muhc clinical activity priority setting a4r and beyond isphc priorities 2010 april 24, 2010 dr tim...
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MUHC Clinical Activity Priority SettingA4R and Beyond
ISPHC Priorities 2010
April 24, 2010
Dr Tim MeagherMUHC, Associate Director General Medical Affairs
Centre universitaire de santé McGill
McGill University Health Centre
Created in 1997, the MUHC is the first andlargest voluntary merger of teaching hospitalsin Canadian history.
The Montreal General HospitalThe Royal Victoria HospitalThe Montreal Children’s HospitalThe Montreal Chest InstituteThe Lachine HospitalThe Montreal Neurological Hospital
Founded 182218931903190319131934General
Royal Vic
Lachine Neuro
Chest
Children’s
MUHC Clinical Activity Priority Setting - context
$2.2 Billion Redevelopment Project : More complex care, health network leadership
mandate Lachine General Hospital became 6th
partner in 2008
HINI
PPP preferred bidder selection
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- why are we doing this exercise?
Budget Redevelopment Project Network Orientation
MUHC Medical Affairs Directorate – 2010
The McGill RUIS
This network of partners assures a broad scope of specialized and ultra-specialized services to 1.7 million people spread across 63% of Quebec’s territory, namely 953,000 km2.
Nunavik 10 497
Terres-Cries-de-la-Baie-James29 117
Abitibi-Témiscamingue 142 974
Outaouais 345 464 Montréal Centre et Ouest
843 150Montérégie Ouest 383 658
Faculté de médecine, Université McGillCentre universitaire de santé McGillCH St. MarySir Mortimer B. Davis Hôpital général juif Institut Douglas CSSS de la MontagneCSSS CavendishCSSS du Sud-Ouest-VerdunCSSS de Dorval-Lachine-LasalleCSSS de l’Ouest-de-l’IleCSSS du PontiacCSSS de la Vallée-de-la-GatineauCSSS des CollinesCSSS de GatineauCSSS de PapineauCSSS du Lac-TémiscamingueCSSS des Aurores-BoréalesCSSS Les Eskers de l’AbitibiCSSS de Rouyn-NorandaCSSS de la Vallée-de-l’OrCSSS de Témiscaming-et-de-KipawaCSSS du SuroîtCSSS Jardins-RoussillonCSSS Vaudreuil-SoulangesCSSS du Haut-Saint-LaurentCentre régional de santé et de services
sociaux de la Baie-JamesCentre de santé InuulitsivikCentre de santé Tulattavik de l’ungavaConseil Cri de la santé et des services
sociaux de la Baie-James
MUHC Medical Affairs Directorate – 2010
To foster excellence.
To better position the MUHC within the network of healthcare institutions.
To align decision-making processes at all levels of the organization.
To foster culture of fair decision-making, grounded in Accountability for Reasonableness (Daniels, Sabin 2002)
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- what is the goal?
5. Work BookEvaluation
1. CAPSFramework
2. Evaluation Criteria
3. Work Book(Beta test)
4. Work Book Submission
Period
6. Preliminary & Revisions
Process
TimeframeJune 2009- June 2010
Process Steps # 1-# 7
June-Sept 2009 Oct 2009 Oct-Dec 2009 Jan-Mar 2010(8 weeks)
Mar-Apr 2010 June 2010
MUHC Clinical Activity Priority Setting (CAPS)
Where are we today?
May 2010
7. Final List Priorities
We are here!
Start Finish
MUHC Medical Affairs Directorate – 2010
Conceptual Framework Criteria Development CAPS Work Book Preliminary Observations Lessons Learned Next Steps
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework – (Sibbald et al 2009)
process elements
Stakeholder engagement (Get the right people involved) Explicit Process (Make the process clear) Information Management (Use the right data) Consideration of Values and Context (Explicitly identify
values relevant to MUHC) RUIS, local network of hospitals, CSSS’s
Revision mechanism (Allow opportunity for review)
MUHC Medical Affairs Directorate – 2010
Conceptual Framework – (Sibbald et al 2009)
outcome elements
Improved stakeholder understanding (Everyone understands why we’re doing this)
Shifted priorities and resources (Resources must follow)
Improved decision making quality (Decisions get better over time)
Stakeholder acceptance (Everyone accepts the decisions)
Positive externalities (Outsiders think you got it right!)
MUHC Medical Affairs Directorate – 2010
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework Criteria Development CAPS Work Book Preliminary Observations Lessons Learned Next Steps
MUHC Proposal AHC Criteria Examples Strategic Fit :Extent to which a clinical activity contributes to advancing thestrategic directions of the organization.
Academic commitments:Education = The role the clinical activity plays in educating future healthProfessionals. Research = The role the clinical activity plays in establishing and/or usingbest practices, generating new medical knowledge or developing and/orapplying technological innovation.
Alignment with external directives = Extent to which a clinical activity islimited by government mandates (e.g. protected programs), and/orcontributes to achieving regional or provincial health services objectives.Community Needs= Extent to which the clinical activity and volumes areconsistent with health needs of a defined community (or catchments area),including present and future demands.Partnerships (external) = Extent to which the clinical activity works inpartnership with other organizations to coordinate the delivery of care to adefined population.
Interdependences (internal) = Extent to which the clinical activitycoordinates and collaborates with other clinical activities within theorganization to enhance quality or optimize resource use.
Clinical Impact = Extent to which the clinical activity volumes are sufficientto ensure:
- clinical competency- patient safety- effective care
Consideration given to the uniqueness of the activity in the local/regionalarea and to the quality of services provided.
Resource Implications = Extent to which the resource context for healthservices delivery has implications for degrees of freedom in relation toPrioritization.
