Transcript Document

Giving Shape to the Vision:
Putting together the puzzle of planning and
integration in the Central East LHIN
Planning Partners Symposium, June 5-7, 2007
James Meloche
Sr. Director, Planning, Integration and Community Engagement
Pause and reflect…
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Framework for Engagement and Planning
Extensive community engagement across the region
Detailed feedback and data collection to validate directions
Establishment of 9 collaboratives, 3 networks, 5 task groups
Integrated Health Service Plan and community consultations
IHSP work plan and feedback
New investments and projects launched
LHIN Board and organizational developmental start-up
A year ago we told you….
…that the path of change would be
challenging and that there would
be bumps along the way
Today…
The Path travelled is clear.
The Path ahead remains unknown.
The journey of change continues….
Objectives of this Presentation
For Planning Partners
– Need: Planning partners (Networks, Collaboratives, Task Groups) are
maturing as planned. As the LHIN develops, these teams are in need of
a overview of how “the pieces fit together.”
– Objective: Give an overview of the planning flow that will ultimately lead
to the provision of advice to the CE LHIN Board
For Health Service Providers (HSPs) & Other Stakeholders
– Need: Enhanced capacity to work across organizational boundaries to
identify and implement health system improvements and integration.
– Objective: Outline CE LHIN planning & engagement framework and
expectations regarding integration decisions; and provide HSPs an
opportunity to leverage LHIN planning structures.
Objectives of this Presentation (2)
For the CE LHIN Board
– Establish clear expectations on the processes used to gather local advice
such that there is increased confidence that the community has been
involved in creating solutions for Board decisions.
Context
• Local Health Integration Act
• Central East LHIN Framework for Community Engagement and Local
Health Planning
• Central East Integrated Health Service Plan & Work Plan
Presupposes future additional context of:
• LHIN Decision Making Framework
• Supporting tools and documentation that will provide
direction/assistance in planning and proposal development.
Commitment to Change and Engagement
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The Central East LHIN is committed to on-going engagement.
Engagement provides an opportunity to unlock and leverage system planning
expertise from within the CE LHIN and overcome artificial barriers between
providers
On-going engagement allows for emerging trends to be identified in support
of existing or future LHIN priorities and/or integration decisions.
The focus on engagement is on improved access and performance
through integration/realignment/establishment of health services.
– It is not focussed on internal health service provider matters (i.e., operations) that
are the prime responsibility of a health service provider and its board.
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Accountability for system performance lies ultimately with the CE LHIN
board and the local health provider boards. Engagement of planning
partnerships does not displace this accountability – only strengthens it.
Other LHIN Interests
• Create Opportunities by through capacity building and/or
removing traditional barriers
• Eliminate gaps in awareness and knowledge (i.e.,
surprises) and the friction that it creates.
• Redesign local health system based on cooperation and
mutual interests (negotiation) rather than the failed
approaches of command and control (provocation).
Caveats
• In addition to CE LHIN priorities, the Minister/Ministry of Health and
Long Term Care set provincial priorities through its strategic plan
and/or Ministry-LHIN accountability agreements (MLAA).
• Ministry direction may require the LHIN to implement without a
fulsome engagement of local planning partnerships
• The CE LHIN may be required to exercise its authority at anytime and
without consultation in the name of public interest.
• The CE LHIN Board and health service provider boards will work
collaboratively in identifying and negotiating integration opportunities.
• This is learning process. Adaptations may be necessary.
Planning Partnerships
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9 Collaboratives
3 Priority Networks
Task Groups (5 current)
Health Professionals Advisory Committee (TBD)
• All are guided by a terms of reference outlining purpose and function.
• All the scenarios presented here are consistent with existing
policy, terms of reference, and the requirements of LHIN
legislation
Planning Partnerships: Functions
Example: Collaborative as defined by the Terms of Reference
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Provide advice on the needs of the population of the Planning and Engagement Zone;
Considering the Central East LHIN strategic priorities and objectives, work with
healthcare providers, local and regional networks and consumers to identify local
service gaps and opportunities for improved coordination and integration of health care
services;
Review LHIN-wide priorities and objectives against local strengths and gaps in capacity;
Identify emerging local health needs and future health care priorities;
Advise on opportunities for improved health care efficiencies and cost effectiveness;
If requested, assist Central East LHIN staff and local providers in the implementation
and monitoring of the Integrated Health Service Plan including assessing progress
against action plans, identifying barriers to progress and advising on strategies to
overcome barriers;
When requested by the Central East LHIN and agreed to by the Collaborative as a
whole, serve as a resource to local service providers/agencies in their planning and
engagement needs.
Health System Planning & Integration
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The Integrated Health Service Plan (IHSP) sets the priorities and context for
the local health system.
Development and implementation of the IHSP, as well as addressing
emerging system challenges and opportunities will require coordinated
efforts of the LHIN, planning partners, and health service providers.
– Scenario 1: Development of IHSP and strategic plans
– Scenario 2: Identifying emerging local needs and opportunities
– Scenario 3: Supporting health service providers and new planning expectations
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The IHSP and other local priorities will also generate opportunities for
integration
– Scenario 4: Facilitated or Negotiated Integration Decisions
– Scenario 5: Required Integration Decisions
– Scenario 6: Stopping Voluntary Integration
Supporting Planning
Scenario 1:
IHSP Action for LHIN-wide implementation
LHIN
LHIN Priority Network
Or Task Group
LHIN
Collaborative
• LHIN Board Approves IHSP and Work Plan
• Network/Task Group creates and/or advises on strategy that
supports IHSP implementation
• Collaboratives and/or agencies provide local direction to strategy
and advice on implementation back to Network.
