HOW WE GET THERE - BC Care Providers

Report
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
2
REALIZING CHANGE
Why is it so difficult to achieve “radical” (transformative)
change?
3
The structure of the health care
system…
4
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)?
5
Competing interests, pressures and
dynamics?
6
Assessing commitment to change
• Status 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)
7
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
8
Supporting continuous improvement at the
local level while driving cross sector change
in a few key areas
9
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)
10
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?
11
PROPOSED STRATEGIC
AREAS OF FOCUS
12
Strategic Analysis
• Setting Priorities for the B.C. Health System (February
2014)
• B.C. Health System Strategy Implementation – A Focused
and Collaborative Approach (April 2014)
13
14
Policy Discussion Papers
• Delivering 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)
15
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
16
17
PRIMARY AND
COMMUNITY CARE
… significantly reduce demand on emergency
departments, medical in patient bed utilization, and
residential care… 95% occupancy rate for large
hospitals
18
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 teambased 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 Conditions
• Multidisciplinary 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
.
19
Systematically and opportunistically establish Community
and Residential Care Services Practices For Patients with
Moderate to Severe Mental Illnesses and/or Substance
Use Issues
• Multidisciplinary 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
20
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
21
Provincial Level – System Based
Enabling Supports
Governance and Strategic Leadership Review
• Improve Coordination, Accountability and Implementation
Complete Legislative, Regulatory and Policy Review
• Policy 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 Areas
• Assess and review Maternity Care
• Increase Appropriate Use of Telemedicine
• Align 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
22
SURGICAL SERVICES
23
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
24
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
25
Provincial Level – System Based
Enabling Supports
Governance and Strategic Leadership Review
• Improve Coordination, Accountability and Implementation - PSAC
Complete Legislative, Regulatory and Policy Review
• Optimize Wait List Management
• Develop and Implement a Comprehensive Performance
Measurement, Reporting, and Accountability Framework for Surgical
Services
Implement a Surgical Health Human Resource Strategy
Implement a Provincial Surgical IM/IT and Technology
Strategy
Align Funding and Costing Strategies to Support Policy
Directions
26
RURAL HEALTH SERVICES
IN B.C.
27
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
28
Provincial
• Health Human Resources Planning and Management
• The 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.
29
A PROVINCIAL STRATEGY
FOR HEALTH HUMAN
RESOURCES
30
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 goforward actions and initiatives.
31
Health Human Resources Framework
32
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.
33
• 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.
34
• 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.
35
Specific Action Challenge – Developing and
Implementing a HR Deployment Methodology
Linked to an Effective, Thoughtful Workplace
Redesign Methodology
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.
36
Proposed HHR approach to
deployment
Staff 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
37
• Professional/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 strategies
38
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.
39
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?
40
Discussion

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