Transformational Leadership Experience From Inception to - - PowerPoint PPT Presentation

Transformational Leadership

Experience From Inception to Implementation

National Healthcare Leadership Conference June 11, 2007

• Dr. Keith Rose

Vice President and Chief Medical Executive North York General Hospital

Agenda

Anesthesia Care Teams Coaching Teams Wait Time Incremental Cases Innovative Delivery Models

Cataract High Volume Centre Total Joint Assessment Centre

Summary – Keys to Success

Anesthesia Care Teams (ACT)– Why?

Health Human Resource supply issue: Anesthesiologist

shortages across Ontario and Canada

The shortage of Anesthesiologists in the health care

system has been a contributing factor in the following results in Ontario:

• Growing surgical wait times
• Cancelled surgeries
• Operating Room closures

Anesthesia Care Teams – Alternate Care Providers

Anesthesia Assistant

• Registered Nurse or Registered Respiratory Therapist can,

with additional training, expand services provided by Anesthesiologists

• Participates in the care of stable surgical patients during

local, regional, or general anaesthesia under medical directives and under the supervision and immediate availability of the Anesthesiologist.

Anesthesia Nurse Practitioner Nurse/RT Monitor

Anesthesia Care Team Model Example

Use of anesthesiology teams for cataract surgeries

• One anesthesiologist covers two rooms
• Provides clinical support to Nurse/RT Monitor or Anesthesia

Assistants who establish IVs, administer sedation, and patient monitoring

• Increase cataract surgical volumes
• Maintaining patient safety

ACT Demonstration Site Project

• In August 2006, Associate Deputy Minister Hugh MacLeod

invited interested Ontario hospitals to submit an Expression

• f Interest to develop an Anesthesia Care Team

Demonstration Site

• The ministry was interested in evaluating different

models of anesthesia care in pre-operative, intra-operative and post-operative settings. The government also wanted to assess the effectiveness of the ACT in Community and Academic hospitals

ACT Demonstration Site Project cont’d

Demonstration sites are expected to run for 2 years

and will roll out in 2 to 3 phases depending on the level of interest and availability of trained personnel:

• Phase I launched in 2006
• Phase II starting in late 2007

Expressions of Interest

42 Ontario hospitals submitted Expressions of

Interest to develop an ACT Demonstration Site. These submissions covered pre-operative, intra-

• perative and post-operative settings:
• 31 pre-operative proposals
• 42 intra-operative proposals
• 29 post-operative proposals

Proposals came from Community Hospitals and

AHSCs across Ontario. Hospitals in all 14 LHINs submitted Expressions of Interest.

ACT Proposal Review Process

Detailed criteria were used to review the proposals

(in order of importance):

• Merits of Proposal
• Anesthesia Shortfall
• Readiness to Proceed
• Wait List Cases
• Budget

Funded Demonstration Sites

• 16 Projects
• 2 pre-operative
• 10 intra-operative
• 1 post-operative
• 3 other
• 10 Hospitals
• 4 community hospitals
• 6 teaching hospitals
• 7 LHINs
• 44 Staff
• 38 anesthesia assistants
• 6 registered nurses

Evaluating Demonstration Sites

Objective:

• Identify safety and efficiency of ACT model for pre-operative

assessment, intra-operative care and acute pain services Indicators:

• Patient safety
• Clinical efficiencies
• Patient & staff satisfactions

Methodology:

• Compare prospective & retrospective data from Demonstration sites
• Compare patients treated by ACTs to patient treated without an ACT

Data collection

• Web-based database registry

Anesthesia Care Teams

Challenges

Change management process

• New roles and relationships
• Training program
• RT/RN choice

Funding for physicians Time and effort for implementation was

underestimated

Coaching Teams – Operating Rooms

What are coaching teams?

Coaching teams are peers with experience in

effective management of peri-operative resources, trained as coaches

They assist hospitals assess their peri-operative

processes

• Based on expert panel recommendations

First visits began in January 2006 First return visits began in November 2006

Coaching Teams

Team Composition

• Team composition depends on the issues identified by the

hospital through their Expression of Interest. Teams generally include four members from the following areas:

• One Physician
• One or two Senior Administrators
• One or two OR Leaders

Out of the 32 coaches;

• 8 are Physicians, 13 are Administrators and 11 are OR Leaders
• Affiliation ranges from teaching hospitals, community hospitals and

small/rural hospitals.

