Carrie Mazoff, MBA, PMP & Marie-Claire Richer, N. PhD McGill University Health Center PMO15BR16

Transcription

1 Carrie Mazoff, MBA, PMP & Marie-Claire Richer, N. PhD McGill University Health Center PMO15BR16

2 Learning Objectives Discuss/analyze the roles of different players within the organization, and the sustainability of the improvement of practices and organizational changes. Present/discuss the key success factors and challenges faced, enabling participants to transpose their learning into their respective organizations. Explain the efforts and methodology used to quantify the added value of the PMO s contribution to the organizational transformation, citing specific examples. 2

3 Outline Overview: MUHC and the Project The Creation and Mandate of the TSO 2 Project Examples The PMO Journey Measuring the PMO s Contribution 3

4 My Story Always a believer in Charters Obtained PMP in 2009 Attended PMI Symposium in

5 MUHC at a Glance Created in 1997, the first voluntary merger of this magnitude in Canada Montréal General Hospital Royal Victoria Hospital Montréal Children s Hospital Montréal Chest Institute Lachine Hospital Montréal Neurological Institute Founded The Children s The General Lachine Royal Victoria The Chest The Neuro 5

6 MUHC at a Glance Part of McGill Health Services Network ( RUIS ): Covers a territory of 953,000 m 2, population of 1.7 million Operational Budget: $800M; Over 13,000 staff Admissions (Acute care) 40,000 Avg. Length of Stay 8.2 days Surgeries 35,000 Ambulatory Care Visits 717,000 ED Visits 173,000 Research Institute: 600+ researchers, $131M in research grants, over 1,800 peer reviewed publications/year 6

7 The Redevelopment Project Glen Site Statistics: Part of the $2.1B overall redevelopment One of the largest hospital PPPs in Canada 500 beds (346 adult, 154 pediatric) 100% single patient rooms 20 operating rooms Almost 300,000 ambulatory visits per year First hospital in Quebec to regroup adult and pediatric specialties under one roof $255 million in new cutting-edge equipment 7

8 The Redevelopment Project 8

9 The Redevelopment Project Beam me up, Scotty! 9

10 One Baby at a Time 10

11 Producing health does not only require that we do the right thing, but that we also do things right! Evans et al, (2010)

12 What Did the Literature Tell Us? Need to integrate the human side of transition to the potential for transformation (Bridges, 2003; Senge, 1994; Poole & Van de Ven, 2000) Pay attention to the human in the context, content and process of change (Pettigrew, 1987; Pettigrew & Whip, 1991;1993) The notion of Transformation is also linked to performance improvement and project management methodologies that help to reach pre-established objectives (Aubry et al, 2011; Biron et al, 2012; Lavoie-Tremblay et al, 2012; Schilling et al, 2010) 12

13 The Transition Support Office (TSO) An innovative idea proposed by MUHC leadership Based on lessons learned (Paris, Washington) Funded by the Ministry of Health as advances on future efficiency gains Activities started in 2008 finishing in 2015 Approximately 90 projects, staffing peak of 30 people Academic mission: students, research projects, publications 13

14 The Transition Support Office Mission To provide support at all levels of the organization To help in the overall coordination of different initiatives/projects linked to organizational transition Values Quality and safety of patient care The redevelopment project is an extraordinary opportunity to innovate in healthcare design and delivery People make it all possible: we aim to develop an effective and sustainable system based on individual strengths and human capital 14

15 Our Axes of Intervention Axis 1: Harmonization of Clinical and Administrative Practices (EIDM) Axis 2: Team Consolidation (Using change management approaches such as Appreciative Inquiry) Axis 3: Optimization of Processes (Using methodologies such as LEAN) All done in a PROJECT structure 15

16 Selecting & Monitoring Projects In line with Strategic Objectives - Depending on the level of engagement of clinicians and decision-makers Based on Planned Hours Estimate based on project phases: planning, development, implementation, and consolidation Estimate based on the type of project (team consolidation, harmonization of practices, optimization of processes) Based on Objectives and Attainment of Expected Results Evaluation plan for each project, developed in partnership with the Quality & Safety department Calculation of value-added for each project (value for patients, the MUHC, and society) 16

17 Project Examples 17

18 1.1) Clinical Practice Project CLABSI Project (Central Line Associated Blood Stream Infections) Need to harmonize practices across sites Bacteremia associated with central lines is avoidable MUHC had the highest level of bacteremias in Canada (200+ per year) Increased LOS 16% mortality (INSPQ 2010) $20,000 per infection 30% in the ICU Significant difference between actual practice and best practice 18

19 1.2) Clinical Practice Project The Harmonization of Central Line Practices Be Line Wise Project Aim Harmonize practices across sites Eliminate central line associated blood stream infections (CLABSI) as well as other complications such as line occlusions across the MUHC Project Objectives Create a culture of safety around central line use Implement best practices and optimize practice (central line insertion and maintenance bundle) Implement a comprehensive central line surveillance process and data management system Put in place strategies to ensure sustainability 19

