PLAN-LHINary

1. PLAN-LHINary Engaging the Planning Future March 9th, 2006

2. Agenda • Welcome and Introductions • Metamorphosis Update • Presentation: Central West LHIN and Mississauga Halton LHIN • Round Table • Dialogue with LHIN CEOs • Networking Break

3. Information Management Project • Presentation on Partnerships • Panel on Effective Community Partnerships • Question Period • End of Morning

4. Welcome & Introductory Remarks Raymond Applebaum, Chair Greetings from the Region of Peel

5. Metamorphosis Update 1st Anniversary Celebration

6. MetamorphosisPlan-LHINary Engaging The Planning Future March 9, 2006 1st Anniversary

7. LHIN Integration Priorities Pre-LHINary March8/9, 2005 The Journey

8. The Journey Continues… • Post-LHINary October, 2006 • Plan-LHINary March 9, 2006

9. Planning Activities • Sharing network development with neighbouring LHINs • Website enhancements • CSS Orientation for Central West and Mississauga Halton LHINs • Discussions with LHIN CEO, Senior Directors, and Board Chair

10. CSS Roundtables to support development of LHIN Integrated Health Services Plan and Community Engagement Governance Board Training Sessions Integration Partnerships and Best Practices (Innovations in Health Care Expo Submission) CSS Business Requirements for Information Systems Partnership Activities

11. Nurturing a Culture of Sectoral & Cross-Sectoral Integration • Geriatric Services Task Force • Shared Training Approaches • CSS and Primary Health Care integration with CHC’s and Family Health Team’s • Information Technology • Back-office pilot project best practices • Effective Community Partnership Opportunities

12. Metamorphosis 1st Anniversary Performance Outcomes • CSS Enhanced Awareness with LHINs and health sector service partners, e.g hospitals, CCAC’s, LTC Homes, Primary Health Care, and Public Health • Partnership with LHIN staff and Board

13. Performance Outcomes Continued… • Conducted bi-annual sessions for CSS providers serving Central West and Mississauga Halton • Achieved key priorities established at inaugural session: website, orientation, bi-annual sessions • CSS Information Management project with Health Results Team and OCSA

14. Central West LHIN and Mississauga Halton LHIN Integrated Health Services Plan & Community Engagement

15. Local Health Integration Networks A new modelA new approachA new dialogue Presentation by Mimi Lowi-Young and Michael Fenn Metamorphosis PLAN-LHINARY Engaging the Planning Future March 9, 2006

16. Presentation Overview • Our challenge • About LHINs • Central West & Mississauga Halton LHIN • What’s been happening • About the Integrated Health Services Plan (IHSP) • Going Forward

17. Our Collective Challenge “A health care system that helps keep people healthy, gets them good care when they are sick, and will be there for our children and grandchildren.” “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.” George Smitherman

18. Governance Mandate “… facilitate health system transformation through building collaborative governance relationships, the outcome of which is an integrated health services plan consolidating planning, systems integration, service coordination, funding allocation and evaluation.”

19. Reduced Wait Times Framework Chronic Disease Prevention & Management Framework Health Human Resources Population Health Public Health Renewal Quality and Accountability Critical Care Capacity Investing in the Community Family Health Teams Managing Drug Program Growth Creating a System System Multi-Year Funding Strategy eHealth Strategy Aligning Internal Resources LHINs – part of the larger transformation agenda Source: Ministry of Health and Long-Term Care

20. LHIN Boundaries • LHIN Areas: • Erie St. Clair • South West • Waterloo Wellington • Hamilton Niagara Haldimand Brant • Central West • Mississauga Halton • Toronto Central • Central • Central East • South East • Champlain • North Simcoe Muskoka • North East • North West

21. LHINs are a “made in Ontario” model • Patient choice of physician and medical or acute services will not be limited by LHIN boundaries • LHINs will not be providers of service • LHINs will not consolidate health organizations’ governance structures

22. LHINs’ Mandate • Will respect & 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, physicians or other stakeholders/providers • Will be a “systems improvement” initiative • Will align the many interdependent parts of local system

23. What we are being asked to do… • Local health system funding & performance monitoring • Localsystem-integration and service-coordination • Allow people to move more easily through the health system and improve general level of accessibility • Community engagement in local health system planning and priority-setting • Overcome institutional & professional obstacles / barriers to integration & collaboration

