The Integrated Health Services Plan It’s About You and Your Health !

1. The Central West LHIN includes all of Dufferin County, the northern portion of PeelRegion, and parts of Mississauga (Malton), Toronto (Rexdale) and York Region (south-west Vaughan). The Integrated Health Services Plan It’s About You and Your Health! Metamorphosis Presentation October 10, 2006

2. What LHINs are being asked to do • Improve the general level of accessibility to health care services • Supportpeople moving more easily across andthrough the health system • Engage the community in local health system planning and priority-setting • Engage providers in new ways that promote integration and collaboration • Develop a local Integrated Health Services Plan • Monitor performance • Fund local health services

3. What we mean by Integration • Integration is from the perspective of the client and family • Removing obstacles to getting into and through the system • Standardization that promotes good health outcomes and eliminates inefficiency and duplication • Developing and implementing “best practices” to improve health results • Developing “critical mass” for better use of skills, equipment and facilities

4. The Integrated Health Services Plan • As set out in the Accountability Agreement between the Ministry of Health and Long-Term Care and each LHIN, the IHSP will: • be a key enabler for the LHIN’s work over the three year term of the plan • promote the integration of the local health system to provide appropriate, coordinated, effective and efficient health services • communicate to the public intended integration strategies

5. The Integrated Health Services Plan • The Accountability Agreement directs LHINs to develop the IHSP guided by the Roadmap to the Integrated Health Service Plan, issued by the ministry, which sets out that the initial Integrated Health Services Plan will be built on the following components: • Community Engagement • Foundation for Future Plans • Priorities for Integration • Demonstrates Achievement of Ministry Strategic Directions • 5. Optimizing Available Resources

6. The Integrated Health Services Plan • The Roadmap to the Integrated Health Service Plan, issued by the ministry, sets out the table of contents to be organized according to the following 7 sections: • 1.Provincial Context – provincial vision and priorities, strategic directions • 2. LHIN Local Vision – introduces key local issues in the context of the • vision the LHIN’s values and principles, demonstrating alignment with the ministry priorities • 3. Environmental Scan – summary of population profile and need assessment, assessment of services, resources, and programs including readiness assessments in key ministry areas • 4. LHIN Priorities for Change – key local issues and challenges identified through engagement and planning. • 5. Current activities – achievements to date and overview of 2006/07 activities • 6. Action Plan – detail goals, action items to address LHIN priority issues, with outcome targets and milestones • 7. Appendices – summary of background materials.

7. 1. Provincial Context • What are LHINs? - The Local Health System Integration Act, passed in March 2006, gives the Central West LHIN the power to plan, coordinate and fund health care providers. • What is an IHSP? - The IHSP sets out local priorities and strategies for the three year period starting April 2007. • Ministry Vision- A health care system that helps people stay healthy, delivers good care when they need it, and will be there for their children and grandchildren.

8. 1. Provincial Context • Draft Strategic Directions - In June, 2006 the LHINs were provided with the government’s draft Strategic Directions for Ontario’s healthcare system. They focus on five areas: • 1. Renewed Community Engagement and Partnership • 2. Health Status • 3. Access and Equity • 4. Quality • 5. Sustainability

9. 2. Central West LHIN local Vision • The Central West LHIN will work to create “a local • health system that helps people stay healthy, delivers • good care when they need it, and will be there for their • children and grandchildren.”

10. 2. Central West LHIN local Principles • The local health system will be built on the following five principles: • Equitable access based on patient need • Preservation of patients' choice • People-centred, community-focused care that responds to local population health needs • Measurable, results-driven outcomes based on strategic policy formulation, business planning, and information management • Shared accountability between providers, government, community and citizens.

11. 2. Central West LHIN local Values • The Central West LHIN will conduct its activities, and expects to be evaluated, based on the following value set: • Person-centred: • We advance the public good with purpose and passion while honouring democratic values. • We work with individuals and the community in pursuit of optimum health status. • We are deeply committed to meeting the health care needs of our community and we constantly focus on client satisfaction. • Transparency: • A commitment to the highest possible ethical standards, and open and timely sharing of information.

12. 2. Central West LHIN local Values • The Central West LHIN will conduct its activities, and expects to • be evaluated, based on the following value set: • Integrity: • In all of our activities, we will foster trust by being truthful, empathetic and consistent. • Stewardship: • In managing all resources to which we have been entrusted, • we will seek ways to ensure appropriate use of resources, and act responsibly, taking actions that align with our vision, values and strategic directions.

13. 2. Key issues that give rise to the Vision and Local Directions • The initial IHSP emphasizes three particular issues that were • recurring themes and have a significant influence on the current • and future state of local integrated health services. • Access - The overriding issue highlighted by members of the public and health service organizations as most pressing for the Central West LHIN’s attention is access, and equity of access. • Capacity - Capacity has been a long-standing concern for the communities that now make up the Central West LHIN. In many cases, access issues are a symptom of under-capacity. • Creation of the Central West Identity – The Central West LHIN needs to bring people together and cultivate a sense of identity to move forward with responsive and realistic action.