20 1.3) Clinical Practice Project Measuring Progress: Collaboration with Quality and Performance to ensure data measurement throughout Objectives: Harmonize practices across 6 sites Eliminate CLABSIs within 2 years of project start Decrease the number of occlusions for all types of central lines Educate clinicians in central venous access device (CVAD) care and maintenance, and measure knowledge acquisition Ensure clinician compliance for insertion and maintenance bundles Decrease number of re-insertions Indicators: % Clinical units harmonized CLABSI rate (number of CLABSIs per 1000 catheter days) and (time to event) Occlusion rates (%) % of targeted staff educated and pre/post knowledge tests results Insertion and maintenance bundle compliance (%) Reinsertion rates (%), by central line type 20

21 1.4) Clinical Practice Project Communication & Internal Benchmarking Show results! Audits and feedback Promotional items Internal communication Annual reports

22 MGH Surgery: 730 days MGH Medicine: 364 days Cardiac Unit: 580 days 22

23 1.5) Clinical Practice Project Data: A Lever for Success Decrease in Re-insertions 24% to 11% Savings of time and money Single lumen = $10 less/day Change of product saves time Reduced Risks of: Infection Occlusion Facilitates home care 23

24 1.6) Clinical Practice Project Results: Total # of Bacteremias per Year (adult inpatients) Change in definition 143 Start of Project

25 2.1) Team Consolidation Project Project: Consolidation of tertiary Cardiac services at the RVH (ultimately going to the Glen site) Services Included: Cardiology, Cath Lab, Cardiac Surgery, Vascular Surgery Implications for Cath Lab: Transfer of all cases from MGH to RVH (spring 2007), representing a significant increase in volume (+60%) Congenital cases (from MGH) added to complexity New procedure room built at RVH (higher tech.) Consolidation of care team (which was short-staffed) 25

26 2.2) Team Consolidation Project Specific Interventions: Appreciative Inquiry Staff morale issues Bringing 2 teams together Process Mapping Patient Flow (throughput, etc.) Roles and Responsibilities (task analysis) Other Links with: Inpatient unit (scheduled cases) Pre-Hospital Services (dedicated ambulance) 26

27 2.3) Team Consolidation Project 27

28 2.4) Team Consolidation Project Results: Intervention Changes Indicators Appreciative Inquiry - Common vision and action plan established - Increased staff satisfaction (descriptive data) Task Analysis Patient Flow Maps Dedicated Ambulance - Constructive discussion re: roles/ responsibilities - Creation of Assistant NM position - Clarification of PAB role, changed to PFT - Elimination of certain bottlenecks - Harmonization of practices - Positive and sustained culture change among staff re: system efficiencies - Decreased overload in pre//post area - Improved transport service for patients - Decreased turnover rate (from 42% in to 0% in ) - Increased productivity by 5% - Decreased time in pre-procedure by 40%; decreased time in postprocedure by 60% - Decreased nursing overtime by 18% ($10K/year) - Increased quality (based on improved referral volume) 28

29 GPO : Additional Mandate Role of the PMO in budget crisis (2012) Medical Imaging Operating Room Nursing Staff Mix Ambulatory Care 29

30 The Journey 30

31 An Eight-Year Marathon : Ramping Up : Steady Plateau : Final Sprint : Cool Down

32 Staffing Up, then Down 30 Budget Crisis Permanent 10 N=

33 Early Days: Identity Crisis Changing our name to include Support Project Manager = Construction PM? Transition = Transition Care? 33

34 Along the PMO Continuum Dilawar Abbas, General Manager at Creative Chaos 34

35 However beautiful the strategy, you should occasionally look at the results. -- Winston Churchill

36 Measuring Success How do we know we achieved our goals?

37 Quantifying Value Added ROI Value Added Cost Avoidance Cost Savings 37

38 Knowledge Development & Transfer Students: over 35 students over 4 years 1 Post-doc, 4 PhD, 12 Masters, 20 Bachelors: nursing, health administration, management, engineering, finance; from many different universities Major Research Projects: Project Management and Trans-professional Collaboration Training: Its Impact During Organizational Transitions, U of Ottawa: Chiocchio, Richer, Lefebvre, Brodeur The contribution of PMOs to change management and organizational performance in the health sector. CIHR Lavoie-Tremblay, Aubry & Richer An innovative strategy in organizational transformation: The creation and implementation of a Transition Office in a university-affiliated multi-site healthcare center - CHSRF Lavoie-Tremblay, Richer & Aubry 38

39 Looking Back: The Challenges Introducing a new way of doing business: project management methodologies, systematic measurement of performance Obtaining dedicated time for staff to learn new skills related to practice change Engaging the physician group to enlist them as champions Reaching a point of saturation of new changes being introduced in the clinical areas Sustaining the desired changes 39

40 Success Factors: The People! Mobilizing around a common goal Mutual respect and trust Collaboration and communication Sharing of expertise (resources), tools, and seeking cross-training opportunities Allowing experimentation, flexibility/adaptation of roles and methods, with consistency in purpose 40

41 What Comes Next? 41

42 Thank You! Name: Carrie Mazoff Web: LinkedIn: ca.linkedin.com/in/carriegmazoff 42