1

Past, Present & Future: Our Experience with

Integration London & Thames Valley

- a case study -Regional Partnership Leadership

Forum14 September 2005Four Points Sheridan

London, ON

Regional Collaboration …… a rich history in SW Ontario

Coordinated Stroke Strategy of SW Ontario

Acquired Brain Injury Network of SW Ontario

Southwest Emergency Services Network

SW Ontario Telehealth Network

Regional Trauma Care Network

Regional Paediatric Network for SW Ontario

Regional Cardiac Care Services Network

Diabetes Complication Network

Paediatric Critical Care Network

Palliative Care Network

Regional Health Planning Partnership

SW Ontario Geriatric Assessment Network

Southwest Region Health Information Partnership

SW Ontario Medical Education Network

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Changes Driving Collaboration

Human resources shortage challengesNeed to develop coalitions for advocacyControlling crushing budget needsDevolving medical educationNeed to adopt and share enabling technology and expertiseOpportunities for research, discovery and funding sourcesSustain Academic Health Sciences Centre Partners

City-Wide Integration Initiatives - Restructuring

1995 merger of three hospital campuses at LHSC

Created a Joint Committee to oversee HSRC directives in 1997

The University of Western Ontario

City of London

London Health Sciences Centre

St. Joseph’s Health Care, London

Community Care Access Centre

District Health Council

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London Hospital LandscapeBeyond 2008

London HealthSciences Centre

St. Joseph’sHealth Care, London

University Hospital

Victoria Hospital

St. Joseph’s Hospital

Parkwood Hospital

Regional Mental Health CareSt. Thomas

City-Wide Integration Initiatives- Governance

Joint Board Committees

Joint Ventures Committee

Joint Audit Committee

Joint venture for Research Enterprise

“Lawson Health Research Institute”

Created cross-Hospital Board appointments

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City-Wide Integration Initiatives - Management

Created eight integrated VP portfolios serving both organizations

Established city-wide credentialing and MAC joint meetings

Surgery CBU

Human Resources &Community Relations

Medical &Professional Affairs

Acute /Ambulatory Care

Human Resources

Finance

Clinical Support

Facilities Planning

CEO CEO

LTC, Rehab, Complex& Veterans Care

Corporate Services

Health InformationAnd CIO

Clinical / AcademicNursing Staff

Academic &Medical Affairs

Fund Development

Shared Executive Leadership

Clinical / AcademicMedical Staff

Mental Health

Support Services

Medicine CBU

Children’s & Women’sCBU

Research Research

Cancer CBU

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City-Wide Integration Initiatives - Foundations

The LHS Foundation and the SJHC Foundation worked in partnership

To achieve the $150 million fundraising objectives necessary to fund the hospitals’ share of capital redevelopment costs

To coordinate several joint annual events

City-Wide Integration Initiatives – Clinical and

Support Services

Created Healthcare Materials Management Services (HMMS)

Serves 17 organizations

Created city-wide Laboratory Services to achieve economies of scale

Consolidated laboratory leadership

Optimal site and equipment utilization

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Early Lessons

Tough to let go…independence is cherishedImproved the way we made decisions collectively and bring more of a systems perspectiveDeveloped ways of working together that allow us to focus on the people we serve collectivelyDemonstrated to the public (our stakeholders) that we are working together to coordinate the delivery of health careApplied best practices across continuum of careRelentless effort to find best ways to make collective decisions…time drain

Success Factors

Trust and credibility of players

Perseverance

Communicate! Communicate! Communicate!

Creativity in developing partnerships

Making progress toward “system planning”

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Integrationin

Thames Valley

Working Together

Started both at community Hospitals and at teaching hospitals, as we all realized we needed to build a systemStarted on both the clinical and admin fronts 2 examples

CDI – Clinical Support Services IntegrationHMMS – Support Services Integration

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The Thames Valley PilotThe Thames Valley Pilot

Lake Huron

Lake Erie

London

Making Canadian HistoryThe vision of the

Southwest Ontario

Digital Imaging

Network Project is

to create a

regional imaging

Cooperative,

using a shared

services model,

that will support

patient care

through access to

and the provision

of timely

diagnostic imaging

services

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Other Thames Valley-based Integration Initiatives

Development of a common laboratory Information System (LIS)

Development of a common Hospital Information System (HIS)

with more to come …

Lessons Learned or How we removed the barriers together

Leveraged shared interests based on a common geography, patient referral patterns, shared clinical interests.Developed a way to work with equity, not equality Developed formal agreements that address and protect individual interests, concernsKept talking and worked issues throughAcknowledged and learned from mistakes

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Automating the Supply Chain

Promoting Efficiency in Supply Chain Management

Collaboration at an Ontario Level

The Ministry of Finance announced the creation of OntarioBuys in the May 2004 Ontario budget.

OntarioBuys’ three-year mission is to facilitate and accelerate the adoption of Integrated Supply Chain Management (iSCM) Leading Practices by the Broader Public Sector (BPS).

Hospitals – Universities – Colleges - School Boards

Promoting Efficiency in Supply Chain Management

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Highlights from Shared Goals & Objectives 2005/2006

• e-Supply Chain Project

• Customer Satisfaction Survey

• Policies & Procedures

• Pandemic Plan

Project Site Selection

Hospital groups that were recruited to form the initial e-Supply Chain Project Team and make a submission to the Ministry of Finance were selected based on the following criteria:

• Willingness to invest in iSCM (time and money)

• Willingness to change and create a shared vision for the future

• Willingness to work closely with all stakeholders

• Willingness to share results and help others

• Current system capabilities

• Level of executive support and project leadership

• Volume of supply chain transactions

Project Sites were not selected because they are the best.

