Managing Change, Transforming Health Care A South West LHIN Webcast on our Refreshed Integrated Heal

1
Managing Change, Transforming Health CareA South
West LHIN Webcast on our Refreshed Integrated
Health Service Plan andHealth Service Blueprint
ProjectApril 30, 2009 930am to 1100am
A Healthier Tomorrow
2
Questions

• Questions are welcome at the end of the Webcast
• You can
• email southwest_at_lhins.on.ca
• call 1-888-789-9572
• Ask moderator for South West LHIN

3
Topics to Discuss

• Welcome
• LHIN Planning and Accountability
• Health System Trends
• The Integrated Health Service Plan 2010 to 2013
• The Health Service Blueprint Initiative
• The Blueprint Framework A Work in Progress
• Alignment of the Emergency Department Study to
  the Blueprint and IHSP
• Community Engagement
• Priority Setting Framework

4
LHIN Planning and Accountability

• Mandate to provide leadership and management of
  the local health system
• Accountable to the Ministry of Health and
  Long-Term Care
• Integrated Health Service Plan is a tool to guide
  improvements to the system
• Blueprint Project and other studies will inform
  the IHSP
• Next IHSP will identify actions and outcomes
  related to our priorities to ensure quality,
  access and sustainability

5
LHIN Planning and Accountability Framework
6
The 2010 - 2013 IHSP will outline the South West
LHIN system level goals and mechanisms to achieve
system level results
7
The Importance of Understanding Health System
Trends

• Health Service Providers and the Public need to
  have an awareness and knowledge of these trends
  to collectively shape strategies for building a
  desirable and sustainable health system
• Understanding and anticipating trends assists us
  in deciding what we need to focus on in the
  short-term and long-term
• Skate to where the puck is going, not where it
  has been
  --Wayne Gretzky

8
Health System Trends (MOHLTC, Health System
Strategy Division, January 2009)

• Person-Centred Care
• Sustainability, Productivity, and Innovation in
  the Health Care System
• Chronic Disease Prevention and Management
• Health Human Resources Management
• Mental Health and Addictions

9
Health System Trends (MOHLTC, Health System
Strategy Division, January 2009)

• E-Health
• Public and Population Health
• Disparities in Health
• Consumerism in Health Care
• Health Care Facility Infrastructure

10
The Integrated Health Service Plan for 2010 to
2013
11
Our First IHSP
ACCESS QUALITY SUSTAINABILITY
Health Human Resources - e-Health
IMPLEMENTATION IMPERATIVES
Accessing the Right Services in the Right Place
at the Right Time by the Right Provider
Strengthening Improving Primary Health Care
Transportation Promotion and Prevention Mobilizi
ng Partnerships Evaluation, Research, Education
Knowledge Dissemination Standardization
Best Practice
Building Linkages Across the Continuum
Seniors and Adults with Complex
Needs
Health Human Resources - e-Health
Preventing Managing Chronic Illness
Integration Priorities Enabling Priorities
12
IHSP Requirements and Assumptions

• Describes priorities, strategies, proposed
  outcomes for the local health system and
  implementation steps for the next three years
  (2010-13)
• Focuses on strategies to integrate the local
  health system
• Aligns with provincial priorities
• Builds on the work of our first IHSP, Priority
  Action Teams and Strategic Alignment Map
• Health Service Blueprint will be a central
  component of our next IHSP

13
Provincial Priorities

• lmprove access to emergency care by reducing the
  amount of time that patients spend waiting in the
  emergency department
• lmprove access to hospital care by reducing the
  amount of time that patients spend waiting for an
  alternate level of care (ALC)
• lmprove access to integrated diabetes care by
  supporting the roll-out of the Ontario Diabetes
  Strategy

14
IHSP Table of Contents

• Introduction
• Summary
• LHIN Vision for local health care system
• Overview of current health care system
• Framework for planning (resources and local
  conditions)
• Priorities and strategic directions for the local
  health system, including specific goals
• Rationale for strategic directions
• How success will be demonstrated and measured
• Supporting documents (research and documentation)

15
IHSP and Blueprint Content Alignment

• Introduction
• Summary
• Provincial Priorities

IHSP

• Blueprint
• Overview of current system
• Framework for planning
• Priorities, directions, goals
• Rationale for directions
• How will success be measured

3-year. action plans and expected outcomes
Vision and Strategic Alignment
16
The Health Service Blueprint Initiative
17
Why a Health Service Blueprint

