Local Health Integration Networks Letting Communities Decide A new model A new approach A new dialog

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Local Health Integration Networks - Letting
Communities Decide ! A new model - A new
approach - A new dialogue -

• OGRA/ROMA Combined Conference
• Royal York Hotel
• Toronto
• Monday February 20, 2006
• Dave Murray North East LHIN

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Is The Glass Half Empty or Half Full?

• Half Empty
• Baby boomers and their expectations will
  overwhelm and bankrupt the system
• Our system is woefully out of date and cannot
  meet todays needs or future needs
• Health care costs continue to escalate far beyond
  the rate of inflation

• Half Full
• Overall as a of GDP costs have not been
  spiraling out of control
• People are living longer and in better health in
  their senior years
• Management of the system is evolving and
  improving on a continual basis

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Why Do We Have An Un(system)?

• Because of our single payer system, healthcare
  has been slow to adopt new organizational
  structures and has failed to develop the
  management, information and decision support
  systems that tend to evolve as matters of
  survival in other industries.

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To put it into perspective,Imagine(Courtesy
of Dr. Michael Guerriere Courtyard Group)
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An airline managed like health care

• Each flight has its own booking agent that you
  can contact only by phone
• Connecting flights cannot be booked in advance
  once you arrive at a stopover point, you wait
  until there is a seat available on a connecting
  flight
• Being handed a ticket that says AC429 yyz-yeg
  dec10 Y 1745 1945 - with no further explanation
• Told that you cannot have access to your flight
  itinerary without the pilots permission
• The public is not given information about
  in-flight mishaps because the pilot might be
  unfairly maligned

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Or a bank managed like healthcare

• The teller writes your transactions into a paper
  ledger
• You are told that you can get your money at only
  one branch because thats where your records are
• You can use your bank card only in bank machines
  at your own bank
• Your balance is incorrect because the tellers
  handwriting is illegible
• You are told to wait for two hours while your
  money is sent by taxi from head office

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Consider

• 15 billion in annual purchases hand-written on
  slips of paper
• The Canadian prescription drug industry
• 1 billion service events scheduled manually over
  the phone
• Annual diagnostic test events in Canada
• An industry that does not increase productivity
• The healthcare industry in Canada, almost 10 of
  the economy
• A service industry that injured 2.5 of its
  customers through preventable errors (30 of
  injuries resulting in permanent impairment, 5
  resulting in death)
• Hospital care in Canada

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The Nature of the Change 

•  FROM
• Fragmented and silo-based health system a
  collection of services
• Separate health-care provider planning and
  funding
• Repeating case histories to various health care
  providers lack of coordination
• Patients making their own way through a complex
  health care system as they move from one health
  service to another

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• TO
• Local health system funding and performance
  monitoring
• Local system integration and service coordination
• Improved accessibility of health services to
  allow people to move more easily through the
  health system
• Community engagement in local health system
  planning and setting of priorities
• Breaking down institutional barriers to
  integration and collaboration

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• 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.
• The Hon. George Smitherman, Minister of Health
  and Long-Term Care

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Ministry Vision

• Our vision is for a health care system that
  strives to keep people healthy, provides them
  with good quality care when they need it, and
  will be there for our children and grandchildren.

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A Mandate for Change

• Transformation must begin with a new way of
  thinking and behaving.
• On September 9, 2004 Minister Smitherman
  announced the Health Results Team, with a clear
  mandate for change.
• What matters most for patients is whether care
  is there for them and their loved ones in times
  of need. They want better access to the right
  care, at the right time, in the right place.

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• The Challenge
• MOHLTC charged with delivering a results-driven
  and evidence-based plan to improve access to
  patient-focused and integrated health services.
• The Solution
• The Health Results Team

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• Health Results Team spearheading the three-year
  transformation agenda
• Improving access and wait times
• Advancing primary health care Family Health
  Teams
• Information management
• System Integration Local Health Integration
  Networks

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• LHIN Areas
• 1. Erie St. Clair
• 2. South West
• 3. Waterloo Wellington
• 4. Hamilton Niagara Haldimand Brant
• 5. Central West
• 6. Mississauga Halton
• 7. Toronto Central
• 8. Central
• 9. Central East
• 10. South East
• 11. Champlain
• 12. North Simcoe Muskoka
• 13 .North East
• 14. North West

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LHINs -A Made-In-Ontario Solution

• Will respect and support local governance of
  health delivery organizations
• Will not provide direct services
• Will be built and work alongside community health
  care providers
• Will not be hard boundaries for patients or
  physicians

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Relying on Local Governance.