14. Environmental Scan

15. Environmental Scan • Population Health Needs • Currently population is relatively young and relatively healthy • Healthy behaviours are evident • Use of formal health care services is relatively low • But there is the potential for health needs to increase significantly due to: • High growth population reaching close to one million residents in ten years • Birth rate is the highest in the province and immigration rates are also high • Aging population with the proportion of seniors increasing by 54% to 2016 • Rich cultural diversity requiring diverse service delivery to meet diverse needs • High levels of physical inactivity • Rate of childhood obesity that is slightly higher than the provincial average • Higher than provincial average rates of low birth weight babies and infant mortality • Low compliance with screening programs and preventative care (particularly mammograms and flu shots)

16. Environmental Scan • Service Delivery Issues • Level of health resources is below other LHINs in all sectors. The Central West LHIN has: • Fewest number of health transfer payment agencies among the 14 LHINs • Lowest, or among the lowest, level of per capita funding in every health services sector • Lowest supply of specialist physicians and nurses in the province • Second lowest supply of family physicians • Two designated “underserviced” communities (Orangeville and Shelburne) • High % receiving health services outside LHIN (2nd lowest localization rate in province) • Many gaps in terms of specialized services • Public concerns about lack of access to local health services and to health professionals • Public seeking improvements for specific services - mental health, seniors services, • prevention • provider perception that local health system doing only a “fair” or “poor” job of meeting • needs of diverse communities • Few services tailored specifically for Francophone and Aboriginal communities • There is evidence that: • Opportunities for efficiency have been explored by hospitals (e.g. lowest level of ALC, lowest • proportion of non-urgent emergency department visits) • Further improvements will require expanded capacity, particularly in the community, and • cross-boundary linkages where local service delivery is not available or possible.

17. 4. LHIN Priorities for Change • The Central West LHIN has identified three overarching strategies to • address local health service issues and achieve the provincial vision • for health. • Increased capacity (more services and supports) • Improved access (more timely, easy, access to high quality, client- • centred culturally appropriate services) • Enhanced integration (better coordination and linkages among • service providers and across the continuum of care)

18. 4. LHIN Priorities for Change Client Focus Priority Areas Maternal / Child Services Mental Health and Addiction Services Palliative / End-of-life Services Rehabilitation Services to Seniors Other Priorities Chronic Disease Prevention & Management Responsiveness to Cultural Diversity Primary Care Linkages Illustration of the relationship of the overarching strategies, client focus priority areas, other priorities, and three of the ministry’s focus areas

19. Current Activities • Recent Community Engagement Activities • “Meet and Greets” • Public “Conversations” • Health Service Provider Organization Survey • Dialogue and action planning in key service areas • Public Polling • Reaching out to the network’s diverse communities • Engaging physicians • Hearing from the frontline

20. Current Activities • Addressing Provincial Focus Areas • French Language Services – GTA session, following up with local francophone community • Aboriginal Health – base work on provincial initiatives, identifying and meeting with members of local aboriginal communities • E-Health – e-health advisory committee established, e-health lead identified, e-health strategic plan being produced • Wait times – meeting with hospitals and CCACs examining opportunities to improve efficiencies and access in five key areas • Health Human Resources – developing data, met “search committee”, establishing Health Professionals Advisory Committee • Critical Care – local lead identified, local inventory underway, priorities being identified critical resource team being established coaching underway, • Back Office Integration – gathering preliminary information, • particularly on cross-LHIN initiatives underway

21. Current Activities • Community Engagement Phase II • next series of public “conversations” focused on IHSP • developing “cross-border” discussions • continuing to develop community engagement, as an on-going process • Building a Stronger Organization • Board members in place • Board planning retreat and development of vision and values • staff recruitment begun

22. Action Plan • … for addressing the provincial Strategic Directions • Access and Equity • Strategic Intent - To identify opportunities to create an • environment that improves access and equity of access • in specific client areas. • The Central West LHIN will initially focus on eight priority client • service areas to improve access, and equity of access. An • action plan for these priority areas is provided later in this • section.

23. Action Plan • … for addressing provincial Strategic Directions Renewed Community Engagement and Partnership Strategic Intent - To engage the community in establishing a robust community engagement process to ensure meaningful participation by the residents and health service providers of the Central West LHIN. Community awareness and community engagement in local health system planning are fundamental to the mandate of LHINs. Successful engagement of the public and providers will require: - creating a sense of identity for the LHIN - bringing stakeholders together in new forums - conducting ongoing outreach to increase the visibility of the LHIN - establishing a formal communication plan, which will include developing a multi-year community engagement strategy, based on the community engagement strategy framework.

