Achieving High Performance in Healthcare Resource Allocation Organizations: Current Practice 2012 CADTH Symposium April 15-17, 2012
Neale Smith, C2E2 Craig Mitton, Principal Investigator, C2E2 Stirling Bryan, C2E2 Jennifer Gibson, U of Toronto Stuart Peacock, BC Cancer Agency Funder: Canadian Institutes of Health Research 2
Project Background Premise: While evidence has gathered in respect to effective resource allocation practices behaviours, structures and processes there is yet little guidance for decision makers about how to improve their performance in these endeavours. The longterm goal of our current research (2010-2013) is to help fill this gap. 3
Project Background (cont.) We are undertaking two phases of data collection on healthcare resource allocation practices in Canada: an on-line survey of decision makers, followed by detailed case studies. From this data, we will develop and pilot test a potential self-assessment instrument. 4
Survey Methods Goal of survey: to have senior management team members describe the organization-wide resource allocation processes in which they are most directly involved. The target population was senior decision makers (i.e., those at the vice-president level) of regional health authorities (or their closest equivalents) in all 10 provinces and 3 territories. 89 organizations were identified. Three responses per organization were sought (target number =267). From late-january through late-april, 2011, contacts were invited to participate in the survey by clicking on the survey link and entering an individualized password. 5
Survey Methods (cont.) After approximately three weeks and one reminder, contacts who did not respond were replaced by a new name; the same procedure was followed through four waves or until contact names were exhausted. Respondents were able to reply to either an English or French language version of the survey. 6
Responses Region Province/ Territory Number of Replies Proportion of target achieved Number of Organizations represented West British Columbia 12 67% 45 6 of 6 25 Alberta 2 67% 1 of 1 Saskatchewan 13 33% 8 of 13 Manitoba 18 55% 10 of 11 Central Ontario 10 24% 23 7 of 14 17 Quebec 13 24% 10 of 18 Atlantic New Brunswick 4 67% 18 2 of 2 12 Nova Scotia 9 33% 6 of 9 Prince Edward Island 1 33% 1 of 1 Newfoundland & 4 33% 3 of 4 Labrador North Northwest Territories 4 17% 6 4 of 8 6 Yukon 1 33% 1 of 1 Nunavut 1 33% 1 of 1 TOTAL 92 34% 60 of 89 Response rate among managers contacted = 24% 7
About the Respondents # Medicine # Other Health Profession # Nonhealth Field Total Finance 0 0 19 19 Operations 8 30 9 47 Planning 3 10 13 26 Total 11 40 41 92 Respondents had a mean of 11.8 years of senior management experience, 10.8 years of senior management experience in healthcare specifically, and had been employed by their organizationfor an average of 10.6 years (range 0-35 years). 8
About the Organizations Less than 500M, 54% Size of Budget 1B or greater, 30% Stable, 20% Three-Year Budget Trend Decrease, 8%, 0 Large Increase, 41% 500M to 1B, 15% Small Increase, 31% 9
40% 35% 30% 25% Reported Turnover among Senior Executive (last 3 years) 38% 35% 27% 20% 15% 10% 5% 0% Major (c. 50%) Moderate (c. 25%) Minimal 10
SOME SURVEY FINDINGS 11
Type of Resource Allocation Process Historical, 24% Formal/Rational, 51% Ext. Politics & Mandates, 22% Int. Politics, 2% 12
Aspects of Formalization 45 40 35 30 25 20 24 16 13 12 12 16 11 7 6 15 5 10 5 16 21 20 18 17 14 18 19 17 13 3 0 Dedicated technical support Explicit internal communication plan Numeric system for weighting criteria and comparing scores System to inform public and external stakeholders Quantitative measures of costs and benefits Based on published framework or research evidence Clearly defined benefit criteria Written procedural manual Appeal mechanism Formal process or outcome evaluation 4 QALYs or similar Formal Other Means Formal =3.8 vs Other =2.8 13
Perceived Fairness of Resource Allocation Processes 70% 60% 62% 50% 40% 30% 33% 34% 25% 20% 15% 16% 10% 8% 9% 0% Strongly agree Agree Neither agree or disagree Disagree 0% 0% Strongly disagree Personal Belief Perception of Others' Belief 14
Formal Process x Fairness Disagree or Strongly Disagree Neither Agree or Disagree Agree or Strongly Agree Mean score (on a five-point scale) Formal Process 2% 5% 93% 4.07 Historical or Political Process 28% 26% 47% 3.19 15
Overall, how would you rate your organization s resource allocation process Very poor, 0 Very good, 2% Poor, 11% Good, 49% Fair, 37% Mean score = 3.43 out of 5 16
Formal Process x Overall Rating Poor or Very Poor Fair Good or Very Good Mean (on a scale of 1-5) Formal Process 2% 25% 73% 3.72 Historical or Political Process 18% 50% 32% 3.16 17
Enablers of Effective Resource Allocation Percent who 'agree' or 'stongly agree' that these features are present 75 79 75 74 65 50 54 48 46 44 42 39 32 25 24 0 18
Net Enablers x Overall Rating 4.5 4 Mean Overall Rating (1-5 scale) 3.5 3 2.5 2 1.5 1-10 -5 0 5 10 Net enablers score (-12 to +12 range) 19
Recap We used three main summative measures: One half of respondents indicated that their organization had a formal process in place, though few respondents report specific aspects of formalization derived from the literature 70% suggested that they would consider their own process to be fair 51% stated that they would assess their process as very good or good Individual and organizational characteristics generally not related to responses 20
CASE STUDIES 21
Case Studies RHA Planning& Purchasing Tertiary Hospital Centre $1B+ Budget 1 1 $500M-$1B 1 1 Less than $500M 1 1 22
Perspectives Board Members Senior Managers Middle Managers 23
Thanks for listening! 24