Hospital Transformation through
Z
Zero
Based
B d Budgeting
B d ti
Windsor Regional Hospital
g
p
Orientation Session
Medical Programs/Departments
June 18 & 19, 2008
Agenda
„
Project Background & Objectives
„
Organizational Transformation Through ZBB
„
Improving Performance of the Organization
„
Medical Programs/Departments Workshops/Workbooks
„
Project Organization
„
Project Schedule
„
Questions
© 2008 Hay Group. All Rights Reserved
2
Background
„
„
„
„
„
Unprecedented
U
d t d growth
th iin programs, services,
i
patient
ti t volume,
l
staffing
t ffi and
d
facilities; now $270 million in revenues and activity
Growth has resulted in operating losses and a working capital deficit of
approximately
i
l $55 million
illi
WRH has worked hard to significantly reduce operating costs:
− From 26% higher than expected cost per weighted case five years ago
− To only 10% above expected cost per weighted case currently
− But, this is still a problem for negotiations with LHIN and MOHLTC
WRH must continue to transform operations
p
to achieve efficiencyy
breakthroughs that will provide additional cost reductions
Zero Based Budgeting (ZBB) provides a tool to rethink approaches to service
delivery to reduce costs
© 2008 Hay Group. All Rights Reserved
3
Zero Based Budgeting
„
„
Historically, hospital budgets have been set based on adjustments to the
Historically
budget for the prior year
After several years, budgets don’t necessarily reflect what is currently needed
if they are based on:
−
−
−
„
Year over year adjustments:
−
−
„
Past operating characteristics
Past technologies
Past inter
inter-departmental
departmental interactions/interdependencies
May not reflect changes in processes, practices and need
May be based more on relative success in negotiations during budget processes
rather than on relative need
Building a budget from zero, rather than adjusting last year’s budget:
−
−
Allows it to reflect current requirements and conditions,
conditions not historical anomalies
Provides an opportunity/stimulus to incorporate more current and best practices
© 2008 Hay Group. All Rights Reserved
4
Objectives for Transformation Through ZBB
1 Re-think methods of providing care
1.
2. Create more efficient processes; restructure inefficient processes
3. Eliminate unnecessaryy activityy
4. Balance workloads; better balance workload with staffing
5. Improve quality of worklife for employees
6. Reduce costs without compromising effectiveness of delivering those
services.
7 A
7.
At a minimum, result
l in hospital
h
l operating at ‘Expected
‘E
dC
Costs per
Weighted Case’
© 2008 Hay Group. All Rights Reserved
5
Organizational Transformation
through ZBB
Organizational Transformation
Focus of approach to transformation is to deliver four key results:
„
Accelerate realization of vision
−
Outstanding Care, No Exceptions!
„
Improve quality of care and customer services
„
Improve quality of worklife
„
Reduce service costs
© 2008 Hay Group. All Rights Reserved
7
Key Assumptions For Budgeting
„
„
Patient
P
ti t volume
l
((measured
d iin episodes
i d off care)) will
ill be
b maintained:
i t i d
− No decreases in necessary care
− No increases in elective activity
Patient days will be the same or be reduced:
− More outpatient care in place of inpatient care
− Shorter lengths of stay
„
Patient mix will be the same
„
Range of medical services will be the same
„
W k content
Work
t t per episode
i d off care will
ill be
b the
th same or reduced
d d
„
Departmental workload will be the same or reduced
„
No reductions in salary or wage rates for staff
© 2008 Hay Group. All Rights Reserved
8
Improving the Performance of the
Organization
Zero Based Budgeting
„
„
„
„
ZBB ffocuses on bbuilding
ildi bbudgets
d t ffrom “b
“bottom
tt
up”” rather
th th
than “t
“top down”
d
”
ZBB involves completely rethinking services and requirements rather than
using incremental changes from prior years
ZBB at WRH will involve rethinking and designing anew the approaches to
providing and supporting care so as to:
− Minimize unnecessary activity
− Balance workload and staffing
− Maximize efficiency
− Maintain or improve quality
− Minimize costs
New budgets for new approaches to providing and supporting care
© 2008 Hay Group. All Rights Reserved
10
Process for ZBB
ZBB workshops will be held in 2 streams:
„
Medical Programs/Departments
„
Hospital Functional Centres
© 2008 Hay Group. All Rights Reserved
11
ZBB for Medical Programs/Departments
„
„
„
„
Workk with
W
ith medical
di l and
d administrative
d i i t ti lleadership
d hi off medical
di l
programs/departments to define anew the hospital’s approach to providing
an episode of patient care
I i i l session
Initial
i to provide
id an orientation
i
i to ZBB at WRH
A series of 5 workshops with leadership of all medical
programs/departments:
1. Identifying best practices
2. Service delivery models, content of care
3. Workflow, delays, discharge planning
4. Materials content of care and sourcing
5. Review
Followingg each workshop,
p, representatives
p
of each pprogram/department
g
p
will
complete a workbook related to workshop content
© 2008 Hay Group. All Rights Reserved
12
Medical Programs/Departments Participating in
ZBB Workshops
„
„
„
„
„
„
„
Emergency Medicine
Family Medicine
Medicine
CCU
ICU
Surgery
Anaesthesia
„
„
„
„
„
„
„
Oncology
Ob & Gyn
Paediatrics
NICU
Psychiatry
Rehabilitation
Continuing Care
Other Heads of Service / Medical Directors will support
Programs/Departments in completing workbooks and/or will
support Functional Centres in budget development.
