Transcript No Slide Title

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“Introducing Local Health Integration Networks (LHINs)”
Enlisting local involvement, local priority-setting & local innovation,
in the cause of better healthcare outcomes for Ontarians
Presentation to:
Canadian Association of Management Consultants and
Institute of Public Administration of Canada
(Toronto Regional Group)
Ontario Club, Toronto, January 17, 2006
Presented by…
W.Michael Fenn, CEO, Mississauga Halton LHIN
Delivered Toronto, January 17, 2006 (Check against
delivery)
Health Results Team
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Presentation…
• What are the challenges facing Ontarians in health care?
• What is the Government’s response?
• What is the leadership role of LHINs?
• How would Bill 36/05 enable the necessary reforms?
Health Results Team
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Caveat
• Legislation, currently before the Ontario Legislature, if
passed, would enable LHINs to leverage their powers and
roles in order to facilitate timely and appropriate access to
care for the residents of each LHIN
• This presentation should not be construed as assuming
that the proposed legislation will pass
• This presentation looks at the opportunities created by the
creation of LHINs
• Until appropriate legislation is in place, the LHINs have
only a planning and advisory function
Health Results Team
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Ontario’s “$30 Billion plus” Health Care Challenge
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Large variation in quality and quantity
No standardization
No interconnecting IS/IT; no “real time” data
Little detailed cost information
Little strategic allocation of human resources
Large variation in management skills and competencies
Health Results Team
Large Variation in Access (examples)
• Hip replacement in the HNHB LHIN
• 6 hospitals provide hip replacement surgery
• The median wait for patients receiving care in July
ranged from 65 days to 387 days (six fold difference)
• Cataract Surgery in the WW LHIN
• 3 hospitals provide cataract surgery
• The median wait for patients receiving care in July
ranged from 13 days to 178 days. (14-fold difference)
• Beyond this, variation between surgeons within each hospital
Health Results Team
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HNHB LHIN Hip Replacement Wait Time (July 2005)
Median and 90th percentile
700
600
DAYS
500
400
300
200
100
0
NHS
HDH
HHSC
SJHH
JBMH
Health Results Team
BGH
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Toronto LHIN Hip Replacement Wait Time (July 2005)
Median and 90th percentile
450
400
350
DAYS
300
250
200
150
100
50
0
SMH
SJHC
TEGH
UHN
Health Results Team
SWCHC
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Cataract Surgery
Waterloo Wellington Wait Time (July2005)
Median and 90th percentile
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350
300
DAYS
250
200
150
100
50
0
CMH
GGH
Health Results Team
SMGH
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“Wait Times” and Primary Care (family medicine)
- they’re connected
• Improving access to Comprehensive Primary Care
• Chronic disease prevention and management
• Appropriate referrals/utilization of
specialists/diagnostic services
• Supporting acute care
• And then there is information management….
Health Results Team
Better Information, Better Decisions
Charting Information Flows
Current Information Flows are Unsustainable (September 9, 2004)
Health Results Team
Data sources
Information Holdings
Analysis & reporting
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Government’s Vision…
“Our vision is of a system where all providers
speak to one another in the same language,
where there are no longer impenetrable and
artificial walls between stakeholders and
services: a system driven by the needs of
patients, not providers.”
Hon. George Smitherman,
Minister of Health & Long-Term Care
Health Results Team
Ontario Government’s
health-care transformation plan…
• Improved Access: Improved access and quality of primary
care, community and hospital services
• Measurement of Outcomes: Wait list registries,
management plans, service-performance agreements
• Structural and System Change: Local Health Integration
Networks (LHINs) and consistent data collection and
reporting
Health Results Team
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Engagement, Consultation & Collaboration
Engagement is the cornerstone of transformation
Engaging the Community
LHINs
• 4,000 people in 14 LHIN community workshops
• 200 attendees at LHIN planning forum
• 30 organizations on LHIN Action Group
• Over 1400 stakeholder participate in LHIN “meet and greet”
Primary Care/Family Health Teams (FHTs)
• FHT Community and Stakeholder Dialogues:
• 16 communities, 250 attended, 800 FHT information resource kits shared
New relationships are formed by new dialogue
Health Results Team
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Engagement, Consultation & Collaboration
