1. Lower Mainland (B.C.) Health Consolidation
A look into
Integrated Protection Services (IPS)
Successes and Challenges
Jeff Young
Executive Director

2. A Brewing Storm
Rapidly escalating healthcare demands from a growing and aging population.
Increasing costs & inflation - unsustainable in the long term.
All six (seven) BC health authorities were facing deficits despite getting a significant portion of the provincial budget.

3. The Opportunity
Geographic proximity of the four Lower Mainland health organizations (FH, PHSA, VCH & PHC) afforded the opportunity to look for efficiencies in common services.
LMC = In size the 2 largest LHINS (8 & 9 + LHIN 10)

4. Lower Mainland Health Organizations
Serve 60% of BC’s population
Have a combined budget of ~$7B
Total employees across the organizations number 65,000
Provide a wide range of health services at:
28 Acute Facilities
27 Residential Care Facilities
Hundreds of community based facilities i.e. storefront clinics

5. August 2009 LMC Mandate
MoH and health organizations initiated consolidation of select service areas for LM-based health organizations
Consolidate as many services as possible
Initiatives in scope specified, timelines and objectives set
Services provided as a single entity
Build on existing collaboration

6. Financial Target $100M annual savings across LMC
= 10% of the $1.0B non- clinical budget
$100M target allocated among the departments
Pace was critical

7. Process
One organization accountable for provision of each consolidated service across the LM
Consolidated service will:
Provide quality services on behalf of all participating organizations based on service agreement
Have authority under the Master Services Agreement
Achieve its specific cost savings target (sustainable savings)
Ensure patient care is not negatively impacted

8. Original LMC Initiatives
VCH FH
PHSA
PHC
Biomedical Engineering
Interpreting Services
Integrated Protection Services
Health Information Management
IMITS
(PHC, PHSA, VCH)
Facilities Management
Pathology and Laboratory Services
Business Initiatives & Support Services
Health Emergency Management
Pharmacy
Services
Communications &
Public Affairs
Integrated
Medical Imaging

9. Strategies Increased process efficiency through:
Alignment and integration across the organizations, including initial staffing reductions
Standardization
Reducing duplication
Leveraging of buying power
Sharing resources and knowledge

10. Governance & Structure
Governance Committee
Collaboration Council
MoH
CAO
Program Management Office
Finance & Capital
Working Group
Data Management
Committee HR
BISS
Dr. David Ostrow
David Handley
Facilities Management
Dr. Nigel Murray
Peter Goldthorpe
IMITS
Carl Roy*
Barry Rivelis
Health Info. Mgmt.
Dianne Doyle
Yoel Robens-Paradise
Integ. Medical Imaging
Mike Nader
Comm. & Pub. Affairs
Clay Adams
Integrated Protection Svs.
Jeff Young
Pharmacy Services
Dr. Shallen Letwin
Interpreting Services
Suzanne Barclay
Path. & Lab. Medicine
John Andruschak
Biomedical Engineering
Chris Buck
Remain accountable through CEOs for
Project Delivery & Savings
HSSBC
Jim Eckler
LMC Initiative
Executive Champion
Executive Lead
IT Design Authority
Lead organization:
VCH FH
PHSA
PHC
Health Emergency Management
John Lavery

11. Key Enablers
Master Services Agreement is the governing document that specifies the roles, responsibilities and obligations of the participating organizations with respect to service quality, access, financial, human resources and other aspects of the program
Information Sharing Agreement facilitates cross-organizational systems access
Signing Authority with consistent authorization levels for similar management grades across the LM

12. Key Enablers
Sharing Formula – to distribute financial risks and rewards resulting from consolidation activities
Customer Service Committees – to enable consolidated services and oversee service performance metrics
Consolidated financial reporting to monitor budgets and savings
Staff Transfers – to Lead organization. (There is an ongoing effort to harmonize HR Benefits, Employee Terms and Conditions)

13. By the end of FY12/13, LMC had achieved an estimated $74
By the end of FY12/13, LMC had achieved an estimated $74.6M in annual savings.
Add cost avoidance: Total estimated savings = $116.4M

14. Systemic Issues Joint capital and IMIT planning Performance measures
Consistent approach for HR issues
Mutual systems access
Data governance
Joint capital and IMIT planning
Legal/risk issues
Savings sharing formula
Consolidated Budgets
Performance measures
Privacy Information Agreements

