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From Innovation to TransformationMoving up the Curve in Ontario Healthcare |
Steps towards revolutionizing health management in Ontario.
This book provides an overview of the Health Transformation Learning Partnership (HTLP) project. This innovative project involves the transformation of three healthcare organizations in Ontario - North York General Hospital, York Central Hospital, and the South East Community Care Access Centre - using a combination of organizational transformation techniques.
The techniques include the development of balanced organizational scorecards, balanced governance scorecards, strategy maps, accountability agreements and process improvements, to improve quality and safety within the organizations, and to enhance the organizations' ability to respond to changes in their environment. The project also involves the innovative use of story-telling to enhance results. The results of these approaches have been tracked and documented, and the lessons learned are harnessed and shared in this book.
The techniques include the development of balanced organizational scorecards, balanced governance scorecards, strategy maps, accountability agreements and process improvements, to improve quality and safety within the organizations, and to enhance the organizations' ability to respond to changes in their environment. The project also involves the innovative use of story-telling to enhance results. The results of these approaches have been tracked and documented, and the lessons learned are harnessed and shared in this book.
Details
Part of the Queen's Policy Studies Series (number 158 in series)
200 Pages, 6 x 9
Institute of Public Administration of Canada
ISBN 9781553393153
December 2011
Formats: Paperback
The Honourable Elinor Caplan is the chief executive officer of Canada Strategies Inc.
Tom Bigda-Peton is an expert on the art and science of storytelling/dynamic evaluation and qualitative analysis.
Maia MacNiven is president of MC MacNiven Consulting.
Sandy Sheahan is current chair and founder of Bethel House, a not-for-profit outreach project in downtown Kingston that provides safe, transitional housing for men recovering from addictions.
Tom Bigda-Peton is an expert on the art and science of storytelling/dynamic evaluation and qualitative analysis.
Maia MacNiven is president of MC MacNiven Consulting.
Sandy Sheahan is current chair and founder of Bethel House, a not-for-profit outreach project in downtown Kingston that provides safe, transitional housing for men recovering from addictions.
Table of Contents
List of Figures, Tables, Text Boxes, Chapter Attachments
and Annexes........................................................................................... ix
Foreword, G. Ross Baker, Ph.D............................................................. xiii
About the Health Transformation Learning Partnership
(HTLP) Project..................................................................................... xvii
Acknowledgements.............................................................................. xix
Chapter 1. Introduction: A New Model of Care:
A New Wave of Innovation.....................................................................1
Moving to Second Curve Healthcare - A New Management
Paradigm Emerges..............................................................................2
An Innovation Journey.........................................................................4
The Four-Legged Stool - Depicting the Second Curve Model
of Care...............................................................................................7
The Project Partners.............................................................................8
The South East Community Care Access Centre (SE CCAC)..............8
North York General Hospital (NYGH)..............................................9
York Central Hospital (YCH)........................................................... 11
A New Environment.......................................................................... 13
Key Learnings.................................................................................... 14
Chapter 2. The Health Transformation Learning Partnership:
Practical Methodologies for Moving to Second Curve
Healthcare............................................................................................ 17
The Problem and the Opportunity..................................................... 17
The Goals of This Project................................................................... 18
Transformational Work....................................................................... 18
Developing a Learning Culture........................................................... 20
Implementing a Strategy Management Infrastructure.......................... 21
The Balanced Organizational Scorecard......................................... 21
The Balanced Governance Scorecard............................................. 23
The Office of Strategy Management (OSM).................................... 23
Performance Agreements............................................................... 23
Applying Process Improvement Methodologies.................................. 24
Story-telling and Story-analysis........................................................... 24
The HTLP Project and the Impact of a Move to Second
Curve Healthcare............................................................................. 25
Bending the Cost Curve..................................................................... 28
In Summary....................................................................................... 29
Chapter 3. Quality and Safety in the Second Curve:
Examples of High Performing Healthcare Systems............................... 39
Emerging from a Crisis in Quality - Maple Leaf Foods........................40
Emerging from a Public Health Crisis - Canadian Blood
Services (CBS).................................................................................. 41
Learning from Other Healthcare Systems - Jönköping
County Council, Sweden.................................................................. 43
NAVCAN - Safety and Quality in the Air...........................................46
In Summary....................................................................................... 47
Chapter 4. The HTLP and the Excellent Care for All Act....................... 51
The New Quality Act in Ontario........................................................ 51
HTLP and the New Vision of Quality Care in Ontario........................ 52
Details of the Act............................................................................... 52
Annual Quality Improvement Plans (QIPs)...................................... 52
Patient/Client, Caregiver Experience, Employees and
Provider Experience..................................................................... 53
Ensure Executive Compensation is Linked to
Achievement of Performance Improvement Targets...................... 53
Critical Incident Reporting.............................................................54
Implementing Systemic Change..........................................................54
Defining and Measuring Quality........................................................ 55
The Need for Systemic Indicators....................................................... 57
In Summary....................................................................................... 58