Other Hospitals will have the opportunity to request OntarioBuys funding to improve their own Supply Chain systems.

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Project Sites

MeditechGaston RoyNEON (Northeast Ontario)

Mike Rosser

Don Cummer

Guy Lemay

Philip Smith

Wayne Coros

Project Lead

McKesson

GEAC Smart Stream

Oracle

Meditech

PeopleSoft

System

Ottawa Hospital

Shared Healthcare Supply Services (UHN, Sunnybrook & Women’s, Mount Sinai)

Hospital for Sick Children

Healthcare Materials Management Services (HMMS)

Shared Services West (Credit Valley, Halton Healthcare, Trillium and William Osler)

Organization

6 Project Sites represent 46 hospital campuses, purchasing more than $700 million annually for supplies (30% of the total Ontario Healthcare annual spend).

Interfaces to other Hospital Systems

Key Stakeholders

GEAC Meditech McKesson Oracle PeopleSoft

CareNET GHX

Other Service Providers

Ministry of Finance

Ministry of Health

OHA

HealthPro Medbuy

Regional Buying Groups

Suppliers (60 represent 70% of total hospital spend)

6 Project Sites representing 46 hospital campuses

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ElectronicCatalogue(832/Web)

Contract Management/E-Tendering

Punch Outto SupplierCatalogue

Electronic Requisitionin

g

Work Flow and

Approvals

VendorOn-Line Ordering

Point-of-Use Data Capture (Bar Coding)

Clinical Consumption

Ordering

Purchase Order(850/Web)

Order Acknowledgement

(855/Web)

Auto Faxing

Auto PO & Scheduling

P-Cards

AdvancedShip Notice(856/Web)

PackageTracking

SupplyTrackingSerial/Lot Numbers

ReturnedGoods to Suppliers

AutomatedOrder

Processing

Carousels

Bar Coding

VendorOwned

Inventory

ParInventory

Management

FixedAssets

Invoice &Credit Memo

(810/Web)

EFT Payment and

Notification(820/Web)

Travel and Expenses Reporting

3-Way Electronic

Match

Invoice Scanning

Distributed Information

Through Business

Intelligence

Activity Reporting to GPO’s and Suppliers

VendorPortal toHospitalSystems

Traditional Manual Supply Chain Processes

Source Request Procure Receive Inventory Payment Reporting

Automating the Supply Chain Continuum

Automating the Supply ChainAutomating the Supply Chain

E-COMMERCE & CONTRACT MANAGEMENT

Within this priority HMMS will further develop and implement existing e-commerce functionality through CareNET and/or GHX to include: Purchase Order 850, Order Acknowledgement 855, Advanced Ship Notice 856, Electronic Catalogue 832 and Electronic Invoice 810. This priority will also include the further development and implementation of existing Contract Management and Auto Purchase Order functionality.

ELECTRONIC FUNDS TRANSFER (EFT) & DOCUMENT IMAGING

Within this priority HMMS will develop and implement a system to reimburse its suppliers and staff (non-payroll expenses) through the use of electronic funds transfer and implement a system to electronically store and retrieve invoice documents.

Project Site Priorities - HMMS

WEB REQUISITIONING & POINT OF USE ORDERING

Within this priority HMMS will implement web based requisitioning system and point-of-use requisitioning using vendor bar codes.

REPORTING THROUGH BUSINESS INTELLIGENCE

Within this priority HMMS will develop and implement a system to distribute customized reports to hospital end users through a web portal and design reports through business intelligence to help better manage HMMS business activities such as: purchasing, accounts payable and inventory management.

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CLEAN SURGICAL WAREHOUSE

Within this priority, HMMS will establish a clean warehouse located at 184 Stronach Cr. with the goal of increasing the number of stocked items for departments such as the Operating Room, Critical Care etc.

ORDER PROCESSSING USING VENDOR BAR CODESWithin this priority HMMS will develop and implement a system to fully automate the order picking process through the use of vendor bar codes, hand held scanners and a wireless warehouse.

PACKAGE TRACKING

Within this priority HMMS will fully implement the existing Order Package Tracking system at all London hospital sites, using bar coded labels, hand held scanners and a wireless warehouse. Hospital end users will have the ability to track the delivery status of their own orders through a web portal.

Project Site Priorities - HMMS

$1,432,200$863,500$568,700Total Funding$130,200$78,500$51,700Contingency

$87,000$65,000$22,000Chatham & TVHPP (Payformance)

$55,000$55,000Package Tracking

$300,000$195,000$105,000Systems Analyst Implementation

Warehouse Automation

$265,000$175,000$90,000Project LeadSurgical Warehouse

$293,000$180,000$113,000Report Analyst/DBA

Reporting$75,000$15,000$60,000TrainerRequisitioning

$167,000$100,000$67,000Systems Analyst Implementation

Document Management

$60,000$60,000ClericalE-Commerce & Contract Management

Total $Other $Staffing $PositionPriority

Funding - HMMS

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Lessons Learned

What is needed for success:A shared visionCommunication and negotiation skills Incentives to bring and keep people engagedResources to support the change process and its implementationAction plan to ensure effective implementation and change management

Integration What’s Next

Bridging hospital and community servicesGreater clinical integrationCommon infrastructure and support servicesRegionalization with a shared governance and management model