© 2008 Hay Group. All Rights Reserved
13
ZBB for Functional Centres
„
„
„
„
Work with hospital departments to rethink approaches to service delivery,
delivery
service interdependencies, staffing and costs
Start with initial session to provide an orientation to ZBB at WRH
A series of 7 workshops for 5 groupings of managers:
1. Identifying best practices
2. Considering services offered
3. Considering service delivery models
4. Considering derivation of departmental workload
5. Considering benefit hours, sick time, etc.
6. Considering materials content and sourcing
7. Defining actions to implement zero based budgets
Followingg each workshop,
p, Department
p
Managers
g
will complete
p
a workbook
related to workshop content
© 2008 Hay Group. All Rights Reserved
14
Groupings of Functional Centres
ƒ Patient Care Services
ƒ Therapeutic Services
ƒ Diagnostic Services
ƒ Support Services
ƒ Administrative Services
© 2008 Hay Group. All Rights Reserved
15
Medical Programs/Departments
g
p
Workshops/Workbooks
ZBB Workshops/Workbooks for
Medical Programs/Departments
„
ZBB will consider all elements of the hospital’s
p
care processes,
p
, including:
g
−
−
−
−
−
−
−
−
−
−
−
−
„
Admission decisions
Most responsible physician models
Service delivery models
Process of care
Content of care
Materials content of care and sourcing
W k flow
Work
fl
Delays in care
Discharge planning
Discharge
Post discharge care
ALC days
New/changed patient care processes will provide new ZBB estimates of
workload for hospital Functional Centres
© 2008 Hay Group. All Rights Reserved
17
ZBB for Patient Care Programs/Medical Departments
„
„
„
„
„
A series of 5 workshops
p with leadership
p of all medical pprograms/departments:
g
p
1. Identifying best practices;
2. Service delivery models, content of care
3. Workflow, delays, discharge planning
4. Materials content of care and sourcing
5. Review
Workshops will be led by Hay Group consultants Dr. Isser Dubinsky and Adam Topp
Following each workshop, representatives of each program/department will complete
a workbook related to workshop content
Program/department leadership will be supported by hospital administrative staff
Initial data to support process developed by Hay Group using:
− Discharge Abstract Data/NACRS Data
− Management Information System Data
− Extant literature
© 2008 Hay Group. All Rights Reserved
18
Workshop/Workbook 1:
Identifying Best Practices
In the first workshop/workbook you will be asked to:
„
Identify the characteristics of high performing medical
programs/departments that might be emulated by WRH
To assist in this process we will provide you with:
„
„
„
Data comparing the performance of WRH medical programs and
departments with high performing hospitals across Canada
Advice on how to contact and query high performing medical programs and
departments to identify best practices that have contributed to their
exemplary levels of performance.
Advice on how to identify examples of best practices from the medical and
administrative literature that can contribute to improved quality and
p
care
efficiencyy of patient
© 2008 Hay Group. All Rights Reserved
19
Workshop/Workbook 2:
Considering Service Delivery Models & Content of Care
I this
In
thi workshop/workbook
k h /
kb k you will
ill be
b asked
k d to:
t
„
„
Identify best practices in service delivery that reduce resources used in an
episode of patient care
Determine if care delivery models are optimally using outpatient care as an
alternative to admission (e.g., considering more use of outpatient surgery,
more use of day hospital care, use of clinical observation/decision units rather
than admission for ED patients, rapid follow up clinics/diagnostics for ED
patients rather than admission, etc.)
Continued on next page
© 2008 Hay Group. All Rights Reserved
20
Workshop/Workbook 2:
Service Delivery Models & Content of Care - Continued
„
„
Determine if the content of an episode of care at WRH is optimal:
− What services are required for all patients?
− What services are required only for selected patients?
− Are there services being provided to patients that might be reduced or
eliminated?
