Lower Mainland (B.C.) Health Consolidation

A look intoIntegrated Protection Services (IPS)

Successes and Challenges

Jeff YoungExecutive Director

2009 - A Brewing Storm

• Rapidly escalating healthcare demands from a growing and aging population.

• Increasing costs & inflation - unsustainable in the long term.

• All six (seven) BC health authorities were facing deficits despite getting a significant portion of the provincial budget.

The OpportunityGeographic proximity of the four Lower Mainland healthorganizations (FH, PHSA, VCH & PHC) afforded the opportunity to look for efficiencies in common services.

Lower Mainland Health Organizations

• Serve 60% of BC’s population

• Have a combined budget of ~$7B

• Total employees across the organizations number 65,000

• Provide a wide range of health services at: 28 Acute Facilities 27 Residential Care Facilities Hundreds of community based facilities i.e. storefront clinics

August 2009 LMC Mandate

• MoH and health organizations initiated consolidation of select service areas for LM-based health organizations

• Consolidate as many services as possible

• Initiatives in scope specified, timelinesand objectives set

• Services provided as a single entity

• Build on existing collaboration

Financial Target

• $100M annual savings across LMC

• = 10% of the $1.0B non-clinical budget

• $100M target allocated among the departments

• Pace was critical

Process

• One organization accountable for provision of each consolidated service across the LM

• Consolidated service will: Provide quality services on behalf of all participating

organizations based on service agreement Have authority under the Master Services Agreement Achieve its specific cost savings target (sustainable savings) Ensure patient care is not negatively impacted

Original LMC Initiatives

Biomedical Engineering

Interpreting Services

Integrated Protection

Services

Health Information Management

IMITS(PHC, PHSA, VCH)

Facilities Management

Pathology and Laboratory Services

Business Initiatives & Support Services

FH PHSA PHCVCH

Communications & Public Affairs

IntegratedMedical Imaging

Pharmacy Services

Health Emergency

Management

Strategies

• Increased process efficiency through: Alignment and integration across the organizations, including initial staffing

reductions

Standardization

Reducing duplication

• Leveraging of buying power• Sharing resources and knowledge

Governance & StructureGovernance Committee

Collaboration CouncilMoH

CAO

Program Management

Office

Finance & Capital

Working Group

Data Management

CommitteeHR

Working Group

BISS

Dr. David Ostrow

David Handley

Facilities Management

Dr. Nigel Murray

Peter Goldthorpe

IMITS

Carl Roy*

Barry Rivelis

Health Info. Mgmt.

Dianne Doyle

Yoel Robens-Paradise

Integ. Medical Imaging

Dr. David Ostrow

Mike Nader

Comm. & Pub. Affairs

Dr. David Ostrow

Clay Adams

Integrated Protection Svs.

Dr. Nigel Murray

Jeff Young

Pharmacy Services

Dr. Nigel Murray

Dr. Shallen Letwin

Interpreting Services

Carl Roy*

Suzanne Barclay

Path. & Lab. Medicine

Carl Roy*

John Andruschak

Biomedical Engineering

Dianne Doyle

Chris Buck

Remain accountable through CEOs for Project Delivery & Savings

HSSBC

Jim Eckler

LMC Initiative

Executive Champion

Executive Lead

IT Design Authority

Working Group

Lead organization:

VCH

FH

PHSA

PHC

Health Emergency Management

Carl Roy*

John Lavery

Key Enablers

• Master Services Agreement is the governing document that specifies the roles, responsibilities and obligations of the participating organizations with respect to service quality, access, financial, human resources and other aspects of the program

• Information Sharing Agreement facilitates cross-organizational systems access

• Signing Authority with consistent authorization levels for similar management grades across the LM

Key Enablers

• Sharing Formula – to distribute financial risks and rewards resulting from consolidation activities

• Customer Service Committees – to enable consolidated services and oversee service performance metrics

• Consolidated financial reporting to monitor budgets and savings• Staff Transfers – to Lead organization. (There is an ongoing effort

to harmonize HR Benefits, Employee Terms and Conditions)

• By the end of FY12/13, LMC had achieved an estimated $74.6M in annual savings.

