Collaborative Governance in North Simcoe Muskoka November 2013

1. Healthy People. Excellent Care. One System. Collaborative Governance in North Simcoe MuskokaNovember 2013 Robert Morton, Board ChairNSM LHIN

2. Continuum of Collaboration

3. Collaboration – T, T, T. The impact of Trust Building http://www.actforyouth.net/youth_development/communities/collaboration.cfm

4. Implementation Structure, 2013-2016 Lead Organizations for each ‘Areas of Focus’: Health Service Provider Boards and LHIN Board NSM LHIN Leadership Council GBGH CCAC/ILS OSMH Waypoint RVH CGMH 1. Complex & Chronic Health Needs 2. In Home & Community Capacity 3. Maternal Child Health 4. Mental Health & Addictions 5. Medicine 6. Surgery Complex Continuing Care Alternate Level of Care Maternal and Child Health Community of Practice Waypoint Schedule1Beds to community hospitals LHIN-wide Critical Care System LHIN-wide Musculoskeletal Program(Bone and Joint) Home First Chronic Disease Prevention and Management LHIN-wide Integrated Vascular Care System Building Child & Adolescent Capacity Seniors Health Strategy Behavioral Support System Community Crisis Management LHIN-wide Emergency Care System LHIN LHIN LHIN LHIN CCAC County of Simcoe 7. Communications and Community Engagement 8. Governance 10. Integrated Health Human Resources 11. System Navigation 12. Transportation 9. Information Communication Technology/eHealth Standardization of Process and Policy Information & Referral Inter-facility Organizational Development Transitions of Care Community Workforce Planning and Education Recruitment and Retention • Boards, Councils & Project Steering Committees supported by: • NSM LHIN Leadership Council - CEOs & Executive Directors (the Care Connections (CC) Steering Committee) • CC Operations Committee ( the Chairs of 12 Coordinating Councils) • CC Implementation Team (LHIN Staff as Liaisons for Councils and Project Steering Committees)

5. Our Successes to Date….to name a few Chronic and Complex Health Needs • Complex Continuing Care – Implemented LHIN-wide Program / Bed Registry Mental Health and Addictions • Redistribution of 31 Schedule 1 Adult beds from Waypoint – Voluntary Integration – acute care beds to RVH (11) and GBGH (20 with redevelopment) • Development of a LHIN-wide Child and Adolescent MHA Program Medicine • Development of a LHIN-wide Stroke Program (Integrated Acute/Rehab Model) Surgery • Development of LHIN-wide Integrated Orthopedic Program Information Communication Technology / eHealth • Hospital Report Manager (HRM) across all hospitals – reduction from 12 days to 30 minutes • E-prescribing Governance • Established Council of Governors and CEOs to develop new governance model in an integrated system

6. Care Connections Governance Working Group, Governance Vision in 2010/11 Purpose • Sustainable Governance model to support future design Challenges and issues • Minimal education, information-sharing, and relationships across the HSP community • Lack of shared vision for the future • Tension between existing organizational fiduciary responsibilities and future system-wide governance and oversight Key stakeholders “A Network” Hospital Boards Long-term Care Boards Community Boards LHIN Board Strategies • Facilitated networking of Boards to support the transformation and delivery of the future health system • Delivered through: • Clear and consistent communication and information-sharing protocols • Effective governor engagement strategies • Platform for Board to Board sharing and relationship building to create a foundation for change

7. Accountability - Organizational Level • ORGANIZATIONAL BALANCED SCORECARD • describes strategy, measures & targets • guides execution • information on performance Dialogue & Continuous Dynamic Evaluation & Learning Accountability Agreement for CEO Managerial Accountability Agreements • ACCOUNTABILITY AGREEMENTS • sets out what parts of the scorecard each individual is accountable for achieving & the supports they need to be successful.

8. Accountability - System Level • ORGANIZATIONAL BALANCED SCORECARD • describes strategy, measures & targets • guides execution • information on performance Dialogue & Continuous Dynamic Evaluation & Learning Accountability Agreement for CEO Managerial Accountability Agreements • ACCOUNTABILITY AGREEMENTS • sets out what parts of the scorecard each individual is accountable for achieving & the supports they need to be successful. • SYSTEM BALANCED SCORECARD • states the financial & customer outcomes • defines the strategic contribution of the board • helps manage the performance of board / committees • clarifies the strategic information the board needs

9. A Governance Model Innovation Teamwork Trust Source: Jim Nininger, Conference Board of Canada

10. North Simcoe Muskoka LHIN’s Governance Journey June 2012 Care Connections Update Governance Coordinating Council Role Collaboration Continuum November 2012 “Made in Ontario Solution” Unique role for governing bodies June 2013 Governance 101 Generative Governance January 2013 Health Links Implications for governing bodies • October 2013 • Governance Leadership in System Transformation • Chairs only session – focused on sub-geography Next Stage? Local improvement plans “Put back on the table of the boards not just a request, but an absolute sense of obligation, that learning who does better and then doing at least that well is central to proper stewardship of health care. The buck stops in the board room.” D. Berwick

11. System Governance: Finding the Balance Board members need to govern on a broader health system level • Board members need to focus on their own organization

12. Questions? Contact Information: Bob Morton robert.morton@lhins.on.ca www.nsmlhin.on.ca