1. Making Tough Choices: A journey to improve Engagement and Transparency National Health Leaders Conference June 16, 2015

2. 2013 – The Burning Platform  Budget Challenges  Claims on resources exceeded available resources… choices had to be made  Historical/ political processes were not generating desired results….the traditional “go to’s” were limited & worn  Stakeholder Concerns about budget decision making process  Lack of transparency  Delegation of authority not clear  Lack of clinician engagement

3. Our Goal Deliver quality care within our means Identify system efficiencies & improvements through engagement of medical community (service providers)

4. Tackling the Challenge…. Choose a new Budget Management Framework for  Identifying savings strategies & initiatives  Evaluating savings initiatives  Obtaining appropriate authorization for savings initiatives Which  recognizes influence of political environment  includes clinician engagement

5. PEI’s Key PBMA Steps….  Confirming time frame for process  Establishing structures, criteria and guidelines  Educating & engaging managers and clinical leaders  Developing & evaluating proposals  Seeking appropriate authorization

6. Key - Setting Criteria & Weighting QualityAccess Efficiency Effective Managemen t Risk Factors Assessed: Financial, Ongoing Operations, Political, Technology, Patient Care and Labor Relations 4115 19 25

7. Our PBMA Scope All services are within scope  Primary focus is on: hospital services, physician services, public drug programs  Concurrently, LEAN work focused on community service areas (e.g. home care, primary care, mental health & addictions)

8. Measures Volume of proposals  creative new solutions Significant improvement in financial results over past 3 years Recognition by Accreditation Canada

9. PBMA Results in millions Savings Target # of Proposals ResultOther Measures Cycle 1$8.5270$7.82$0.68 Cycle 2$5.572$3.33$2.17 Cycle 3Budget pending TBD Cycle 2 included a separate investment target  $4 million of system-generated investment proposals  $2.6 million of approved proposals have been actioned

10. Results PEI Health Spending Trends Fiscal YearNet Expenditure (in millions) % IncreaseSurplus (deficit) * (in millions) 2009-10$458.62($4.22) 2010-11$500.979.2%($6.28) 2011-12$525.384.9%($5.78) 2012-13$545.643.9%($2.37) 2013-14$565.703.7%$0.71 Results for FY2014-15 not yet publically available

11. Key Insights & Lessons Learned Executive leadership is essential Support Resources needed  Electronic system facilitated tight timelines and use of existing support resources Explicit Criteria and opportunity to have ‘say in the decision’ valued  Enables understanding but not always acceptance Struggle to balance urgency and time needed to complete process

12. Key Insights & Lessons Learned Re-investment needed for on-going engagement Ancillary benefit - general improvement in financial management

13. Challenges: Tips for Others Developing Organizational Trust Reality of political overlay PBMA rating of system enablers Implementation of approved proposals  Inter-agency issues  “You mean they said ‘Yes’?” Maintaining staff engagement Communicate, Communicate, Communicate!

14. Contact Information Denise Lewis Fleming Executive Director, Financial Services & Pharmacare Health PEI PO Box 2000, 16 Garfield St, Charlottetown PE, C1A 7N8 E-mail:dmlewis@gov.pe.ca