The Facilitation of a Visioning Session

A visioning session for a provincial healthcare organization was facilitated during a half day face to face meeting. This was supported by planning with the group’s executive using two short teleconferences to discuss agenda and pre-meeting work circulated by email.  Based on the facilitated session, we provided  PowerPoint slides to the executive for presentation to the larger membership the following day, as well as supporting detail at a later date.

Strategy for the Commercial Health Market

Identifying profitable growth opportunities in the Canadian commercial healthcare market was the focus of this strategy study for a major Canadian bank.  The work involved extensive use of secondary databases, as well as interviews with key informants.  A future-oriented look that included changes in licensure and scope of practice formed part of the work. 


Review of Clinical Information Service & Registration & Admission Processes

This review, conducted in a mental health setting, had central goals regarding the data process within the organization. The review began with key informant interviews. Findings from this phase contributed to direct observation, and interviews in the reviews of clinical information services and registration and admission. These specific reviews resulted in detailed findings and associated recommendations aimed at the central data process goals, as well as the clients’ areas of interest regarding the current organization of process, internal capacity, and organizational challenges.

Work Flow Analysis for a Community Health Centre

A team conducted a workflow analysis aimed at facilitating change to current clinical administrative systems. This project took place in a highly complex setting, where client privacy must be sensitively respected.  As well, the client must remain consistent with best practice in their clinical service areas. A redesign of the administrative structure was presented in text and visual format, and supported by quantitative results from work flow studies and in-depth key informant interviews.

Integrated Health Service Plans and Community Engagement Strategies – An Initial Review

Participated in the review conducted for the 14 Ontario LHINs by  MC Mac-Niven Consulting. This was an independent comparison and assessment of each organization’s community engagement strategies and their initial Integrated Health Services Plans. The MC MacNiven report  provided general recommendations, and  a comparative analysis of information presented across the 14 LHINs. The report also identifies opportunities to improve processes across the system.

Future of Healthcare in Canada

This is a massive opinion leader study based on in-depth personal interviews with 80 of the most influential people in healthcare today, as nominated by their peers. Participants include deputy ministers, academics, hospital executives, healthcare practitioners and other qualified parties. The aim is to identify how healthcare will develop over the next 5-10 years and why this will happen. Royal Bank of Canada and Manulife Financial are sponsoring the work. The study includes a special report on funding & financing issues for RBC, as well as a special report on insurance & benefits for Manulife Financial. Link to Overview of Findings.

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- Quality & Risk
- Analysis of Care Systems
- Data, Detail & Decisions

Therapy Service Delivery Model Project

A community based multidisciplinary care organization is engaged in developing an overview of major client groups, along with consistent therapy service models across all clients and service sites. In addition to the clear picture of major client groups, the key stakeholders in the project group have also identified critical junctures in the client journey. Development of flow charts of the clients’ experiences for the basis of related care management tools. The project management plans take into account the organization’s steps in integrating learning organization processes and attitudes.

Link to more studies on:
- Analysis of Care Systems
- Utilization Management

Patient Registration, Booking and Registry Project

The Brondesbury Group produced a report, documenting their findings of the Registration, Booking and Bed Registry environment review in a large multi-site community hospital. The report included suggested recommendations for improvement and supporting business cases as well as implementation plans.
The objective of this project was to gain a complete and thorough understanding of the processes and workflows within the Registration, Booking, and Bed Registry environments, such that the efficiencies and inefficiencies were clearly understood and documented. The review involved in-depth analysis of staff and process at both the larger facilities and a sample of community based clinics. Click here to see a Brief Overview.

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- Information Management
- Data, Detail & Decisions

Design of Survey Instruments – Provincial Study of Primary Care Processes

In order to effectively move primary care record-keeping to an electronic environment, one needs to understand the critical information flows. As part of a larger study for a provincial government, we created survey instruments to track communications flows related to primary care. The instruments identified the source and destination of communications, their nature, the information conveyed and the priority level of information exchanged. Instruments were designed to identify both frequency and importance of information, so that a system geared to both considerations could be developed.

