Transcript Special OHA Forum on Local Health Hubs for Rural and

Local Health Hubs for
Rural and Northern Communities
Discussion Highlights – May 9-10, 2013
Special OHA Forum on Local Health Hubs for
Rural and Northern Communities
Thursday, May 9th, 2013 (1:00 – 4:00 PM)
• 1:00 - Welcome and Opening Remarks (Wade Petranik)
• 1:10 - Why Status Quo Is Not An Option (Pat Campbell)
• 1:20 – Overview of Local Health Hub Paper (Jim Whaley)
• 1:45 – 3:00 – Small Group Discussions
• 3:00 – 4:00 – Small Group Reports
Friday, May 10th , 2013 (8:00 – 11:00AM)
• 8:00 - Presentation of Small Group Discussion Highlights (Jim Whaley)
• 8:30 – Small Group Discussions: part 1
• 9:30 - Small Group Reports
• 10:15 – Small Group Discussions: part 2
• 10:45 – Small Group Reports
• 11:00 – Closing Remarks (Ray Hunt)
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Small Group Discussion Questions (May 9th)
1.
What strategies have you successfully implemented at your hospital, with your health system
partners, to move towards a Local Health Hub model in your catchment area? What supports, if
any, have you sought or received from the MOHLTC, your LHIN, healthcare partners/community,
E-Health or other funding agencies?
2.
How do small hospitals engage and gain support from other local health care providers (e.g.
CCAC, primary care, community support services, public health etc.) to be part of the solution and
work toward a more integrated local health care system? What engagement has occurred with your
elected officials with respect to health system transformation?
3.
In a period of constrained resources, what are you doing as a small hospital to improve access to
quality care? (Please give examples in the following categories: human resources, technology,
clinical care processes)
4.
The challenges for all SRN hospitals have been well-documented in previous reports . What are
the key ones we need to focus on to inform OHA’s advocacy agenda?
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Rural and Northern Integration Success Stories
• Multi-Hospital linkages:
• Shared governance, management
• IT (GBIN, NEON)
• Regional programs (lab, imaging etc.)
• Supply chain partnerships
• Hospital-CCAC linkages
• CCAC-other agency linkages
• Hospital-Primary Care linkages
• Primary Care-Community Service linkages
• Co-location, health campus models
• Shared back office functions
• Shared EMR
• LHIN integration plans and strategies
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R&N Community Success Stories (cont’d)
• Blind River
• Hornepayne
• Carleton Place
• Kemptville
• Deep River
• Listowel-Wingham
• Dryden
• Lake of the Woods
• Espanola
• Manitouwadge
• Goderich
• Manitoulin
• Grey Bruce
• Sturgeon Falls
• Haliburton Highlands
• Temiskaming
• Hearst
• Wellington
*NOTE: OHA has put out a call for rural & northern
communities to submit their integration success stories on-line
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Current Local Strategies for Improving Access
and Quality
• Use of SRN transformation fund ($20 M)
• OTN – connecting all providers
• LEAN training across multiple sites
• Patient order sets ensure best practice
• Use of common information systems, shared IT
• Technology supports – EMR, telehealth, virtual care
• CCAC – ED notification electronically
• Implementation of best practices/evidence-based care
• FHTs recruiting QI support
• Critical Care Extramural – physician consults
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Local Strategies for Working Towards a More
Integrated Health System
• Co-location of services builds communication and trust
• Build on local collaboratives
• Focus on what is best for the community - creating a community health plan with
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a common vision
Focus on what’s best for the patient – not structures & funding
Broad-based stakeholder engagement (health, housing, social services)
Involvement of municipal partners is essential
Regular briefing of elected officials
Cross-board appointments
Collaborative problem-solving around quality issues
Ensure new funding initiatives are discussed with all partners to ensure success
Shared back office functions
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Enablers to support voluntary integration
processes
• Facilitation
• External consultants for specialty skills
• Transitional funding and incentives
• Flexible new funding models
• Health Links
• Formal agreements between parties
• Co-location of services
• Leadership
• Local dialogue
• Better access to best practices (website)
• Capacity planning
• Analytics, better data and decision support
• Change management resources
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Challenges to creating integrated local health
systems for rural and northern communities
• Funding:
• Funding silos
• Lack of multi-year funding
• Lack of infrastructure funding
• Capital funding doesn’t support integrated solutions
• Misaligned labour costs, wage disparities (hospital vs. community)
• Hospital and physician funding strategies
• Transformation Strategy:
• Messaging & support is different across LHINs
• Confusion about roll-out of provincial strategies
• Fear of forced integration
• Multiple reporting with different performance indicators
• Ministry mistrust of hospitals
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Challenges (cont’d)
• Hub Model:
• Getting to collaborative governance will be a problem with multiple boards
• Where will real accountability be?
• Is single funding envelope the right answer?
• What drives the Hub – Funding? Governance?
• Single funding envelope will be perceived as a threat
• Lack of Resources/Lack of Access:
• HR shortages
• Access to Schedule 1 beds, youth mental health services, rehab services, palliative care
• Need small hospital flex beds instead of ALC designation
• Non-urgent transfer problems
• Large distances between sites – communication and transportation challenges
• Cultural and language issues (e.g. francophone and First Nation populations)
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Moving Forward with the Local Health Hub
Model
• Many of the existing success stories have evolved organically based
on local leadership
• Evolution not revolution
• Partnership not takeover
• Community uniqueness – build solutions from the ground up
• Introduce Hubs without being hospital-centric
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Small Group Discussion Questions (May 10th)
1.
What are the key enablers to support local strategies for voluntary integration?
2.
