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Governance to Governance Session North West Local Health Integration Network

January 30, 2013

Planning Session Objectives

To continue the education of the Boards on the Health Services Blueprint

To identify progress made to-date on the Health Services Blueprint

To understand the role of the Health Service Providers and North West LHIN in moving the Health Services Blueprint framework forward

To develop a common understanding of the establishment of Health Links in Ontario

To engage in discussion regarding the sense of urgency and bold leadership required to move forward with transformational change

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Time Topic Speaker/Facilitator/ Participant(s)

8:00 - 8:30 Breakfast

8:30 - 8:45 Welcome and ‘Housekeeping’ Joy Warkentin

8:45 - 9:30 Transforming the Health System in the North West LHIN Reg Jones Dianne Miller

Laura Kokocinski

9:30 - 10:30 Health Links Initiative Plan Helen Angus

10:30 - 10:45 Networking Break

10:45 - 12:15 Exercise #1 KPMG/All

12:15 - 1:00 Lunch

1:00 - 2:00 Transforming the System: Sense of Urgency and Bold Leadership

Janet Davidson

2:00 - 3:30 Exercise #2

Break KPMG/All

3:30 - 4:15 Pulling it All Together: Summary of Action Items for the Day KPMG

4:15 - 4:30 Closing Remarks Joy Warkentin Laura Kokocinski

4:30 Session Closure

Agenda

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Welcome and ‘Housekeeping’ Joy Warkentin

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Transforming the Health System in the North West LHIN

G2G Survey Summary – Reg Jones & Dianne Miller Health Services Blueprint Update – Laura Kokocinski and Team

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Governance to Governance Survey Summary

January 30, 2013

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Governance to Governance Surveys

In April 2012, the North West LHIN Board of Governors met with 266 Board Governors from LHIN-funded health service provider organizations.

At these sessions the Governors were informed that they will be asked to participate in a survey to gather information for the next Governance to Governance sessions with Health Service Provider Boards.

The surveys focused on the following: − Checklist for Board/Council Review of Strategic Plan Alignment

(10 questions); − Checklist for Board/Council Accountability for Voluntary Integration

Initiatives (11 questions); and, − Health Service Utilization.

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G2G Survey Results

Board/Council Strategic Plan Alignment (24 responses): − 19/24 = aligns with North

West LHIN Strategic Directions

− 23/24 = reflects common principles

− 11/24 = using Integration tools

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G2G Survey Results

Where in Local Health Hub could integration take place? − 13/24 = Back office – IT − 10/24 = Back office – Finance − 13/24 = Back office – Quality − 12/24 = Back office – Safety − 10/24 = Back office – Human

Resources − 8/24 = Services - Clinical − 6/24 = Services - Medical − 7/24 = Services – Physicians − 7/24 = Administration -

Management

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G2G Survey Results Voluntary Integration Initiatives

(24 responses): − 24/24 = fully briefed on LHSIA

and the LHINs Integrated Health Services Plan

− 19/24 = receive regular updates on LHIN policies and activities

− 9/24 = established a Board/Council policy on voluntary integration

− 13/24 = have designated a member of Board/Council to liaise with LHIN

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G2G Survey Results

Health Service Utilization (26 responses): − 9/26 = circulatory − 9/26 = neoplasms − 9/26 = external causes − 11/26 = digestive − 9/26 = endocrine − 2/26 = homemaking − 4/26 = respite

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G2G Survey Results

Voluntary Integration Initiatives (24 responses): − 16/24 = Board/Council

provides direction to CEO regarding integration and reflect in CEO performance agreement

− 7/24 = Board/Council proposes an integration plan that is consistent with the LHIN Strategic Plan

− 17/24 = Have a “no surprise” policy

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G2G Survey Results

Health Service Utilization (26 responses): − 4/26 = long-term care − 26/26 = mental health − 24/2 = addictions − 2/26 = primary care − 9/26 = supportive housing − 18/26 Have a wait list for

their services − Length of stay for service is

variable depending on the service

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Health Service Providers Feedback on the Survey

Difficult to understand the survey questions and how they applied to the organization.

