2nd Curve Health Care Organizations

As part of IPAC's "Sustaining Transformation: Building a Resilient Organization" conference that we held on May 31st & June 1st, Dr. Marty Merry spoke about the opportunity to create 2nd curve health care organizations.

His premise is that the complexity of our health care system as outpaced its capacity to deliver safe patient care under the old "craft" model. What is required to move from a 4 sigma (6,210 defects/1 million = avoidable deaths) to a 6 sigma organization (3.4 defects/1 million) is a paradigm shift. Moving to a second curve system that imports the best of management science into the field of health care delivery would move an organization from 4 to 6 sigma. As Dr. Merry noted - what is the rate of preventable deaths that would be acceptable. If we say that we are satisfied with 95% success rate, that means that 50,000 people die from preventable deaths in our system. The only real answer that is acceptable is ZERO!

But how do we get there?

Dr Merry laid out "The Vision: 10 Rules of Performance in a Redesigned/2nd Curve Health Care System" (adapted from the Institute of Medicine, 2003):

1. Care is based on continuous  healing relationships;
2. Care is customized based on patient needs and values;
3. The patient is the source of control;
4. Knowledge is shared and information flows freely;
5. Decision making is evidence based;
6. Safety is a system property;
7. Transparency is necessary;
8. Needs are anticipated;
9. Waste is continuously decreased; and
10. Cooperation among clinicians is a priority.

Dr. Merry spoke about the characteristics of a second curve health care organization that is patient focused.  I could not do justice to his full talk, but have no fear as we will be posting the videos of his talk on teh IPAC website shortly.

Resilience Conference

As I wrote previously, on Monday & Tuesday, we organized a conference entitled “Sustaining Transformation: Building a Resilient Organization” that focused on health care.  We had an amazing array of speakers! The conference was videoed and will be posting the videos on our website in the next short while.

Among our keynote speakers was Saäd Rafi, DM of the Ministry of Health and Long Term Care who spoke to the delegates on the need for resilience and a focus on quality of care. He spoke of the need for health care organizations to act as a real system that is better aligned to quality health outcomes and that the future core business of the sector is a focus on quality care. There are some who equate the amount of funding to the level of quality. Saäd emphasized that more money does not result in better quality. Indeed there is an argument that true quality is less expensive as it focuses on the best practices for the delivery of care based on evidence. Saäd spoke about the Ontario government’s new legislation “Excellent Care for All” that is presently being debated in the Legislature. This legislation focuses on quality and patient outcomes and requires every hospital to develop an annual Quality Plan that includes regular surveys of patients, their families, and staff to gauge the level of quality being delivered.

Saäd also connected what the Ministry is doing to the 4 parts of resilience model- Responds, Monitors, Anticipates and Learns. He emphasized that the learn is the most difficult as it requires behavioral changes in the system as a whole. The delegates appreciated his take on the challenges and opportunities ahead and the need to build truly resilient organizations in order to be successful.

There were a number of other incredible speakers, such as Dr. Marty Merry and Dr. Josh Tepper on 2nd curve health care organizations that I will blog about in a future update.

Innovative Management Award

In 1990, IPAC established "The IPAC Award for Innovative Management" to recognize the exceptional management within the public sector of Canada. Each year a new theme is chosen by the IPAC Board of Directors and our sponsors - IBM Canada and KPMG. In those 20 years we have been privileged to see many extraordinary examples of innovation at its best from right across the full spectrum of the public sector in Canada. On the IPAC website we have a database of all the winners and finalists through all these years.

In many years IPAC receives 100 submissions from across the country. These 100 submissions are whittled down to a group of finalists who are invited to present their innovative management submission to a jury composed of distinguished public servants. The top three finalists are then invited to make presentations at the IPAC Annual Conference and winners are announced.

This years theme is "Collaboration at Work".

Governments in Canada and around the world face complex problems that reach across ministerial mandates, regulatory purview and jurisdictions, and affect citizens and stakeholders in predictable and unintended ways. While resources are increasingly limited, citizens expect governments to work together to tackle "wicked problems."