• Response to first IHSP priority to ensure access
  to the right services, in the right place, at the
  right time, by the right provider
• Need for a detailed understanding of current
  services to develop ideas about how the system
  should be structured across programs and
  geography
• Allows health care providers and the LHIN to plan
  for change rather than react to health system
  trends, challenges and best practices
• To collectively leverage our resources rather
  than reacting to single issues faced by one
  organization, sector, or discipline

A Healthier Tomorrow
18
A 3-Phased Approach to the Health System Design
Initiative
Phase 1 Charter Confirmation (completed)
Phase 2 Current State Assessment Framework
Development
Phase 3 To Be Model Configuration of
Services (Framework Application)
Stakeholder Engagement
Communications / Change Management
A Healthier Tomorrow
19
Current State Assessment Framework Development
- Project Objectives

• Develop an inventory of health care programs and
  services in the South West LHIN
• What services are available
• Where services are delivered
• Utilization profiles
• Service provider profile
• Identification of gaps and duplication
• What services will be needed in the future
  (demographics and population health)
• Future capacity considerations
• Develop a Health Service Blueprint that focuses
  on the configuration and inter-relationships of
  health services across the LHIN
• Develop an implementation plan for the future
  application of the framework to high priority
  population and/or clinical areas

20
Project Scope

• Hospital and community-based services
• Development of a Blueprint (the mid-level
  plan/framework) for health services that clearly
  conveys to key stakeholders the future
  configuration and inter-relationships of services
  that will achieve identified objectives -- what
  services at what level (i.e., local, geographic,
  LHIN, provincial), not where
• Opportunity to identify priority areas to apply
  the framework (i.e., determine what
  services/where)

21
Health System Design Steering Committee

• Michael Barrett, South West LHIN 
• Dr. Sean Blaine, Physician 
• Mark Brintnell, South West LHIN
• Sandra Coleman, SW CCAC 
• Ralph Ganter, Erie St. Clair LHIN
• Kelly Gillis, South West LHIN 
• Brent Gingerich, PeopleCare Inc. 
• Catherine Hardman, Choices for Change 
• Sue Hillis, Dale Brain Injury 

• Dr. David Hollomby, London Health Sciences
  Centre 
• Sue McCutcheon, Grey Bruce Health Services 
• Tom McHugh, Tillsonburg Hospital 
• Caroline Tykoliz, Grey Bruce Health Services 
• Sandy Whittall, St. Joseph's Health Centre 
• Dr. Nancy Whitmore, St. Thomas Elgin General
  Hospital
• Andrew Williams, Huron Perth Health Care Alliance

Purpose The purpose of the Health System Design
Steering Committee is to guide decision-making
for health system design by identifying local
needs and capacity and to make recommendations on
strategic direction for achieving an integrated
health system in the South West LHIN.
22
The Blueprint Framework A Work in Progress
23
The following three lenses form the blueprint
framework and were used as the starting point to
assess the provision of South West LHIN
healthcare services

• Health services should meet needs ranging across
  complexity and population demands
• Specialized / High Complexity
• Targeted / Moderate Complexity
• General (non-specific) / Low Complexity

Spectrum of Need

• Healthcare services should be provided at the
  most appropriate level
• Local
• Geographic
• LHIN
• Provincial

Service Delivery Model
Continuum of Care

• Range of healthcare services should meet the
  needs along the continuum of care
• Promotive/Preventive
• Curative
• Rehabilitatiive
• Supportive

24
Service Delivery Model Considerations

• Service delivery model view enables consideration
  of the following
• Relationship between local characteristics and
  provincial services and priorities (e.g. wait
  times and critical care strategies)
• Relationship between service provision and
  accountability across the spectrum
• Embeds complexity of care within the levels of
  service delivery

25
Collection and analysis of comprehensive
inventory, studies, and reports of health
programs across population segments
Within this assessment, we have incorporated
population segment needs to assess the services
in each program across the continuum of care
26
Alignment of the Emergency Department Study to
the Blueprint and IHSP
27
Emergency Department Human Resource Study

• Increasingly, several hospitals have had
  difficulty maintaining emergency department (ED)
  coverage due to human resource shortages.
• In response to this human resource trend, the
  LHIN commissioned a study to obtain accurate,
  detailed information about the current state of
  its emergency departments in addition to gaining
  insights from emergency department health
  professionals to help identify the strategies
  needed to strengthen our emergency department
  system.
• This comprehensive look at our ED human resource
  challenges and opportunities will contribute to
  the Blueprint current state assessment and future
  service configuration discussion.