Health Service
Provider
LHIN
• CE LHIN considers strategy and negotiates implementation
through Service Accountability Agreements (SAA) or facilitated
integration decision with health service providers (Scenario 4)
• Health Service Providers implement strategy
Health Service Provider
Denotes potential referral back to LHIN
Scenario 2:
Identifying Emerging Local Needs/Opportunities
LHIN Collaborative
Networks / Task
Groups
• Collaborative, Network or Task Group identifies system need,
service realignment and/or integration opportunity. Notifies and
seeks direction from LHIN staff.
• Reciprocal engagement of relevant CE LHIN planning partners
• Appropriate engagement of relevant providers
• Networks/Task Groups/Collaboratives provide advice and
findings to the CE LHIN
Task Group/Networks
LHIN Collaborative
Health Service
Provider
LHIN
Health Service Provider
• CE LHIN considers advice. May decide to
• Approve, and negotiate with health service providers through the SAA or
negotiated integrated decision (Scenario 4)
• Consider further engagement and planning or issue a required integration
order (Scenarios 1 and 5, respectively)
• Defer decision
• Health service providers implement local strategy as outlined in
SAA or integration decision.
Denotes potential referral back to LHIN
The Transition to LHINs:
Supporting HSPs and New Planning Expectations
As of April 1, 2007 Health Service Providers are now expected to
• 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
• Implement the directions for integration laid out in the accountability
agreements with LHINs
• Demonstrate continuous improvement in service integration, coordination and
quality
• Play a role in informing the community and general public about opportunities
for participate in LHIN initiatives
• Provide the input and necessary information for the development of LHIN
plans
• Participate in LHIN planning exercises (e.g., utilize LHIN community
engagement/planning partnerships)
Scenario 3:
Supporting HSPs and New Planning Expectations
Health Service
Provider (s)
• Local health service provider (s) identify to the LHIN
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Integration opportunity
New program / services
Local barriers for improved performance
• Health service provider(s) engage local and LHIN planning
partners for expert advice, information and/or support in the
development of a business plan
• Health service providers may plan for voluntary integration (see
Scenario 6).
LHIN Collaborative
Task Group/Networks
LHIN
Health Service
Provider (s)
• Health service provider submits business (with demonstrated
engagement of LHIN planning partners) to the LHIN for further
consideration.
• LHIN may implement plan through service accountability
agreements (SAA) with service providers, or integration
decisions (see below)
Denotes potential referral back to LHIN
Informing Integration Decisions
Facilitated or Negotiated Integration Decisions
under 25(2)(a)
25 (2) A local health integration network shall issue an integration decision when the
network,
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facilitates or negotiates the integration of persons or entities where at least one of
the persons or entities is a health service provider or the integration of services
between health service providers or between a health service provider and a person
or entity that is not a health service provider and the parties reach an agreement
with respect to that integration;
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.
Scenario 4:
Facilitated or Negotiated Integration Decisions under 25(2)(a)
Ministry-LHIN Accountability Agreement
Scenarios 1, 2, 3 and/or
Board-to-Board Engagement
Presupposes prior negotiation with Ministry of Health
and/or engagement of health service provider, other
entities and LHIN planning partners.
LHIN facilitates or
negotiates integration
involving HSP(s)
LHIN issues integration decision
Health Service Provider(s)
(or other)
Required Integration Decisions under 25(2)(b)
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;
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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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
Scenario 5:
Required Integration Decisions under 25(2)(b)
Anyone may make
submissions regarding
proposed decision, including
LHIN requires integration by funded
HSPs
LHIN issues proposed integration decision
Task Group/Networks
Within 30 Days
LHIN Collaborative
Health Service Provider
LHIN considers any submissions; may change
or confirm original integration decision
No timeframe
specified
LHIN issues final integration decision
Health Service Provider
Integration Decisions that Stop Voluntary
Integrations under 25(2)(c)
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;
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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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.
Scenario 6:
Integration Decisions that Stop Voluntary Integrations under
25(2)(c)
HSP gives notice to LHIN that it
wishes to integrated funded services
See Scenario 3 for generation of
such opportunities
Within 60 Days
LHIN does not issue a proposed
decision stopping integration
LHIN considers HSP notice
Integration may proceed
Within 30 days, anyone may make
submissions regarding proposed
decision, including
Task Group/Networks
LHIN issues proposed decision
stopping integration
LHIN Considers any submissions;
may change or confirm proposed
integration decision
LHIN Collaborative
Health Service Provider
Within 30 Days
LHIN does not issue a final
decision stopping integration
LHIN issues a final decision
stopping integration
Integration may proceed
Integration may NOT proceed
Together, we will deliver change!
The costs of competition are
greater than….
…the costs of cooperation!
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 (that is,
acting as a Network).
• To do so requires a plan and a commitment to building
capacity for integration and cooperation across the
system.
Look Around You – Feel Empowered!
• You are members of new teams with new mandates!
• Collectively, your talent and motivation is unparalleled!
• Replace self-doubt and permission-seeking with
confidence and courage!
• Forget perfection – you are it! 
Together, we are unstoppable!