Engaging the Experts
Access & Wait Times
• MRI and CT Expert Panel (11 experts)
• Cataract Expert Panel (12 experts)
• Hip and Knee Joint Replacement Expert
Panel (15 experts)
• Cancer Committee (14 experts)
• Institute for Clinical and Evaluative Studies
Atlas on Access (27 experts)
• Ontario Critical Care Committee (44
experts)
• Ontario Critical Care Expert Panel (18
experts)
• Surgical Process Analysis & Improvement
Expert Panel (22 experts)
• OHA Conferences on Improving Access
Information Management
• Data Gap Analysis (36 experts)
• Clinical Data Blitz (200 coders)
• Ontario Health Planning Guide (125 experts)
• Health System Scorecard Indicator Selection (20
experts)
• Hospital Health Records Survey (142 experts)
Primary Care
• Primary Heath Care Transition Fund Summit (over
100 projects funded)
• FHT Action and Working Groups
LHINs
• LHIN Action Group (29 Organizations)
• LHIN Funding & Planning Think Tanks
A new age of transparency in Government
Health Results Team
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Building Capacity
Building Capacity with Existing and New Resources
Family Health Team
• 69 FHTs announced, 81 to follow
• Expand access to healthcare to over 2.5
million patients
• Deliver services in health promotion,
disease prevention and chronic disease
management
Information Management
• Reducing the burden of data collection
Access & Wait Times
• Increase capacity by way of a rational
purchasing process
• 17% more cardiac procedures
• 28% more hip&knee replacements
• 16% more cataract surgeries
• 42% more MRI scans
• Innovation and Education Funds
• 18 Education Fund projects
• 36 Innovation Fund projects
Improving capacity and efficiency translates
into better quality outcomes
Health Results Team
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LHINS
“You cannot micro-manage a $33 billion operation
from head office.”
Minister George Smitherman
14 Local Health Integrated Networks (LHINs)
 Geographically based, recognizing hospital-related
health-care delivery patterns
 Non-profit organizations
 Designed to plan, integrate and fund local health
care services
 Community-based care: community needs are best
met when they are planned, co-ordinated and funded
within the community
Health Results Team
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LHINs Goals
1. Manage health system planning, coordination and funding
at the local level
2. Engage community in local health system planning
priority-setting, including establishing formal channels for
citizen input / community consultation
3. Better integration of services; improved accessibility of
health services; allow people to move more easily through
the health system.
4. Bring economic and operational efficiencies to delivery of
health services: promoting service innovation; improving
quality of care; making health care system more
sustainable and accountable.
Health Results Team
8 principles guiding LHIN role…
1. Patient focus – improving population health and the citizen's
experience
2. Strategic partnership – leadership to build long-term sustainable
partnerships
3. Stakeholder engagement – coordinated community engagement and
consultation
4. Evidence-based approach – planning / decision-making based on local
analysis
5. Transparency – open communication - transparent, non-partisan
decision-making
6. Fostering change through incentives – encouraging integrative /
creative solutions
7. Provider boards – provider board corporations to continue
8. Partnership of equals – valuing the contribution of all health and
community service providers
Health Results Team
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Achieving an integrated system
• Achieving integration goals depends on LHINs fostering a
culture supporting LHINs as leaders of integration and
coordination at the local level.
Integration outcomes:
• Seamless experience for user,
where boundaries between
organizations minimized
• Improved match between single
services provided and the multiple
needs of clients and families
• Effective and efficient use of
system resources and capacity
Health Results Team
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Timing & phase-in of LHIN functions
Phase in of LHIN functions will depend on a variety of factors including
approval of necessary legislative changes as well as LHINs own
internal capacity
START-UP
MATURITY
2006
2007
Local Community Engagement
Local Health System Planning
Integration and Service Coordination
Accountability & Performance Mgt.
Funding and Allocation
Health Results Team
LHINS
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Focused Leveraging & Alignment
• LHINs are intended to leverage:
• Strategy: provincial and local integration strategies to improve
access, quality and sustainability
• Structures: key accountability relationships; existing provider
boards, planning capacity, and networks of engagement
• Resources: existing and future financial and human (physical,
intellectual and leadership) resources, including funding
