Taking the next steps April - PowerPoint Presentation

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Taking the next steps April 2015 to June 2017

Working Together as a Cross Sector Team to Strategically

Reposition

Key Areas of the

Health Sector

Ministry of Health Presentation

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Realizing changeWhy is it so difficult to achieve “radical” (transformative) change?

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The structure of the health care system…

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Can we realize change in such a large and complex system?

What ability do you as an “

organizational actor

” have…

to

make system level change

happen…

relative to the role of other players in the

organizational context

… and the interaction between multiple structural elements (organizational structures, hierarchies, mandate letters, budgets, agreements etc)?

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Competing interests, pressures and dynamics?

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Assessing commitment to changeStatus quo commitment of key dominant groups to prevailing institutional template in use

Indifferent commitment with key dominant groups neither committed nor opposed

Competitive commitment by key dominant groups to different templates

Reformative commitment in which key dominant groups are against current template in use and prefer an articulated alternative (situation required for “radical” change)

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Constraints to enablers - collaboration as critical enabler for change

Assessing and the working with organizational culture – working with the dominant organizational ideologies, discourses and interpretive schemes – to make collaboration work

Assessing and then working with power and status to make collaboration work

Working with emergent change embedded at practice level supported by organizational and provincial levels to make collaboration work

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Supporting continuous improvement at the local level while driving cross sector change in a few key areas

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So how have we situated our game plan?

Directional policy papers for discussion on a few key areas (an articulated possible alternative for discussion) but allowed for local and regional continuous improvement activities and initiatives

Leadership Council and its Standing Committees as the engine for collaborative operational and strategic management (internal collaboration and consensus building around an alternative)

Reaching out to engage key service partners (“dominant groups”) to become part of this process

(external collaboration and consensus building around an

alternative)

Establishing a Health Sector Strategic Project Coordination Secretariat (coordination across levels focused on practice level at SDA/LHA – denominator, numerator targets, measurement and evaluation)

Establishing cross sector project teams linked to the key cross sector areas (collaborative effort, iterative learning emergent/prescribed)

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What do you think?Have we hit the mark?

Have we hit the mark in assessing the population needs?

Have we hit the mark in focusing our efforts on those health services - primary and community care, surgical services, and rural services – which are critical to the sustainability of the publicly funded health system in B.C

.?

Are there key pieces of information we have missed?

Are there gaps in our analysis, and if so, what are they?

Do you agree with the recommendations in the policy papers?

What would be the top three recommendations you would see as a priority for each paper?

Are there other cross system actions that you believe would provide better system wide results?

If you could do anything in the current system to improve it, what would it be?

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Proposed Strategic areas of focus

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Strategic AnalysisSetting Priorities for the B.C. Health System (February 2014)B.C. Health System Strategy Implementation – A Focused and Collaborative Approach (April 2014)

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Policy Discussion PapersDelivering a Patient-centred, High Performing and Sustainable Health System - Strategic

Overview

The

British Columbia Patient-Centered Care Framework

Primary

and Community Care in B.C.

Future Directions for Surgical Services in B.C.

Rural Health Services in B.C.

A

Provincial Strategy for Health Human Resources

A Provincial Strategy for IM/IT (early March)A Provincial Strategy for Health Sector Funding (early March)

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Areas Requiring Substantive Repositioning and Results as First Priority…

Over the coming two years the health sector needs to make substantive measurable progress on the three cross sector areas of focus:

Improving

the effectiveness of primary, community (including residential care), medical specialist and diagnostic and pharmacy

services for patients with moderate to high complex chronic conditions, patients with cancer, patients with moderate to severe mental illness

such as to significantly reduce demand on emergency departments, medical in patient bed utilization, and residential care.

Significantly improving timely access to appropriate

surgical treatments and procedures

.

Establishing a coherent and sustainable approach to delivering

rural health services

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Primary and Community Care… significantly reduce demand on emergency departments, medical in patient bed utilization, and residential

care… 95% occupancy rate for large hospitals

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Practice Level - Service Delivery

Support

the continued development of

full service family practices

that support patients across their life spans but incrementally plan for and support the establishment of team-based family practices as full service sole practitioners

retire.