15. Achievements NO NEG. IMPACT ON PATIENT CARE SAVINGS
PMO & Standard Processes
Consolidated LM Structures
Master Service Agreement & 12 Service Schedules
Consolidated LM Budgets/Reporting
Quality Assurance Mechanisms
Standardized Best Practices
Savings Sharing Formula
SAVINGS
Integrated Service Models
NO NEG. IMPACT ON PATIENT CARE
Achievements

16. LMC Successes Efficiencies Leaner structures, reduced duplication
Economies of scale, leveraging buying power
Shared resources
Financial reporting
Consolidated budgets
LM financial reporting structures
Savings sharing formula

17. Other LMC Successes Consolidated LM structures
Streamlined roles and accountabilities across LM for better efficiency & productivity
Alignment & integration
Staff transfers to lead health authority (where identified as an enabler)
Standardization, moving to Best Practices
Standardization to agreed-on service levels
No negative impact on patient care

18. Other LMC Successes Service Agreements
Master Service Agreement with 12 Service Schedules
Ensure consistent quality service across the LM
Commitment to provide service levels that are acceptable for each organization
Customer Service Committees for feedback/input
KPIs monitored
Mechanisms to escalate issues identified
Include solutions to most systemic LMC issues

19. The Future
Savings goal will be substantially (if not entirely) achieved by end of 2013/14
LMC provides a solid platform for provincial collaboration and consolidation strategies
HEM
BioMed

21. Integrated Protection Services
Core Services
Protection/Security
Parking, Access & Commuter Services (PACS)
Budget
LMC Protection/Security $21M
With additional budget exists outside LMC budgets
LMC PACS $20M net revenues
1/3 operating costs includes access costs
Note: Each HO retains its own net parking revenue

22. Integrated Protection Services
Core Objectives
Support a secure and accessible environment of care to ensure the highest standard of quality services being delivered across the 4 Health Organizations.
Create an integrated program that incorporates process excellence and industry best practices to provide quality service to the Health Organizations.
To seek innovative and sustainable value solutions.
Foster a culture that develops High Performance Teams.

23. Integrated Protection Services
IPS Streams - Overview
Security/Protection
Strategic Initiatives & Contract Management
Operations
Parking, Access & Commuter Services (PACS)
Process Excellence & Performance Reporting *NEW*

24. Integrated Protection Services
Service Delivery Model Overview
Outsourced site based security services & parking management with corporate IPS oversight
Inherited 3 legacy security contracts each with different scope of services
3 legacy parking management contracts

25. Integrated Protection Services
Service Delivery Model Overview
Functional program management model that aligned protection leadership to LMC wide responsibility vs. previous East - West model
Consolidate PACS core production services and IPS management having LMC wide responsibility into one of two “hubs” - East & West with vision to move to one (Centralized vs. Decentralized)

26. Integrated Protection Services
Protection/Security - Operations
Governance of the site based security vendor services
Direct management of Forensic Psychiatric Hospital & Provincial Special Constables
Routine incident review, Tier notification and management thereof when required
HO / Site / Program liaison
Threat Management program
Investigations

27. Integrated Protection Services
Protection/Security – Strategic Initiatives and Contract Management
Recently combined security services RFP contract for the LMC:
Aligned scope to our preferred service delivery model
Additional cost savings by bundling services and other contract initiatives realizing ~ $2.85M in savings !!!

28. Integrated Protection Services
Protection/Security – Strategic Initiatives and Contract Management
Review, reconciles and audits the security vendor partner invoicing ~ $20M annual combined spend
Currently engaged in 103 construction projects LMC wide
Development of standardized assessment and audit tools for Operations team
Further consolidation and standardization of security related systems i.e. card access, CCTV

29. Integrated Protection Services
Parking, Access & Commuter Services (PACS)
Expand Transportation Demand initiatives ~ where parking capacity issues
Continue with expanding automation & pay parking sites
LMC wide Parking Policy
Continue with centralization of access services and LEAN processes to reduce production time
Evaluate and roll out new integrated technologies i.e. Smart Cards
RFP to consolidate legacy parking management contracts into 1 LM wide contract for fiscal 15/16 29

30. Integrated Protection Services
Process Excellence & Performance Reporting
Supports both Protection/Security & PACS programs
Lower mainland PMO/CSC Reporting
Process mapping / LEAN initiatives
IPS Enterprise Incident Reporting system oversight
IPS data warehouse management
Analysis of data to support evidence based decision making
Standardized quarterly reporting at site/program/HO level in progress

