“Introducing Local Health Integration Networks (LHINs)”

1. “Introducing Local Health Integration Networks (LHINs)” Enlisting local involvement, local priority-setting & local innovation, in the cause of better healthcare outcomes for Ontarians Presentation to: Canadian Association of Management Consultants and Institute of Public Administration of Canada (Toronto Regional Group) Ontario Club, Toronto, January 17, 2006 Presented by… W.Michael Fenn, CEO, Mississauga Halton LHIN Delivered Toronto, January 17, 2006 (Check against delivery)

2. Presentation… • What are the challenges facing Ontarians in health care? • What is the Government’s response? • What is the leadership role of LHINs? • How would Bill 36/05 enable the necessary reforms?

3. Caveat • Legislation, currently before the Ontario Legislature, if passed, would enable LHINs to leverage their powers and roles in order to facilitate timely and appropriate access to care for the residents of each LHIN • This presentation should not be construed as assuming that the proposed legislation will pass • This presentation looks at the opportunities created by the creation of LHINs • Until appropriate legislation is in place, the LHINs have only a planning and advisory function

4. Ontario’s “$30 Billion plus” Health Care Challenge • Large variation in quality and quantity • No standardization • No interconnecting IS/IT; no “real time” data • Little detailed cost information • Little strategic allocation of human resources • Large variation in management skills and competencies

5. Large Variation in Access (examples) • Hip replacement in the HNHB LHIN • 6 hospitals provide hip replacement surgery • The median wait for patients receiving care in July ranged from 65 days to 387 days (six fold difference) • Cataract Surgery in the WW LHIN • 3 hospitals provide cataract surgery • The median wait for patients receiving care in July ranged from 13 days to 178 days. (14-fold difference) • Beyond this, variation between surgeons within each hospital

6. HNHB LHIN Hip Replacement Wait Time (July 2005)Median and 90th percentile

7. Toronto LHIN Hip Replacement Wait Time (July 2005)Median and 90th percentile

8. Cataract Surgery Waterloo Wellington Wait Time (July2005)Median and 90th percentile

9. “Wait Times” and Primary Care (family medicine)- they’re connected • Improving access to Comprehensive Primary Care • Chronic disease prevention and management • Appropriate referrals/utilization of specialists/diagnostic services • Supporting acute care • And then there is information management….

10. 10 Data sources Information Holdings Analysis & reporting Better Information, Better DecisionsCharting Information Flows Current Information Flows are Unsustainable (September 9, 2004)

11. Government’s Vision… “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.” Hon. George Smitherman, Minister of Health & Long-Term Care

12. Ontario Government’s health-care transformation plan… • Improved Access: Improved access and quality of primary care, community and hospital services • Measurement of Outcomes: Wait list registries, management plans, service-performance agreements • Structural and System Change: Local Health Integration Networks (LHINs) and consistent data collection and reporting

13. Engaging the Community LHINs 4,000 people in 14 LHIN community workshops 200 attendees at LHIN planning forum 30 organizations on LHIN Action Group Over 1400 stakeholder participate in LHIN “meet and greet” Primary Care/Family Health Teams (FHTs) FHT Community and Stakeholder Dialogues: 16 communities, 250 attended, 800 FHT information resource kits shared Engagement, Consultation & CollaborationEngagement is the cornerstone of transformation New relationships are formed by new dialogue

14. Access & Wait Times MRI and CT Expert Panel (11 experts) Cataract Expert Panel (12 experts) Hip and Knee Joint Replacement Expert Panel (15 experts) Cancer Committee (14 experts) Institute for Clinical and Evaluative Studies Atlas on Access (27 experts) Ontario Critical Care Committee (44 experts) Ontario Critical Care Expert Panel (18 experts) Surgical Process Analysis & Improvement Expert Panel (22 experts) OHA Conferences on Improving Access Engagement, Consultation & CollaborationEngaging the Experts Information Management • Data Gap Analysis (36 experts) • Clinical Data Blitz (200 coders) • Ontario Health Planning Guide (125 experts) • Health System Scorecard Indicator Selection (20 experts) • Hospital Health Records Survey (142 experts) Primary Care • Primary Heath Care Transition Fund Summit (over 100 projects funded) • FHT Action and Working Groups LHINs • LHIN Action Group (29 Organizations) • LHIN Funding & Planning Think Tanks A new age of transparency in Government