Systematically

and opportunistically establish Linked

Community

and Residential Care Service Practices for

Older Adults with Moderate to Complex Chronic ConditionsMultidisciplinary Practices – Responsive Community Based Primary and Community CareLinked to Modified Assisted LivingLinked to Residential Medical Short Term Stay

Linked to Proactive Residential Care Placements

.

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Systematically and opportunistically establish Community and Residential Care Services Practices For Patients with Moderate to Severe Mental Illnesses and/or Substance Use IssuesMultidisciplinary Practices – Responsive Community Based Primary and Community Care

Linked to Modified Assisted Living

Linked to Residential Medical Short Term Stay

Linked to Proactive Residential Care Placements

Support full service practice teams with appropriate medical specialist shared care and consultations and redesigned approaches to consultant services for older people, those with chronic conditions and patients with moderate to severe mental

illnesses

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Organizational Level – Operationally Based Enabling Supports Regional

Health Authorities in collaboration with Divisions of Family Practice will create the enabling organizational structures and processes in support of the practice directions set out above

.

Increase Practice Support Change

Management

Increase Appropriate Access to Specialist Consultation and

Support

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Provincial Level – System Based Enabling Supports

Governance and Strategic Leadership Review

Improve

Coordination, Accountability

and

Implementation

Complete

Legislative, Regulatory and Policy ReviewPolicy to support practice level actions

Clarify

The Role Of Walk In Clinics

Assess and review Patient Attachment (the GP for Me) initiative Assess and review In-Patient GP Care in Metro and Urban AreasAssess and review Maternity CareIncrease Appropriate Use of TelemedicineAlign Home and Community Care and Residential Regulation/Policy

Align

Mental Health and Substance Use Regulation/Policy

Significantly Strengthen

Human Resources Planning and Management for the Primary and Community Care

Sector

Improve Data and Analytics to Support the Strategic

Direction

Strengthen

Enabling Information

Technology

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Surgical Services

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Practice Level - Service Delivery

Implementing

a Patient and Family Centred Approach to

Surgical Care

Implement Practice Guidelines for Consulting with Patients on Treatment

Options

Encourage, Support and Implement Alternative Practice

Models

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Organizational Level – Operationally Based Enabling Supports

Optimize

Surgical Infrastructure, Eliminating Backlogs, Ensuring Flow Based on Appropriate

Timelines

Optimizing Surgical

Input and Supply Costs

Improve Quality Monitoring and Reporting

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Provincial Level – System Based Enabling Supports

Governance and Strategic Leadership Review

Improve

Coordination, Accountability

and

Implementation - PSAC

Complete

Legislative, Regulatory and Policy ReviewOptimize Wait List Management Develop and Implement a Comprehensive Performance Measurement, Reporting, and Accountability Framework for Surgical

Services

Implement

a Surgical Health Human Resource StrategyImplement a Provincial Surgical IM/IT and Technology StrategyAlign Funding and Costing Strategies to Support Policy Directions

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Rural Health Services in B.C.

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Practice Level - Service Delivery Population Health, Health Prevention and Wellness

Primary

and Community Care

Organizational

Level – Enabling Supports to Rural Health

Practice

Support

Teams

Home

Support and Residential Care in Rural Communities

Access to Specialist Consultation and Support Emergency Health Services and Access to Higher Levels of Emergency Health Care:

Rural

Hospitals

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ProvincialHealth Human Resources Planning and ManagementThe Ministry through the Health Service Policy and Quality Assurance Division will establish public reporting, monitoring and impact/outcome assessment mechanisms for deployment starting April 2015.

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A Provincial Strategy for Health Human Resources

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Establishing a Coherent Policy Framework

The

Ministry of Health in collaboration with Health Authorities, Colleges, the Doctors of BC and Health Unions will establish a single provincial Health Human Resource Framework that will be used to plan, link and coordinate go-forward actions and initiatives.

