Medical Affairs: Innovations in the Calgary Health Region

Transcription

1 Medical Affairs: Innovations in the Calgary Health Region Dr Rollie Nichol, Calgary Health Region Sandra MacDonald Goy, Calgary Health Region Nicholas Tait, Social Sector Metrics Inc Catherine Keenan, Calgary Health Region

2 Calgary Health Region Context One of the largest fully integrated, publicly funded health systems in Canada $2.8 billion budget Population of 1.2 million people, some of the fastest growing communities in the country Over 29,000 employees, 3,000 physicians Over 100 health care locations, including 12 acute hospitals 4 comprehensive health centres 41 care centres variety of community and continuing care settings

3 Calgary Health Region

4 Population Growth Population Growth in the Calgary Health Region ,300,000 1,250,000 1,200,000 P o p u latio n 1,150,000 1,100,000 1,050, % increase (n=125,448) in the population of the Calgary Health Region between ,000,

5 Physician Growth Physicians working in the Calgary Health Region % increase (n=575) in the number of physicians practicing in the Calgary Health Region between April April Apr-04 Jul-04 Oct-04 Jan-05 Apr-05 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Number of Physicians

6 Panel Presentation A Systematic Approach to Regional Physician Workforce Planning e-partners Project Future Physician Workspace Project

7 A Systematic Approach to Regional Physician Workforce Planning Dr. Rollie Nichol, Calgary Health Region Mr. Nicholas Tait, Social Sector Metrics Inc.

8 Purpose Support Rational Decision Making Internal Meeting patient need Aligning with infrastructure development and evolving service delivery models External Funding UGME/PGME expansion and mix Increased provincial funding of APPs

9 Methodology Research 1. Adjusted Needs Models estimate the current and projected supply of physicians required for the perceived burden of disease. Based on an understanding of current and projected prevalence of disease and capacity of specific specialties to care for that disease burden e.g. GMENAC (Graduate Medical Education National Advisory Committee) 1979 and 1991; Complex, data intensive 2. Demand-Utilization Models project supply of physicians required to provide health care services at current utilization levels. Projects future use based on forecast changes in demography & productivity; Baseline is current utilization rates, identify current supply deficit (if any), project future need based on demography (adjusted) & programs Calgary Health Region Adopted Modified Version; 3. Requirements Models are based on current Health Maintenance Organization staffing patterns; Not applicable in Canadian context 4. Socio-Demographic Models project the effects of socioeconomic and demographic factors on the availability of future practice opportunities for physicians; Market opportunity approach 5. A Physician Human Resource Strategy for Canada (03/2006) incorporate needs-based factors; Conceptual only 6. Comparative Ratios & Benchmarking is a fifth model that is an alternative to the four quantitative models above. This method uses physician to population ratio s e.g. CIHI (not intended for PWP); Simplistic

10 Policy Framework Assessment, Forecasting, Planning Evidence-based Needs Assessment Supply Assessment Balance Hours of Work & 50 hour work week Sustainable Call Rotation 1:4 Guideline Alternate Care Providers right time, right place Defining an hours plus Hrs on Call Integration Need Assessment Balancing the need for appropriate access with the demand for immediate access Current Demand plus Future Need Not Current Demand plus Future Demand

11 Summary Model Assessment, Forecasting, Planning Integration Supply Assessment Need Assessment Apply Variables Apply Variables Current Roster Future Supply Forecast Population Current Utilization Forecast Programs

12 Supply Assessment Model Supply Assessment Life Style/Work Week (survey, T&M study) Migration (CIHI, Roster Analysis) Apply Variables Age Gender Departure Build Current Roster Assess Future Supply Data Sources (College, HA, etc.) Base Roster Counts Time/Motion Studies Surveys (CMA, CFPC, etc.) Practice Profiles FTEs Undergraduate (Medical Schools) Matching (CaRMS) Postgraduate (Residency Pgrms) Practice Entry (CAPERS) Fellows IMGs (CaRMS, CAPERS) Foreign

13 Operationalizing Supply Assessment Model delivers Baseline Department addresses other parameters e.g. Colon screening 50+ e.g. Teaching model

14 Needs Assessment Model Need Assessment Growth Age Gender Migration Multi-cultural Apply Variables Sustainability Expansion Priorities Population Programs Demographic Socio-Economic Health Status Morbidity Referral Patterns Data Sources Infrastructure Capacity Access Services Education Research Technology

15 Operationalizing Need Assessment Model delivers Baseline Department addresses other parameters e.g. minimally invasive surgery e.g. core services in remote areas e.g. diabetes e.g. new hospital e.g. deficit indicator or 1x catch up indicator e.g. Expansion of Undergraduate & Post-Graduate e.g. Full-time academic funded position 50% protected time Less: [population growth]

16 Automating Baseline Plan

17 Modelling Scenario Planning & Sensitivity Analysis

18 epartners Project Sandra MacDonald Goy, Calgary Health Region

19 Purpose The epartners Project will deliver: Business process and customer service improvements A Medical Staff appointments solution (replacement of the existing Medical Staff database) An authoritative, integrated source of information for the Provider Registry Integration with the Oracle Financial system epartners will not deliver: Technology and information related to patient/client care Duplication of Oracle Financial systems

20 epartners Concept Diagram Regional Clinical Departments Communications Physician Relations Physicians & Allied Health Demographics Applications Contract Review Account Status Invoice Entry Portal Medical Staff Appointments & Credentialing Demographics e-partners Contracts & Finance Applications Recruitment Contracts Reports ARPs Workforce Plans Workflow Notifications Finance Regional Medical Staff Office Chief Medical Officer Communications

