Implementing a single statewide pathology service key challenges keys to success
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Implementing a Single Statewide Pathology Service Key Challenges Keys to Success. Professor Ruth Salom August 29, 2013. The Journey : SA Pathology 2008 – 2012 . 2008 – 2012: Inaugural Executive Director, SA Pathology 17 hospital laboratories; 2000 staff; $280M budget;

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Implementing a Single Statewide Pathology Service Key Challenges Keys to Success

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Implementing a single statewide pathology service key challenges keys to success

Implementing a Single Statewide Pathology ServiceKey ChallengesKeys to Success

  • Professor Ruth Salom

  • August 29, 2013


The journey sa pathology 2008 2012

The Journey : SA Pathology 2008 – 2012

  • 2008 – 2012:

  • Inaugural Executive Director, SA Pathology

  • 17 hospital laboratories; 2000 staff; $280M budget;

  • comprehensive pathology services; selected clinical services; research & teaching

  • 2012 – current:

  • KPMG: Director NAT Health and Human Services

  • Melbourne Health: Non-Executive Director

  • Monash University: Professor


The journey sa pathology 2008 20121

The Journey : SA Pathology 2008 – 2012

  • 2008 - SA Government Proclaimed the formation of SA Pathology, a Single StatewidePathology Service

  • Mandated Project Quality Key Performance Indicators

    • Restructure from existing budget 

    • Budget savings of $1.5M in the first year  2012: > $30M recurrent savings 

    • Retain private market share 33%  2012: 37.5%

    • 60% of staff are satisfied with the transition process  85% @ 12 months 

    • Hospital CEOsand clinicians are satisfied with the new service with fee reduction from 100% MBS to 85% MBS

    • Fee for service established for CMBS and NCMBS across all hospitals 


The journey sa pathology 2008 20122

The Journey : SA Pathology 2008 – 2012


The journey major initiatives resulting in productivity gains

The Journey :Major Initiatives Resulting in Productivity Gains


The journey organisational restructure

The Journey: Organisational Restructure

Executive Director

ClinicalGovernance

CorporateGovernance

ServiceDirectorates

ResearchGovernance

  • Business and Governance Director

  • Commercial Contracts and Proposal Management Director

  • Laboratory Operations Director

  • ICT Director

  • Business Change Director

  • Marketing and Communications Director

  • Deputy Director

  • Chief Pathologist

  • Chief Scientist

  • Research Director

  • Automated Laboratory

  • Chemical Pathology

  • Cytopathology

  • Genetics & Molecular

  • Pathology

  • Haematology

  • Immunology

  • Microbiology & Infectious

  • Diseases

  • Regional Services

  • Surgical Pathology


Implementing a single statewide pathology service key challenges keys to success

TQEH

LYELL M

MODBURY

FMC

WCH

WCH

RAH

RAH

FMC

LMH

TQEH

  • The Journey: Organisational Restructure

  • Discipline leadership across the state, not site based.

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

Mod

HEAD OF DEPT/ LAB MGR

HEAD OF DEPT/ LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

HEAD OF DEPT / LAB MGR

LAB MGR X 13 REGIONAL LABS

LAB MGR X 13 REGIONAL LABS


Key challenge 1 negative feelings feedback by impacted staff

Key challenge 1 : Negative feelings / feedback by impacted staff

  • At start of the process - most enthused

  • As the project progresses -negative feelings

  • Staff impacted...either by a direct challenge to their employment or to the way that they have been used to working.

  • Key to Success

    • CE / Ministerial support. Well informed stakeholders. Planning for negative impact.

make sure that you go up the ladders and don’t slide down the snakes


Key challenge 2 governance of multiple projects during the transformation

Key challenge 2 : Governance of Multiple projects during the transformation

  • Key to Success

    • Established an effective Project Management Office.

    • Maintained a strong management group

    • Met regularly and signed off recommendations

    • All projects governed by the ‘Quality Lens’

make sure that you go up the ladders and don’t slide down the snakes


Implementing a single statewide pathology service key challenges keys to success

Key challenge 2 : Governance of Multiple projects during the transformation

Note:(a)[...].

Source:[...].

SA PATHOLOGY MANAGEMENT GROUP 2012


Key challenge 2 governance of multiple projects during the transformation1

Key challenge 2 : Governance of multiple projects during the transformation

Quality Reporting Established across the State


Key challenge 3 implementation of uniformity transparency and equity

Key challenge 3: Implementation of Uniformity, Transparency and Equity

Key to Success

Extensive due diligence of current state processes in order to:

  • Establish one common and transparent pathologist private practice arrangement across the organisation

  • Establish organisational structure that is equitable across the organisation

  • Establish common test nomenclature and cost structure for all hospitals

  • Capture all costs relating to pathology in a uniform way (including overheads)

make sure that you go up the ladders and don’t slide down the snakes


Key challenge 4 the transformation process to a single state service

Key challenge 4: The Transformation Process to a Single State Service

Key to Success

  • Speed of implementation (< 6/12)

  • Advertised / Matched roles not individuals to grades and job requirements, appointed the best

  • Built specifications that defined the service need rather than favoured a particular technology or discipline

  • Identified the real-estate required to host the service through a transparent process.

make sure that you go up the ladders and don’t slide down the snakes


Key challenge 5 stakeholder management

Key challenge 5: Stakeholder Management

  • Key to Success

    • Engaged with all stakeholders (including staff, customers, unions, government etc)

    • Communicated widely and regularly with all groups.

      • newsletters, website, road-shows

      • engaged with representatives of the new groups / unions / clinicians etc.

    • Celebrated achievements / milestones

make sure that you go up the ladders and don’t slide down the snakes


Our research

Our Research


Implementing a single statewide pathology service key challenges keys to success

National & International Benchmarking of Government Pathology Integration......................Little Information Available


Implementing a single statewide pathology service key challenges keys to success

The integration challengeMore than two thirds of North American private deals fail to deliver value

Findings from KPMG’s global 2011 mergers and acquisitions survey: “A new Dawn”

Less than 1/3 of deals enhance value

What would companies do differently next time?

31%

Better due diligence and planning

Enhance value

30%

Faster implementation and integration

Value neutral

39%

More attention to HR and

culture matters

Reduce value


Implementing a single statewide pathology service key challenges keys to success

Measuring Success of Public Pathology Consolidation ....Pre and Post integration Key Performance Indicators


An amazing journey

An amazing journey.........


Implementing a single statewide pathology service key challenges keys to success

Q & A

  • THANK YOU


Key achievements for each stakeholders

Key Achievements for each Stakeholders:

Patients / Clinicians / Hospitals Standardised processes ; Improved Quality Systems – Q Pulse / ISO introduced / State quality reports; Decreased pathology cost to Local Health Networks; Maintained bulk billing for South Australian population through competing in the private pathology market sector; introduced state based registrar training in AP & Haem

  • The State >$30M recurrent savings ; increased productivity; Increased private pathology market share / revenue; Commercialised IP with net worth to state of $90M; gifts given to charity

  • The Staff Additional 1/52 leave for 24/7 lab staff, Training & Travel Fund, Uniformity of Classifications , Improved Staff Career Progression, Established Staff Common Room / Cafe / Improved Lab Facilities

  • Research & Education Establishment of Centre of Cancer Biology; (2012: $17.2M in competitive grants); Establishment of Genomics Facility; Improved IP&CManagement, Improved researcher salaries


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