New Expectations, New Possibilities: Creating an Integrated Health System June 5 th, 2007.

New Expectations, New Possibilities:Creating an Integrated Health System

June 5th, 2007

Overview

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What we Have Done

• Extensive community engagement across the region• Establishment of planning partnerships• Detailed feedback and data collection to validate directions• Integrated Health Service Plan • IHSP work plan • New investments and projects launched• LHIN Board and organizational developmental start-up• April 1 transition to LHINs

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LHINs New Expectations Health Service Providers

• Align their strategic and service planning within the overall LHIN framework, with specific reference to the priorities identified in the 2006-2010 Integrated Health Service Plan

• Participate in LHIN planning exercises and provide the input and necessary information for the development of LHIN plans

• Identify integration opportunities and demonstrate continuous improvement in service integration, coordination and quality

• Implement the directions for integration laid out in the accountability agreements with LHINs


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5 main areas where the public can expect change:

1. Increased integration and improved service coordination

2. Increased local decision-making about funding and allocation

3. Greater emphasis on local health system planning

4. Increased community engagement

5. Enhanced Accountability


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Alignment to the Integrated Health Service Plan

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Central East LHINNew Investments


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$1.35M for Geriatric

Emergency Management

$1.5M for ICU in Rouge Valley

Ajax-Pickering

$.9M for Musculoskeletal

Assessment Centre

$.6M to increase home care &

community supports

Criteria for Integration Innovations and Proposals

1. Was it vetted by LHIN Planning Partners?

2. Is it aligned with the IHSP?

3. Is it evidence-based and can it be measured & monitored?

4. Who shares accountability for its accomplishment?

5. How will it be resourced?


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Our Commitment to Leading Change Through Engagement

• We will promote and reward a culture of cooperation and mutual interests (negotiation) rather than the failed approaches of command and control (provocation).

• Engagement will happen at all levels from governance to front lines to community residents

Because….• Engagement unlocks and leverages system planning expertise to

create real solutions • Provides a means for emerging trends to be identified• Involvement stimulates ownership and responsibility for results!

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LHIN StrategicLHIN Strategic LHIN TacticalLHIN Tactical LHIN CommunityLHIN Community

NetworksNetworks Mental health and addictions / Seamless Care for Seniors / Chronic Disease Prevention and Management

Alternative Levels of Care

Emergency Department Wait Times Task GroupsTask Groups Rehabilitation Services / E-Health

Primary Care Working Group

9 Planning and Engagement Collaboratives CollaborativesCollaboratives

Central East LHIN Planning Partnerships

Local residents, seniors, family members, physicians, nurses, pharmacists, physiotherapists, administrators,

and other health professionals are working together!

Governance for System Change• The Central East LHIN Board has identified the engagement of local

health care governance as a top priority.• “Board to Board” engagement will focus on bringing together

governance leaders within health service providers and the LHIN to for information sharing and strategic planning

• It is expected that health service providers will engage each other in the efforts to meet local need

• A governance steering committee will be established in the Fall of 2007 that will examine ways to equitably and effectively engage local governance


“Integration” as defined through Legislation

2(1) “integration” includes (a) to co-ordinate services and interactions between different persons and

entities;

(b) to partner with another person or entity in providing services or in operating

(c) to transfer, merge or amalgamate services, operations, persons or entities

(d) to start or cease providing services

(e) to cease to operate or to dissolve or wind up the operations of a person or entity.

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In simple language…

• Health system experienced as a coordinated system: People will get the right treatment at the right time by the right provider

• Seamless flow of information that supports patient care• A system that begins with primary care providers with an equal focus

on prevention and health maintenance• Create timely access to quality services by aligning people,

processes and resources• Elimination of wasteful and time consuming duplication• Involvement of patients, residents, family and informal caregivers


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Making Integration Happen

• Requires coordinated efforts of the LHIN and health service providers.