• Add cost avoidance: Total estimated savings = $116.4M

Consistent approach for HR issuesMutual systems access

Data governance

Joint capital and IMIT planning

Legal/risk issues

Savings sharing formula

Consolidated Budgets

Performance measures

Privacy Information Agreements

Systemic Issues

PMO & Standard Processes

Consolidated LM Structures

Master Service Agreement & 12 Service

Schedules

Consolidated LM

Budgets/Reporting

Quality Assurance Mechanisms

Standardized Best Practices

Savings Sharing Formula

SAVINGS

Integrated Service Models

NO NEG. IMPACT ON PATIENT CARE

Achievements

Efficiencies Leaner structures, reduced duplication Economies of scale, leveraging buying power Shared resources

Financial reporting Consolidated budgets LM financial reporting structures Savings sharing formula

LMC Successes

Other LMC Successes

Consolidated LM structures Streamlined roles and accountabilities

across LM for better efficiency & productivity Alignment & integration Staff transfers to lead health authority (where identified as an enabler)

Standardization, moving to Best Practices Standardization to agreed-on service levels No negative impact on patient care

Service Agreements Master Service Agreement with 12 Service Schedules Ensure consistent quality service across the LM Commitment to provide service levels that are acceptable for each organization Customer Service Committees for feedback/input KPIs monitored Mechanisms to escalate issues identified Include solutions to most systemic LMC issues

Other LMC Successes

The Future

• Savings goal will be substantially (if not entirely) achieved by end of 2013/14

• LMC provides a solid platform for provincial collaboration and consolidation strategies

• HEM

• BioMed

Core Services1. Protection/Security2. Parking, Access & Commuter Services (PACS)

Budget LMC Protection/Security $21M

• With additional budget exists outside LMC budgets LMC PACS $20M net revenues

• 1/3 operating costs includes access costs

Note: Each HO retains its own net parking revenue

Integrated Protection Services

Core Objectives

Integrated Protection Services

1) Support a secure and accessible environment of care to ensure the highest standard of quality services being delivered across the 4 Health Organizations.

2) Create an integrated program that incorporates process excellence and industry best practices to provide quality service to the Health Organizations.

3) To seek innovative and sustainable value solutions.

4) Foster a culture that develops High Performance Teams.

IPS Streams - Overview1. Security/Protection

• Strategic Initiatives & Contract Management• Operations

2. Parking, Access & Commuter Services (PACS)

3. Process Excellence & Performance Reporting *NEW*

Integrated Protection Services

Service Delivery Model Overview

•Outsourced site based security services & parking management with corporate IPS oversight

– Inherited 3 legacy security contracts each with different scope of services

– 3 legacy parking management contracts

Integrated Protection Services

Service Delivery Model Overview

•Functional program management model that aligned protection leadership to LMC wide responsibility vs. previous East - West model

• Consolidate PACS core production services and IPS management having LMC wide responsibility into one of two “hubs” - East & West with vision to move to one (Centralized vs. Decentralized)

Integrated Protection Services

25

Protection/Security - Operations• Governance of the site based security vendor services• Direct management of Forensic Psychiatric Hospital & Provincial

Special Constables• Routine incident review, Tier notification and management

thereof when required• HO / Site / Program liaison• Threat Management program• Investigations

Integrated Protection Services

Protection/Security – Strategic Initiatives and Contract Management

• Recently combined security services RFP contract for the LMC: Aligned scope to our preferred service delivery model Additional cost savings by bundling services and other

contract initiatives realizing ~ $2.85M in savings !!!

Integrated Protection Services

Protection/Security –Strategic Initiatives and Contract Management

• Review, reconciles and audits the security vendor partner invoicing ~ $20M annual combined spend

• Currently engaged in 103 construction projects LMC wide• Development of standardized assessment and audit tools for

Operations team• Further consolidation and standardization of security related

systems i.e. card access, CCTV

Integrated Protection Services

29

Parking, Access & Commuter Services (PACS)• Expand Transportation Demand initiatives ~ where parking capacity

issues• Continue with expanding automation & pay parking sites• LMC wide Parking Policy• Continue with centralization of access services and LEAN processes to

reduce production time• Evaluate and roll out new integrated technologies i.e. Smart Cards• RFP to consolidate legacy parking management contracts into 1 LM

wide contract for fiscal 15/16

Integrated Protection Services

Process Excellence & Performance Reporting • Supports both Protection/Security & PACS programs• Lower mainland PMO/CSC Reporting• Process mapping / LEAN initiatives• IPS Enterprise Incident Reporting system oversight• IPS data warehouse management• Analysis of data to support evidence based decision making• Standardized quarterly reporting at site/program/HO level in progress