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Health Human Resources Framework31Slide32

Enabling Effective Cross Sector Health Human Resource Management – Range of Actions

Leadership

Council will establish a Standing Committee on Health Human Resources (SCHHR) as BC’s senior level HHR governance structure, reporting into Leadership Council.

By

September 30 2015 Health Authorities will complete an organizational change management assessment of their organization’s current capacity, approaches and

infrastructure

By

September 30 2015 Health Authorities will complete an HHRM (including physician human resource management) assessment of the organization’s current capacity, approaches and infrastructure.

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The Ministry of Health and the Health Employers Association of BC (HEABC) will complete the development of a new Integrated Health Human Resource Planning (IHHRP) tool to improve the province’s HHR planning ability.

Inventory of public and private post-secondary education and training programs, including clinical placement capacity

.

Patient-

centred

, culturally sensitive and inter-professional learning opportunities.

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Enable effective transition to practice in the BC health system The SCHHR will lead the development and implementation of a leadership and management development framework for both the senior management and senior executive management of the BC health system

.

The SCHHR in collaboration with the Doctors of BC and health unions will round out and ensure the implementation of an inter-professional multilevel engagement strategy that builds from existing agreements and processes to support the creation of inclusive, vibrant and healthy workplaces across the health sector.

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Specific Action Challenge – Developing and Implementing a HR Deployment Methodology Linked to an Effective, Thoughtful Workplace Redesign Methodology

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There

are difficulties with developing optimal HHR

deployment strategies for models of

providing

care due

to the scarcity and inconclusiveness of relevant research.

Existing evidence on skill mix has several limitations:

difficult to tease out the effect of staffing models on patient outcomes from the effect

of the care intervention itself inconsistency with which the terms “staff-mix” and “skill-mix” have been conceptualized

and

measured

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Proposed HHR approach to deploymentStaff Mix

There is no clear guidance from the literature on what the ideal mix of health professionals might be

.

The most common approaches for optimizing staff mix are:

adjusting the number of personnel, mixing qualifications (i.e., basic versus advanced credentials)

balancing junior and senior staff members (i.e., experience), and

mixing disciplines (i.e.,

interprofessional care teams).

Skill

Management

Role enhancement involves expanding an individual’s skills within their scope of practice through new, non-traditional roles Role enlargement involves expanding the scope (breadth) and diversity of the worker’s skills like expanded skills that support chronic disease care

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37Professional/Inter-professional

Culture

Health professions have distinct cultures, including differing beliefs, language, values, customs and knowledge which impact the direction and success of patient-centred health system change.

Motivation/Engagement

Motivation exists when there is alignment between the health service provider’s individual goals and the organization’s goals:

perceived alignment between goals leads to support for change

perceived misalignment between goals leads to provider resistance to change.

Physician

Engagement

engaging physicians in health system decision-making is seen as critical to successfully executing on health system strategiesSlide38

Enabling Strategic Policy Paper Directions

The

SCHHR in collaboration with Health Professional Colleges, the Doctors of BC, health unions and other relevant provincial stakeholder groups, will undertake specific planning to take coordinated HR actions across different levels (practice, regional/organizational, and provincial), across the scope of service delivery (public health, community, diagnostics and pharmacy, and hospital), and across delivery settings (metro, urban, rural, remote) in support of the directions set out in the Primary and Community Care, Surgical Care and Rural Health policy papers.

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Questions?

We

want now to see what you think:

Have we hit the mark?

Have we hit the mark in assessing the population needs, and as a result focus our efforts on those health services critical to the sustainability of the publicly funded health system:

primary

and community care

surgical

services

rural

services? Are there key pieces of information we have missed?Are there gaps in our analysis, and if so, what are they?Do you agree with the recommendations in the papers?

What would be the top three recommendations you would see as a priority?

Are there other actions that you believe would provide better system wide results?

If you could do anything in the current system to improve it, what would it be?

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Discussion

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