1. Public sector/stakeholder collaboration - moving beyond “the clenched fist” Strategies for Public Sector Transformation 2002 - October 16, 2002

2. Agenda  introduction  Physician Office System Program – a case study  challenges & solutions “You cannot shake hands with a clenched fist” - Indira Gandhi

3. Introduction  lessons learned from walking in the other guy’s moccasins  experience is the best teacher or “how I got the scars on my back”  Alberta Wellnet  CYNCH  Western Health Information Collaborative  Alberta “One Window”  Common opportunities  Western Canadian Continuing Care EHR Initiative  Physician Office System Program  the usual disclaimer

4. The Physician Office System Program A case study…

5. Physician Office System Program  joint initiative of the Alberta Medical Association and Alberta Health & Wellness  negotiated under the AMA/AH&W master agreement  a contractual relationship  provides three types of assistance to the physician:  financial assistance to defray the cost of hardware/software  information technology services  change management services  targets improvement in physician office systems, services and business models (e.g., ASP)

6. POSP vision “to establish a physician office information infrastructure that is integrated with the health information system”

7. Electronic health record Physician office system: Electronic medical record Integrated decision support Billing Scheduling Office productivity tools Stand-alone information sources: Labs Pharmacies Radiologists = Interface Regional clinical systems - acute: MPI/ADT Lab Pharmacy ER Radiology Home care Immunization Speech Pathology “ EHR” – a longitudinal record of a patient’s health & healthcare, from cradle to grave… Regional clinical systems – sub- acute and continuing care: Continuing care delivery systems, including case management, care protocols, clinical data and reports Client/patient surveys

8. Physician Office System Program Evaluation Howard Research Evaluation Howard Research POSP Subcommittee POSP Subcommittee Program Director Program Support Admin. Assistant Program Director Program Support Admin. Assistant Operations (AMA) Operations (AMA) Communications (AMA/AH&W) Communications (AMA/AH&W) IT Delivery (alberta we//net) IT Delivery (alberta we//net) Change Management Change Management AMA AH&W Program Management Office Finance Cttee.

9. Delivery of change management services… POSP Program Director Program Support Admin. Assistant POSP Program Director Program Support Admin. Assistant Operations IT Delivery Communications Change Management Manager Karen Shimko Change Management Manager Karen Shimko Advisor Nancy Stewart Advisor Nancy Stewart Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Advisor South

10. POSP results to date...  1,212 physician participants to date; target 2,138  standing offers for physician office system vendors developed (1 st in Canada); “2 nd round” of requirements definition underway  physician led; 5 stakeholder groups  national and regional participation  POS to POS interface feasibility study in process  support for electronic reporting of lab results  standing offers for Microsoft and Dell negotiated

11. POSP results to date…  “first of its kind” change management program  web-based tools (POSP Software Lab, electronic “doctors’ lounge”), communication and knowledge products, workshops (computer literacy, decision support, change management, privacy impact assessments…) & on-site consultations  communications strategy and products developed  external evaluation ongoing, first reports issued  operational, change management and groupware IT systems implemented

12. POSP results to date…  cited as the “premier” physician program in Alberta  seen as a successful collaboration by the Program sponsors  proposed for renewal by both sponsors

13.  POSP developed “standing offers” with vendors for the delivery of hardware and software that will support achievement of physicians’ program outcomes  standing offers published April, 2002  first time in Canada comprehensive physician office system requirements articulated IT services

14. Learning as we go…  significant learnings through standing offer process  external evaluation conducted and results shared with stakeholders  process was fair  no need to issue another RFP  POSP should develop and maintain standards  independent evaluation agency should evaluate applications against standards

15. Benefits of this approach  consultation with stakeholders will:  ensure requirements carry weight  address vendors’ business issues  result in increased alignment between physicians’ & other stakeholder needs and vendor offerings  allows time for vendors to meet any new requirements  vendors who already meet VCUR can market by reference to these requirements, as soon as requirements published

16. Public sector/stakeholder collaboration Lessons learned…

17. Barriers to successful collaboration  absence of shared vision, commitment  inappropriate governance model  lack of specificity re: outcomes & targets  lack of clarity re: roles & responsibilities  misunderstanding the nature of the relationship  inadequate resourcing of the collaborative effort  positional stereotyping & mistrust  dogmatic adherence to past decisions

18. Strategies that work…  you can’t outsource strategic planning  business owners need to “own” the vision and define/approve key strategies  environmental scan helps clarify the “larger picture”  listen with an “empty teacup”

19. Strategies that work…  give careful thought to your governance structure and respect it once its in place  appropriate to the task  terms of reference  if you’ve delegated authority…don’t meddle! but hold parties accountable with respect to agreed-upon outcomes  consider “orientation” to ensure governance level and operating level are clear on respective roles and responsibilities

20. Strategies that work…  collaboration requires dedicated resources  consider implementing an appropriately resourced program management structure, accountable to the project sponsors  keeping sponsors, stakeholders informed is key

21. Strategies that work…  articulate and communicate expected outcomes, targets…  link to strategies  assign owners to strategies  monitor and report on performance relative to these outcomes  linkage with related initiatives?

22. Outcomes/targets example

23. Linking outcomes to strategies…

24. Strategies that work…  don’t confuse the way you treat people with the nature of the business relationship  partnership?  contractual relationship?  don’t expect a vendor to act like the owner of the initiative…their primary focus is their own bottom line  don’t let suspicion based on different agendas taint the relationship

25. Strategies that work…  do your best not to fall back on stereotypes  encourage a climate of continuous improvement…its okay not to get it perfect the first time!  formal evaluation function or periodic external reviews are just good practice  don’t get trapped “sticking with” decisions that time & circumstances have proven sub-optimal  change what you can on the fly… schedule reviews when more substantive policy changes can be implemented  invite the stakeholders in at the earliest opportunity…doesn’t have to be perfect

26. Getting beyond the clenched fist… The law of “win/win” says “let’s not do it your way or my way…let’s do it the best way” - Greg Anderson The 22 Non-negotiable Ways of Wellness