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- Information Management

National Infrastructure for Electronic Health Records

Electronic Health Records (EHR) are increasingly part of our health care system, but access to them remains in the paper based paradigm. What would be the impact of an infrastructure creating a comprehensive EHR system on a national scale -- not as a replacement for local systems but as a central repository for information on patient care of all kinds? This study looks at the economic and social impact of this kind of system for representative groups of patients. Expert reviews of information flow and patient care are compared, before and after creating a comprehensive system. We look at the use of information across the health care system when dealing with a patient episode and the kinds of benefits that would accrue from better access to a wide range of reliable information. Concerns of data integrity and privacy are also part of the discussion. Expert opinion establishes both the economic value and the quality of care benefits that are likely to follow from this kind of system.

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- Information Management

Evidence-Based Care Management Tools for a Multi-Site Care Provider

This Evidence-Based Care Management Tool process uses teamwork to support consistency across all sites and services in use of principles, processes, and services, to provide clients with similar potential outcomes. The Major Components of the Evidence-Based Care Management Tool Process include Assessment, Planning, Team Discussion, Goal Setting, and Tracking.
The evaluation of tools developed includes a pilot of draft 1 with 10-20 clients, and multiple caregivers. It also includes setting goals, objectives and related indicators, mapping a program logic model to guide detection of indicators for tracking, and collecting information about both intended and unintended effects. The evaluation also includes a review cycle for pathways which is linked to both CQI and administrative reporting schedule, as well as any new evidence relating to the client group. A review of referenced information is included as well. It addresses questions such as “Can the level of information be improved?” “Is new research evidence available?” Click here to see a Brief Overview.

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- Evidence Based Care Management Tools & Systems

Review & Future Plans for Quality and Utilization Management Programs

The Quality and Utilization Management Program at a large community hospital was felt to be an important influence on patient care management processes. It has been cited as a benchmark program for external facilities as an example of successful approaches to managing resources and patient access to hospital services. In light of the changes within the hospital and in the external community, a project was initiated to conduct a review to determine future plans for this program within the hospital.
Through consultation with various internal stakeholders, various goals were identified for the review. A confidential, semi-structured interview process was utilized with all stakeholder groups. The final report was structured around the goals, identified common themes and specific key concerns identified in the review process, and included recommendations regarding new structures, adapted processes, and valued elements to retain. Click here to see a Brief Overview.

Link to more studies on:
- Data, Detail, & Decisions
- Quality & Risk
- Utilization Management

Using Decision Support Feedback for Care Management Planning

A clinical team in a large teaching hospital had excellent decision support information to support their ongoing clinical and utilization management. An initial meeting with the core team members set the goals and framework for their ongoing process. This was followed by the facilitation of an initial full team meeting. Team members were supported in the important steps of depersonalizing the message, and working step by step in isolating key information to guide the selection of areas of success and challenge. An action plan from that meeting was provided, and the team continued the meeting process independently.

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- Data, Detail & Decisions

Pathway Implementation in a Small Hospital

A work-learn session on pathway implementation was customized to the small hospital setting. Among the issues identified as key concerns in implementing pathways at a smaller hospital are:
- What patient groups do we target?
- Who in our area needs to be involved in this process with us? e.g. CCAC, feeder hospitals?
- How do we keep the pathways concise, patient outcome focused, and easy to use?
- What is the best way to give feedback from pathway use back to the caregivers?

Link to more studies on:
- Evidence Based Care Management Tools & Systems

Decision Support Framework for a Multi-Site Community Hospital

A large multi-site community hospital used a stakeholder driven process to identify key areas to support with a decision support department. The framework built on skills of data analysis from health records, patient care management from utilization management and pathways processes, and program evaluation processes to support both ongoing hospital program development and the formative evaluation and development of the new department. Challenges included meeting the needs of administrators for decision support when data were not yet available, and developing ways of collecting and communicating information about the data flow, the data message, target patient groups, and summary messages.

Link to more studies on:
- Data, Detail, & Decisions
- Utilization Management