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PBMA at St Joseph’s Health Centre

PBMA at St Joseph’s Health Centre. Francois Dionne School of Population and Public Health, UBC Craig Mitton Centre for Clinical Epidemiology and Evaluation, VCHRI Carolyn Baker President and CEO, SJHC. Why this case study?. Use of PBMA in budget making decisions

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PBMA at St Joseph’s Health Centre

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  1. PBMA at St Joseph’s Health Centre Francois Dionne School of Population and Public Health, UBC Craig Mitton Centre for Clinical Epidemiology and Evaluation, VCHRI Carolyn Baker President and CEO, SJHC

  2. Why this case study? • Use of PBMA in budget making decisions • Integration into budget making process of a large acute care organization

  3. Presentation outline • What is St. Joseph’s Health Centre (SJHC) • Why PBMA at SJHC • PBMA process at SJHC • Results of the evaluation of the PBMA process at SJHC • Recommendations and lessons

  4. St Joseph’s Health Center • 371 bed teaching community hospital in Toronto, Ontario • 21,000 admissions a year at the hospital and almost 220,000 ambulatory care visits • Annual budget around $230 million

  5. Why PBMA at SJHC • Starts with budget pressures- current and expected • Which led to the search for a broader approach than basic ‘do more with less’ • Which led to PBMA

  6. PBMA process at SJHC • Existing structure: Operating Plan • Operations Committee • Operations Planning Committee • PBMA structure: • Operations Committee– Advisory Panel • Resource Allocation Committee– Working group

  7. Criteria

  8. Criteria continued

  9. Short form to long form • Selection made by Senior Management • Business cases: 6 investments 15 resource releases

  10. Ratings- investments • #1 141.900 • #2 129.000 • #3 92.300 • #4 72.100 • #5 54.600 • #6 (5.600)

  11. Ratings- Disinvestments • #1 Eliminate a Clinic 37.400 • #2 Eliminate b Clinic (4.900) • #3 Eliminate c program (6.700) • #4 Eliminate d Health Centre (13.300) • #5 Reduce e service(14.400) • #6 Eliminate f Clinic (16.000) • #7 (87.000) • #8 (91.300)

  12. Impact on resource allocation • Top 6 disinvestments approved for implementation • Freed up a little over $1 million for reallocation to investments

  13. Evaluation • Observation of results • Semi-structured interviews: 14 respondents, - clinicians and managers - 3 levels of authority

  14. Strengths of the process • Rigor • Participation

  15. Areas for improvements • Transparency and communication • Mechanics

  16. Recommendations • Transparency - Formalized Short form to Long form selection process - Communication strategy for decisions - Confirmation of the role of OPs - Criteria for membership in the RAC - Explicit and inclusive Appeals process

  17. Recommendations • Technical issues: - Stricter requirements for evidence in proposals - Clear authority for RAC to send back proposals - Better defined role for support service managers

  18. Impact of PBMA at SJHC • Overall, evaluation results very positive • 13/14 respondents strongly support continued use of the process • “I think it’s a culture shift in terms of the way we use resources and I think what this does is it helps people understand the opportunity cost better, which is what this is always all about, right.”

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