New Expectations, New Possibilities: Creating an Integrated Health System

1. New Expectations, New Possibilities:Creating an Integrated Health System June 5th, 2007

2. Overview vision review alignment leadership for change integration accountability

3. vision review alignment leadership for change integration accountability

4. vision review alignment leadership for change integration accountability What we Have Done • Extensive community engagement across the region • Establishment of planning partnerships • Detailed feedback and data collection to validate directions • Integrated Health Service Plan • IHSP work plan • New investments and projects launched • LHIN Board and organizational developmental start-up • April 1 transition to LHINs

5. vision review alignment leadership for change integration accountability LHINs New Expectations Health Service Providers • 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 • Participate in LHIN planning exercises and provide the input and necessary information for the development of LHIN plans • Identify integration opportunities and demonstrate continuous improvement in service integration, coordination and quality • Implement the directions for integration laid out in the accountability agreements with LHINs

6. vision review alignment leadership for change integration accountability 5 main areas where the public can expect change: • Increased integration and improved service coordination • Increased local decision-making about funding and allocation • Greater emphasis on local health system planning • Increased community engagement • Enhanced Accountability

7. vision review alignment leadership for change integration accountability Alignment to the Integrated Health Service Plan

8. vision review alignment leadership for change integration accountability Central East LHINNew Investments $1.35M for Geriatric Emergency Management $.9M for Musculoskeletal Assessment Centre $1.5M for ICU in Rouge Valley Ajax-Pickering $.6M to increase home care & community supports

9. vision review alignment leadership for change integration accountability Criteria for Integration Innovations and Proposals • Was it vetted by LHIN Planning Partners? • Is it aligned with the IHSP? • Is it evidence-based and can it be measured & monitored? • Who shares accountability for its accomplishment? • How will it be resourced?

10. vision review alignment leadership for change integration accountability Our Commitment to Leading Change Through Engagement • We will promote and reward a culture of cooperation and mutual interests (negotiation) rather than the failed approaches of command and control (provocation). • Engagement will happen at all levels from governance to front lines to community residents Because…. • Engagement unlocks and leverages system planning expertise to create real solutions • Provides a means for emerging trends to be identified • Involvement stimulates ownership and responsibility for results!

11. vision review alignment leadership for change integration accountability Central East LHIN Planning Partnerships Local residents, seniors, family members, physicians, nurses, pharmacists, physiotherapists, administrators, and other health professionals are working together!

12. vision review alignment leadership for change integration accountability Governance for System Change • The Central East LHIN Board has identified the engagement of local health care governance as a top priority. • “Board to Board” engagement will focus on bringing together governance leaders within health service providers and the LHIN to for information sharing and strategic planning • It is expected that health service providers will engage each other in the efforts to meet local need • A governance steering committee will be established in the Fall of 2007 that will examine ways to equitably and effectively engage local governance

13. vision review alignment leadership for change integration accountability “Integration” as defined through Legislation 2(1) “integration” includes • to co-ordinate services and interactions between different persons and entities; • to partner with another person or entity in providing services or in operating • to transfer, merge or amalgamate services, operations, persons or entities • to start or cease providing services • to cease to operate or to dissolve or wind up the operations of a person or entity.

14. vision review alignment leadership for change integration accountability In simple language… • Health system experienced as a coordinated system: People will get the right treatment at the right time by the right provider • Seamless flow of information that supports patient care • A system that begins with primary care providers with an equal focus on prevention and health maintenance • Create timely access to quality services by aligning people, processes and resources • Elimination of wasteful and time consuming duplication • Involvement of patients, residents, family and informal caregivers

15. vision review alignment leadership for change integration accountability Making Integration Happen • Requires coordinated efforts of the LHIN and health service providers. • LHIN Planning Partnerships are a resource to the LHIN and its health service providers

16. vision review alignment leadership for change integration accountability Denotes potential referral back to LHIN Example: Supporting Health Service Provider Planning Health Service Provider (s) • Local health service provider (s) identify to the LHIN • Integration opportunity • New program / services • Local barriers for improved performance LHIN Collaborative • Health service provider(s) engage LHIN planning partners for expert advice and information in support of meeting local needs, advancing new ideas, or in the preparation of business plans • May also involved governance to governance engagement Task Group/Networks Governance Advisory Bodies (TBD) • Health service provider(s) submit business plans or ideas (with demonstrated engagement of LHIN planning partners) to the LHIN for further consideration. Central East LHIN • LHIN may implement through service accountability agreements (SAA) with service providers or integration decisions. Health Service Provider (s)

17. vision review alignment leadership for change integration accountability Opportunities for Integration & Integration Decisions • Facilitated or Negotiated Integration Decisions • Required Integration Decisions • Stopping Voluntary Integration

18. vision review alignment leadership for change integration accountability Example: Facilitated or Negotiated Integration Decisions under 25(2)(a) Presupposes prior negotiation with Ministry of Health and/or engagement of health service providers, other entities and LHIN planning partners. Ministry-LHIN Accountability Agreement Use of Planning Partnerships Board-to-Board Engagement LHIN facilitates or negotiates integration involving HSP(s) LHIN issues integration decision Health Service Provider(s) implement

19. vision review alignment leadership for change integration accountability Example: Required Integration Decisions 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; • 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

20. vision review alignment leadership for change integration accountability Required Integration Decisions under 25(2)(b) LHIN requires integration by funded HSPs Anyone may make submissions regarding proposed decision, including LHIN issues proposed integration decision Task Group/Networks Within 30 Days LHIN Collaborative LHIN considers any submissions; may change or confirm original integration decision Health Service Provider No timeframe specified LHIN issues final integration decision Health Service Provider

21. vision review alignment leadership for change integration accountability Example: Integration Decisions that Stop Voluntary Integrations 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; • 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.

22. vision review alignment leadership for change integration accountability Within 30 days, anyone may make submissions regarding proposed decision, including Task Group/Networks LHIN Collaborative Health Service Provider Example: Integration Decisions that Stop Voluntary Integrations HSP gives notice to LHIN that it wishes to integrated funded services Within 60 Days LHIN issues proposed decision stopping integration LHIN does not issue a proposed decision stopping integration LHIN considers HSP notice Integration may proceed LHIN Considers any submissions; may change or confirm proposed integration decision 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

23. vision review alignment leadership for change integration accountability A Focus on Accountability • People have the right to expect accountability from their governments • To that end, Central East LHIN has entered into an accountability agreement with MoHLTC That sets out the mutual understandings and performance obligations of both parties in the period from April 1, 2007 to March 31, 2010 • The public also have the right to expect that their health service providers will be accountable for the quality of services they provide • To that end, part of CE LHIN mandate is to negotiate Service Accountability Agreements (SAAs) with health service providers

24. vision review alignment leadership for change integration accountability The Purpose of the Planning to Action Symposium June 6-7, 2006 • Network and celebrate champions for change: Networks, Collaboratives and Task Groups • Create capacity of system to plan, coordinate and innovate across organizations • Align planning partnerships to specific tasks outlined in the Integrated Health Service Plan

25. vision review alignment leadership for change integration accountability 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 • New challenges and opportunities for health system governance

26. Confidence Abounds! vision review alignment leadership for change integration accountability Thank You!