• LHINs, Ontarios response to regionalization, is
  a recognition of the importance of local
  governance, planning and engagement.
• LHINs represents less a weakening, but a
  collective strengthening and challenging of local
  board governance!

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Our roles

• Our roles will be phased in over time.
• If legislation is passed, the process would be
• Community engagement (05/06)
• Local health system planning (05/06)
• Local health system integration and service
  coordination (06/07)
• Evaluation and reporting (06/07)
• Accountability and performance management (06/07)
• Local health system funding (06/07 and 07/08)

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Your roles Municipalities have significant
responsibilities in health-care and related
fields (a partial list)
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• Health services (public health, long-term care
  homes, land-ambulance, hospital capital, etc.).
• Social services (including licensing and
  inspection of operators of facilities)
• Recreational services (e.g., wellness programs
  and for kids with special needs)
• Community services (e.g., transportation for
  disabled planning new communities that create
  additional health-care demands sourcing medical
  practitioners for underserved communities)

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An example of the importance of the municipal
role in health carelong-term care homes

• Total Long-term Care Homes 611
• Total Long-term Care Beds 74,509
• Municipal Long-term Care Homes 103
• Municipal Long-term Care Beds 16,606
• OR 22 of Long-term Care System

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Characteristics of Municipal Homes

• Re-investment in care not-for-profit
• Local accountability through locally elected
  councils
• Strong community support high commitment of
  volunteers
• Innovation and excellence community
  partnerships
• Community outreach programs seniors day
  centres, meals-on-wheels, alzheimer day away
  program

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Municipalities have significant
statutory responsibilities in health care and
related areas, as operators, inspectors, program
providers, and licensing authoritiesHomes for
the Aged and Rest Homes Act, R.S.O. 1990 Chapter
H-13 - ExcerptSection 3 - Establishment of
homesHome for the aged, rest homes3.  (1)  Excep
t as otherwise provided in subsection (2) or in
section 7, every municipality not in a
territorial district and The District
Municipality of Muskoka shall establish and
maintain a home for the aged.  2002, c. 17,
Sched. F, Table.Joint homes(2)  Instead of
establishing separate homes, the councils of two
or more municipalities described in subsection
(1) may, with the approval in writing of the
Minister, enter into an agreement to establish
and maintain a joint home for the aged.  2002,
c. 17, Sched. F, Table.Rest homes(3)  Except as
otherwise provided in subsection (4) or in
section 7, any municipality not in a territorial
district and The District Municipality of Muskoka
may, and any lower-tier municipality not in a
regional municipality may, with the prior
approval of its upper-tier municipality,
establish and maintain a rest home.  2002, c. 17,
Sched. F, Table.
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What will be different?

• A new planning framework that allows communities
  to assess their own needs and make decisions
  about how to meet those needs
• LHINs will support planning efforts, fund
  services and ensure outcomes are being met.

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The need to engage

• For too long the system has relied on experts and
  stakeholders to define what is needed, how much,
  where, who gets served, who doesnt.
• The public is better educated, better informed
  (the web!), and far more demanding. (30 minutes
  or its free mentality!)

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A need to inform..

• The greatest challenge we face is one of a new
  style of communication
• We need input but it has to be informed
• The public must better understand the system, the
  options available and the ramifications of
  decisions
• Communication must be two way and in depth!

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Engage Inform - Decide

• LHINs will seek to inform, and gain input into
  decisions that make the most sense for the
  communities we serve.
• Health care system decisions will have to
  increasingly balance options that make the most
  sense. We cant do it all we dont have the
  resources, expertise or ability.

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Basic Planning Premises

• Data driven
• Equitable resource allocation
• Alignment with Provincial Goals
• Leverage successes
• Collaboration is the goal
• Engage, Educate and Communicate

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• The role of the LHIN is to work as a catalyst for
  change, working in partnership and building upon
  the strong community commitment to health care
  that already exists.
• The key to successful leadership today is
  influence, not authority.
• -- Ken Blanchard