21 epartners Project Timeline Defined business requirements & issued RFP Jan Dec Contract negotiations completed January 2007 Oracle selected as product Impac selected as the vendor for implementation Approved separate Operating Org configuration Oct 2007 User acceptance testing/regression testing June 2008 Configure for Production July 2008 Limited production access September 2008 Data migration/data entry Passive feed to Regional Provider Registry Implementation with governing offices October 2008 Begin rollout to regional departments 2009

22 epartners Project Status Appointments & Credentialing Configuration complete May 2008 Automated workflow development deferred Finance & Contracts Configuration complete May 2008 Automated workflow development deferred Communications Implementation deferred until regional delivery channels in place (eg. Enterprise fax upgrade, paging system replacement) Self Service (Portal) Roll out deferred in order to ensure data integrity and system functionality established

23 Business Process Redesign Example Physician Contact Information (Risk Management) AS IS and TO BE mapping completed Regional Medical Staff Office (RMSO) Health Records Services (HRS) - Transcription Services IT Access Office Business Roles Confirmed Data entry responsibilities for internal providers epartners Governing Offices Regional Medical Staff Office (RMSO), Medical Education Office (MEO) Allied Health Office Data entry responsibilities for external providers epartners (HRS) Data integrity (back end validation) - HRS

24 Risks Project timelines Managing risks Managing expectations Communications Transition to business & service owners

25 Rewards Medical Affairs One database shared by 14 clinical departments for 3,000 physicians Financial Accountability Automated business processes for $200million in annual physician payments Risk Management Standard business processes and templates for physician contracts erecord Source of truth for the information about healthcare providers to support rolebased access to health information Communication Single point of contact for physician updates Physician have identified as preferred route for communication

26 Future Physician Workspace Project Catherine Keenan, Calgary Health Region

27 Purpose To provide standard processes and guidelines to enable consistent and transparent decisions concerning physician office space requirements in the Calgary Health Region. To support regional clinical departments, site administrators, capital planning and space management teams in the strategic allocation of physician office space in current and future facilities owned, leased and/or operated by the Calgary Health Region. To provide the tools and resources that physicians and regional teams will use to explore innovative and creative solutions to physician office space issues across the Region, including options that explore off-site and community-based physician office space.

28 Change Drivers Aging and changing physician workforce Changing economic environment in Calgary Issues highlighted by Family Medicine Historical and current practices, agreements and relationships Stakeholder expectations Changing practice Limited space and capacity for physician offices

29 Progress and Deliverables Completed Tasks (June 2007 June 2008) Project management structure Physician office data collection Framework document Assessment toolkit Innovative physician office space models Support and implementation service

30 Project Resources Project Management and Governance 12 months from start to finish (June 2007 June 2008) 12 senior-level steering committee meetings 40 hours Associate Chief Medical Officer 40 hours Executive Director, Physician Leadership 1500 hours project management, tools and documentation Data Collection and Analysis 5 months from start to finish (July 2007 December 2008) 500 hours summer students 500 hours management/analysis 140 hours Regional Clinical Departments

31 Data Collection and Analysis Lack of a common understanding of the current physician office space situation Baseline data collected at July 20, 2007 from sources: Medical Staff Office Database UofC Faulty Academic Appointments Database CMO Contracts for Administrative Roles Database Regional Clinical Department physician office location data Significant variation among regional clinical departments in how physician offices are allocated and managed in the number of physicians who have been allocated offices More information on physicians with offices in the community is required

32 Physician Office Space Toolkit Policy and Process Map outlines the overview of policies and processes relating to physician workspace Physician Practice Profile Tool allows physicians to assess their tolerance for change and appetite for risk Situational Analysis and Problem Definition helps physician determine their office space problems Proposed Support Models matches results of the situational analysis with support models Business Case Tool provides guidance on creating a business case (when required) with strategic, economic, financial, commercial and management dimensions

33 Guide to Future Physician Workspace Support Models Model Description Service Broker Model Lease Negotiation Model Capacity Broker Model CHR Sub-Lease Model CHR Health Centre Model Business Broker Model P3 (Public Private Partnership) Renovation Support Model Regional Grant Model Targeted Services Model Shared Workspace Model CHR Revenue Model Satellite Office Model Academic Partnership Model Onsite Physician Model Short-term Space Model Mobile/Virtual Working Model Mentorship Model Incubator Model Match physician requirements with existing services (e.g. practice development) Use Calgary Health Region resources and leverage to support physicians lease negotiations. Match physicians with excess capacity in owned/leased space with physicians in need of office space. Calgary Health Region holds head lease on office space, sub-leases to physicians. Calgary Health Region provides a full service health centre with multi-disciplinary team Match physician who want to share business risk with other physicians or partners Physicians partner with Private Sector investors to provide clinic space Support renovation process of existing physician space with expertise and planning support Support physician revenue and capital costs through grants, reimbursements, or incentives Provide support or incentives to physicians who are will to provide targeted services Several physicians can use one workspace, scheduled to meet individual requirements Lease spare capacity in Calgary Health Region facilities to physicians Space on or near a health campus is designated for targeted physician office space Create a clear process with University of Calgary to maximize space for academic physicians Ensure there is a uniform formula for physician overhead costs in Calgary Health Region facilities Create a process to use short-term space that is temporarily vacated by physicians (e.g. sabbatical) Use advances in AT to allow physicians to have a mobile, virtual offices Match new physicians with more experienced physicians for coaching and mentoring Provide time-limited incubator space for physicians new to practice

34 Risks Stakeholder expectations Resistance to change Commitment to new models Limited resources Adaptability of models Exit strategies

35 Rewards Robust project management Validated data on current state Targeted stakeholder engagement Effective decision support tools Innovative physician office space solutions Leverage of strengths, resources, capacity Clear concept of value exchange

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