Regional Health AuthorityCentral Manitoba Inc.

“Scheduling” ChangeAn O.R. System Transformation

eHealth Conference 2012

Outline:

1. Preamble – Shelley Barnes

2. 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

3. EHR Services – Shelley Barnes:• Project Methodologies

Surgical Sites:

1. Altona Health Centre2. Boundary Trails Health

Centre3. Carman Memorial

Hospital4. 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

• 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

Benefits:

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

Thank you!

In Closing……..

Questions

Contact Information:Southern Regional Health Authority

Eileen VoddenRegional Program Director – AcuteTel: 204 428 2769 Fax: 204 428 2774Email: evodden@rha-central.mb.ca

Shelley Barnes, CHIM, PRINCE2™ PractitionerProsci ™ Change Management CertifiedRegional Director Electronic Health Records

Tel: 204 428 2723 Fax: 204 428 2774Email: sbarnes@rha-central.mb.ca