What collaborative structures and processes are required at the provincial level
between health associations to support ongoing dialogue about health hubs and
other integration strategies for rural and northern communities?
3.
What should be the key rural & northern advocacy issues for the OHA and its
Small Rural and Northern Hospitals’ Leadership Council? Should the
membership and mandate of the Council be expanded?
4.
Comments/suggestions regarding the Recommendations for Action in the
Health Hub paper? Do you have any other advice for the OHA regarding the
paper?
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Key enablers to support local strategies for
voluntary integration?
• Facilitated local dialogue that:
• Builds trust , develops healthy relationships and creates ‘buy-in’
• Engages boards and communities
• Engages all sectors (health & social services) and physicians
• Creation of a Community Health Plan:
• With a common vision and shared goals
• That is people, community and patient-centred
• Includes capacity planning and service mapping
• Builds on local demographics and local assets
• Local champion(s) to support common vision
• Strong communications strategy with consistent messaging , dispel fears
• LHIN support for local processes and change management
• Remove Ministry barriers – policy, regulations, funding silos
• Greater flexibility of funding models
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Collaborative structures required at the
provincial level between health associations?
• All provincial stakeholders (including all health associations, LHINs, MOHLTC)
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at a common “health system transformation” table
Policy Advisory Group with multi-sector representation to advise
MOHLTC/LHINs on rural & northern health issues
Committee of all key health partners/associations to share different visions of
“Hub model”
Associate DM of Transformation to establish a Health Hub “action group” to
provide implementation advice to the Ministry/Minister
Provincial body needs to:
• Develop clear common vision and principles
• Develop collaborative data collection/management tools
• Provide seed money to help develop “local integration plans”
• Use “bottom-up” approach to allow members to identify local issues, challenges,
resources required
• Support flexibility in model development and allow innovation to meet each
community’s needs
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Key rural & northern advocacy issues for the
OHA’s SRN Hospitals’ Leadership Council?
• Regular consultation with members
• Advocate for provincial pilot projects or case studies of current successful integrations
• Ongoing advocacy for small hospital funding – need to land on a better SRN methodology
• Capital funds for Health Hubs that align with integrated local models
• Flexible funding approaches for hospitals managing multiple accountability agreements
• Broaden quality metrics for rural & northern communities that give a better picture of what
is happening at the local level (e.g. determinants of health, capacity, gaps, etc.)
• Engagement of primary care sector (OMA, AFHTO, AOHC) to align incentives
• Facilitate new SRN delivery models that support full circle of care, e.g. hospital providing
home care, primary care hubs in non-hospital communities etc.
**If SRN Council maintains its current mandate/membership, then a sub-committee with
other health partners should be established to refine Health Hub model
**If SRN Council chooses to expand its mandate and possibly report to other associations,
then membership would obviously need to be expanded
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Comments/suggestions regarding the Health
Hub paper?
• Tone of report must change – too prescriptive, too hospital-focused
• Acknowledge slow engagement of provincial partners – need to establish cross•
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sectoral provincial table
Need time to digest paper
Clearer messaging on intent of Health Hubs - “integrated structure” to accomplish
what?
Use a cautious approach to single funding envelope
Community needs to lead the conversation with hospitals as partner
Branding matters - change reference to small hospitals to SRN communities,
change Hub name
SRN communities can achieve integration without a formal Hub structure
Gather/disseminate key learnings from existing Hubs and other multi-service
partnerships
Defining Hubs must be based on geography, not just population size
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Top Action Items for Supporting More
Integrated Rural and Northern Health Care?
• 1. For Small Hospitals and their Local Partners?
• 2. For the Ontario Hospital Association and its Provincial Partners?
• 3. For the Ministry and the LHINs?
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1. For SRN Hospitals and their Local Partners?
• Meet with partners, establish local leadership table (‘collaborative’) and identify
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local champions
Focus on strategies for improving patient care instead of governance or funding
Foster and build trusting relationships between local boards
Develop a local framework for engagement
Engage Ministry and LHIN reps at the local level
Establish shared vision and common goals
Prepare a local environmental scan – inventory of resources, services gaps etc.
Develop a shared Community Health Plan with implementation strategy
Create ‘quick wins’ and communicate the success stories
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2. For the OHA and its Provincial Partners?
• Create a multi-sector, rural health advisory council with representation from
existing provincial health associations, Francophone and First Nation
communities and Ministry/LHINs – begin dialogue immediately
• Priorities for this new provincial rural & northern ‘leadership’ table should
include:
• More support for collaborative local governance strategies, processes, solutions
• Create common vision and principles to guide local leadership
• Development of common SRN policy framework
• Resources for development/implementation of local Community Health Plans
• Clearinghouse of successful integration projects
• Strengthen SRN definition with quality metrics that are customized for rural/northern
• Recognize diversity of health care providers in rural and northern communities
• Communicate impact of demographics and geography on health care delivery to
Ministry/LHINs
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3. For the Ministry and the LHINs?
• Accept that they need a provincial rural health strategy – begin dialogue immediately
• Create Ministry Advocate/Secretariat for rural health that supports action and will work
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with new provincial advisory committee
Role clarity between Ministry, LHINs on rural/northern health issues with clear direction
on common goals
Remove Ministry/LHIN silos that are creating policy/funding barriers
Consistent messaging between LHINs
Improve communication within MOHLTC and between Ministry’s to support multi-sector
approach
Enhanced community-based funding and strengthened accountability for primary care
Flexible long term funding for SRN communities with simplified accountability
agreements
Determine appropriate outcomes, measures for rural & northern communities with an
integrated outcomes matrix for all health service providers
LHIN to support those communities that are struggling with integration
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