31. Integrated Protection Services
Performance Reporting – Quick Facts
OPERATIONS CENTRE CALLS Fiscal Year
PHSA FH
VCH/PHC
TOTALS
Urgent Calls
1,491
5,589
8,490
15,570
Non-Urgent Calls
22,228
75,208
98,471
195,907
TOTAL ANNUAL CALLS
23,719
80,792
106,961
211,472
AVERAGES
Percentage of Urgent Calls
6.3%
6.9%
7.9% 7%
Percentage of Non-Urgent Calls
93.7%
93.1%
92.1%
93%

32. Integrated Protection Services
Performance Reporting – Quick Facts
TOTAL SECURITY INCIDENT REPORTS Calendar Year
PHSA FH
VCH/PHC
TOTALS
Security Incident Reports
754
47,094
48,090
95,938

34. Integrated Protection Services
Progress to date
At the end of the FY 2012/13, IPS fully achieved its LMC targets:
Protection realized $0.518M in cost direct savings
Parking realized $5.98M in net new revenues
Completed employer transfer of all staff to Fraser Health
Rolled out an enterprise incident reporting systems across the LM

35. Integrated Protection Services
Progress to date
Expanded program through system resource transfer or reinvestment of efficiency savings
Heliport management
Security systems maintenance & repair
Commuter services
Consolidated 3 legacy security contracts into 1 single scope contract
Consolidated card access platforms from 7 to 2
Expanded preferred CCTV NVR platform from 3 to 24 sites

36. Integrated Protection Services
Priorities 14/15
Review/renew 5-Year IPS Strategic Plan
Provide → Support → Partnership Evolution
Further standardization of systems, processes and reporting throughout LMC
Further pursue automation, reducing operating costs and revenue enhancements within PACS
Build upon the creation of high performing team

37. Integrated Protection Services
Priorities 14/15
Continue to expand Protection/Security community sector* and community based facilities outreach
Expand MOU with FM (key management, heliport management and security systems maintenance and repair) to leased site facilities.
Prepare RFP for LM Parking management for 24 locations combined for 16,500 parking stalls

38. Integrated Protection Services
Challenges
Reality of having 4 “masters” with 20 combined “strategic imperatives”
Increased system wide budget constraints / access to capital $
IT connectivity between the 4 HO’s
Support programs to IPS not being consolidated adds complexity
Increased activity compounded by downloading/scope creep with no resource increase

39. Integrated Protection Services
Challenges
Global reduction in vehicle use, increased local taxation, TDM success and corresponding decrease on parking demand impacting revenues negatively, but also celebrated as a success too!
Media / public and advocate group applying political pressure on hospital pay parking

40. Healthcare Spending….unsustainable!
British Columbia
Fiscal 13/14 - $16.5B / $43.3B or 38% of the Provincial Budget
Total spending increase of 75% between 2000 and 2010 – which equates to an average annual increase of 6% during that time period

41. Healthcare Spending….unsustainable!
Ontario
Fiscal 13/14 $48.9B/$112.6B or 43% of the total Provincial budget
The Ontario government is committed to eliminating the deficit by
The deficit for is estimated to be $9.8 billion

42. So GTA …..are you ready?! Transforming Health Care
The government will build on Ontario’s Action Plan for Health Care to create a sustainable and high-quality health care system by:
Transforming health care to reduce the rate of growth of spending to an average of 2.1 per cent annually over the next three years
Enhancing community-based care to treat patients in alternative settings such as non-profit clinics and at home instead of in hospitals, where appropriate
Moving to patient-centred funding models to improve the value and quality of care

43. So GTA AKA Lower Mainland ONT …..Are you ready?!

44. System savings must be found!
So GTA …..are you ready?!
Proactively combine/bundle some of the 14 LHIN non clinical support services? Like an IPS program?
Government - Shared Support Services mandate to consolidate? Not if, but when.
Fact Current healthcare spending run rates are unsustainable
System savings must be found!

45. So GTA…..My advice Be part of the solution…
Be proactively looking for cost savings, efficiencies and standardization through partnerships with other LHIN’s or risk it (consolidation) being forced upon you.

46. Build A Program Scalable to absorb increased capacity
Flexible to absorb “other” services: Parking, HEM, transportation/fleet mgmt., etc.
Show cost savings! Find $ through efficiencies
Risk based / data supported decision making (have the data!)

47. Build A Program That has a business acumen about it
Fiduciary responsible – oversight of taxpayer $
Every operating support $ spent takes $ away from direct patient care
Process excellence / performance reporting / evidence based / data supported decision making / tie to clinical indicators
Tie services directly back to support patient care wherever possible
HAVE THE VISION !

48. Consolidation….It’s coming…
Online survey seeks community views on possible hospital merger

49. Lower Mainland Integrated Protection Services
Thank You