Chapter 5. Thinking Differently: How to Build Capacity
within Your Organization..................................................................... 63
The Learning Journey: Building Capacity............................................64
Personal Mastery............................................................................... 65
Team Learning...................................................................................68
Dialogue........................................................................................68
Team Rituals.................................................................................. 69
Team Development Stages............................................................. 70
Mental Models.................................................................................. 71
Adaptive Leadership...................................................................... 71
Ladder of Inference........................................................................ 73
The Wheel Model.......................................................................... 74
The Tower of Power....................................................................... 75
Building Vision.................................................................................. 77
Systems Thinking............................................................................... 78
The Capacity Building Journey at the SE CCAC..................................80
The Capacity Building Journey at NYGH............................................ 82
The Capacity Building Journey at YCH............................................... 83
Key Learnings....................................................................................84
Chapter 6. Managing Differently: Strategy Management
Systems and Scorecards........................................................................ 87
The Strategy Management System...................................................... 87
Executing Strategy - A Difficult Move................................................88
The Strategy Map............................................................................... 89
Developing a Strategy Management System....................................... 92
Stage 1: Develop the Strategy......................................................... 92
Stage 2: Plan the Strategy............................................................... 93
Stage 3: Align the Organization to the Strategy............................... 93
Stage 4: Plan the Operations.......................................................... 93
Stage 5: Monitor and Learn............................................................94
Stage 6: Test and Adapt the Strategy...............................................94
The Office of Strategy Management (OSM)........................................94
Leadership is Key, Strategy Refresh at NYGH -
NYGH Case Study........................................................................... 95
Strategy Development during Transition - South East
Community Care Access Centre Case Study................................... 101
The Office of Strategy Management and Project
Management.................................................................................. 102
Learning Strategy Execution - YCH Case Study................................ 105
Leadership Takes Ownership for Strategy..................................... 108
Narrowing the Focus.................................................................... 108
Gearing Up for an Operational Review........................................ 110
Moving to Execution.................................................................... 112
The OSM at YCH..........................................................................113
Process Improvement Methodologies, Accountability
Agreements and Execution..............................................................113
Use of Process Improvement Methodologies - Going Lean...............116
In Summary..................................................................................... 120
Chapter 7. Can Boards Make a Difference?........................................ 129
The Role of Governance.................................................................. 129
The ECFAA and the Changing Role of the Board.............................. 129
Boards Do Have an Impact on Quality............................................ 130
Directors Need to Have the Right Skill Sets and Training.................. 131
Governance Renewal at NYGH........................................................ 133
Where did the Board Begin?............................................................ 134
The HTLP Project and its Impact on Quality and Safety at
the Governance Level.................................................................... 141
In Summary..................................................................................... 141
Chapter 8. Story-telling and Story-analysis to Inform
the HTLP Journey................................................................................ 143
Story-telling and the HTLP Project.................................................... 143
The Importance of Stories................................................................ 143
How Stories Assist the Decision-making processes within
Organizations................................................................................ 144
The Link between Story-telling and Analysis..................................... 144
Bedside to Boardroom Story-based Learning at NYGH..................... 145
Formal Incident Review at the Staff Level......................................... 147
Taking It to the Frontline at the SE CCAC.......................................... 148
The Swamp.................................................................................. 149
What’s Up/Why So?..................................................................... 150
What’s Possible?.......................................................................... 150
Let’s Go!...................................................................................... 151
Story-telling and Physician Accountability Agreements
at YCH........................................................................................... 152
Round One.................................................................................. 153
Round Two.................................................................................. 154
Round Three................................................................................ 156
Final Story-telling Session to Review Physician
Accountability Agreements........................................................ 157
In Summary..................................................................................... 158
Chapter 9. Project Summary - Moving Up the Curve:
The HTLP Project and Measuring its Impact....................................... 161
The Partners Comment on the HTLP Project.................................... 161
Project Wrap-Up............................................................................. 161
Key Themes/Key Learnings from the Project..................................... 162
A Strategy Management System Helps Organizations to
Respond Better to Change.......................................................... 163
Proven Transformation Methodologies Can Sustain Change.......... 163
Focus is Key to Success............................................................... 163