24. Action Plan • … for addressing provincial Strategic Directions Health Status Strategic Intent - To focus on improving the health status of the population of the Central West LHIN with an emphasis on those with the poorest health status. The Central West LHIN will support local health service provider organizations (including Public Health) and the public in improving the overall health status of the population by developing strategies for high need/low access, culturally diverse, geographically isolated, and youth, communities. Health status improvements will be evaluated using the Ontario Local Health Care System Scorecard Indicators and other measures as required.

25. Action Plan • … for addressing provincial Strategic Directions Quality Strategic Intent - To establish performance measures specific to the Central West LHIN to evaluate quality of services within the Central West LHIN. The Central West LHIN will measure health system performance and facilitate LHIN-based quality improvement initiatives.

26. Action Plan • … for addressing the provincial Strategic Directions Sustainability Strategic Intent - To identify opportunities for new partnerships focused on improving service capacity in the Central West LHIN. The Central West LHIN views ministry funding for local health service organizations as a system resource and will work to ensure that any additional resources for the LHIN will be focused on population need. The LHIN will also ensure that it communicates all opportunities for new or enhanced funding to ensure gaps in service are addressed and local access is improved for the residents of the Central West LHIN.

27. Action Plan for priority areas • Maternal and Child Services 07/08 08/09 09/10 • Action Steps • 1. Initiate a cross-sectoral planning session √ • to identify local issues and priorities • 2. Establish an “expert panel” to develop √ • a local integrated maternal / child services • plan • 3. Document baseline and monitor performance √ √ √ • Outcomes • Defined planning process • Completed local integrated maternal / child services plan • Increased perinatal care, including culturally appropriate care • Improved access to high risk obstetrical services

28. Action Plan for priority areas • Mental Health and Addiction Services 07/08 08/09 09/10 • Action Steps • 1. Support establishment of steering committee √ • 2. Undertake comprehensive inventory √ • 3. Develop local integrated mental health √ • and addiction service plan • 4. Develop template and protocol for service √ • 5. Develop common assessment tool √ • 6. Coordinate shift to new model √ √ • 7. Document baseline and monitor performance √ √ √ • Outcomes • Inventory of resources • Development of local integrated service plan • Common service agreement template, protocols and assessment tool • Improved outcomes • Increased client / family satisfaction

29. Action Plan for priority areas • Palliative / End-of-Life Services 07/08 08/09 09/10 • Action Steps • 1. Align Palliative Care Network to boundary √ • 2. Develop local integrated palliative / end-of-life √ • service plan, building on provincial initiatives • 3. Undertake comprehensive inventory √ • 4. Document baseline and monitor performance √ √ √ • Outcomes • Establishment of local Palliative Care Network • Inventory of resources • Development of local integrated palliative / end-of-life services plan • Increased family satisfaction

30. Action Plan for priority areas • Rehabilitation Services 07/08 08/09 09/10 • Action Steps • 1. Undertake needs assessment, comprehensive √ • survey, describe patient flow, identify gaps, • 2. Develop local integrated hospital and community- √ √ • based rehabilitation services program plan • 3. Document baseline and monitor performance √ √ √ • Outcomes • Completed needs assessment, survey • Completed hospital and community-based rehabilitation services plan • Improved patient outcomes • Increased patient satisfaction

31. Action Plan for priority areas • Services for Seniors 07/08 08/09 09/10 • Action Steps • 1. Work with ministry to ensure adequate CCAC funding √ • 2. Undertake comprehensive inventory of seniors services √ • 3. Assess services availability, identify gaps, align √ • services to community as preferred location • 4. Develop local integrated seniors services plan, • focusing on partnerships and best practices √ • 5. Document baseline and monitor performance √ √ √ • Outcomes • Completed inventory • Development of local integrated seniors services plan, including navigation model • Improved client outcomes • Increased rate of seniors staying in their homes with appropriate assistance • Increased client satisfaction

32. Action Plan for priority areas • Chronic Disease Prevention and Management 07/08 08/09 09/10 • Action Steps • 1. Facilitate sharing of information on CDP&M √√ √ • 2. Based on provincial initiative, bring together local √ • service providers, including Public Health, to • develop local CDP&M model • 3. Document baseline and monitor performance √ √ √ • Outcomes • Increased awareness and focus on prevention and promotion • Understanding and acceptance of local model • Reduced (or stable) prevalence of chronic conditions • More linkages and referrals between Public Health and service providers