24. LHINs: What’s In? • In: • Public and Private Hospitals • Long-Term Care Homes • Community Care Access Centres • Community Mental Health • and Addiction • Community Health Centres • Community Support and • Service Agencies • e.g. Meals on Wheels • Community Health Centres • $ 18-20 Billion in total • Provincial: • OHIP • Doctors • Family Health Teams • Other Practitioners • Provincial Drug Programs • Trillium • Ontario Drug Benefit • Public Health • Private Labs • Ambulance Services • Independent Health Facilities • Provincial Networks / Programs Note: Continued provincial involvement based on common-sense notion of quick-start - Knowledge management Re: complex negotiations (i.e., OMA, Drugs) - Provincial rather than solely regional mandate - High cost services requiring high volumes to protect cost-effectiveness; and new programs Opportunity for refinements to service scoping at legislative consultations • Assistive Devices • Trillium Gift of Life • Telehealth Ontario • Cancer Care Ontario • Cardiac Care Network • Emergency Management

25. LHINs’ Goals • Manage health system planning, coordination and funding at the local level • Engage community in local health system planning priority-setting, including establishing formal channels for citizen input / community consultation • Better integration of services; improved accessibility of health services; allow people to move more easily through the health system. • Bring economic and operational efficiencies to delivery of health services: promoting service innovation; improving quality of care; making health care system more sustainable and accountable.

26. What is “integration”? • Not just about consolidation and amalgamation - as some would suggest • Not “cheaper is better” - but it might mean productivity improvement - “more with same” or “same with less”. • Integration = perspective of the customer, not the provider, of the service • Removing obstacles to efficient hand-off (you should not have to be “in” the system to understand it or get it to respond) • Standardizing service-delivery to eliminate duplication, inefficiency - there should not be alternatives to “best practice” or approved “clinical pathways” • Developing “critical mass” to allow better use of talent, equipment and facilities - develop areas of expertise / “centres of excellence”

27. 8 principles guiding LHIN role… • Patient focus – improving population health and the citizen's experience • Strategic partnership – leadership to build long-term sustainable partnerships • Stakeholder engagement – coordinated community engagement and consultation • Evidence-based approach – planning / decision-making based on local analysis • Transparency – open communication - transparent, non-partisan decision-making • Fostering change through incentives – encouraging integrative / creative solutions • Provider boards – provider board corporations to continue • Partnership of equals – valuing the contribution of all health and community service providers

28. Achieving an integrated system Achieving integration goals depends on LHINs fostering a culture supporting LHINs as leaders of integration and coordination at the local level • Integration outcomes: • Seamless experience for user, where boundaries between organizations minimized • Improved match between single services provided and the multiple needs of clients and families • Effective and efficient use of system resources and capacity

29. START-UP MATURITY 2006 2007 Local Community Engagement Local Health System Planning Integration and Service Coordination Performance & Accountability Accountability & Performance Mgt. Funding and Allocation Timing & phase-in of LHIN functions Phase in of LHIN functions will depend on a variety of factors including approval of necessary legislative changes as well as LHINs own internal capacity

30. LHINs - Focused Leveraging & Alignment LHINs are intended to leverage: • Strategy:provincial and local integration strategies to improve access, quality and sustainability • Structures:key accountability relationships; existing provider boards, planning capacity, and networks of engagement • Resources:existing and future financial and human (physical, intellectual and leadership) resources, including funding • Information:information management and performance-based mechanisms tied to specific strategic outcomes • Incentives:mechanisms to deal with success or non-compliance

31. Collaborative Governance Success Factors • Boards are educated about LHINs’ role and mandate • Boards engage in “systems thinking” • Board policy puts health services integration at the heart of decision-making • “Building Collaborative Relationships” is at the centre of all engagement activities • Engagement processes are approached in an open, respectful, client-focused manner • Boards and management are held accountable

32. A snapshot of what’s been happening since June 2005? • General “Meet and Greet” Sessions • Public session for Board Nominating Process • Site visits to CCACs, Hospitals, LTC facilities, CHCs, Community Support Services, Mental Health and Addictions Services • New discussion tables: Primary Care, Family Health Teams, Regional Geriatric Networks, Chiefs of Staff, e-health, seniors groups, Medical Officers of Health and many more • Meetings with MPPs, MPs, Regional Councils, Municipal Councils, community groups • Development of Community Engagement Framework • Development of Integrated Health Services Plan Framework