28
Emergency Departments Proposed Strategies

• Human Resource Strategies
• Enhance Recruitment and Retention Capability
• Support Local MD Leadership
• Support RN and MD Workplace satisfaction
• Maximize ED Coverage Within Current Resource
  Pool
• System Design Strategies
• Distribution of Hospital Resources to ensure
  access
• Maximize Integration of NPs in Primary Care

29
Emergency Department Study Next Steps

• At a local level, hospitals can consider
  potential of proposed strategies to address HR
  challenges
• At a LHIN level, HR strategies will be considered
  in the future within the context of potential
  health system design directions
• System design strategies and future models of
  care to be discussed as part of the Blueprint
  Project
• Further consultations and engagement prior to any
  LHIN-wide decisions about the proposed strategies

30
Community Engagement
31
Engagement Framework
32
Stakeholder Engagement Key Informant Interviews

• 45 stakeholder groups have been engaged to inform
  the current state assessment
• HSPs (executives, providers, Board members)
• HSPs not funded by LHIN (same group as for HSPs)
• Various LHIN groups (steering committees, Board,
  staff)
• Networks
• Academic community
• Local/provincial/federal government
• Aboriginal, Francophone, Mennonite

33
Stakeholder Engagement Symposiums

• Conduct two, 2-day symposiums, June 1-2 (north)
  and June 8-9 (south) in the North and South areas
  of the LHIN
• The purpose of the symposiums is to assist in
  finalizing the To Be model (Blueprint
  Framework) and seek input on priority populations
  and programs/service
• Audience for symposiums include LHIN funded and
  non-funded health service providers including
  Board members
• Health System Design Steering Committee will
  assist in developing the To Be model and
  refinement of the priority programs and
  populations

34
Stakeholder Engagement Refinement Sessions

• Multiple sessions to occur (9-12)
• Purpose is to
• Communication with Key Stakeholders on Health
  Service Blueprint Framework
• Seek input from key stakeholder groups to inform
  the refinement of the Draft Health Service
  Blueprint

35
Public Engagement

• In-person engagement sessions in mid-July and
  early September.
• 17 sessions planned
• July sessions - 3 locations in North, 3 locations
  in Central, 5 locations in South.
• September sessions 2 locations in each planning
  area to provide an opportunity for those unable
  to attend in July.
• For those who cannot attend the public sessions,
  will provide opportunities to provide feedback
  through our website or postal mail.
• Telephone Survey
• Web Feedback Form

36
Objectives of Public Sessions

• Reach a broad cross-section of the community to
  raise awareness and receive input on the
  Blueprint Project and IHSP
• Inform the public about the LHINs mission,
  vision and priorities
• Educate public about health system trends
• Consult with communities about issues of
  importance to them

37
Priority Setting Framework
38
Goals of the Priority Setting Approach
The proposed decision-making framework draws on
economic principles of value for money and
ethical principles of fair process to help LHINs

• Align resources strategically with system goals
  and community needs
• Reach publicly defensible decisions based on
  evidence and community values
• Facilitate constructive stakeholder engagement
  around better meeting system and/or
  organizational objectives within the constraint
  of limited resources
• Fulfill their public accountability for the use
  of public health service resources

39
Recently the LHINs have been working with a
decision tool to help set priorities
40
It is important that the priority setting
approach aligns with the South West LHINs System
Level Goals

• Healthier South West LHIN Community
• Equitable Access to Services
• Quality of Care and Service
• Sustainability of the Local Health System
• Integration of Health Care Delivery

41
and community values
Community Values

• Compassion We appreciate all our actions have
  real implications for people and communities
• Courage We will make difficult decisions and
  challenge the status quo when required
• Evidence Informed Our decisions will be guided
  by the best available information
• Innovation We will encourage and support new
  thinking and the sharing of new knowledge
• Integrity We will act in a fair, consistent and
  unbiased manner
• Trust and Respect We believe in mutual trust and
  respect

42
IHSP1 Priority Setting Criteria
43
New Cross-LHIN Priority Setting Criteria
44
Priority Setting Framework Next Steps

• Share framework and criteria with Area Provider
  Tables and other key groups (e.g., Steering
  Committees) for discussion and feedback on
  proposed criteria
• Synthesize feedback and modify criteria as
  appropriate for final discussion with Health
  System Design Steering Committee
• Bring recommended criteria to Board of Directors
  for approval (May 27, 2009)

45
IHSP and Blueprint High Level Timeline
Mar Apr May Jun
Jul Aug Sept Oct Nov
Project Launch
Current State Assessment
Health Service Blueprint Development
Implementation Planning
Current State Inventory Development
Develop To Be Models
Provider Engagement
Public Engagement
Review Findings from Engagement
Refinement
Approval and Public Release
46
Thank you and Questions

• Questions are welcome
• You can
• email southwest_at_lhins.on.ca
• call 1-888-789-9572
• Ask moderator for South West LHIN