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OPTIMIZING REGISTRY RESOURCES:

OPTIMIZING REGISTRY RESOURCES:. California's Workgroup-Based Strategic Planning Project to Manage Declining Resources and Streamline Registry Functions. Authors: Barry Gordon, Margaret McCusker, Lilia O'Connor, Kurt Snipes Cancer Surveillance and Research Branch

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OPTIMIZING REGISTRY RESOURCES:

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  1. OPTIMIZING REGISTRY RESOURCES: California's Workgroup-Based Strategic Planning Project to Manage Declining Resources and Streamline Registry Functions

  2. Authors: • Barry Gordon, • Margaret McCusker, • Lilia O'Connor, • Kurt Snipes • Cancer Surveillance and Research Branch • California Department of Public Health

  3. The Perfect Storm Hits California

  4. The ‘Perfect Storm’ • State budget cut of 10% with more anticipated • Newly created CA Dept. of Public Health • New Cancer Surveillance and Research Branch • Need to comply State contract audit findings • New top registry management • New state and NPCR 5-year contracts • NPCR central registry budget cut

  5. Action Strategy • Set up inclusive planning process • Emphasize transparency • Meet short timeframe • Establish formal decision processes • Manage process as a project • Set clear overall goals

  6. Inclusive Planning Process • Established at start • Included all 150 staff • Regional and central • All job categories • Goals • Draw on creative talent and experience • Maximize buy-in on decisions

  7. Regional Registries (2007)

  8. All Ideas Welcome • No barriers for idea-gathering • Ideas evaluated on • No overall loss of data quality • No retreat from full state monitoring • Continue to meet NCI, CDC, CA standards • Bottom Line • Don’t make changes we can’t recover from if funding improves

  9. Emphasize Transparency • CCR-wide transparency • All parts of analysis and decision processes • New Sharepoint website • Plans, timelines, reports, and Q&A’s • All data analyses, FTE effort surveys, and other decision-support documents • “Ask CCR” email address • Questions and answers posted on website • Periodic statewide teleconferences

  10. Strategic Goals • Agreed to by Regional Directors and CCR Unit Chiefs • Approved November 1, 2007 • Primary Goal: Recommend cost-saving measures to meet expected 10% state budget cut starting July 1, 2008

  11. Other Goals • Continue to meet contractual obligations • Plan for additional 10% savings to meet expected FY 09-10 state budget cut • Streamline Administrative Structure Statewide • Standardize How Registry Functions are Carried Out Statewide

  12. More Goals 6. Ensure high quality data sets ready for research within 18 months of diagnosis 7. Expand CSRB capacity for chronic disease surveillance and research 8. Allocate funds for policy and communications activities to promote broader use of registry data and resources

  13. Short Time Frame to Complete Planning Process • November 1-2: Initial Planning Leadership Meeting • November 9: WG participants identified • December 3: WG project initiation documents completed • December 13 and January 15: WG status reports due • February 29: WG final reports due • March 6: Milestone meeting to review all recommendations and decide to implement • June 30: Plan complete and ready for distribution

  14. Timeline (partial)

  15. Making Good Decisions • Openness and inclusiveness not enough to guarantee good decisions • Established rules for deciding which ‘efficiencies’ were real, which had hidden costs • Fact-based decisions • e.g. # FTE’s currently needed for each activity in each location • Developed decision criteria for work groups, plus criteria for oversight team to evaluate top recommendations

  16. Example of Decision-support Data Collection

  17. Work Group Strategy Guidelines: What to Document • FTE cost savings • Resources required to implement • Benefits and limitations • How strategy supports overall CCR mission • How strategy facilitates other registry functions and activities • At least two options for comparison

  18. Evaluating Each Strategy Recommendation • Is it feasible? • Does it meet core responsibilities? • Does it encourage program building? • Does it encourage integrated activities and build constituency/stakeholder base?

