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

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

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

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

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

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

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

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

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 - 3 Winnipeg

Communication:

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

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

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

System Implementation Cycle:

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

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

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

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”

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

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

Questions Thank you! In Closing…….. Contact Information: Southern Regional Health Authority Eileen Vodden Regional Program Director – Acute Tel:            204 428 2769 Fax:           204 428 2774 Email:        evodden@rha-central.mb.ca Shelley Barnes, CHIM, PRINCE2™ Practitioner Prosci ™ Change Management Certified Regional Director Electronic Health Records Tel:            204 428 2723 Fax:           204 428 2774 Email:        sbarnes@rha-central.mb.ca Thank you!