agile health systems: aligning financial, operating and prioritization processes in real-time to...

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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

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

Unhappy Healthcare Headlines... Any Options or Solutions?

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


• 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


• 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


• 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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Performance

The Vancouver Coastal Story



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

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

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

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

• 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

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

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)

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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Performance

The Coastal COC Story



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%

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

Steadily Declining Admits within 10 hours. Lowest point 30%

0%

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80%

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%<10hrs by period 12/13-16/17FY

%<10…

Demand is 98% Predictable

21

Increased Y/Y ED Visits and Admissions

Demand Forecast OK, Discharges and Staffing not alligned

Christmas Learning’s Applied to Family Day Long Weekend

Weekly Plan to Operational Forecast

Projected Discharges vs. Actual

Spring Break/Easter Forecast Patient Flow Update

Identical Spring Break Discharge Pattern Over Past 3 Years

ED Visit Surge Analysis

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SPRING BREAK/EASTER FORECAST (OCCUPANCY)

Opportunities decreasing staffing

Opportunities increasing staffing

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

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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Performance

Imagine Tomorrow – Findings from CIHI/AHS Agile Performance Research



Agile Performance

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

$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

Siloes Kill – Quality, Productivity, Efficiency … and even Patients

• 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

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

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

Integrated Operations Centre

Mackenzie Health Day Surgery Unit- Family Waiting Area

Integrated Operation Centres Middlemore: Wait for Bed. Discharge Delays. Housekeeping.

Integrated Operation Centres Middlemore: Location. Status. Alerts.

Integrated Operation Centre Middlemore

Demand Forecast. Occupancy. Staffing.

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

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

Questions?

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

mailto:[email protected]

mailto:[email protected]