2. Regional Health Authority An O.R. System Transformation
Central Manitoba Inc.
“Scheduling” Change
An O.R. System Transformation
eHealth Conference 2012

3. Outline: Preamble – Shelley Barnes
The Program Director – Eileen Vodden:
Surgical Sites
Strategic Vision & Focus
Regional Surgical Team
Current State
Inpatient Surgical Volumes
Standardization
Communication
Key Improvements, Benefits & What’s Next
EHR Services – Shelley Barnes:
Project Methodologies

4. Surgical Sites: Altona Health Centre Boundary Trails Health Centre
Carman Memorial Hospital
Portage District General Hospital

5. The Strategic Vision:
The first Surgical Vision Report was developed in 2007 to:
Respond to the needs of clients throughout
the Region
Fulfil an identified need to coordinate surgical services at four sites within RHA Central
To develop a standardized and consistent approach to meet surgical standards and patient needs
To establish a gap analysis at each site
Today it continues to guide surgical services to meet the needs of the client stakeholders throughout RHA Central and beyond

6. The Strategic Focus:
Create Surgical Centres of Excellence – coordinated by a regional plan versus each site
Improving the patients’ surgical journey through better coordination of care - access
Increasing patient access to surgery – reduce wait times
Increased patient options for surgery
Standardize practices across the surgical sites
Consistency at the program delivery level
Enhance capacity within the 8 virtual OR’s

7. Regional Surgical Team – The Glue!
The Surgical Team includes:
Nurses
Surgeons, anesthetists
Infection Control
Pharmacy
Medical Device Reprocessing
Administration

8. Current State Surgeons Anesthetists OR Teams 8 virtual operating rooms
Inpatient surgery
Same day surgery
Types
Gaps
Carman Training
PDGH Training
BTHC Training
Altona Training

9. RHA CENTRAL INPATIENT SURGERY VOLUMES 2007/08 TO 2011/12
RHA CENTRAL SAME DAY SURGERY VOLUMES 2007/08 TO 2011/12

10. Standardization: Booking form and guidelines Pre-op tests
Elective and Urgent Slating Policy
Emergency Slating Forms
Hip, knee, colonoscopy, bowel, ENT etc. Pathways
8 surgeon offices follow the same guidelines Winnipeg

11. Communication:

12. Key Improvements:
Standardized and improved patient flow with booking patients for surgery
Standard definitions for wait times, case times, and procedure names
Standardized pre-op processes, order sets, some clinical pathways
Improved waitlist management
Standard slating process for elective and emergency surgeries
A consistent approach to access of surgery across the region
Minimize opportunity for inputting error
ADT interface – demographic input by the right resource at the right time – integrity issue avoidance

13. Benefits: Quality Monitoring:
Ability for off-site or centralized slating functionality
Ability to produce utilization statistics and comparative data – standardized and consistent across 2 regions
Wait time data availability with submission to Manitoba Health meeting provincial standard – reliable data
Elective and emergency slating guidelines established
Cost Avoidance:
Ability to monitor 8 virtual O.R. Suites to ensure operating efficiencies are realized & maintained
Real time data availability
Improved budgeting process
Blocks identify reasons for O.R.
closures

14. What’s Next? Adding a tracking system for medical devices
Clinical documentation within the O.R.
Case costing
Read only access at the surgeon clinics
Recommend this be the SIMS system of choice for the province

15. System Implementation Cycle:

16. Readiness & Change Management….
Building Awareness & Desire:
Project Announcement
Staged approach
Project Team Kick-Off Meeting
Participation, Review & Validation from all Stakeholders:
Current State & Future State
Requirements Gathering
Gap Analysis
Individual Site Readiness Evaluations
Quality plans
Risk Assessment
© Prosci 2008

17. Deployment & Change Management….
Enabling Knowledge & Ability:
Implementation delayed to allow:
more change management activities with physician clinics & adoption of reengineered processes
Sufficient time to procure the required human and physical resources to perform slating tasks
Training approach revised to accommodate:
system build requirements - site x site
backlog catch up with limited resources

18. Sustainment & Change Management….
Ensuring Continued Adoption:
Online procedure manual
Support process
Slating Clerk User Group
Plan to initiate bi-yearly meetings with site teams
Recognized resource requirement - Clinical Systems Analyst role:
Administrative Support
Application Documentation
Application Support
System & Data Management

19. Challenges Encountered:
Ensuring the project scope & business case are clearly documented & understood by all stakeholders prior to project initiation
Solution chosen prior to the definition and analysis of business requirements
Ensuring all project roles are fully understood by the project and governance teams to avoid role creep and confusion
Allocating sufficient time for the first deployed site to work out “glitches”

20. Lessons Learned: Initiate change management plan early in project
Identify & make recommendations to address any gaps found during current project stage
Ensure there is a reinforcement plan to address resistance to change
Work with Operations to ensure proper resourcing is in place prior to project initiation
Project leads must assume responsibility that current state processes have all been captured and documented adequately

21. Lessons Learned:
Ensure there is an active Senior User role throughout project lifecycle
Define sustainment role and sustainment role back up during planning stages
Ensure statistical reporting requirements are well defined and determined in advance
Provision of on site support during training and go-live
Backfill to allow end users to attend training uninterrupted
Just-in-time training
Availability of a test/training database with sufficient time to access
Weekly conference calls with site teams

22. Questions Thank you! In Closing……..
Contact Information:
Southern Regional Health Authority
Eileen Vodden
Regional Program Director – Acute
Tel:            Fax:                  
Shelley Barnes, CHIM, PRINCE2™ Practitioner Prosci ™ Change Management Certified Regional Director Electronic Health Records
Tel:            Fax:                  
Thank you!