Collaboration is needed within an entire governmental enterprise or public organization, with other governments, the broader public sector, NGOs and with citizens. Natural disasters or flu epidemics, adapting to and mitigating climate change, dealing with the impacts of a global recession, caring for the most vulnerable members of our society, or helping other countries develop their institutions and public services: one single government entity, acting alone, cannot achieve the results that our citizens expect.

We demand that governments act in concert with actors from business, civil society as well as with citizens, and work effectively with other orders of government to achieve the best outcomes. We require that this cooperative approach be cost effective, swift, innovative and transparent. We also expect public sector values to be respected.

For 2010, the Innovative Management Awards will recognize governmental/public sector organizations that have shown new and innovative ways of cutting across bureaucratic boundaries and silos to address the complex issues facing society.

The deadline to submit your application is June 7, 2010.  Go to the Innovative Management section of the IPAC website to fill in the application form.

Resilience, Reliability and Results

On Monday May 31st, and Tuesday June 1st, IPAC will be holding a conference focusing on health care entitled Sustainable Transformation: Building a Resilient Organization.

As part of IPAC's health care research project we will be releasing a study of five acute-care hospitals in the Waterloo-Wellington region that highlight the stories of these "high performers in the making" and their respective experiences with ED PIP – the Ontario Ministry of Health and Long-Term Care’s “Emergency Department Process Improvement Program.”

This 8 month initiative which ran from March – October 2009 engaged front-line staff from across these organizations in "quality by design" decision-making, planning, piloting and implementing of process improvement changes in Emergency Departments and across Inpatient Units. With Wave 2 just finishing and an additional 17 Ontario Hospital sites added to the roll-out, ED PIP may be one of the most significant transformational efforts to take place in Ontario hospitals in decades. In its early days PIP has clearly demonstrated success by enhancing the quality of the patient experience through improved access to care and flow through the system at the following Wave 1 sites:

• Groves Memorial Hospital, Fergus
• Guelph General Hospital, Guelph
• St. Mary’s General Hospital, Kitchener-Waterloo
• Grand River Hospital, Kitchener-Waterloo
• Cambridge Memorial Hospital, Cambridge

The case studies provide a context for specific process improvement strategies that could be adopted in other hospitals and outline the challenges or barriers that may prevent the adoption of these process improvements. This study considers:

• the significance of a learning culture that builds capacity and resilience in its people;
• the importance of process improvement designs that enhance system effectiveness and efficiencies and increase overall reliability in care delivery and patient outcomes; and
• the value of a management and performance measurement infrastructure that encourages and supports the desired results of the transformation.

With a spirit of persistent crafting and sustaining of robust strategies and improvements in care, these ‘stories’ and ‘lessons learned’ can influence, inspire and dare us to consider what is possible as we continue the journey of healthcare reform in the province of Ontario.

You can access these cases and much more on the IPAC Health Care Leaders Forum page of the IPAC website.

Next week I will be blogging from our Health care conference.  As I've written before on this blog, we must come to grips with the increased demands of our health care system if we are to ensure a longer term fiscally sustainable future and a society that invests in other important areas such as education, the arts and infrastructure.

Patient Safety & Quality Health Care

An interesting new report, published in April 2010, by the European Commission on the perceptions of patient safety and the quality of healthcare. The survey was conducted in 27 members states of the European Union. Nearly half the respondents feel that they could be harmed by healthcare in their country, and the majority of respondents feel hospital infections or incorrect, missed or delayed diagnoses are either fairly likely or very likely to occur.

• The majority of respondents feel hospital infections or incorrect, missed or delayed diagnoses are either fairly likely or very likely to occur when receiving healthcare in their own country.

• Over 25% of respondents claim that they or a member of their family have experienced an adverse event with healthcare. However, these events largely go unreported.

• Where adverse experiences were reported this was mainly to the hospital management or the relevant doctor, nurse or pharmacist.