• LHIN Planning Partnerships are a resource to the LHIN and its health service providers


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Example: Supporting Health Service Provider Planning

LHIN Collaborative

Central East LHIN

• Local health service provider (s) identify to the LHIN• Integration opportunity• New program / services• Local barriers for improved performance

• Health service provider(s) engage LHIN planning partners for expert advice and information in support of meeting local needs, advancing new ideas, or in the preparation of business plans

• May also involved governance to governance engagement

• Health service provider(s) submit business plans or ideas (with demonstrated engagement of LHIN planning partners) to the LHIN for further consideration.

Health Service Provider (s)

Health Service Provider (s)

Task Group/Networks

Denotes potential referral back to LHIN


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Governance Advisory Bodies

(TBD)

• LHIN may implement through service accountability agreements (SAA) with service providers or integration decisions.

Opportunities for Integration & Integration Decisions

• Facilitated or Negotiated Integration Decisions• Required Integration Decisions• Stopping Voluntary Integration


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Example: Facilitated or Negotiated Integration Decisions under 25(2)(a)

LHIN facilitates or negotiates integration

involving HSP(s)

Health Service Provider(s)implement

LHIN issues integration decision

Presupposes prior negotiation with Ministry of Health and/or engagement of health service providers, other entities and LHIN planning partners.

Ministry-LHIN Accountability Agreement

Use of Planning PartnershipsBoard-to-Board Engagement


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Example: Required Integration Decisions

25 (2)(b) A local health integration network shall issue an integration decision when the network requires a health service provider to proceed with an integration under s. 26;

• Such instances may be a result of government action or policy, or public interest requiring expedited outcomes

• In all other instances, use of such authority signals a shortcoming by the LHIN in meeting its standards of collaborative planning


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Required Integration Decisions under 25(2)(b)

LHIN considers any submissions; may change or confirm original integration decision

LHIN requires integration by funded HSPs

Health Service Provider

LHIN issues proposed integration decision

LHIN issues final integration decision

Within 30 Days

No timeframe specified

Anyone may make submissions regarding

proposed decision, including

Task Group/Networks

LHIN Collaborative

Health Service Provider


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Example: Integration Decisions that Stop Voluntary Integrations

25 (2)(c) A local health integration network shall issue an integration decision when the network orders a health service provider not to proceed with an integration under s. 27;

• Use of such authority by the LHIN signals a shortcoming by the health service provider(s) in providing early awareness of the issues and/or health service providers lack of participation in LHIN collaborative planning.


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Example: Integration Decisions that Stop Voluntary Integrations HSP gives notice to LHIN that it

wishes to integrated funded services

LHIN considers HSP noticeLHIN does not issue a proposed decision stopping integration

LHIN issues proposed decision stopping integration

LHIN Considers any submissions; may change or confirm proposed

integration decision

LHIN does not issue a final decision stopping integration

LHIN issues a final decision stopping integration

Integration may proceed

Integration may proceed Integration may NOT proceed

Within 60 Days

Within 30 days, anyone may make submissions regarding proposed decision, including

Task Group/Networks

LHIN Collaborative

Health Service ProviderWithin 30 Days


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A Focus on Accountability

• People have the right to expect accountability from their governments– To that end, Central East LHIN has entered into an accountability

agreement with MoHLTC That sets out the mutual understandings and performance obligations of both parties in the period from April 1, 2007 to March 31, 2010

• The public also have the right to expect that their health service providers will be accountable for the quality of services they provide– To that end, part of CE LHIN mandate is to negotiate Service

Accountability Agreements (SAAs) with health service providers

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The Purpose of the Planning to Action SymposiumJune 6-7, 2006

• Network and celebrate champions for change: Networks, Collaboratives and Task Groups

• Create capacity of system to plan, coordinate and innovate across organizations

• Align planning partnerships to specific tasks outlined in the Integrated Health Service Plan


N = Network!

• Identifying and implementing change is our collective responsibility

• Your LHIN is committed to removing the barriers that keep all of us from working and achieving together

• New challenges and opportunities for health system governance


Confidence Abounds!

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Thank You!

New Expectations, New Possibilities: Creating an Integrated Health System June 5 th, 2007.

Documents

change slide

leading change

service planning

service integration

lhin planning exercises

lhin planning partners

lhin board

integrated health system