2009 - Strategic Performance Management Implementation - Oncology Example

1. Steering us Toward Excellence
Peel Regional Cancer Centre
35 39 42
May Current Goal
% IMRT
June 2009
Michelle Goulbourne
June 2009

2. Outline
• Outline the drivers of change
• Discuss how planning reduces uncertainty and
will help us achieve our goals
• Describe the rationale for program-wide strategic
planning and performance measurement
• Describe the current oncology program strategic
plan and scorecard
• Describe the performance management vision
• Outline next steps for the committee as we
prepare for 2009-2010
Michelle Goulbourne June 2009

3. Oncology Program Steering Committee
Terms of Reference
Purpose: To oversee and monitor the Cancer Centre performance, planning and
service delivery to ensure our patients and families have access to high quality,
integrated evidence-based cancer care across the continuum.
Objectives:
1. To establish and review the Oncology Programme’s strategic goals and
performance.
2. To monitor progress towards our strategic goals and performance (clinical and
business) as they reside within each of the five dimensions of the Oncology
Programme’s Strategic Plan: Patient Experience and Satisfaction, Utilization and
Clinical Outcomes, Financial, Worklife and System, Integration and Change.
3. Provide direction for important action items and issues as they pertain to
achieving strategic goals and performance within each of the five dimensions.
4. Develop a communication strategy to share our progress and performance
across all oncology programme stakeholders.

4. Current Context
Our concerns?
1. Increase in health care costs vs current and future demand.
2. Patients are living longer.
3. Variations in outcomes reflect spatial and sociocultural
factors.
4. Access issues such as wait times and variation in utilization
rates remain.
5. Aging of baby boomers and concerns about the burden of
care weigh heavily on all stakeholders.
6. Patient evaluations of care.
7. Data quality issues hindering efficient management.
8. Limited systematic technology integration within and across
the region.
Michelle Goulbourne June 2009

5. The Future
Certainty?
The only certainty is
that nothing is certain.
Pliny the Elder

6. Planning for Excellence
• Face uncertainty squarely and preparedly.
• Harness the best possible management tools.
• Develop collaborative and long-term
knowledge building relationships between the
oncology program and other programs, health
care stakeholders, government and
academia.
• Create principled strategies for dealing with
competing healthcare priorities that include
decisions about health care operations and
clinical practice.
• Maintain the focus on quality, safety and
value.
Michelle Goulbourne June 2009

7. What is Quality?
Quality: Meeting or exceeding our customer’s requirements
in a cost effective way, the first time and every time.
Quality Gap: The difference between where you are and
where you want to be in order to meet or exceed your
customer’s requirements. When quality gaps exists time is
spent searching, checking, re-doing and/or waiting.
Domains where quality is created?
1. Customers: Patients and families
2. People: Clinical and administrative staff, physicians,
volunteers, donors, community partners & stakeholders
3. Processes: Clinical and business operations
The quality sphere…we’re all in this together!
Michelle Goulbourne June 2009

8. Enhancing Quality and Value
We are all in this together!
Economic The Quality Sphere Socio-cultural
Community
Ambulatory Hospitals Support
Inpatient Services Long-Term
Care
Patients and Mental Staff
Current
Families Health
Community
Addictions Care Access
Future Previous Children’s Centres
Treatment
Donors Centres
Community Community
Suppliers
Partners
Government Service Providers
Environmental
Political
Michelle Goulbourne June 2009

9. What is value?
• The quest to provide value in service is one that
ensures that patients receive the best possible care
in the most cost effective manner.
• “…should occur in the prevention, diagnosis, and
treatment of individual health conditions. It is at this
level that true value is created – or destroyed –
disease by disease and patient by patient. It is here
where huge differences in cost and quality persist.”
Porter and Olmsted Teisberg 2004
Michelle Goulbourne June 2009

10. Getting there Involves Focus on Our Processes
Provider System Processes
• Timely access to the right treatment
• Accurate patient assessment, treatment and follow-up
Patient Level Processes
• Patient and family satisfaction and quality of experience along
the trajectory of care to end of life
Medical Care Process Factors
• Guideline based clinical care paths at point of care
• Standardization of patient care
Organizational Processes
• Resource utilization, efficiency and cost effectiveness
• Managed costs
Technological Processes
• Accurate data for clinical and business decision making
• Integrated clinical system supporting the trajectory of care
Michelle Goulbourne June 2009

11. Performance Management Framework
Linking Strategy, Performance Measurement for Excellence
Policies Tools Structure Levels of
Operation
1. CVH / CCO
CVH and CCO Strategic Balanced Score Innovation for
Goals and Priorities Card Sustainability 2. PRCC
- Systemic
Formalized policy Performance Creation of programs,
framework that measurement and operational - Radiation
informs: system that consists processes that
- Palliative
1. evidence based of health care and enhance our ability to
planning and quality indicators achieve our goals and - Surgical
2. accountability whose measures may sustain them over
processes. be tracked and space and time.
compared over time.
*Revised Strategy Diagram – Original in Veillard, J., Ardal, S. and Gilbart, E. 2006.
Michelle Goulbourne June 2009

12. Oncology Program Plan 2009-2010
1. Strengthen accountability in care across the
trajectory.
2. Actively manage program performance.
3. Target better clinical and operational processes
and outcomes for the program and its
stakeholders.
Towards this end a strategy map and performance
management framework have been established with
agreed upon performance indicators associated with
each dimension.
Michelle Goulbourne June 2009

13. Value Domains and Performance Dimensions
In summary the domains or people, operations and
locations where value resides are:
These are grouped into dimensions – those perspectives
we need to consider as we plan for achieving our goals.
1. Patient Experience and Satisfaction
2. Utilization and Clinical Outcomes
3. Financial
4. Worklife
5. System Integration and Change Michelle Goulbourne June 2009

14. Need a Strategy
“Strategy fundamentally reflects a statement about what
you are doing and what you hope to achieve.”
Veillard, J., Ardal, S. and Gilbart, E. 2006.

15. Strategy Map and Goals
Strategic Direction Performance Goals
Michelle Goulbourne June 2009

16. Need Performance Measurement
You can’t manage processes and outcomes for
improvement if you don’t measure them.

17. PRCC Measurement Framework
Michelle Goulbourne – Template - December 2008

18. Performance Measurement Framework
PRCC key performance indicators (KPIs)
Strategic goals are linked to performance are linked to the corporate KPIs in the
management framework indicators BSC
Michelle Goulbourne June 2009

19. Cascading PM Frameworks
Hospital
Corporate Strategic Goals and Indicators
Oncology Progr am
Str ategic Goals and Indicator s
Medical Oncology Radiation Oncology Surgical Oncology Palliative Care Goals
Goals and Indicators Goals and Indicators Goals and Indicators and Indicators
Michelle Goulbourne June 2009

20. Contact
Michelle Goulbourne
Sr. Consultant
Diamind Health
mgoulbourne@diamindhealth.com