  19. Managing the Process • Important to establish neutral perspective • Outside consultant facilitated planning meetings (someone without a stake) • Managed like any important project • Standard initiation & status reporting documents for each WG • Included issue management and change management

  20. Oversight Workgroup • Led by Dr. McCusker • Included state program leads and WG leads • Managed timeline, progress, and review process

  21. Workgroup Areas • Automation: Lilia O’Connor • Capacity Planning: Dennis Deapen and Mignon Dryden • Epidemiology Capacity: Janet Bates • External Revenue: Dee West • Internal Revenue: Kathy Marineau • Hospital Reporting: Barry Gordon • Visual Editing and Audits: Nancy Schlag

  22. Automation • Casefinding • Decide what is needed to complete Eureka-based statewide casefinding system to realize efficiencies it will provide • Physician Reporting • Evaluate options for improving physician reporting in order to decrease resources required • Electronic Pathology Reporting • Define actions needed to promulgate electronic pathology reporting throughout California

  23. Capacity Planning • Determine what registry functions should be conducted statewide vs. regionally or locally • Look at advantages and disadvantages of merging regional registries • Epidemiology subgroup

  24. External Revenue Survey, list, and categorize ideas for external revenue generation

  25. Internal Revenue • Generate cost-saving ideas within regional and central CCR offices by soliciting suggestions from all CCR staff • Ideas forwarded to other workgroups

  26. Hospital Reporting Recommend ways to enhance hospital reporting and find associated cost-savings or revenue generation opportunities • Direct Upload of hospital cases, follow-up, and corrections • Evaluate benefits of Direct Abstracting of hospital cases • Assess +/- results of implementing incidence reporting / 3-stage reporting/ semi-automated hospital abstracting • Increase revenue from hospital registries

  27. Visual Editing and Audits • Develop sampling plan to reduce number of cases visually edited while continuing to maintain quality • Determine number and types of audits needed statewide • Evaluate impact of plans on cost savings

  28. The ResultsApproved Budget-Cutting Recommendations • Visual Editing (VE) • Reduce visual editing from 100% to 40% of admissions, except for key specific sites • Enact VE sampling plan through Eureka • Audit to evaluate effects of VE reduction

  29. Approved Budget-Cutting Recommendations • Registry Software • Start charging basic fee for providing CNExT software to hospitals in CA

  30. Other Approved Recommendations • Account for efficiencies realized by moving to statewide database management system • Streamline audit process by being more selective about which data items and sites to audit • Decrease number of times follow-back sources are contacted

  31. Other Central Office Efficiencies • Decreased rent costs • Decreased printing budget • Close out majority of consultant contracts • Look for alternative sources of funds • Move towards matrix management

  32. Reductions Summary • By combining all these measures we reached our 10% reduction goal for ‘08-09’ • Planning continues for handling potential cuts the following year.

  33. Other Recommendations • Capacity Planning • No significant cost savings from regional reorganization, given associated risks • Do not implement any reorganization during next 12 months • Improved integration of the three CA SEER regional operations and data utilization

  34. Other Recommendations • Epidemiology Capacity • Allocate coverage of epidemiologic functions across Greater CA according to function instead of geography • Hire Health Educator to • Create centralized response system for community cancer concerns • Assist local cancer control collaborations • Build relationships with cancer centers, public health schools, and national programs

  35. Other Lessons Learned • Planning for downsizing is daunting • Must engage all staff in process • Can lead to better decisions and more positive attitudes • Some ‘great’ ideas don’t actually save money • Transparency and open communication critical to strategic planning process

  36. More Lessons Learned • It takes money to save money • This is a ‘passionate, committed group’ • Our common ground outweighs our differences.

  37. The Adventure Continues • Strategic planning process ongoing • Plan to integrate recommendations of SEER Visioning workgroups to develop other efficiencies • Many new questions generated • Need to monitor impact of changes on data completeness, timeliness and quality • Goal: continue to meet CCR mission in sustainable manner

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