Past, Present & Future: Our Experience with Integration London & Thames Valley - a case study -

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1 Past, Present & Future: Our Experience with Integration London & Thames Valley - a case study - Regional Partnership Leadership Forum 14 September 2005 Four Points Sheridan London, ON Regional Collaboration a rich history in SW Ontario Coordinated Stroke Strategy of SW Ontario Acquired Brain Injury Network of SW Ontario Southwest Emergency Services Network SW Ontario Telehealth Network Regional Trauma Care Network Regional Paediatric Network for SW Ontario Regional Cardiac Care Services Network Diabetes Complication Network Paediatric Critical Care Network Palliative Care Network Regional Health Planning Partnership SW Ontario Geriatric Assessment Network Southwest Region Health Information Partnership SW Ontario Medical Education Network 1

2 Changes Driving Collaboration Human resources shortage challenges Need to develop coalitions for advocacy Controlling crushing budget needs Devolving medical education Need to adopt and share enabling technology and expertise Opportunities for research, discovery and funding sources Sustain Academic Health Sciences Centre Partners City-Wide Integration Initiatives - Restructuring 1995 merger of three hospital campuses at LHSC Created a Joint Committee to oversee HSRC directives in 1997 The University of Western Ontario City of London London Health Sciences Centre St. Joseph s Health Care, London Community Care Access Centre District Health Council 2

3 London Hospital Landscape Beyond 2008 London Health Sciences Centre St. Joseph s Health Care, London St. Joseph s Hospital University Hospital Parkwood Hospital Victoria Hospital Regional Mental Health Care St. Thomas City-Wide Integration Initiatives- Governance Joint Board Committees Joint Ventures Committee Joint Audit Committee Joint venture for Research Enterprise Lawson Health Research Institute Created cross-hospital Board appointments 3

4 City-Wide Integration Initiatives - Management Created eight integrated VP portfolios serving both organizations Established city-wide credentialing and MAC joint meetings Shared Executive Leadership CEO CEO Research Corporate Services Research Medical & Professional Affairs Finance Clinical / Academic Medical Staff Clinical Support Clinical / Academic Nursing Staff Facilities Planning Academic & Medical Affairs Acute / Ambulatory Care Human Resources Health Information And CIO LTC, Rehab, Complex & Veterans Care Human Resources & Community Relations Surgery CBU Mental Health Medicine CBU Fund Development Support Services Children s & Women s CBU Cancer CBU 4

5 City-Wide Integration Initiatives - Foundations The LHS Foundation and the SJHC Foundation worked in partnership To achieve the $150 million fundraising objectives necessary to fund the hospitals share of capital redevelopment costs To coordinate several joint annual events City-Wide Integration Initiatives Clinical and Support Services Created Healthcare Materials Management Services (HMMS) Serves 17 organizations Created city-wide Laboratory Services to achieve economies of scale Consolidated laboratory leadership Optimal site and equipment utilization 5

6 Early Lessons Tough to let go independence is cherished Improved the way we made decisions collectively and bring more of a systems perspective Developed ways of working together that allow us to focus on the people we serve collectively Demonstrated to the public (our stakeholders) that we are working together to coordinate the delivery of health care Applied best practices across continuum of care Relentless effort to find best ways to make collective decisions time drain Success Factors Trust and credibility of players Perseverance Communicate! Communicate! Communicate! Creativity in developing partnerships Making progress toward system planning 6

7 Integration in Thames Valley Working Together Started both at community Hospitals and at teaching hospitals, as we all realized we needed to build a system Started on both the clinical and admin fronts 2 examples CDI Clinical Support Services Integration HMMS Support Services Integration 7

8 The Thames Valley Pilot The vision of the Southwest Ontario Digital Imaging Network Project is to create a regional imaging Cooperative, using a shared services model, that will support patient care through access to and the provision of timely diagnostic imaging services Making Canadian History Lake Huron London Lake Erie 8

9 Other Thames Valley-based Integration Initiatives Development of a common laboratory Information System (LIS) Development of a common Hospital Information System (HIS) with more to come Lessons Learned or How we removed the barriers together Leveraged shared interests based on a common geography, patient referral patterns, shared clinical interests. Developed a way to work with equity, not equality Developed formal agreements that address and protect individual interests, concerns Kept talking and worked issues through Acknowledged and learned from mistakes 9

10 Promoting Efficiency in Supply Chain Management Collaboration at an Ontario Level Automating the Supply Chain Promoting Efficiency in Supply Chain Management The Ministry of Finance announced the creation of OntarioBuys in the May 2004 Ontario budget. OntarioBuys three-year mission is to facilitate and accelerate the adoption of Integrated Supply Chain Management (iscm) Leading Practices by the Broader Public Sector (BPS). Hospitals Universities Colleges - School Boards 10

11 Highlights from Shared Goals & Objectives 2005/2006 e-supply Chain Project Customer Satisfaction Survey Policies & Procedures Pandemic Plan Project Site Selection Hospital groups that were recruited to form the initial e-supply Chain Project Team and make a submission to the Ministry of Finance were selected based on the following criteria: Willingness to invest in iscm (time and money) Willingness to change and create a shared vision for the future Willingness to work closely with all stakeholders Willingness to share results and help others Current system capabilities Level of executive support and project leadership Volume of supply chain transactions Project Sites were not selected because they are the best. Other Hospitals will have the opportunity to request OntarioBuys funding to improve their own Supply Chain systems. 11