1. Strategic FitPositions, or has the potential to position, the MUHC as one of the world’sforemost academic health centres. 2. Academic Health Centre - Teaching Of particular interest is how excellence in teaching supports and relates (e.g. isdependant on, improves) to clinical activity.3. Academic Health Centre – Research Of particular interest is how the research component supports (e.g. is dependanton, improves) the clinical activity. 4. Health Care Context/Positioning Provides details as to how the clinical activity positions the MUHC as a leader inproviding tertiary-quaternary level care within the McGill network of hospitals. Itcompares clinical activity to other institutions inside and outside the McGill RUISand describes the extent to which collaborative relationships have developed. It also highlights the regional or provincial designations conferred by the MSSS. 5. Integrated Complex CareThe extent to which the clinical activity involves complex care delivery such ainterdependent care (Transitions from Paediatrics to Adult), cross-discipline care(cardiac sciences), and inter-professional collaborations (physician, nurse, alliedhealth). 6. Clinical Impact The extent to which this activity is consistent with health care needs (incl.
presentand future demand) of the community. This includes assessment of the patientvolumes (by level of complexity), trends, and innovative care delivery models.Information on the extent to which the clinical activity volumes are sufficient toensure clinical competence, effectiveness, and safety, if available, should also
beprovided.7. Sustainability The extent to which the types of resources used are able to support the currentand future development of the clinical activity without compromising others. Thisincludes details such as budget allocations (operating & fundraising), and humanresource requirements.
MUHC Clinical Activity Priority Setting- criteria development
Criterion 1: Strategic Fit
Criterion 2: Clinical Impact (needs & trends)
Criterion 3: Academic Health Centre – Teaching
Criterion 4: Academic Health Centre – Research
Criterion 5: Health Care Context – Positioning (leadership & partnership)
Criterion 6: Integrated Complex Care
Criterion 7: Sustainability
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- evaluation criteria
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework Criteria Development CAPS Work Book Preliminary Observations Lessons Learned Next Steps
A self-evaluation tool to evaluate clinical activities based on the 7 criteria.
A series of questions to answer with supporting data.
Scoring of each equally-weighted criterion: 1-3 = low (poor, marginal, fair)4-6 = moderate (satisfactory, good, very good)
7-9 = high (excellent, outstanding, exceptional)
Clinical teams identify activities to prioritize, increase network collaboration or to divest.
MUHC Clinical Activity Priority Setting
- work book
MUHC Medical Affairs Directorate – 2010
MUHC IntranetEnglishhttp://www.intranet.muhc.mcgill.ca/CAPS/index.html
Frenchhttp://www.intranet.muhc.mcgill.ca/CAPS/index_fr.html
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
- access to supporting information
MUHC Medical Affairs Directorate – 2009
MUHC CAPS Submission/Evaluation Process
Preliminary Priorities
Work BookCompletion
SDC SDC
Revision Period May 2010
Preliminary Priorities May 2010
Work Book SubmissionJan – Mar 2010
Final List of Priorities June 2010
MUHC Priorities
7 Missions
CEO
Submission Evaluation Mar-Apr 2010
Revision Submissions- SDC review
Board
OtherStakeholder
Groups
SDC
CLINICALTEAMS
Work BookSubmission
Criteria & Work Book
Development
CLINICALTEAMS
Additional Information for SDC consideration
Work Book &Data Tool BoxMUHC Intranet
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting - work book submission
86 Work Books received: 81 departments or divisions, and 5 ‘core’
clinical support areas (e.g. ER, Pharmacy) 166 separate clinical activities evaluated Average 60 pages (range 40 to 270), excluding
annexes and supporting documents
MUHC Medical Affairs Directorate – 2010
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework Criteria Development CAPS Work Book Preliminary Observations Lessons Learned Next Steps
MUHC Clinical Activity Priority Setting - preliminary observations
MUHC Themes Complex / specialised medical care Transition care across the life span Innovation focused around the patient Knowledge transfer to the community Elderly-aware hospital
MUHC Medical Affairs Directorate – 2010
MUHC Medical Affairs Directorate – 2010
Conditions for Success Accountability culture at all levels of the organization System wide performance and quality measurement Coordination of clinical activities between the McGill
teaching hospitals. Evaluate impact prior to accepting mandates or
programs
MUHC Clinical Activity Priority Setting - preliminary observations
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework Criteria Development CAPS Work Book Preliminary Priorities Lessons Learned Next Steps
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- lessons learned
After... 10 months of planning and roll-out 2 Town Halls standing agenda item on 12 committees 67 internal & 10 external presentations 4600 intranet hits many phone calls, emails, and hand holding later...
What have we learned?
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- lessons learned
This is not for the faint of heart
‘Off-the-rack’ models are not available.
‘Lean’ approach has pros and cons
Communications - no matter how well you think you’ve done……………
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting- lessons learned, contd.,
Timeline - stick to the schedule!
Clinical ‘Priority’ is a problematic term: Better to identify activities to ‘grow’ or ‘maintain at current
levels’- both may still be ‘priorities’
Unintended positive results: Capitalizing on CAPS for local strategic planning Snapshot of all clinical activity - many different uses Importance of data
MUHC Medical Affairs Directorate – 2010
MUHC Clinical Activity Priority Setting
Conceptual Framework Criteria Development CAPS Work Book Preliminary Priorities Lessons Learned Next Steps
MUHC Clinical Activity Priority Setting implementation
Resources must follow clinical choices: $$: revisit traditional budgets HRSpaceEquipmentInfrastructure (IS, telecom, logistics...)
MUHC Medical Affairs Directorate – 2010
Thank you!
MUHC Clinical Activity Priority Setting
MUHC Medical Affairs Directorate – 2010