OPTIMIZING REGISTRY RESOURCES:

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OPTIMIZING REGISTRY RESOURCES

• California's Workgroup-Based
• Strategic Planning Project to Manage Declining
  Resources and Streamline Registry Functions

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

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The Perfect Storm Hits California
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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

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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

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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

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Regional Registries (2007)
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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
• Dont make changes we cant recover from if
  funding improves

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Emphasize Transparency

• CCR-wide transparency
• All parts of analysis and decision processes
• New Sharepoint website
• Plans, timelines, reports, and QAs
• All data analyses, FTE effort surveys, and other
  decision-support documents
• Ask CCR email address
• Questions and answers posted on website
• Periodic statewide teleconferences

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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

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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

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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

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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

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Timeline (partial)
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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. FTEs currently needed for each activity
  in each location
• Developed decision criteria for work groups, plus
  criteria for oversight team to evaluate top
  recommendations

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Example of Decision-support Data Collection
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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

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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?

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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

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Oversight Workgroup

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

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Workgroup Areas

• Automation Lilia OConnor
• 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

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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

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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

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External Revenue

• Survey, list, and categorize ideas for external
  revenue generation

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Internal Revenue

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

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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

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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

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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

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Approved Budget-Cutting Recommendations

• Registry Software
• Start charging basic fee for providing CNExT
  software to hospitals in CA

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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

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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

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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.

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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

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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

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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 dont actually save money
• Transparency and open communication critical to
  strategic planning process

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More Lessons Learned

• It takes money to save money
• This is a passionate, committed group
• Our common ground outweighs our differences.

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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