• Nearly one third of respondents do not know which body is responsible for patient safety in their country. Others see the ministry of health or the healthcare providers (e.g. clinic, hospital, doctor, nurse) as the responsible bodies.

• Of the people who underwent surgery, 17% say written consent was never obtained, though great variance across the Member States is evident.

• Most respondents (73%) say television is their main source of information regarding adverse events in healthcare, followed by newspapers and magazines (44%) and friends or family (31%). Only 9% would seek information in official statistics or in hospital.

• Whether harm occurred in their own country, or another Member State, respondents expect that an investigation into the case or financial compensation would be the forms of redress.

• Should they be harmed in their own country, most respondents anticipate that they would seek help from a lawyer, or else the hospital management or ministry of health. If the harm occurs in another Member State, they claim they would first contact their embassy or consulate.

• When thinking of high quality healthcare, the most important criterion is well trained medical staff, followed by treatment that works. Thereafter, no waiting lists, modern medical equipment and respect of a patient’s dignity receive roughly equal responses.

• Most respondents rate the healthcare in their country as good, though the majority feel it is fairly good rather than very good. However, there is again great variance on a national level (from 97% to 25% of respondents rating quality of healthcare in their country as good).

• Respondents from 16 EU Member States consider the quality of healthcare in their country as worse than in other Member States, whereas respondents from 11 Member States consider it as better.

This is a fascinating report and Canadians should be aware that we have similar issues in this country.

La Gouverneure générale remet la Médaille Vanier

Le 13 mai la gouverneure générale du Canada a présenté la Médaille Vanier au Dr Gordon S. Smith lors d'une cérémonie à Rideau Hall. Ce fut une occasion merveilleuse et l'IAPC est fier que Son Excellence a présidé cette cérémonie importante.

Dr Smith, Wynne Young (la présidente de l'IAPC) et moi sont arrivé à 9:30 où nous avons été accueillis par le merveilleux personnel de Rideau Hall. On nous a montré où la cérémonie aurait lieu et ce que nous avions à faire. Après nous sommes allés à la salon "Mme Vanier" et ont nous a offert café, thé, etc que nous avons attendu que la cérémonie commence a 10h30.

La gouverneure générale a prononcé un discours admirable sur le service public que vous devriez tous lire. Wynne Young a ensuite remercié la GG pour son hospitalité et a présenté le Lauréate de 2009 de la médaille Vanier, Dr Smith. Dr Smith a ensuite reçu sa médaille de la Gouverneure générale et il a parlé pendant quelques minutes sur le service public et sa carrière et sa relation avec Rideau Hall.

Après le chant de «O Canada» nous avons été invités à une réception où la merveilleuse GG nous a rejoint.

Ce fut un événement merveilleux et nous sommes très reconnaissants que la gouverneure général a été en mesure de présider à la cérémonie de cette année.

Pictures from Vanier Reception/Photos de la réception de la Médaille Vanier

Here are a few pictures from the reception at Rideau Hall following the Vanier Medal ceremony.  This picture is of our incoming President, Denise Amyot and the Governor General.

Voici quelques photos de la réception à Rideau Hall, après la cérémonie de la Médaille Vanier. Cette photo est de notre présidente entrante, Denise Amyot et de la Gouverneure générale Michaëlle Jean.

These pictures were taken in the beautiful gardens of Rideau Hall.  Picture below from left to right are: Kaili Levesque, Chair National Capital Regional Group, Denise Amyot, Incoming IPAC President, Nancy Chahwan, IPAC National Secretary, me and Nancy Faraday-Smith, IPAC VP.

Ces photos ont été prises dans les jardins magnifiques de Rideau Hall. Photo ci-dessous, de gauche à droite: Kaili Lévesque, présidente du Groupe régional de la capitale nationale, Denise Amyot, présidente entrante de l'IAPC, Nancy Chahwan, Secrétaire national de l'IAPC, moi et Nancy Faraday-Smith, vice-présidente de l' IAPC.