systems Max. distance between sites 150 km North-South 120 km East-West

  6. Star Model Galbraith (1995) proposed an organizational design framework (a five-point “star” model) to evaluate and improve infrastructure effectiveness RSS adopted this process to align and reinforce the organization, all the while considering the underlying “culture” differences which naturally exist between partner hospitals.

  7. RSS – Framework • STRATEGY • LHINs • E-Health (MOHLTC) • Growth (new sites) CULTURE • PROCESSES • Financial • Communications • Requests • Project Mgmt • PERFORMANCE • Service Level Agreements • Balanced Scorecard • PEOPLE • RSS Staff • Regional Hospital Partners • Vendors • LHSC Corporate (IT, Finance) • STRUCTURE • MOU (3) • JMC • User Groups

  8. Evolution of Star Model

  9. Balanced Scorecard (BSC) Developed by Kaplan and Norton in 1992, BSC is a performance measurement tool that measures the implementation of a strategic plan through the use of indicatorsgrouped in 4 categories: Customer (operations, reliability and service) Financial Quality (project mgmt, internal processes) Learning/ Innovation/ Growth 5/24/2014 9

  10. Measuring Performance As RSS evolves, it was deemed critical to: Continually show “value” for investment Demonstrate sound stewardship of invested funds A Balanced Scorecard tool increases accountability: Communicate progress to stakeholders Promote focus and dialogue Facilitate operational decision-making Assist in the prioritization of projects Provide guidance to staff in defining benchmarks

  11. Customer

  12. Financial

  13. Quality

  14. Early findings No clear, robust indicators have emerged; preference to focus on other three quadrants: Easier to demonstrate “quick wins” for use of BSC Reflective of “startup” nature of RSS Preliminary ideas on future indicators Leverage regional systems in place to provide rapid “value add” reports and assist in regional planning: Cerner EPR/Surginet: OR utilization? GE PACS/Radnet: CT/MRI wait times? EPR/PACS utilization: Hospital market share by patient’s postal code? Learning and Innovation

  15. Case study #1: Duplicate PINs in EPR 169,000+ historical duplicates on regional EPR Staff workload in auditing CPI: 1FTE (Comm. Hospitals) + 4 FTE (London Hospitals) Reconcile 5,000 duplicates each month With no added resources: could take approximately 3.5 years to eliminate most duplicate records from the CPI 700 – 1,000 new duplicates added monthly Clearly a “process” that needs “scorecard” monitoring!

  16. Impact of Duplicate Records Patient safety issue Full record not accessible Cost to reconcile Decrease integrity of Provincial EMPI Regional records can not be properly linked No longer “one patient, one record”

  17. Duplicate PINs: Action Plan Strategies to reduce occurrences: Regional CEO awareness (via BSC) Engage Health Information Group Educate users on proper patient search (road shows) Provide error feedback to users Promote patient Naming Convention standard Require accurate & complete information from referral sources Early results: From 8% to 6% in 8 months

  18. Case study #2: Regional Compliance to Privacy Standards EPR MOU contains a Privacy Addendum with roughly 40 items covering: Accountability and Openness Privacy Education System Access Policy Restrictions to paper PHI and requests to correct PHI Auditing and Breach policy/procedures Contracts/MOA's Data Share Agreements While partner hospitals signed, compliance was low (20%), especially in approving/documenting policies. Clearly another “process” that needs “scorecard” monitoring!

  19. Privacy (non-) compliance: Impact “Only as good as the weakest link” in preventing privacy breaches: As clinical users can access records of other organizations  trust becomes a factor Employees often work in multiple organizations  requires the need for consistency amongst sites

  20. Privacy Compliance: Action Plan Strategies to increase compliance: Regional CEO awareness (via BSC) Engaged regional privacy officers Leveraged regional project to enhance access: 80% compliance had to be achieved before each site could “go live” Early results: From 20% to 85% of compliance in 8 months

  21. Key Learnings Combining elements of the star model and the balanced scorecard forms an effective approach developing a high-performing regional IT infrastructure. Regional relationships are enhanced by improving: Performance Accountability Collaboration and Communication Trust and Respect

  22. The process does not end… Star Model When making changes to strategy, review impact on other “points” of the star for alignment Balanced Scorecard Regularly review indicators: Develop and Benchmark Measure & Collect (Designated individual) Interpret (Management Team comments & Action Plan) Share (Communication Plan to stakeholders) Evaluate the process

  23. Thank you! For more information, contact:stephane.ouellet@lhsc.on.ca

  24. Additional readings Healthcare Quarterly, 7(4) 2004: 34-42 Aligning the Stars: Using Systems Thinking to (Re)Design Canadian Healthcare Brian R. Golden and Roger L. Martin Designing Organizations by J. Galbraith, Jossey-Bass Publishers, San Francisco, 1995 Kaplan R S and Norton D P (1996) “Balanced Scorecard: Translating Strategy into Action” Harvard Business School Press

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