Government budgets and how they are spent is a continued topic of debate around the world and Canada is no exception. However, one point of agreement everywhere would be that taxpayer money should be spent efficiently and wisely. Canada is projected to spend over 253 billion dollars on healthcare in 2018, which represents around 11% of the National GDP; of this, the public sector pays approximately 69%. While the number does seem high, there are still competing demands for how the budget should be spent and it is imperative that the money be spent effectively.

It is thus heartening to read an example of how project management is improving the efficiency of healthcare delivery in Canada and thus has become a shining example for public sector project management. I refer to the "UHN (University Health Network) Discharge Summary Program" that has received numerous accolades, including winning the PMI Project Excellence award (2018), Business Transformation Operational Excellence Award (2017),  and 3M Canada Health Care Quality Team Award (2017), and being nominated for the PwC Vision 2 Reality Innovator of the Year Award (2017).

Our team at PMI Toronto was able to catch up with Andre D'Penha and Michael Caesar from UHN’s Data and Implementation Science Team, who gave us some insights into the project and the steps that led to them achieving these great results.

The Data and Implementation Science Team at UHN supports (a) impactful delivery of solutions benefiting the health system; (b) discovers, validates, designs, and delivers opportunities of change; and (c) brings contextual awareness through data to ensure successful implementations, value and outcomes.

So let's get to what they did:

The Situation

UHN discharges over 35,000 inpatients every year and generates over 46,000 Discharge Summary reports that are delivered to primary care providers. These reports summarize the patient’s hospital stay, and are very important for family practitioners and other medical specialists to resume care for the patient after they leave UHN.

However, in 2014, UHN faced three significant challenges:

1. Only 50% of patients had a report completed on time
2. Only 40% of the completed reports were auto-faxed to primary care providers, and due to sometimes inaccurate provider contact information, many never went through and piled up massive amounts of paper in the hospital, resulting in slower delivery via mail.
3. UHN practitioners, medical students, and residents did not have centralized education tools available to them to ensure consistency in value-add and quality of the reports

One of the bigger challenges the team faced was influencing organizational behaviour change for this multi-year, complex, clinical initiative – a challenge that was successfully overcome through our organization’s use of data in all aspects of the project,” explains Andre D’Penha, Program Manager, UHN Data Science Program

The Response

Recognizing this challenge, UHN launched the Quality Improvement Plan (QIP) Discharge Summary Program in Fall 2014 and took the following steps:

1. Established appropriate program and project governance to ensure support and commitment from leadership
2. Launched three business subject matter expert panels on three individual projects within the program to focus on identifying and actioning deliverables that enabled progress towards program goals
3. Developed and implemented an organization-wide change management strategy that actively engaged seven health professions from 51 inpatient units at seven hospital sites through a multi-media communications approach
4. Utilized Project Management Institute processes outlined within the Project Management Body of Knowledge Guide to implement organization-wide best practices, policies, standards, and electronic clinical documentation and reporting tools, through collaboration with UHN Clinicians, primary care providers, and Patient Partners

The Results

By engaging multiple stakeholder groups internally and externally, and utilizing data-based decision-making and evidence-enabled improvements, UHN was able to substantially improve operational process efficiencies, tighten connections with the community it served, and positively impact the patient continuity of care. It also resulted in the following:

1. 94% of UHN inpatients now have a timely Discharge Summary completed - a significant improvement from 50% in 2014
2. 89% of UHN Discharge Summaries are now auto-faxed to primary care providers within 48 hours of completion, a significant improvement from 40% in 2014
3. Clinicians can now customize patient medication and discharge information based on a patient's preferences, ensure standardized instructional content to improve patient safety, and reduce the likelihood of adverse medication-related events and medication errors post-discharge
4. Collaboration with the Royal College of Physicians and Surgeons of Canada to create a Continuing Professional Development - Discharge Summary quality module eligible for physician Maintenance of Certification credits
5. Collaboration with the University of Toronto to ensure education on the importance of a Discharge Summary for all medical students prior to their rotation at Toronto-area hospitals

Conclusion

This program is a great example of how public sector projects can be successfully implemented with engaged and effective leadership supported by project management standards and framework. The involvement and interaction with external and internal stakeholders and end-users as seen here, also helped to ensure operational sustainability of program outcomes and benefits.

“Problem-solving is not a straight line – focus on learning and gathering evidence, rather than on assumptions and solutions” concludes Michael Caesar, Executive Director, Data & Implementation Science. Some other key lessons learned include:

1. Utilize organizational data to (a) understand actual business problems to be addressed, (b) determine scope, (c) establish success indicators, and (d) demonstrate progress
2. Establish subject matter expert panels to monitor progress, highlight organizational risks, resolve issues, and advise on next steps to ensure continued progress towards established goals
3. Ensure leadership engagement and awareness in order to advocate for change, influence behaviour, and support areas for improvement
4. Engage both stakeholders and end-users to ensure value-add and sustainable adoption
5. Focus work effort and targeted incremental improvements to enable significant organizational change
6. Focus communications to address perceptions and assumptions, and change behaviour

References

• https://www.national.ca/en/perspectives/detail/three-ways-the-2018-federal-budget-will-impact-the-healthcare-sector/
• https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends/how-much-does-canada-spend-on-health-care
• https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends/who-is-paying-for-these-health-services
• https://www.cbc.ca/news/canada/calgary/alberta-spends-2-4m-an-hour-on-health-care-here-s-what-s-being-done-to-reduce-it-1.4589048
• https://www.benefitscanada.com/news/85-of-canadians-agree-mental-health-services-are-underfunded-survey-119178
• https://www.uhn.ca/corporate/News/Pages/how_transcription_services_saved_seven_feet_of_paper_per_month.aspx
• https://www.uhn.ca/corporate/News/Pages/improved_discharge_summaries_enable_patient_centred_care.aspx
• https://www.uhn.ca/corporate/News/Pages/website_helps_with_writing_a_better_discharge_summary.aspx
• https://www.uhn.ca/corporate/AboutUHN/Patient_Experience/Pages/spotlight.aspx
• https://www.uhn.ca/corporate/News/Pages/2017_Year_in_Review_Discharge_Summary_Program_at_UHN_earns_3M_Health_Care_Quality_Team_Award.aspx

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About the Author

Anand is a seasoned project management professional with experience in Railways, E-commerce  & financial services and currently works in consumer tech. Anand comes from an engineering background and holds an MBA as well as an MSc in Project Management.