Coaching Teams - Themes

Leadership and Accountability Allocation of OR Resources Flow and Space Issues Data Collection Human Resource Issues Equipment and Supplies

Coaching Teams – Follow-up

Coaching follow up visit

• Occurs between 6 and 9 months
• 2-3 hour on site visit
• Senior management representation
• Perioperative team members
• Coaching team members (physician and administrative lead)
• Follow up with the team to evaluate successes/challenges
• Review and assessment of progress with action plan
• More advisory in nature

Coaching Teams – Early Observations

• Broad engagement of perioperative team and senior management
• Consensus of issues
• Readiness for change
• Coaching process has assisted with team development
• Helps provide direction for the team
• Improved access to expertise

Coaching Teams –Early Observations

• Coaching for action/trusted advisor was the right model
• Coached organizations are leveraging the model internally
• Using the coaching process for other departments
• Organizations are finding capacity, savings and improving quality
• Coaching teams have identified system problems which are being addressed
• Process mapping workshops being developed for hospitals

Coaching Teams - Challenges

Some organizations see coaching teams as an

evaluation rather than an opportunity for learning and growth

Some organizations have been slow to adopt Implementation of recommendations

Coaching Teams – Future Steps

• Evaluation of the coaching process by University of Toronto

researchers; initial work started in January 2007

• Development of follow-up visit assessment tools, development
• f data trend analysis and tools that measure change and

improvement

• Updated website – materials for coaches and hospitals
• Toolkit of useful tools and templates created and accessible to

all hospitals

Wait Time Incremental Cases

Additional funding has been provided to perform

incremental volumes in the following areas:

• MRI
• Cardiac
• Cancer surgeries
• Joints (Hips and Knees)
• Cataract surgeries
• Paediatric surgeries
• Endoscopy
• Chemotherapy visits

Wait Time Incremental Cases

Accomplishments

• Decrease in wait times
• Increased efficiency
• Surgical Efficiency Target (SET)
• Process Mapping
• Standardization
• Focus on Quality

Wait Time Incremental Cases

Accomplishments continued

New IT Infrastructure

Wait time management Scheduling process

Acquisition of new equipment Innovative delivery models New surgical and anesthetic techniques Improved Discharge Planning

Wait Time Incremental Cases

Challenges

Fixed funding (no COLA), one year only Short notice period Cannibalization

• Need to focus on other system priorities

Clawbacks for unmet targets Requirement for additional IT infrastructure

and data collection

Innovative Delivery Models

High Volume Cataract Centre Total Joint Assessment Centre

Cataract High Volume Centre

Partnership between North York General Hospital,

Markham Stouffville Hospital, Humber River Regional Hospital

Dedicated ophthalmology operating room suite Goal: work in partnership to improve access, and

reduce wait time

Cataract High Volume Centre

Objectives:

• Reduce the wait time for patients from to the time of

decision to treat by an ophthalmologist to time of surgery

• Improve access - increase the number of surgical cases

performed

• Improve operative efficiencies (standardization)
• Improve patient outcomes

Cataract High Volume Centre

Accomplishments:

• Cross-credentialing
• Standardized work processes (operative packs, instruments,

supplies, forms)

• Process re-design
• Implementation of alternative care providers
• Effective buy-in
• No threat to referral patterns
• No threat to number of cases (financial impact)
• Significant reduction in wait time for cataract surgery

Cataract High Volume Centre

Next Steps

Comprehensive eye care plan for the Central LHIN

• Base volume cataract surgery consolidation
• Scheduled non-cataract surgery
• Urgent non-cataract surgery

Cataract High Volume Centre

Challenges

Change management New environment New Team Fee schedule – premium lenses

Total Joint Assessment Centre

Partnership between North York General Hospital,

Markham Stouffville Hospital, York Central Hospital

Goal: work in partnership to improve access, and

reduce wait time

Total Joint Assessment Centre

Objectives:

• Reduce wait time for patients from the point of referral

from their primary care physician to surgical assessment and surgery

• Increase the number of surgical cases performed
• Maximize orthopedic surgical time
• Improve patient and family involvement in their plan of

care

• Improve patient outcomes

Total Joint Assessment Centre

Accomplishments

• Innovative delivery model
• Inter-professional team conducts a comprehensive assessment and

develops a plan of care through to the recovery stage of the joint replacement surgery

• Learning and Development
• Surgeons worked with clinicians to teach and monitor assessment skills
• Standardization of processes and assessment forms
• Significant reduction in wait time for hip and knee replacement

surgeries

Total Joint Assessment Centre

Challenges

• Staff and physician engagement
• Fear of loss of referral patterns
• Communication with orthopedic surgeons, general

practitioners, public

Summary

Transformational Leadership – Keys to Success

• Strong Leadership
• Change management
• Systems thinking
• Innovation
• Appetite for risk
• Consistent and determined leadership
• Stakeholder engagement
• Patient focused
• Physician champions
• Understanding scope of influence and scope of control

Questions?