Public sector/stakeholder collaboration - moving beyond “the clenched fist”

1. Public sector/stakeholder collaboration - moving beyond “the clenched fist” Strategies for Public Sector Transformation 2002 - October 16, 2002

2. Agenda • introduction • Physician Office System Program – a case study • challenges & solutions “You cannot shake hands with a clenched fist” - Indira Gandhi

3. Introduction • lessons learned from walking in the other guy’s moccasins • experience is the best teacher or “how I got the scars on my back” • Alberta Wellnet • CYNCH • Western Health Information Collaborative • Alberta “One Window” • Common opportunities • Western Canadian Continuing Care EHR Initiative • Physician Office System Program • the usual disclaimer

4. The Physician Office System Program A case study…

5. Physician Office System Program • joint initiative of the Alberta Medical Association and Alberta Health & Wellness • negotiated under the AMA/AH&W master agreement • a contractual relationship • provides three types of assistance to the physician: • financial assistance to defray the cost of hardware/software • information technology services • change management services • targets improvement in physician office systems, services and business models (e.g., ASP)

6. POSP vision “to establish a physician office information infrastructure that is integrated with the health information system”

7. “EHR” – a longitudinal record of a patient’s health & healthcare, from cradle to grave… Electronic health record Physician office system: Electronic medical record Integrated decision support Billing Scheduling Office productivity tools Stand-alone information sources: Labs Pharmacies Radiologists Regional clinical systems - acute: MPI/ADT Lab Pharmacy ER Radiology Home care Immunization Speech Pathology Regional clinical systems – sub-acute and continuing care: Continuing care delivery systems, including case management, care protocols, clinical data and reports Client/patient surveys = Interface

8. Physician Office System Program AMA AH&W Finance Cttee. POSP Subcommittee Evaluation Howard Research Program Management Office Program Director Program Support Admin. Assistant Operations (AMA) Change Management Communications (AMA/AH&W) IT Delivery (alberta we//net)

9. Delivery of change management services… POSP Program Director Program Support Admin. Assistant Operations Change Management Manager Karen Shimko IT Delivery Communications Advisor South Advisor Nancy Stewart Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources

10. POSP results to date... • 1,212 physician participants to date; target 2,138 • standing offers for physician office system vendors developed (1st in Canada); “2nd round” of requirements definition underway • physician led; 5 stakeholder groups • national and regional participation • POS to POS interface feasibility study in process • support for electronic reporting of lab results • standing offers for Microsoft and Dell negotiated

11. POSP results to date… • “first of its kind” change management program • web-based tools (POSP Software Lab, electronic “doctors’ lounge”), communication and knowledge products, workshops (computer literacy, decision support, change management, privacy impact assessments…) & on-site consultations • communications strategy and products developed • external evaluation ongoing, first reports issued • operational, change management and groupware IT systems implemented

12. POSP results to date… • cited as the “premier” physician program in Alberta • seen as a successful collaboration by the Program sponsors • proposed for renewal by both sponsors

13. IT services • POSP developed “standing offers” with vendors for the delivery of hardware and software that will support achievement of physicians’ program outcomes • standing offers published April, 2002 • first time in Canada comprehensive physician office system requirements articulated

14. Learning as we go… • significant learnings through standing offer process • external evaluation conducted and results shared with stakeholders • process was fair • no need to issue another RFP • POSP should develop and maintain standards • independent evaluation agency should evaluate applications against standards

15. Benefits of this approach • consultation with stakeholders will: • ensure requirements carry weight • address vendors’ business issues • result in increased alignment between physicians’ & other stakeholder needs and vendor offerings • allows time for vendors to meet any new requirements • vendors who already meet VCUR can market by reference to these requirements, as soon as requirements published

16. Public sector/stakeholder collaboration Lessons learned…

17. Barriers to successful collaboration • absence of shared vision, commitment • inappropriate governance model • lack of specificity re: outcomes & targets • lack of clarity re: roles & responsibilities • misunderstanding the nature of the relationship • inadequate resourcing of the collaborative effort • positional stereotyping & mistrust • dogmatic adherence to past decisions

18. Strategies that work… • you can’t outsource strategic planning • business owners need to “own” the vision and define/approve key strategies • environmental scan helps clarify the “larger picture” • listen with an “empty teacup”

19. Strategies that work… • give careful thought to your governance structure and respect it once its in place • appropriate to the task • terms of reference • if you’ve delegated authority…don’t meddle! but hold parties accountable with respect to agreed-upon outcomes • consider “orientation” to ensure governance level and operating level are clear on respective roles and responsibilities

20. Strategies that work… • collaboration requires dedicated resources • consider implementing an appropriately resourced program management structure, accountable to the project sponsors • keeping sponsors, stakeholders informed is key

21. Strategies that work… • articulate and communicate expected outcomes, targets… • link to strategies • assign owners to strategies • monitor and report on performance relative to these outcomes • linkage with related initiatives?

22. Outcomes/targets example

23. Linking outcomes to strategies…

24. Strategies that work… • don’t confuse the way you treat people with the nature of the business relationship • partnership? • contractual relationship? • don’t expect a vendor to act like the owner of the initiative…their primary focus is their own bottom line • don’t let suspicion based on different agendas taint the relationship

25. Strategies that work… • do your best not to fall back on stereotypes • encourage a climate of continuous improvement…its okay not to get it perfect the first time! • formal evaluation function or periodic external reviews are just good practice • don’t get trapped “sticking with” decisions that time & circumstances have proven sub-optimal • change what you can on the fly… schedule reviews when more substantive policy changes can be implemented • invite the stakeholders in at the earliest opportunity…doesn’t have to be perfect

26. Getting beyond the clenched fist… The law of “win/win” says “let’s not do it your way or my way…let’s do it the best way” - Greg Anderson The 22 Non-negotiable Ways of Wellness