15. Family Health Team 69 FHTs announced, 81 to follow Expand access to healthcare to over 2.5 million patients Deliver services in health promotion, disease prevention and chronic disease management Information Management Reducing the burden of data collection Access & Wait Times Increase capacity by way of a rational purchasing process 17% more cardiac procedures 28% more hip&knee replacements 16% more cataract surgeries 42% more MRI scans Innovation and Education Funds 18 Education Fund projects 36 Innovation Fund projects Building Capacity Building Capacity with Existing and New Resources Improving capacity and efficiency translates into better quality outcomes

16. LHINS “You cannot micro-manage a $33 billion operation from head office.” Minister George Smitherman 14 Local Health Integrated Networks (LHINs) • Geographically based, recognizing hospital-related health-care delivery patterns • Non-profit organizations • Designed to plan, integrate and fund local health care services • Community-based care: community needs are best met when they are planned, co-ordinated and funded within the community

17. 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.

18. 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

19. 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

20. START-UP MATURITY 2006 2007 Local Community Engagement Local Health System Planning Integration and Service Coordination 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

21. LHINSFocused 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

22. Inter-LHIN cooperation & coordination Models for inter-LHIN coordination are being developed to: • Provide system advice to ministry policy • Provide a forum for sharing information and best practices • Reinforce lines of communication between the ministry, LHINs and service providers • Coordinate standard practices and systems across LHINs • Proactively manage risks and strategic issues related to implementation • Ensure operational consistency and policy alignment Initial focus on: • LHIN Board Chairs / Minister forums • LHIN CEOs / Deputy Minister forum

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. Successful public sector transformation:the five “Cs” of the five winning strategies… • Core strategy: clarity of purpose, role and direction; • Consequences strategy: evidenced-based performance; enterprise / entrepreneurship; efficiency / productivity; positive & targeted incentives / penalize poor performance not the patient; • Customer strategy: quality and consumer control; • Control strategy: empowerment of communities, employees and delivery organizations; remove artificial barriers to performance and good outcomes; • Culture strategy: “breaking habits”, “touching hearts”, “winning minds”. Based on: David Osborne & P. Plastrik, Banishing Bureaucracy: Five strategies for Reinventing Government (1996) pg. 39 inter alia.

25. First order of business:Integrated Health Services Plan (IHSP) • First 3-year Plan: due Fall 2006, after community engagement process • Pre-condition for integration orders • Public consultation / stakeholder organizations’ consultation • February 2005 report on LHIN priorities • Government priorities; related LHINs’ priorities • Strategic priorities; “early wins” • Local priorities, within and beyond our “fiscal envelope”, including health promotion, public health, and primary-care renewal

26. Introduction of Legislation • On November 24, 2005, the Honourable George Smitherman, Minister of Health and Long-Term Care, introduced the Local Health System Integration Act, 2005 (Bill 36/05) • The purpose of the legislation is to build a system for managing health care in Ontario and to continue the 14 LHINs. • The legislation would provide for an integrated health system to improve the health of Ontarians through: • better access to health services; • coordinated health care; and • effective and efficient management at the local level by LHINs.

27. Key Components of the Legislation The Legislation includes the following key components: • Part I: Interpretation and Definitions • Part II: Local Health Integration Networks • Part III: Planning and Community Engagement • Part IV: Funding and Accountability • Part V: Integration and Devolution • Part VI: General • Part VII: Complementary Amendments • Part VIII Consequential Amendments

28. Part I - Interpretation and Definitions • The proposed legislation sets out the purpose of the Act and defines key terms used in the Act. • The definition section includes a list of health service providers that would be responsible to and receive funding from LHINS, which include: • Hospitals • Most psychiatric facilities • Long-term care homes • Community care access corporations • Community service providers • Community mental health and addiction service providers • Authority for Cabinet to include other providers under the LHIN umbrella in the future; certain providers could also be excluded by LGIC regulation. • The definition would specifically exclude physicians, podiatrists, dentists, and optometrists who offer their professional services to individuals.