12 Project Sites Organization Hospital for Sick Children Shared Services West (Credit Valley, Halton Healthcare, Trillium and William Osler) Ottawa Hospital Shared Healthcare Supply Services (UHN, Sunnybrook & Women s, Mount Sinai) Healthcare Materials Management Services (HMMS) NEON (Northeast Ontario) Project Lead Wayne Coros Philip Smith Guy Lemay Don Cummer Mike Rosser Gaston Roy PeopleSoft Meditech Oracle GEAC Smart Stream McKesson Meditech System 6 Project Sites represent 46 hospital campuses, purchasing more than $700 million annually for supplies (30% of the total Ontario Healthcare annual spend). Key Stakeholders GEAC Meditech McKesson Oracle PeopleSoft CareNET GHX Other Service Providers Suppliers (60 represent 70% of total hospital spend) 6 Project Sites representing 46 hospital campuses Interfaces to other Hospital Systems Ministry of Finance Ministry of Health OHA HealthPro Medbuy Regional Buying Groups 12

13 Automating the Supply Chain Traditional Manual Supply Chain Processes Source Request Procure Receive Inventory Payment Reporting Automating the Supply Chain Continuum Electronic Catalogue (832/Web) Contract Management /E-Tendering Punch Out to Supplier Catalogue Electronic Requisitionin g Work Flow and Approvals Vendor On-Line Ordering Point-of-Use Data Capture (Bar Coding) Clinical Consumption Ordering Purchase Order (850/Web) Order Acknowledgement (855/Web) Auto Faxing Auto PO & Scheduling P-Cards Advanced Ship Notice (856/Web) Package Tracking Supply Tracking Serial/Lot Numbers Returned Goods to Suppliers Automated Order Processing Carousels Bar Coding Vendor Owned Inventory Par Inventory Management Fixed Assets Invoice & Credit Memo (810/Web) EFT Payment and Notification (820/Web) Travel and Expenses Reporting 3-Way Electronic Match Invoice Scanning Distributed Information Through Business Intelligence Activity Reporting to GPO s and Suppliers Vendor Portal to Hospital Systems Project Site Priorities - HMMS E-COMMERCE & CONTRACT MANAGEMENT Within this priority HMMS will further develop and implement existing e-commerce functionality through CareNET and/or GHX to include: Purchase Order 850, Order Acknowledgement 855, Advanced Ship Notice 856, Electronic Catalogue 832 and Electronic Invoice 810. This priority will also include the further development and implementation of existing Contract Management and Auto Purchase Order functionality. ELECTRONIC FUNDS TRANSFER (EFT) & DOCUMENT IMAGING Within this priority HMMS will develop and implement a system to reimburse its suppliers and staff (nonpayroll expenses) through the use of electronic funds transfer and implement a system to electronically store and retrieve invoice documents. WEB REQUISITIONING & POINT OF USE ORDERING Within this priority HMMS will implement web based requisitioning system and point-of-use requisitioning using vendor bar codes. REPORTING THROUGH BUSINESS INTELLIGENCE Within this priority HMMS will develop and implement a system to distribute customized reports to hospital end users through a web portal and design reports through business intelligence to help better manage HMMS business activities such as: purchasing, accounts payable and inventory management. 13

14 Project Site Priorities - HMMS CLEAN SURGICAL WAREHOUSE Within this priority, HMMS will establish a clean warehouse located at 184 Stronach Cr. with the goal of increasing the number of stocked items for departments such as the Operating Room, Critical Care etc. ORDER PROCESSSING USING VENDOR BAR CODES Within this priority HMMS will develop and implement a system to fully automate the order picking process through the use of vendor bar codes, hand held scanners and a wireless warehouse. PACKAGE TRACKING Within this priority HMMS will fully implement the existing Order Package Tracking system at all London hospital sites, using bar coded labels, hand held scanners and a wireless warehouse. Hospital end users will have the ability to track the delivery status of their own orders through a web portal. Funding - HMMS Priority Position Staffing $ Other $ Total $ E-Commerce & Contract Management Clerical $60,000 $60,000 Document Management Requisitioning Reporting Surgical Warehouse Systems Analyst Implementation Trainer Report Analyst/DBA Project Lead $67,000 $60,000 $113,000 $90,000 $100,000 $15,000 $180,000 $175,000 $167,000 $75,000 $293,000 $265,000 Warehouse Automation Package Tracking Chatham & TVHPP (Payformance) Contingency Systems Analyst Implementation $105,000 $22,000 $51,700 $195,000 $55,000 $65,000 $78,500 $300,000 $55,000 $87,000 $130,200 Total Funding $568,700 $863,500 $1,432,200 14

15 Lessons Learned What is needed for success: A shared vision Communication and negotiation skills Incentives to bring and keep people engaged Resources to support the change process and its implementation Action plan to ensure effective implementation and change management Integration What s Next Bridging hospital and community services Greater clinical integration Common infrastructure and support services Regionalization with a shared governance and management model 15