Integrated Protection Services

Performance Reporting – Quick Facts

Integrated Protection Services

OPERATIONS CENTRE CALLS 2012 - 2013 Fiscal Year

PHSA FH VCH/PHC TOTALS

Urgent Calls 1,491 5,589 8,490 15,570

Non-Urgent Calls 22,228 75,208 98,471 195,907

TOTAL ANNUAL CALLS 23,719 80,792 106,961 211,472

PHSA FH VCH/PHC AVERAGES

Percentage of Urgent Calls 6.3% 6.9% 7.9% 7%

Percentage of Non-Urgent Calls 93.7% 93.1% 92.1% 93%

Performance Reporting – Quick Facts

Integrated Protection Services

TOTAL SECURITY INCIDENT REPORTS 2012 Calendar Year

PHSA FH VCH/PHC TOTALS

Security Incident Reports

754

47,094

48,090

95,938

Progress to date

• At the end of the FY 2012/13, IPS fully achieved its LMC targets: Protection realized $0.518M in cost direct savings Parking realized $5.98M in net new revenues

• Completed employer transfer of all staff to Fraser Health• Rolled out an enterprise incident reporting systems across the

LM

Integrated Protection Services

Progress to date

•Expanded program through system resource transfer or reinvestment of efficiency savings

Heliport management Security systems maintenance & repair Commuter services

•Consolidated 3 legacy security contracts into 1 single scope contract•Consolidated card access platforms from 7 to 2 •Expanded preferred CCTV NVR platform from 3 to 24 sites

Integrated Protection Services

35

Priorities 14/15

• Review/renew 5-Year IPS Strategic Plan• Provide → Support → Partnership Evolution

• Further standardization of systems, processes and reporting throughout LMC

• Further pursue automation, reducing operating costs and revenue enhancements within PACS

• Build upon the creation of high performing team

Integrated Protection Services

Priorities 14/15

•Continue to expand Protection/Security community sector* and community based facilities outreach •Expand MOU with FM (key management, heliport management and security systems maintenance and repair) to leased site facilities.•Prepare RFP for LM Parking management for 24 locations combined for 16,500 parking stalls

Integrated Protection Services

37

Challenges

• Reality of having 4 “masters” with 20 combined “strategic imperatives”

• Increased system wide budget constraints / access to capital $• IT connectivity between the 4 HO’s• Support programs to IPS not being consolidated adds

complexity• Increased activity compounded by downloading/scope creep

with no resource increase

Integrated Protection Services

Challenges

•Global reduction in vehicle use, increased local taxation, TDM success and corresponding decrease on parking demand impacting revenues negatively, but also celebrated as a success too!•Media / public and advocate group applying political pressure on hospital pay parking

Integrated Protection Services

39

British Columbia

Fiscal 13/14 - $16.5B / $43.3B or 38% of the Provincial Budget

Total spending increase of 75% between 2000 and 2010 – which equates to an average annual increase of 6% during that time period

Healthcare Spending….unsustainable!

Ontario

•Fiscal 13/14 $48.9B/$112.6B or 43% of the total Provincial budget•The Ontario government is committed to eliminating the deficit by 2017-18.•The deficit for 2012-13 is estimated to be $9.8 billion

Healthcare Spending….unsustainable!

• The government will build on Ontario’s Action Plan for Health Care to create a sustainable and high-quality health care system by:– Transforming health care to reduce the rate of growth of spending to an

average of 2.1 per cent annually over the next three years– Enhancing community-based care to treat patients in alternative settings

such as non-profit clinics and at home instead of in hospitals, where appropriate

– Moving to patient-centred funding models to improve the value and quality of care

So GTA …..are you ready?!

Transforming Health Care

So GTA AKA Lower Mainland ONT …..Are you ready?!

So GTA …..are you ready?!

So GTA…..My advice

Be part of the solution…

Be proactively looking for cost savings, efficiencies and

standardization through partnerships with other LHIN’s or

risk it (consolidation) being forced upon you.

• Scalable to absorb increased capacity• Flexible to absorb “other” services: Parking, HEM,

transportation/fleet mgmt., etc.• Show cost savings! Find $ through efficiencies • Risk based / data supported decision making (have the

data!)

Build A Program

• That has a business acumen about it• Fiduciary responsible – oversight of taxpayer $

– Every operating support $ spent takes $ away from direct patient care

• Process excellence / performance reporting / evidence based / data supported decision making / tie to clinical indicators

• Tie services directly back to support patient care wherever possible

• HAVE THE VISION !

Build A Program

Online survey seekscommunity views onpossible hospital merger

Consolidation….It’s coming…

Lower MainlandIntegrated Protection Services