Alberta Health Services Performance Review
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Alberta Health Services Performance Review Final Report December 31, 2019 Contents 1. Executive summary ____________________________________________ 2 2. Introduction __________________________________________________ 6 3. Review approach and methodology ____________________________ 13 4. Stakeholder engagement findings _____________________________ 16 5. Workstream findings and recommendations ____________________ 22 Improvement Theme: People ________________________________ 25 Workforce ______________________________________________ 25 Management review _____________________________________ 46 Physician optimization ___________________________________ 57 Improvement Theme: Clinical services _______________________ 63 Clinical utilization _______________________________________ 63 Service configuration ____________________________________ 92 Clinical support services _________________________________ 110 Improvement Theme: Non-clinical support services ___________ 125 Non-clinical support services _____________________________ 125 Corporate and back office services _______________________ 140 Supply chain ___________________________________________ 154 Improvement Theme: Governance __________________________ 164 Functional duplication and accountability __________________ 164 6. Opportunity prioritization ___________________________________ 178 7. Implementation recommendations and the path forward_________ 190 8. Appendices ________________________________________________ 195 Appendix A: AHS employee survey results ___________________ 195 Appendix B: Summary of Recommendations _________________ 212 Appendix C: Summary of prioritized opportunities ____________ 217 NOTICE Ernst & Young LLP (EY) prepared the attached report only for Alberta Health (AH) pursuant to an agreement solely between EY and AH. EY did not perform its services on behalf of or to serve the needs of any other person or entity. Accordingly, EY expressly disclaims any duties or obligations to any other person or entity based on its use of the attached report. While EY undertook a thorough review of AH spending per the terms of agreement, EY did not perform an audit or review (as those terms are identified by the CPA Canada Handbook – Assurance) or otherwise verify the completeness of any information provided to us of AH, the Government of Alberta, or any of its funded operations financial statements. Accordingly, EY did not express any form of assurance on accounting matters, financial statements, any financial or other information or internal controls. EY did not conclude on the appropriate accounting treatment based on specific facts or recommend which accounting policy/treatment AH, the Government of Alberta, or any funded operations should select or adopt. The observations relating to all matters that EY provided to AH were designed to assist AH in reaching its own conclusions and do not constitute EY’s concurrence with or support of AH’s accounting or reporting or any other matters Alberta Health Services Performance Review | 2 1| Executive summary 1 Executive summary Alberta’s provincial health care model is one that deserves great praise. Through many years of regionalization, restructuring and redesign, Alberta has established the largest integrated provincial health care system across Canada, with more than 125,000 staff and 10,000 physicians serving 4.3 million Albertans. Alberta’s model has driven many successes. Integration has enabled Alberta Health Services (AHS) to streamline governance and accountability, driving standardization through provincially-delivered programs. Organizational leadership and culture have strengthened through consolidation – AHS is one of Canada’s top 100 employers and is consistently recognized as a great place to work. AHS also raises more than $250 million annually through its foundations, which are invested in the health care system. The transition from regional health authorities to AHS has also enabled greater integration, including through the consolidation of administrative systems like payroll, and through the current implementation of Connect Care, the largest province-wide clinical information system across Canada. The shift away from regionalization over the last 20 years has clearly begun to pay off while providing Albertans with a platform from which to continually modernize and improve health services delivery. However, a significant challenge remains in Alberta. Alberta spends more money on public services than any other Canadian province. Health care, which accounts for approximately 43% of the public spend in Alberta, continues to outpace provinces such as Ontario, BC and Quebec on a per-capita basis. Considering the structural growth pressures that exist in health care, notably negotiated wage increases and population growth, Alberta’s spending on health would have to remain flat over the next four years to align with these provinces. This is a key component of Premier Kenney’s Health-Care Guarantee to Albertans, which included a performance review of AHS. In conducting this review, we aimed to provide clear answers on how health care dollars are being spent, what improvement opportunities exist across AHS when considering leading organizations and systems, and to provide recommendations on how long-term sustainability of the health care system can be achieved. In alignment with the Health-Care Guarantee, core to our review approach was hearing directly from Albertans, including patients, staff and physicians working in AHS. We also heard from key stakeholder groups including patient advocates, regulatory bodies and associations, as well as municipalities and universities. We received an overwhelming response from Albertans, AHS employees and physicians. More than 30,000 responses were received through surveys, interviews and focus groups. This signals to us that Albertans recognize that change is needed and want to be part of it. At the commencement of our work we were given clear direction by the Minister to engage broadly, and to hear directly from Albertans. We have done so and have been guided by the thousands of Albertans – from physicians and care providers to front line staff, managers and the organizations that work alongside AHS - who have shared their perspectives and ideas through this process. Alberta Health Services Performance Review | 3 1| Executive summary We leveraged the response from across the province to design ten focus areas, or workstreams, that aligned with where the current state analysis and benchmarking of AHS’ performance took us. We then took opportunities aligned to these workstreams to staff closer to the front-line to validate and further understand their causes and historical drivers. We also assembled a panel of Global Experts with experience working with health systems like AHS, and who have led significant optimization efforts, to provide an international point of view on potential opportunities, as well as key considerations for implementation and long-term sustainability. This led to the design of recommendations grouped into 4 key areas of improvement: governance, people, clinical services and non-clinical services. Each area is associated with specific workstreams. The recommendations and opportunities in this report are provided at the workstream level. Figure 1. Improvement themes and workstreams1 The reality is that AHS will need to take actions on a range of opportunities to meet their budget targets, while managing growth pressures and funding provincial strategies such as reducing surgical wait times. We are not suggesting AHS can implement the opportunities we’ve described in this report all at once. In fact, we expect that appropriate validation and phasing of opportunities will be a critical element of the path 1 In addition to recommendations aligned to the workstreams, 5 recommendations have been put forward aligned to Implementation. These are outlined in Section 7 of this report. Alberta Health Services Performance Review | 4 1| Executive summary forward. Our intention is to provide AHS with potential areas of focus, evidence, and opportunities that they can leverage in their future planning efforts to manage operational costs and anticipated pressures. AHS will need to consider the opportunities presented and, in coordination with Alberta Health (AH), develop an achievable plan for implementation. The values included in this report are presented as gross opportunity amounts and do not represent expected or even achievable savings. The values are presented in this manner to illustrate the breadth of the opportunity that is available to AHS. Achievable savings need to factor in implementation costs, the selection, phasing and sequencing of opportunities, and any potential interdependencies across opportunities. This report provides AHS with a framework from which to begin designing specific initiatives as part of a multi-year implementation strategy. This will inform a savings value that the organization can plan for. The development of this strategy is discussed in greater detail in the final section of this report. AHS was an active and helpful participant in this exercise. Their executive team led by CEO Dr. Verna Yiu, was highly responsive, providing us with all relevant information and access to key staff within the organization and across the province. The report that follows summarizes the findings, recommendations, and opportunities identified throughout our review. It is our hope that this will inform Alberta’s continued journey