For example,
p WRH might
g consider:
− Less use of psychology
− More selective use of clinical dietetics, OT, Clinical Nurse Specialists,
diagnostic services, etc.
− More selective (and more intensive) use of discharge planning
− More use of more discriminating standard care plans
© 2008 Hay Group. All Rights Reserved
21
Workshop/Workbook 3:
Work Flow; Delays in Care & Discharge Planning
In this workshop/workbook
p
y
you will be asked to:
„
„
Identify best practices in work flow to reduce delays in care & reduce ALOS
For example, WRH might consider:
− Standard
St d d order
d sets/medical
t / di l di
directives
ti
so th
thatt care iis nott d
dependent
d t on th
the
attendance of the physician
− Independent case finding by allied health professionals
− Availability
A il bilit off (selected)
( l t d) di
diagnostic
ti services
i
24/7
− Priority (morning) access to diagnostic services by inpatients
− Rapid turnaround of test results for inpatients/ED patients
− More
M
active
i care management off patients
i
by
b physicians
h i i
− More immediate assignment of MRP
− Weekend and holiday discharges
− Follow up clinics for “unattached” patients
Continued on next page
© 2008 Hay Group. All Rights Reserved
22
Workshop/Workbook 3:
Work Flow; Delays & Discharge Planning - Continued
„
„
Identify
Id
tif approaches
h tto reducing
d i d
delays
l
iin di
discharge
h
after
ft completion
l ti off an
episode of acute care
For example, WRH might consider:
− Writing discharge orders that would expedite discharge
− Organizing care for ALC patients that would expedite discharge
− Utilizing a wider variety of post acute care destinations, etc.
© 2008 Hay Group. All Rights Reserved
23
Workshop/Workbook 4:
Considering Materials Content of Care & Sourcing
In this workshop/workbook you will be asked to:
„
Consider the medical surgical equipment, devices, drugs and supplies that
are being used at the hospital:
− What
Wh t is
i really
ll required
i d ffor patients?
ti t ?
− Are there opportunities to be more selective in the use of supplies, drugs,
special diets, devices, etc.?
− Are there opportunities to use lower cost medications?
− Are there opportunities for standardization?
− Are there ways to reduce unit costs by consolidating ordering?
© 2008 Hay Group. All Rights Reserved
24
Workshop 5: Review Session
Hay Group Consultants will summarize:
„
Actions identified and required to implement the new care processes
„
Impact
p of new pprocesses on ppatient days
y and functional centre workloads
You will be asked to:
„
Confirm initiatives and potential impact
© 2008 Hay Group. All Rights Reserved
25
Project Organization
HayGroup Project Team
Project Director: Mark Hundert
Project Manager: Irene Petersen Gray
Medical Departments
„
„
Dr. Isser Dubinsky
Dr
Adam Topp
Functional Centres:
„
Patient Care Services – Irene Petersen Gray,
Adam Topp
„
Therapeutic Services – Kelly Jennings
„
Diagnostic Services – Adam Topp
„
Support Services – Robert Kimsto
„
Administration – Robert Kimsto
© 2008 Hay Group. All Rights Reserved
Communication
„
Alyssa Montmarquette
Workshop/
Workbook Design
g
„
Paula Kerr
27
Project Schedule
Project Schedule
Week Ending
Ongoing
25-Sep
19-Sep
12-Sep
05-Sep
29-Aug
22-Aug
15-Aug
08-Aug
01-Aug
25-Jul
18-Jul
11-Jul
04-Jul
27-Jun
20-Jun
13-Jun
06-Jun
30-May
23-May
Activity
1.0 Project Organization & Planning
2.0 Project Communication
2.1 Initiating Process
2.2 Communications Planning
2.3 Communications Delivery
3.0 Medical Dept. Zero Based Budgeting
3 1 Orientation Session
3.1
4.1 Orientation
4.2 ZBB Workshops
Break Week
3.3 Derive Departmental Workloads
4.0 Dept / Functional Centre ZBB
Break Week
3.2 ZBB Workshops
4.3 Inter-workshop activities
4.4 Refinement of ZBB
5.0 WRH Zero Based Budgets
5.1Consolidate ZBBs
5.2 Summarize recommendation
5 3 Review & approval
5.3
5.0 Implementation
© 2008 Hay Group. All Rights Reserved
29
Medical Programs/Departments
Workshop Dates & Times
„
Workshop 1:
Wed June 25
Wed.,
0700 0900
0700-0900
„
Workshop 2:
Thurs., July 10
0700-0900
„
Workshop 3:
Tues., July 15
0700-0900
„
Workshop 4:
Thurs., July 24
0700-0900
„
Review Workshop: Thurs., July 31
0700-0900
© 2008 Hay Group. All Rights Reserved
30
Q esti ns
Questions