Organizations Need to Build the Foundation for Strategy
Execution to Work..................................................................... 164
Systems Thinking is a Key to Executing Strategy............................ 164
Anticipating the Future - Implementing the ECFAA....................... 164
Champions are Needed............................................................... 165
Organizations Should Focus on Quality and Safety...................... 165
Measurement Can Promote Success............................................. 165
Innovative Uses of Story-telling Can Highlight Learnings............... 165
Evaluating the Results of the Project................................................. 166
Capacity Building......................................................................... 166
The Patient/Staff Experience............................................................. 171
Going Forward................................................................................ 172
The HTLP Contribution to System Transformation............................ 173
The Authors......................................................................................... 175
Index................................................................................................... 177
List of Figures, Tables, Text Boxes, Chapter Attachments
and Annexes........................................................................................... ix
Foreword, G. Ross Baker, Ph.D............................................................. xiii
About the Health Transformation Learning Partnership
(HTLP) Project..................................................................................... xvii
Acknowledgements.............................................................................. xix
Chapter 1. Introduction: A New Model of Care:
A New Wave of Innovation.....................................................................1
Moving to Second Curve Healthcare - A New Management
Paradigm Emerges..............................................................................2
An Innovation Journey.........................................................................4
The Four-Legged Stool - Depicting the Second Curve Model
of Care...............................................................................................7
The Project Partners.............................................................................8
The South East Community Care Access Centre (SE CCAC)..............8
North York General Hospital (NYGH)..............................................9
York Central Hospital (YCH)........................................................... 11
A New Environment.......................................................................... 13
Key Learnings.................................................................................... 14
Chapter 2. The Health Transformation Learning Partnership:
Practical Methodologies for Moving to Second Curve
Healthcare............................................................................................ 17
The Problem and the Opportunity..................................................... 17
The Goals of This Project................................................................... 18
Transformational Work....................................................................... 18
Developing a Learning Culture........................................................... 20
Implementing a Strategy Management Infrastructure.......................... 21
The Balanced Organizational Scorecard......................................... 21
The Balanced Governance Scorecard............................................. 23
The Office of Strategy Management (OSM).................................... 23
Performance Agreements............................................................... 23
Applying Process Improvement Methodologies.................................. 24
Story-telling and Story-analysis........................................................... 24
The HTLP Project and the Impact of a Move to Second
Curve Healthcare............................................................................. 25
Bending the Cost Curve..................................................................... 28
In Summary....................................................................................... 29
Chapter 3. Quality and Safety in the Second Curve:
Examples of High Performing Healthcare Systems............................... 39
Emerging from a Crisis in Quality - Maple Leaf Foods........................40
Emerging from a Public Health Crisis - Canadian Blood
Services (CBS).................................................................................. 41
Learning from Other Healthcare Systems - Jönköping
County Council, Sweden.................................................................. 43
NAVCAN - Safety and Quality in the Air...........................................46
In Summary....................................................................................... 47
Chapter 4. The HTLP and the Excellent Care for All Act....................... 51
The New Quality Act in Ontario........................................................ 51
HTLP and the New Vision of Quality Care in Ontario........................ 52
Details of the Act............................................................................... 52
Annual Quality Improvement Plans (QIPs)...................................... 52
Patient/Client, Caregiver Experience, Employees and
Provider Experience..................................................................... 53
Ensure Executive Compensation is Linked to
Achievement of Performance Improvement Targets...................... 53
Critical Incident Reporting.............................................................54
Implementing Systemic Change..........................................................54
Defining and Measuring Quality........................................................ 55
The Need for Systemic Indicators....................................................... 57
In Summary....................................................................................... 58
Chapter 5. Thinking Differently: How to Build Capacity
within Your Organization..................................................................... 63
The Learning Journey: Building Capacity............................................64
Personal Mastery............................................................................... 65
Team Learning...................................................................................68
Dialogue........................................................................................68
Team Rituals.................................................................................. 69
Team Development Stages............................................................. 70
Mental Models.................................................................................. 71
Adaptive Leadership...................................................................... 71
Ladder of Inference........................................................................ 73
The Wheel Model.......................................................................... 74
The Tower of Power....................................................................... 75
Building Vision.................................................................................. 77
