Best practices in leadership and transformation to create healthcare sustainability

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1 Best practices in leadership and transformation to create healthcare sustainability National Health Leadership Conference Halifax, NS, June 4, 2012 Dr. Graham D. Sher, MB BCh, PhD Chief Executive Officer Canadian Blood Services

2 Outline Canadian Blood Services at a glance Transforming the national blood system Leveraging pan-canadian capabilities Creating sustainable health system change Organ and tissue donation and transplantation Bulk purchasing of drugs Conclusions

3 Canadian Blood Services at a glance Service delivery 43 permanent clinics, 3 bloodmobiles Consolidated laboratories and production sites 8 OneMatch field sites 20,000 annual clinic events ~ 1 million collections 1.8 million units shipped 732 hospitals served People 4,700 employees 17,000 volunteers (200,000 hours of service) 418,000 active blood donor (avg. frequency 2.18) 300,000 stem cell donors Funding Funded by P &Ts, based on utilization and population Rolling 3-year business plan with 1 year budget approval >$1 billion annual revenue $20 M contingency fund $1 billion insurance captive

4 Legacy Tainted blood: greatest public health crisis in Canadian history 2,000 HIV infections 30,000 HCV infections C$ 2.7 billion in compensation

5 Legacy Krever Inquiry Federal government determines need for a commission of inquiry Justice Horace Krever, appointed by Order in Council, 1993 To review/report on mandate, organization, management, operations, financing and regulation of all activities of the blood system in Canada

6 Legacy - Krever s recommendations System principles Blood is a public resource Donors should not be paid Free and universal access Safety is paramount Domestic sufficiency National coordination/management Stable, secure funding Openness and transparency Clear accountability No-fault insurance Blood operator Independent arm s length Publicly administered Public involvement National inventory Medical and admin mgmt Audits SOPs Integrated IT systems R&D investment Regulator/Public Health Active, risk-based regulation Hemovigilance Enhanced surveillance and monitoring Frequent, and thorough inspections Mandatory reporting Incentives for TM practitioners

7 Case Study: Leadership and transformation - Blood system transformation

8 Explicit transformation of purpose 8

Transformation journey Phase 1 1998 2002 CRISIS MANAGEMENT Phase 2 2001 2007 STRATEGIC MANAGEMENT Phase 3 2007

on quality excellence Strategy as core competency Stewards of the blood system Model for health care delivery

9 Transformation journey Phase CRISIS MANAGEMENT Phase STRATEGIC MANAGEMENT Phase STRATEGY RENEWAL Restore trust Restore safety Rebuild core operations Stabilize infrastructure Manage crises Focus on quality excellence Strategy as core competency Stewards of the blood system Model for health care delivery Evaluate value of the system Leverage our capabilities Identify new opportunities New mandate no longer only a blood operator

Progress report Safety Supply Service delivery model

Duplicative, inefficient Underinvested, uncertain

edge Sustained, meets needs Integrated, efficient

10 Progress report Safety Supply Service delivery model Cost Satisfaction Trust Lagging Irregular, inadequate Duplicative, inefficient Underinvested, uncertain Poor customer satisfaction Eroded, absent Leading edge Sustained, meets needs Integrated, efficient Efficient, in-line Sustained high scores Restored, but fragile

11 Other major transformation People Comprehensive talent strategy Human capital investment optimization Culture Business excellence, commitment to quality, values-based Agile, responsive and innovative Preparedness Forward looking, broad-based business continuity readiness Local and national emergency response teams World-leading pandemic plan

12 Trust System transformation and walking the talk on safety has regained trust Trust is fragile, and must continuously be earned

13 Leveraging our capabilities Proven expertise and leadership to solve other pan- Canadian healthcare challenges based on reform of blood system Governments see opportunities by leveraging their investment for the benefit of all Canadians No longer viewed as simply a blood provider strategic shift to trusted partner in health care delivery

14 Case Study: Leadership and transformation Organ and Tissue Donation and Transplantation

15 Mandate In April 2008, the F/P/T governments gave Canadian Blood Services a mandate for organ and tissue donation and transplantation: Activities of the former Canadian Council for Donation and Transplantation (CCDT), including leading practices, public awareness and education, system performance metrics and benchmarks Patient Registries: Living Donor Paired Exchange, Urgent Status Patients, Highly Sensitized Patients and other related databases Development of a coordinated strategic plan for Organ and Tissue Donation and Transplantation on behalf of the OTDT community

The Need Despite pockets of excellence, Canada not realizing its full OTDT potential System inefficient, lacks equity, transparency, and sustainable funding Organ donor rates are less than half of