• Information: information management and performance-based
mechanisms tied to specific strategic outcomes
• Incentives: mechanisms to deal with success or non-compliance
Health Results Team
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Inter-LHIN cooperation & coordination
Models for inter-LHIN coordination are being developed to:
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Provide system advice to ministry policy
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Coordinate standard practices and systems across LHINs
Provide a forum for sharing information and best practices
Reinforce lines of communication between the ministry, LHINs and service
providers
Proactively manage risks and strategic issues related to implementation
Ensure operational consistency and policy alignment
Initial focus on:
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LHIN Board Chairs / Minister forums
LHIN CEOs / Deputy Minister forum
Health Results Team
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What we are being asked to do…
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Local health system funding & performance monitoring
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Local system-integration and service-coordination
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Allow people to move more easily through the health system and
improve general level of accessibility
Community engagement in local health system planning and prioritysetting
Overcome institutional & professional obstacles / barriers to
integration & collaboration
Health Results Team
Successful public sector transformation:
the five “Cs” of the five winning strategies…
1.
Core strategy: clarity of purpose, role and direction;
2.
Consequences strategy: evidenced-based performance; enterprise /
entrepreneurship; efficiency / productivity; positive & targeted incentives /
penalize poor performance not the patient;
3.
Customer strategy: quality and consumer control;
4.
Control strategy: empowerment of communities, employees and delivery
organizations; remove artificial barriers to performance and good
outcomes;
5.
Culture strategy: “breaking habits”, “touching hearts”, “winning minds”.
Based on: David Osborne & P. Plastrik, Banishing Bureaucracy: Five strategies for Reinventing
Government (1996) pg. 39 inter alia.
Health Results Team
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First order of business:
Integrated Health Services Plan (IHSP)
◘ First 3-year Plan: due Fall 2006, after community engagement process
◘ Pre-condition for integration orders
◘ Public consultation / stakeholder organizations’ consultation
◘ February 2005 report on LHIN priorities
◘ Government priorities; related LHINs’ priorities
◘ Strategic priorities; “early wins”
◘ Local priorities, within and beyond our “fiscal envelope”, including
health promotion, public health, and primary-care renewal
Health Results Team
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Introduction of Legislation
 On November 24, 2005, the Honourable George Smitherman,
Minister of Health and Long-Term Care, introduced the Local Health
System Integration Act, 2005 (Bill 36/05)
 The purpose of the legislation is to build a system for managing
health care in Ontario and to continue the 14 LHINs.
 The legislation would provide for an integrated health system to
improve the health of Ontarians through:
 better access to health services;
 coordinated health care; and
 effective and efficient management at the local level by LHINs.
Health Results Team
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Key Components of the Legislation
The Legislation includes the following key components:
 Part I:
Interpretation and Definitions
 Part II:
Local Health Integration Networks
 Part III:
Planning and Community Engagement
 Part IV:
Funding and Accountability
 Part V:
Integration and Devolution
 Part VI:
General
 Part VII:
Complementary Amendments
 Part VIII
Consequential Amendments
Health Results Team
Part I - Interpretation and Definitions
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 The proposed legislation sets out the purpose of the Act and defines key
terms used in the Act.
 The definition section includes a list of health service providers that
would be responsible to and receive funding from LHINS, which include:
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Hospitals
Most psychiatric facilities
Long-term care homes
Community care access corporations
Community service providers
Community mental health and addiction service providers
 Authority for Cabinet to include other providers under the LHIN umbrella
in the future; certain providers could also be excluded by LGIC regulation.
 The definition would specifically exclude physicians, podiatrists, dentists,
and optometrists who offer their professional services to individuals.
Health Results Team
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MINISTRY HEALTH SERVICE PROVIDERS
The Ministry would continue to be responsible for:

public health

individual practitioners and Family Health Teams
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ambulance services
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laboratories
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provincial networks and programs (e.g. Telehealth,
Trillium Gift of Life Network, Cancer Care Ontario)
Health Results Team
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Part III - Planning & Community Engagement…
 The Minister to develop and publish provincial strategic plan:
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vision, priorities, strategic directions for health system.
LHINs required to develop Integrated Health Service Plan (IHSP)
IHSP would include a vision, priorities and strategic directions for
the local health system.
IHSP must be consistent with the provincial strategic plan and the
funding provided to the LHINs.
It must also include any planned integration strategies….
Health Results Team
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Part III - Planning and Community Engagement
… cont’d
 LHINs to engage the community and service providers about the needs and
priorities of the local health system on an ongoing basis
 Service providers to engage the community when developing plans and
setting priorities for the delivery of health services
 LHINs to establish a Health Professional Advisory Committee to act in an
advisory capacity
 Regulations could also set out other requirements for community
engagement
Health Results Team
Part IV - Funding and Accountability
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Sets out authority for Minister to fund LHINs on terms and conditions Minister
considers appropriate.
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Establishes a requirement for Minister and LHIN to enter into an accountability
agreement and sets out general content of such agreements. Other terms
could be prescribed.
►
Permits Minister to adjust a LHIN’s funding to take into account a portion of any
savings generated through efficiencies in a previous year to be used for patient care in
subsequent years. (i.e., keep savings for use the following year)
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Provides LHINs with the authority to fund health service providers in accordance
with LHINs’ agreement with the Ministry. (i.e., ability to direct and redirect funds)
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Establishes a requirement for LHINs and health service providers to enter into
service accountability agreements under Commitment to the Future of Medicare
Act and provides LHINs with compliance authorities under that Act.
Health Results Team
Part V - Integration
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LHINs and service providers would be required to develop integration strategies
to better coordinate health care and use health resources more efficiently.
Legislation would recognize LHINs could achieve integration through:
funding; facilitation and negotiation of integration plans with service
providers; or, ordering integration.
LHINs would have authority to require the following types of integration where it
was in the public interest:
 to provide certain services to a specified extent or specified volume;
 to cease to provide specified services;
 to increase/decrease the extent or volume of specified services;
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to move programs/services from one location to another;
to move programs/services from one provider to another;
to take action to give effect to any of the above orders; and,
to amend or revoke an order that has been issued.
Health Results Team
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Part VII - Complementary Amendments
Community Care Access Centres Realignment
 Legislation would enable the government to align CCACs
with LHIN boundaries;
 Return CCAC boards to community-based organizations by
allowing CCACs to select their directors and Executive
Directors; and
 Allow the LGIC to add to the mandate of the CCACs to allow
them to take on a broader role in the future, such as working
with or as part of various social services for children and
youth services.
Health Results Team
Part VII - Complementary Amendments…
Labour Relations…
 Integration and other changes in the health system could
result in employment and labour relations changes.
 The proposed legislation would make the Public Sector
Labour Relations Transition Act (PSLRTA) available to
employers and their bargaining agents where they are
affected by health system integration.
 PSLRTA provides framework for resolving complex issues
arising from significant reorganizations, addressing:
bargaining unit structures, bargaining agents, seniority
rights, and collective agreement transitions.
Health Results Team
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Status

Second reading debated November 29th, December 5th/6th

Bill passed second reading and referred to Standing
Committee on Social Policy on December 7th.

Standing Committee and public hearings are scheduled from
January 30th - February 2nd in: Toronto, Thunder Bay, London
and Ottawa.

Comments and input on the Bill welcomed.
Health Results Team
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Is there a role for expert consulting services?
►Assist with consultation processes
► LHINs
► Provider organizations
► Other interested organizations
►Assist with the Integrated Health Services Plan
► Data collection and analysis
► Plan development
►Assist with governance and system-development
► Board governance
► Business processes
► Ministry transition processes
►Assist with integration initiatives
► LHINs
► Provider organizations
Health Results Team
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Thank you –
Questions??
Health Results Team