Where There s a Spark Counties Manukau District Health Board THERE S A WAY FORWARD Changing our Game Geraint Martin, CEO, Counties Manukau District Health Board Ron Pearson, Deputy CEO, Counties Manukau District Health Board Counties Manukau District Health Board Our Case for Change The Burning Platform Quality is at the heart of our strategy How the Dollars have fallen How we got there What needs to happen next 1
The Case for Change We have > 500,000 residents Fastest growing DHB Forecast increase Next 20 years: 36% The Case for Change and Ageing Population: + 65 years age group double in 20 years Socioeconomic Deprivation: 34% population very deprived High rates of chronic diseases: 13% Diabetes/CVD generate 46% of Hospital costs 33% Obesity Health inequalities 2
The Case for Change and Harm, waste, variation: Medication Errors, Falls, CLABs Increasing public and political expectations: Technology, quality of life for elderly Our Moral Obligation: Optimising Vote Health Complexity within the Health System GFC - Permanent? The Case for Change Resource Constraint As of 2013 we have projected a shortfall of approximately 24 acute beds Do Nothing +/- 30 beds per year for foreseeable future Inefficient configuration NO infrastructure 3
The Case for Change Funding Constraint Revenue still growing, but at a decreasing and capped rate 2012/13 $?? Is Survival Mandatory? It is not necessary to change. Survival is not mandatory. (W Edwards Deming) 4
but at CMDHB organisational culture kicked in and we acknowledged our own burning platform and committed to solve the issues Thinking Differently - Costs and Quality Where DHBs go to reduce costs Where other industries go to Reduce Costs Inputs to Core Processes: Suppliers Staff Equipment Core Processes Clinical Evaluating Diagnosing Treating Communicating Outcomes: Quality Results Safety Results Costs CMDHB Health System approach Improved efficiency/ productivity Improved effectiveness Delivering the triple aim 5
Our Quality Proposition Poor quality cannot be solved by further scientific advances Poor quality cannot be solved by re-organising bureaucracy Poor quality cannnot be solved by more money We have to change how we manage the quality of health and healthcare Successful change needs a recognition that it is an individual and system issue Delivering quality care is a science with a considerable literature and taxonomy Above all it is an ethical issue Quality is at the Heart of our Strategy and the Unifying Enabler Look after Quality and Safety and the Dollars will look after themselves When quality goes up, costs go down. Quality Improvement is the primary source of cost reduction (Eureka moment - Tom Peters) 6
Keeping Our Strategic Shape, i.e. a Balanced Strategy Triple Aim Our Stories Six Executable Strategies our results and how the dollars have fallen 7
Results : Emergency Care Results : Emergency Care Ministry of Health definition: 95% of patients are transferred or discharged from EC within 6 hours... Our interpretation All patients are transferred or discharged from EC within 6 hours unless clinically indicated 8
Results : Emergency Care From 25% patients housed in corridors to ZERO S Sustained Despite record attends (18%) Results : Emergency Care From 75% in 6 hrs to 95% ++ Improving Productivity Maintained despite record attends ( 18%) 9
Results: Elective Surgery Elective Productivity Increased by >50% over five years Results : CLABs Absolute CLAB numbers: From 14, to 1 in three years Fiscal year 2011/12: $751K 351 Bed Days 10
Results: Falls Prevention Fiscal year 2011/12: $337k 488 Bed Days Results: Reducing Pressure Injuries Hospital Acquired: From143, down to 46 Fiscal year 2011/12: $1.8m 1,563 Bed days 11
Results : Medication Safety Saving ICU: 27% per bed day, $136,000/year (PYXIS) Automated unit for distribution and secure storage of medicine in clinical areas Direct: Pharmaceutical cost saving (decreased waste) Indirect: reduction In adverse events Results: Medication Safety New Medication Chart: 6 redundant carbon copies removed from chart Saved 22cents per chart or $435/week for EC But importantly: Significantly lessened medical errors through columned charts 12
Results: Thriving in Difficult Times (T2) 8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 ha Consumabl es ha Consumables ha Procurement/ ha Procureme nt/ Capital Capital ha Contractual ha Contractual Year Supply Chain management Improved Contracting Consumable and Capital Procurement Other Savings Waste, cost reduction Revenue enhancement Process changes Results: Adding value - Time & Money Last three years we have saved $60m (5 % of turnover) through better quality) and Permanently reduced costs by almost $40m 13
Why Are We Succeeding? Brave Leadership Ownership Ideas Commitment Will / Focus Celebration = PEOPLE How we Made it Happen Ideas - Will - Execution - Passion Robust Methodology Mantra for Transformation Brave Leadership Clinical Engagement Front Line Staff Continuing investment in Expertise and Innovation 14
Not just Leadership BRAVE Leadership The task of leadership is to create opportunity, The task of us all is to seize it (Geraint Martin) And Celebrate! 15
The Future What needs to happen next? Challenges Ahead of Us. Power to the people: masters not servants Granny Test : Patients first Frontline Design : A team not a bunch of Silos Organisational support : Safe Staffing Reinforcing the Can Do culture Changing how we make decisions Devolution, Empowerment, Responsibility Learning to live with less!! 16
Challenges Ahead of Us. Our emphasis will continue to be Continue to invest in Clinical Leadership Optimal delivery : We will do what we are experts at Innovation and Best Practice Systematic change 17