“Transformational Change: Achieving Performance and Accountability through Behavioural Change” Liz Buller, Senior VP Pa

1. “Transformational Change: Achieving Performance and Accountability through Behavioural Change” Liz Buller, Senior VP Patient Services, William Osler Health System Barbara Pitts, Associate Partner, PricewaterhouseCoopers June 10, 2010

2. Background Osler’s Requirements Methodology (Process Management) & Governance Project Management Current State Assessment Key Considerations for Implementation Planning Tools and Techniques for Improving Accountability and Performance Key Success Factors Questions Slide 1 Agenda

3. Background • William Osler Health System (WOHS) is one the largest community hospitals in Ontario • Serves one of the fastest growing, culturally diverse populations in Canada • Amalgamated in 1998, WOHS has three sites – two hospitals providing acute care services, and one (currently under re-development) that will provide ambulatory services • New Brampton Civic Site opened Fall 2007

4. Background (continued) The Health System Plan developed within the Central West Local Health Integration Network identified three key areas: • Mandate for the Health System: A strong foundation of integrated community-based health services which is fully supported by an acute care system. The health service providers collectively deliver consistent, high-quality services at the most effective location for the citizens of the LHIN.

5. Background (continued) • Mandate for Community-based Health Services: Community-based health services are the first point of contact for residents of the Central West LHIN. The goal is to provide more services which support health and well-being closer to where people live. The health service providers need to deliver services locally but manage in an integrated regional model. • Mandate for Acute Care:A fully integrated hospital system which provides a comprehensive range of services to meet the needs of LHIN residents and support the community-based service providers.

6. Osler’s Requirements • Osler required transformational change designed to achieve the following objectives: • Improve patient access and flow; • Enhance care management; • Design regional health systems; and • Implement a financial improvement plan for Q4 of 2009-10.

7. Osler’s Requirements (Continued) • Identify a consulting firm with whom partner to support: • Current state assessment; • Detailed design; • Implementation planning; and • Full-scale execution. • Utilize strong process and project management. • Provide knowledge transfer and capacity building.

8. Methodology to Support Process PwC’s Health System Integration Methodology • Five-step methodology that spans the gap from the awareness of the need to change to developing innovative solutions for the change to successful implementation. • A "deliverables based“ methodology with gated review points.

9. Governance Structure

10. Project Management • Transformation Management Office (TMO) – a project management office established to provide oversight and guidance across all work streams to ensure consistency, continuity in applying standards of best practice and coordination of change management and communications. • Project Management Tools and Processes – An array of tools and techniques from the HSIM toolkit were employed by, such as: • Standardized Project Charters • Standardized Status Reports • Implementation Metrics

11. Current State Assessment • The organization-wide current state assessment resulted in the creation of 27 performance improvement projects that included both “Quick Wins” and longer term “Design and Redesign” projects. • The projects spanned a wide range of focus, including: • The redesign of processes, policies and procedures and roles and responsibilities to improve patient access and flow from ER to discharge; • The design of regional health systems for cancer, seniors care, cardiovascular, mental health & additions, and women & children;

12. Current State Assessment (continued) • Optimization of perioperative services including scheduling, OR blocks, turnaround times and CSR; • Surfacing and executing financial improvement initiatives to leverage opportunities for additional revenue generation or cost savings across the organization; and • The development of business cases for opportunities with a return on investment which contributed to the achievement of the goals.

13. Key Considerations for Implementation Planning • What is the magnitude of change for the key stakeholders? What is the duration of the change? • What are the goals for execution? (i.e., What do we need to accomplish?) • What are the critical barriers and risks to successful implementation? How will they be managed / mitigated? • What resources are required for successful implementation? (e.g., people; IT; equipment; space)

14. Key Considerations for Implementation Planning • What indicators will need to be tracked during transition to ensure the changes are being adopted? • How are you going to communicate the benefits and success to the impacted stake holders (e.g., patients, staff, physicians, management, partners)? • How is tracking and monitoring of success during transition going to be handled efficiently? • How will you use the information tracked during transition to support any course corrections if targets are not met?

15. Tools and Techniques for Improving Accountability and Performance: Stake Holder Analysis and Change Strategies

16. Tools and Techniques for Improving Accountability and Performance: Implementation Reporting Framework Detailed Design (Phase 2a) Implementation Planning (Phase 2b) Phase 3 Implementation (Phase 3) Sustainability • Design and development • Alignment to project objectives • Engagement of leadership and stake holders • Progress and achievements of key milestones, deliverables in Phase 2 • Project management updates at project meetings (core; extended PM) • Status Reports • SC presentations • No degradation of performance improvement • Active responses to evolving changes in internal and external environment (continuous improvement • Transition indicators • Outcome indicators • Permanent measurement systems in place for ongoing monitoring • Transition indicators trending and exception reporting • Senior Leadership dashboard • Launch and execution • Monitoring and reporting of performance improvements • Adjustments based on feedback (primarily metrics) • Transition indicators that reflect demonstration of real improvement (i.e. outputs of change) • Temporary measurement systems in place • Leverage existing systems where possible (via Fin, DSS) • Transition reporting to SC via ACTION project Office • SC presentations Focus Metrics Data Collection Reporting

17. Tools and Techniques for Improving Accountability and Performance: ER Quick Win – Registration & Triage • Implementation Start Date: January 4, 2010 • Baseline Average: Unknown – March 13 – 28 Collection Began • Narrative: • Over time the greet nurse attendance at the greet desk has been increasing, although last week the compliance trended down. • This likely happened because we had a higher than average number of sick calls, and the ER was short staffed, and the greet nurse desk was not staffed during breaks. • A suggestion was made to get the resource nurses to cover breaks when the ER experiences staffing shortages. • 65% • 60% Better/Same as Previous Week Worse Than Previous Week

18. Key Success Factors • Highly Engaged Leadership: • Executive Sponsors, Steering Committee members, Project Leaders, Project Managers and Physician Champions have: • led and advocated the importance of the project to physicians, administration and staff; • provided support to the teams when working through challenges and risks and approving or proposing innovative solutions.

19. Key Success Factors (continued) • Rigorous Project Management Structures and Processes • Standardized project management and gated reviews facilitated: • The coordination of project activities in a consistent manner that adhered to the principles embedded in transformation (i.e., high quality; patient-centred; evidence-based; supportive of the LHIN, etc.); • Consistent monitoring of progress and risk; and • Reporting genuine performance improvement in a measureable manner and making course corrections in real time.

20. Key Success Factors (continued) • Knowledge Transfer: • Osler staff and the PwC team worked in a highly collaborative manner to develop and improve capacity. • All Project Leaders were Osler management staff to ensure decisions were made locally and supported by the PwC project managers. • A number of Osler employees were seconded specifically to lead work streams in order to maximize the knowledge transfer during the engagement so future initiatives can be executed effectively by the hospital.

21. Slide 20 Questions… Comments…