Performance Measurement: Accelerating Health System Transformation in Saskatchewan?

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Noreen Austin
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1 Performance Measurement: Accelerating Health System Transformation in Saskatchewan? Sharon Bishop PhD Candidate Johnson-Shoyama Graduate School of Public Policy University of Regina, Saskatchewan 1

2 Strategic Plan Brief explanation of role as embedded researcher within the Saskatchewan Ministry of Health s Saskatchewan Surgical Initiative Overview of research question and design Brief summary of findings Demonstrate the extent to which this new approach to strategy deployment is impacting transformation efforts within Saskatchewan

3 Embedded Researcher Surgical Initiative PhD Candidate embedded as a researcher within the SK MoH Surgical Initiative Collaboration: CFHI, Saskatchewan Ministry of Health, and Johnson Shoyama Graduate School of Public Policy, University of Regina Timeline: September 2011-August 2014 Purpose: Systematically examine change processes relating to the Saskatchewan surgical initiative and to explore the major obstacles and enablers for large system transformative change

4 Research Question Question: To what extent is the newly adopted hoshin kanri approach to strategy deployment impacting transformation efforts? Why study hoshin kanri? Hoshin Kanri = Lean term for Strategy Deployment = core element of Saskatchewan s Lean Management System Saskatchewan is the first jurisdiction in Canada to apply Lean methodology across its entire health system SK Health emphasizes the centrality of Lean approaches and initiatives to transforming health care delivery and administration (MoH Plan )

5 Research Design Ethnographic field research- immersed in the daily business Data sources: - Participant observation- field notes - Semi-structured key informant interviews- purposive sample (Mar- Apr, 2013, 10 x 90min- RHA Board Chair & senior execs (4), MoH ADM & ED (2), Physician Leaders (3), HQC (1)) - Document review (public/ private)

6 The Saskatchewan Context Fall MoH and Health system partners adopted a new approach to strategy deployment Hoshin Kanri to develop and deploy a health system strategic plan ( ) contracted Lean consulting services of John Black and Associates Mar 2013 completed 2 nd cycle of strategic planning Goal-Think And Act As One

7 Set Priorities: Clearly Articulate Goals Surgical Initiative is a system breakthrough initiative Target (e.g.): By March 31, 2014, all patients have the option to receive necessary surgery within 3-months

8 Performance Measurement and Monitoring Saskatchewan: All Specialties: Number Waiting by Number of Cases Waiting at Month End Wait Time Colour Key (% change from: 31Mar2009 to 31Mar2013, 31Mar2 All (-30%, -30%) > 3 mth (-53%, -52%) > 6 mth (-65%, -64%) > 12 mth (-79%, -77%) > 18 mth (-93%, -92%) 30,662 28,429 28,686 26,843 26,734 27,667 27,580 24,760 21,227 21,539 18,630 19,263 17,564 16,125 16,262 15,582 15,468 15,341 13,114 12,133 12,133 9,781 10,876 10,640 10,152 9,875 9,020 7,890 6,521 7,271 7,325 5,519 5,140 4,313 4,502 6,144 3,999 3,577 4,428 2,484 3,482 2, ,575 1,859 1, Total: -30% 3 mo: - 52% 6 mo: - 64% 12mo: - 77% 18 mo: -92% 31Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar2013 Month End Dates (Data Source: 19May2013 refresh of the SK Surg

9 Performance Measurement and Monitoring Visibility Walls- at all levels across the province

10 RHA Visibility Walls

11 Summary of Findings Shift toward networked governance Unprecedented levels of engagement- engaging a conversation across the system Enhanced alignment- clear set of system wide goals Narrowed focus- few select priorities- pulling in the same direction

12 Summary of Findings Crucial conversations/ enhanced accountability among system partners I think, over time, as this process matures people are becoming more and more honest and the questions seem to be becoming a little bit more probing. Soft regulation approach- persuasion and collaboration

13 Limitations Single case study Purposive sampling strategy

14 Conclusions S- Building the infrastructure to better lead and govern the Saskatchewan health system W- current data quality and flow of information undermines effective clinical governance O- Network governance- imposing top-down governance not effective T- Soft- truncated accountability mechanisms

15 Thank you! Sharon Bishop PhD Candidate- JSGS Public Policy, University of Regina Embedded Researcher Ministry of Health, Saskatchewan Surgical Initiative

Sooner, Safer, Smarter: Transforming Surgical Care in Saskatchewan. Taming of the Queue Ottawa March 21, 2013

Sooner, Safer, Smarter: Transforming Surgical Care in Saskatchewan Taming of the Queue Ottawa March 21, 2013 About the Saskatchewan Surgical Initiative Four-year timeframe: April 1, 2010 to March 31, 2014