29. MINISTRY HEALTH SERVICE PROVIDERS The Ministry would continue to be responsible for: • public health • individual practitioners and Family Health Teams • ambulance services • laboratories • provincial networks and programs (e.g. Telehealth, Trillium Gift of Life Network, Cancer Care Ontario)

30. Part III - Planning & Community Engagement… • The Minister to develop and publish provincial strategic plan: vision, priorities, strategic directions for health system. • LHINs required to develop Integrated Health Service Plan (IHSP) • IHSP would include a vision, priorities and strategic directions for the local health system. • IHSP must be consistent with the provincial strategic plan and the funding provided to the LHINs. • It must also include any planned integration strategies….

31. Part III - Planning and Community Engagement … cont’d • LHINs to engage the community and service providers about the needs and priorities of the local health system on an ongoing basis • Service providers to engage the community when developing plans and setting priorities for the delivery of health services • LHINs to establish a Health Professional Advisory Committee to act in an advisory capacity • Regulations could also set out other requirements for community engagement

32. Part IV - Funding and Accountability • Sets out authority for Minister to fund LHINs on terms and conditions Minister considers appropriate. • Establishes a requirement for Minister and LHIN to enter into an accountability agreement and sets out general content of such agreements. Other terms could be prescribed. • Permits Minister to adjust a LHIN’s funding to take into account a portion of any savings generated through efficiencies in a previous year to be used for patient care in subsequent years. (i.e., keep savings for use the following year) • Provides LHINs with the authority to fund health service providers in accordance with LHINs’ agreement with the Ministry. (i.e., ability to direct and redirect funds) • Establishes a requirement for LHINs and health service providers to enter into service accountability agreements under Commitment to the Future of Medicare Act and provides LHINs with compliance authorities under that Act.

33. Part V - Integration LHINs and service providers would be required to develop integration strategies to better coordinate health care and use health resources more efficiently. Legislation would recognize LHINs could achieve integration through: funding; facilitation and negotiation of integration plans with service providers; or, ordering integration. LHINs would have authority to require the following types of integration where it was in the public interest: • to provide certain services to a specified extent or specified volume; • to cease to provide specified services; • to increase/decrease the extent or volume of specified services; • to move programs/services from one location to another; • to move programs/services from one provider to another; • to take action to give effect to any of the above orders; and, • to amend or revoke an order that has been issued.

34. Part VII - Complementary Amendments Community Care Access Centres Realignment • Legislation would enable the government to align CCACs with LHIN boundaries; • Return CCAC boards to community-based organizations by allowing CCACs to select their directors and Executive Directors; and • Allow the LGIC to add to the mandate of the CCACs to allow them to take on a broader role in the future, such as working with or as part of various social services for children and youth services.

35. Part VII - Complementary Amendments… Labour Relations… • Integration and other changes in the health system could result in employment and labour relations changes. • The proposed legislation would make the Public Sector Labour Relations Transition Act (PSLRTA) available to employers and their bargaining agents where they are affected by health system integration. • PSLRTA provides framework for resolving complex issues arising from significant reorganizations, addressing: bargaining unit structures, bargaining agents, seniority rights, and collective agreement transitions.

36. Status • Second reading debated November 29th, December 5th/6th • Bill passed second reading and referred to Standing Committee on Social Policy on December 7th. • Standing Committee and public hearings are scheduled from January 30th - February 2nd in: Toronto, Thunder Bay, London and Ottawa. • Comments and input on the Bill welcomed.

37. Is there a role for expert consulting services? • Assist with consultation processes • LHINs • Provider organizations • Other interested organizations • Assist with the Integrated Health Services Plan • Data collection and analysis • Plan development • Assist with governance and system-development • Board governance • Business processes • Ministry transition processes • Assist with integration initiatives • LHINs • Provider organizations

38. Thank you – Questions??