33. Action Plan for priority areas • Primary Care Linkages07/08 08/09 09/10 • Action Steps • 1. Expand on physician engagement √√ √ • 2. Help develop initiatives that improve linkages between √√ √ • primary care providers to community-based services • and hospitals • 3. Facilitate initiatives that address and improve local √√ √ • access to primary care (such as Family Health Teams) • 4. Where appropriate, support local recruitment initiatives √√ √ • 5. Promote initiatives that expand Community Health √√ √ • Centre capacity • 6. Document baseline and monitor performance √ √ √ • Outcomes • Increased proportion of residents served by local family physician • Improved access to teams of health care professionals • Improved public satisfaction

34. Action Plan for priority areas • Responsiveness to Cultural Diversity 07/08 08/09 09/10 • Action Steps • 1. Connect to cultural-based or culture-focused √√ √ • organizations • 2. Join “regional diversity roundtable” to gather √ • advice and formalize connections • 3. Develop “strategic diversity plan” √ • 4. Incorporate cultural / linguistic measures into √ • system performance • 5. Document baseline and monitor performance √ √ √ • Outcomes • Completed “strategic diversity plan” • Established cultural / linguistic based performance indicators • Increased number of ethno-specific agencies/groups engaged • Increased public satisfaction

35. Action Plan for priority areas • French Language Services 07/08 08/09 09/10 • Action Steps • Work ministry FLS Coordinators and local “identified” √ • health service providers, develop strategy to engage • local francophone communities • 2. With francophone community identify and √ • develop plan to address issues and priorities • 3. Document baseline and monitor performance √ √ √ • Outcomes • Increased number of francophone groups and individuals engaged • Increased understanding of obligations under French Language Services Act • Increased access to services provided in French to francophone community • Increased francophone client / family satisfaction

36. Action Plan for priority areas • Aboriginal health 07/08 08/09 09/10 • Action Steps • 1. Work with provincial and GTA groups to develop √ • strategies to engage local aboriginal communities • 2. Develop local framework for addressing health √ • needs of local aboriginal communities based on • the work of the Aboriginal and First Nations Health • Council,provincial Aboriginal Wellness Strategy and • provincial Aboriginal Diabetes Strategy • 3. Document baseline and monitor performance √ √ √ • Outcomes • Completed strategy for local Aboriginal community engagement • Completed network for identifying and addressing needs of local Aboriginal • communities • Increased understanding of provincial Aboriginal policy initiatives • Increased access to culturally-sensitive services to Aboriginal communities • Increased Aboriginal client / family satisfaction

37. Action Plan for priority areas • E-Health 07/08 08/09 09/10 • Action Steps • 1. Complete e-health strategic plan √ • 2. Implement e-health strategic plan in partnership √ • with local health service providers • 3. Document baseline and monitor performance √ √ √ • Outcomes • Completed e-health strategic plan • Improved flow of information across health service provider organizations • Increased information sharing • Reduction of patient repetition of information to different service providers • Increased client / provider satisfaction

38. Action Plan for priority areas • Wait Times 07/08 08/09 09/10 • Action Steps • Continue to meet with hospitals and CCACs √ • to examine opportunities to improve efficiencies • and capacities to increase local access in the • five key areas identified by the ministry • 2. Support planning and innovative initiatives by local √ • partners to improve local performance • 3. Document baseline and monitor performance √ √ √ • Outcomes • Reduced wait times in all five priority areas • Increased number of joint initiatives to address wait times • Increased client / family satisfaction

39. Action Plan for priority areas • Health Human Resources 07/08 08/09 09/10 • Action Steps • Work with local groups involved in health human √ • resource planning • 2. Establish Health Professionals Advisory Committee √ • 3. Partner with local health service providers to develop √ • local health human resources plan • 4. Document baseline and monitor performance √ √ √ • Outcomes • Establish Health Professionals Advisory Committee • Completed local health human resources plan • Improved numbers of health human resources • Increased client / family satisfaction with access to health professionals

40. Action Plan for priority areas • Critical Care 07/08 08/09 09/10 • Action Steps • Working with local Critical Care Lead help implement √√√ • initiatives to improve local critical care services • Facilitate cross-boundary partnerships √√ • To develop access to services not now available √√ • within the LHIN • In partnership with providers ensure emergency / √√√ • pandemic plans are in place • 6. Document baseline and monitor performance √ √ √ • Outcomes • Inventory of existing and planned critical care resources • Completion of review and local critical care plan • Improved cross-border partnerships and transfer protocols • Increased client / family satisfaction

41. Action Plan for priority areas • Back Office Integration 07/08 08/09 09/10 • Action Steps • 1. Continue to work with health service provider √√√ • organizations to inventory back office integration • initiatives • 2. In partnership with health service provider √√√ • organizations identify opportunities • 3. Document baseline and monitor performance √ √ √ • Outcomes • Identification of back office opportunities • Increased number of joint initiatives for sharing back office services • Improved efficiency and reduced duplication of back office services

42. Questions/Comments? Thank you! Joe McReynolds, Board Chair Central West LHIN Mimi Lowi-Young, CEO Central West LHIN