33. Purpose of Initial Meetings • Learn about the role of the specific group, organization or person in relation to the health care system • Update the participants on the progress of LHIN implementation • Understand what needs to shift or change to engage stakeholders in system improvement • Share potential outcomes or opportunities envisioned with the implementation of LHINs  • Discuss negative outcomes or barriers participants are concerned about • Set the stage for future meetings and activities of Integrated Health Services Plan (IHSP)

34. Building Blocks for the first IHSP • Community Engagement - will inform the IHSP about issues, opportunities & priorities • Foundation for Future Plans - the first IHSP is a general-level, 3-year plan on which future LHIN plans will be built • Priorities for Integration - the first IHSP will reference the Integration Priority Report, will communicate local integration opportunities, and will be consistent with Ministry’s strategic directions • Demonstrates achievement of Ministry strategic directions - LHINs will demonstrate they are meeting the Ministry’s current strategic directions and priorities (wait times, IM/IT, lab reform, HHR, back office, FLS) • Optimizing available resources - LHINs will need to recognize resource constraints and will plan within the defined funding envelope .

35. IHSP Framework Environmental Scan Demographics & projections Pressures / Trends Needs / Gaps Resources, capacity, competency LHIN Mandate Ministry Priorities / Directions Assessment of Local Issues LHIN Vision & Strategic Goals LHIN Action Plan & Targets Action & Results LHIN Values / Principles Community Engagement Community priorities Opportunities / existing initiatives Readiness / barriers Partners & collaborators

36. Going Forward • Increase visibility of LHINs in all areas of the LHINs • Support the “transformation agenda”   • Support relationship-building • Develop population profile • Review Integration Priority Report • Review ministry priorities & directions • Engage public, health care users & providers • Develop current state assessment • Establish LHIN “vision statement”, strategic directions & priorities, action plan • Develop measures, monitoring & reporting tools • Submit & release first IHSP

37. Leadership Challenge • Transformation begins with new ways of thinking and behaviour •   Health care leaders and members of the public are being asked to play an increasingly important role, especially in the local context •  Focus is on achieving rapid results •   Experience needs to be distilled and applied broadly • Boundaries need to be broken down

38. How to Reach Us Central West LHIN Mississauga Halton LHIN 8 Nelson Street West Suite 300 700 Dorval Drive Suite 500 Brampton ON L6X 4J2 Oakville ON L6K 3V3 (905) 455-1281 (905) 337-7131 Mimi Lowi-Young, CEO Michael Fenn, CEO mimi.lowi-young@lhins.on.ca michael.fenn@lhins.on.ca www.lhins.on.ca

39. Reflect on the Conversation • Take a Few Minutes to Collectively Reflect on the Presentation • What topics were covered? • What information stood our for you? • Where were you intrigued or excited by what you heard? • How did it challenge or affirm the way we work together?

40. Dialogue with the LHIN CEOs Questions from the Tables Clarity How Other

41. Networking Break

42. Information Management Project

43. Health Results Team for Information ManagementMinistry of Health and Long-Term Care Presentation to Metamorphosis Training and Education Session March 9th, 2006

44. Information Management Supports System Change • Current Information Managementthreatens the success of transformation: • Information management costs ($ 600M) are increasing more rapidly ( 25%) than overall costs with evidence of waste • Information quality and coverage continues to compromise the system • These and other factors point to the need for an Information Management strategy to ensure high quality data are available to produce meaningful performance measures to be used in decision-making • New MOHLTC Health System Information Management Division

45. Information Is Critical For Accountability • Information is crucial to the system’s efficiency, effectiveness, and accountability: • To improve access, we need better information about where care is available quickly and what services are needed • Geographically-based planning requires good information about patient flows and where services are received • Using information to plan for the system strengthens governance of the system • Better information allows better system management • Access to better information will result in better decisions, which will drive improved accountability

46. Current Information Flows Were Unsustainable…

47. Information Flow Vision: Sustainability And More Effective Use of Data

48. The 4-point Information Management Strategy For Change

49. Better Data Requires Rationalization of Low Value Data and Identification of Data Gaps • Making the data that describes cost, quality, and resources in our system more accurate, readily available and comprehensive, while reducing the overall costs of data collection • Rationalizing existing data flows and responsibilities, putting an end to the collection of irrelevant and low-value data, and identifying data gaps; • Creating new data where gaps exist and instituting new data management practices and standards; and • Creating appropriate vehicles and structures to sustain changes to data.

50. One Person One Record Relies on Integration and Standards • Continuing care e-health aim to provide tools and systems to standardize clinical and business information • One Person One Record relies on the integration and adoption of standards, tool and processes across the sector