16 The Need Despite pockets of excellence, Canada not realizing its full OTDT potential System inefficient, lacks equity, transparency, and sustainable funding Organ donor rates are less than half of the world s top performing countries (Canada ranks just behind Lithuania) Public supportive of organ and tissue donation, but system is failing them National donation rates have stagnated for a decade Reliance on imports for tissue Provincial service delivery model is shackling the good work of healthcare professionals in the field

Leadership Expertise and Capabilities Purchasing & distribution IT Infastructure Biological manufacturer Marketing & recruitment Engagement &

National, not-for-profit corporation with independent Board of Directors Accountable, transparent, with public participation Subject to Federal

17 Leadership Expertise and Capabilities Purchasing & distribution IT Infastructure Biological manufacturer Marketing & recruitment Engagement & partnerships Canadian Blood Services National Service Delivery Model Donor testing laboratories Quality & regulatory Research infrastructure National, not-for-profit corporation with independent Board of Directors Accountable, transparent, with public participation Subject to Federal regulations (under Food and Drugs Act) P/T Ministers of Health are Members (shareholders) of the corporation Extensive risk management programs embedded

18 System Performance - Organs Canada performs in the lower half of developed countries. Sources: Canada: CORR e-statistics; International: irodat Canada s rate for DCD could improve significantly (currently, only practised in some provinces).

19 System Performance - Organs 30.0 Organ Living Donors PMP 6.0 Organ DCD Donors PMP Canada is among the top performing countries for living donation/transplantation. Sources: Canada: CORR e-statistics; International: irodat Canada s rate for DCD could improve significantly (currently, only practised in some provinces).

20 Months System Performance Organs Median Wait Time - Kidneys 0 Canada BC AB SK MB ON QC ATL 2007 Provincial wait list times have a wide range of variation. Source: Canada: CORR e-statistics

21 ODT Recommendations

22 System Performance -Tissues Tissue Donors per Million Population

23 System Performance - Tissues Canadian Surgical Market for Allograft (Units) Non-Proprietary Musculoskeletal Machined Bone Cornea Cardiovascular Imported Domestic Valves Sources: 2010 Supply of Human Allograft Tissue in Canada, Canadian Imported Surgical and Dental Allograft, Allograft Substitute, and ADM Study 2010 Utilization and Cost of Procurement of Skin, Cardiac and Vascular Allografts and Allograft Products -Final Report 2010 Demand for Ocular Tissue in Canada - Final Report January 2010 (Cornea Data)

24 System Performance - Tissues Provincial wait times for cornea transplants can be up to 3 years.

26 TDT Recommendations

27 Some accomplishments since 2008 Living Donor Paired Exchange registry 127 transplants to date. Leading Practices: e.g., DCD practices and protocols Policies: e.g., Living Donor Reimbursement Forums: e.g., Allocation in Combined Transplant Forum Workshops: e.g., Eye and Tissue Banking Workshop National accreditation standards for OTDT activities National Organ Waitlist (go-live May 2012) Highly Sensitized Patient registry (go-live late 2012)

international), professional associations, patients and patient groups, governments and other

28 OTDT national strategy Call To Action delivered 25 recommendations on how to significantly improve performance Three years worth of consultation, dialogue, and planning with experts (domestic and international), professional associations, patients and patient groups, governments and other stakeholders Delivered to F/P/T governments April 2011 Impact assessments ongoing, decision pending Spring 2012

29 Case Study: Leadership and transformation pan-canadian bulk drug purchasing

30 Bulk drug purchasing a pan-canadian approach Canadian Blood Services operates a $500 million plasma protein product (PPP) portfolio that purchases and distributes 32 biological agents on behalf of the P/Ts Provides equal access to drug treatments regardless of an individual s postal code Grounded in evidence-based guidelines and rigorous surveillance and post-surveillance information A large bulk-purchaser means significant clout, which results in getting access and good pricing for drugs Procurement strategy seeks multiple suppliers, guaranteed inventories, preferential global access in event of shortages ensures security of supply while achieving significant cost containment

Today, Canadian Blood Services: a mature, sustainable, cross jurisdictional healthcare system provider model that encourages

31 Conclusion Pan-Canadian collaborations are challenging, and it s an issue to be debated and discussed Canadian Blood Services experience in leadership and transformation can and should be emulated. Today, Canadian Blood Services: a mature, sustainable, cross jurisdictional healthcare system provider model that encourages collaboration and cooperation and is firmly centred on patient outcomes trusted partner and leader in health care and health service delivery, which continues to evolve through pan-canadian collaboration

32 Questions

Empire Club Toronto, Ontario. A Bridge Across Silos: Collaboration for Innovation and Better Value in Health Care

Empire Club Toronto, Ontario. A Bridge Across Silos: Collaboration for Innovation and Better Value in Health Care Empire Club Toronto, Ontario A Bridge Across Silos: Collaboration for Innovation and Better Value in Health Care Dr. Graham Sher Chief Executive Officer Canadian Blood Services 1 Introduction Thank you