Systems Thinking............................................................................... 78
The Capacity Building Journey at the SE CCAC..................................80
The Capacity Building Journey at NYGH............................................ 82
The Capacity Building Journey at YCH............................................... 83
Key Learnings....................................................................................84
Chapter 6. Managing Differently: Strategy Management
Systems and Scorecards........................................................................ 87
The Strategy Management System...................................................... 87
Executing Strategy - A Difficult Move................................................88
The Strategy Map............................................................................... 89
Developing a Strategy Management System....................................... 92
Stage 1: Develop the Strategy......................................................... 92
Stage 2: Plan the Strategy............................................................... 93
Stage 3: Align the Organization to the Strategy............................... 93
Stage 4: Plan the Operations.......................................................... 93
Stage 5: Monitor and Learn............................................................94
Stage 6: Test and Adapt the Strategy...............................................94
The Office of Strategy Management (OSM)........................................94
Leadership is Key, Strategy Refresh at NYGH -
NYGH Case Study........................................................................... 95
Strategy Development during Transition - South East
Community Care Access Centre Case Study................................... 101
The Office of Strategy Management and Project
Management.................................................................................. 102
Learning Strategy Execution - YCH Case Study................................ 105
Leadership Takes Ownership for Strategy..................................... 108
Narrowing the Focus.................................................................... 108
Gearing Up for an Operational Review........................................ 110
Moving to Execution.................................................................... 112
The OSM at YCH..........................................................................113
Process Improvement Methodologies, Accountability
Agreements and Execution..............................................................113
Use of Process Improvement Methodologies - Going Lean...............116
In Summary..................................................................................... 120
Chapter 7. Can Boards Make a Difference?........................................ 129
The Role of Governance.................................................................. 129
The ECFAA and the Changing Role of the Board.............................. 129
Boards Do Have an Impact on Quality............................................ 130
Directors Need to Have the Right Skill Sets and Training.................. 131
Governance Renewal at NYGH........................................................ 133
Where did the Board Begin?............................................................ 134
The HTLP Project and its Impact on Quality and Safety at
the Governance Level.................................................................... 141
In Summary..................................................................................... 141
Chapter 8. Story-telling and Story-analysis to Inform
the HTLP Journey................................................................................ 143
Story-telling and the HTLP Project.................................................... 143
The Importance of Stories................................................................ 143
How Stories Assist the Decision-making processes within
Organizations................................................................................ 144
The Link between Story-telling and Analysis..................................... 144
Bedside to Boardroom Story-based Learning at NYGH..................... 145
Formal Incident Review at the Staff Level......................................... 147
Taking It to the Frontline at the SE CCAC.......................................... 148
The Swamp.................................................................................. 149
What’s Up/Why So?..................................................................... 150
What’s Possible?.......................................................................... 150
Let’s Go!...................................................................................... 151
Story-telling and Physician Accountability Agreements
at YCH........................................................................................... 152
Round One.................................................................................. 153
Round Two.................................................................................. 154
Round Three................................................................................ 156
Final Story-telling Session to Review Physician
Accountability Agreements........................................................ 157
In Summary..................................................................................... 158
Chapter 9. Project Summary - Moving Up the Curve:
The HTLP Project and Measuring its Impact....................................... 161
The Partners Comment on the HTLP Project.................................... 161
Project Wrap-Up............................................................................. 161
Key Themes/Key Learnings from the Project..................................... 162
A Strategy Management System Helps Organizations to
Respond Better to Change.......................................................... 163
Proven Transformation Methodologies Can Sustain Change.......... 163
Focus is Key to Success............................................................... 163
Organizations Need to Build the Foundation for Strategy
Execution to Work..................................................................... 164
Systems Thinking is a Key to Executing Strategy............................ 164
Anticipating the Future - Implementing the ECFAA....................... 164
Champions are Needed............................................................... 165
Organizations Should Focus on Quality and Safety...................... 165
Measurement Can Promote Success............................................. 165
Innovative Uses of Story-telling Can Highlight Learnings............... 165
Evaluating the Results of the Project................................................. 166
Capacity Building......................................................................... 166
The Patient/Staff Experience............................................................. 171
Going Forward................................................................................ 172
The HTLP Contribution to System Transformation............................ 173
The Authors......................................................................................... 175
Index................................................................................................... 177
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