Focus seemed more hospital-based than community based. Didn’t understand what the top 1% and top 5% utilization meant

to their respective organization. Difficult to obtain the data on top 1% and top 5%. Challenging to complete the data request when offering multiple

services/programs within or across one organization (e.g. which option to choose to respond to on the survey).

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North West LHIN Health Services Blueprint

Governance to Governance Session January 30, 2013

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Desired Outcomes

1. Strong focus on population health and improving health outcomes

2. Improving the patient care experience—right care, right time, right place

3. High quality care 4. Increased accountability and transparency 5. Increased communication, partnerships and integration 6. System sustainability 7. Value for money

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INTERPRETING THE BLUEPRINT RECOMMENDATIONS

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Recommendations 1-8 R1 to R8: Implement an integrated health system model to organize services and delivery of care at the local, district and regional level

Local Health Hub (LHH): • Plan and provide health care

services to local community • Improve access to care for stable

patients including: • Chronic conditions • Mental Health and Addictions

• Communities with hospitals

District Health Campus (DHC): • One hospital in each District • Secondary care for District population Integrated District Network (IDN): • Five IDNs in North West LHIN • Formalized network within each district

comprised of all LHIN HSPs • Coordinate services for district

population across local, district, regional levels

Regional Program (RP): • High cost, high complexity, high

impact services • Education, research, knowledge

exchange, adoption of evidence-based practice, and system navigation

LOCAL HEALTH HUB INTEGRATED DISTRICT NETWORK REGIONAL PROGRAM

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The Local Level • Local Health Hubs will plan and provide health

care services to the local community • Local Health Hubs will focus on improved

access to care for stable patients, including those with chronic conditions and mental health and addictions issues

• Services at the local level will include: o Primary care o Community support services o Community mental health and addictions o Acute care o Post-acute care (rehab, complex

continuing care, transitional care) o Long-term care

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The District Level • One hospital in each District will be a District

Health Campus • The District Health Campus will provide more

specialized, secondary care to the population • District Hospital site • Visiting clinics in local health hubs • Technology-based services (e.g. telemedicine,

tele-psychiatry) • The District Health Campus may host regional

programs and CCAC satellite office • Integrated District Networks will be made up of all

LHIN-funded HSPs that deliver health services within the District

• The Integrated District Network will arrange a coordinated continuum of services for the District population across local, district and regional levels

• The Integrated District Network doesn’t provide “services”

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The Regional Level • Regional Programs will focus on high cost, high

complexity, high impact services • Regional Programs will enable the provision of

highly specialized care within the North West LHIN • Regional Programs will deliver some services at

the local level; more specialized services delivered at a District or Regional level

• Regional Programs will include components of education, research, knowledge exchange, adoption of evidence-based practice and system navigation

• Regional or LHIN-wide Programs and services will incorporate leading practice evidence-based care and will set the standards of care across the LHIN

• Regional Programs will be disease-based (e.g. cancer), population-based (e.g. Seniors), or will enable delivery of key services across the LHIN (e.g. back office solutions)

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How It All Works Together • Local Health Hubs deliver primary care close to home

• There is one designated District Health Campus within each District

• The District Health Campus will provide more specialized care within the District

• Local Health Hubs can make referrals to specialty programs at the District Health Campus and Regional Program levels

• The Local Health Hubs and the District Health Campus is part of the Integrated District Network

• The Integrated District Network will act like a steering committee, overseeing the coordination of care across the District, facilitating the link with highly specialized regional programs

• Regional Programs will work closely with and support the Districts to spread best practices and deliver specialty programs and services to all populations across the LHIN

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Recommendation 9

• The integrated health system model will be comprised of five Integrated District Networks that will work across the entire North West LHIN: • District of Thunder Bay IDN • City of Thunder Bay IDN • District of Kenora IDN • District of Rainy River IDN • Northern IDN

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• Integrated District Networks will reduce the reliance on acute inpatient hospital use by developing a comprehensive continuum of care for each of the following programs:

Thunder Bay District

Rainy River District

Kenora District

City of Thunder Bay

Northern District

North West LHIN

Circulatory Circulatory Circulatory Circulatory Circulatory Circulatory

Neoplasms External Causes

External Causes Neoplasms External Causes Neoplasms

Respiratory Neoplasms Neoplasms External Causes Neoplasms External Causes

External Causes Respiratory Respiratory Respiratory Respiratory Respiratory

Digestive Digestive Digestive Digestive Digestive Digestive

Endocrine, Nutritional, Metabolic






Recommendation 10

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Sector District of Thunder Bay IDN

Rainy River IDN Kenora IDN Northern IDN City of Thunder Bay IDN

Mental Health Improve access to services across the continuum for Mental Health and Addictions patients Improve coordination/delivery of community and hospital services

Implement substance misuse programs

Improve access to designated MH beds Home Care and Long Term Care

Increase access to home care services Increase access to home care services

Increase access to long term care services Post Acute Care

Increase access to post acute care services, including transitional care beds that promote reactivation and independence

Realign inpatient/ outpatient rehab

Ambulatory Care

Implement community based programs for high impact clinical programs (see recommendation 10)

Other MYWHC lead • culturally

appropriate care across the region

• regional approach to addiction issues in obstetrics/ maternity care

Continue to evolve relationship between SJCG and TBRHSC SJCG lead regional post-acute care (rehab, LTC, palliative)

Recommendations 11-40 by IDN

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Sector District of Thunder Bay IDN

Rainy River IDN Kenora IDN Northern IDN City of Thunder Bay IDN

Information Management /Information Technology

Implementation of Connecting Northern and Eastern Ontario (cNEO) across the LHIN Expansion of tele-homecare and tele-medicine

Back Office Integration

Integrated back office s across all health service providers including: • Heath Human Resources • Finance • Procurement • Supply Chain • Learning and Development • Information Technology

Health Human Resources

Develop consolidated 10 year plan for Health Human Resources to help manage accessibility of HHR in rural and remote regions

Recommendations 41-44 by IDN

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Alignment to Provincial Initiatives Support to become

healthier

Faster access and a stronger link to family

health care

The right care, at the right time, in the right

place Childhood Obesity

Strategy

Smoke-Free Ontario

Expanded Cancer Screening

Family Health Care at the Centre of the System

Faster Access

House Calls

Local Integration of Family Health Care

A Focus on Quality in Family Health Care

High Quality Care

Timely, Proactive Care

Care as Close to Home as Possible

Seniors Strategy

Moving Procedures into the Community

Funding Reform

Family Health Care at the Centre of the System

Local Integration of Family Health Care

High Quality Care

Timely, Proactive Care

Care as Close to Home as Possible

Seniors Strategy

Moving Procedures into the Community

Funding Reform

Faster Access

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Context: North West LHIN High Users

28 2/1/2013

• 1.5% of provincial high users live in the

City of Thunder Bay – this is the largest proportion of high users in a city in the province

• 59% of the LHIN’s high users in our LHIN reside in Thunder Bay

• 52% of the LHIN’s population resides in Thunder Bay City

• 98.3% of the high user expenses for the North West LHIN were incurred within the LHIN boundaries, offering a unique opportunity to change this pattern of hospital use

# of Patients

Total Expenses for Patients

Number of Events

Avg. Expense per Client

Total % ALC for this population

% total NW LHIN ALC

top 1% 1,145 people $123m 11,830 $108,000 65.7% ALC 44.9%

top 5% 5,075 people $230m 44,335 $45,500 49.6% ALC 73.4%

top 10%

9,880 people $279m 72,685 $28,000 39.9% ALC 83.1%

All Users

105,740 people $372m 279,845 $3,500 8.4% ALC

Overview: North West LHIN High User System Impact

29 2/1/2013 Source: Health Analytics Branch, Analysis of High Users of Health System 2009/10, Analysis of 'High Users' of Health Care Services, Ontario, 2009/10, Table 1.1 Distribution of patients and expenses; events and expenses by LHIN of service for all care types, 2009/10

IMPLEMENTING THE BLUEPRINT

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High-Level Implementation Plan

Year 1 – Year 2 Phase 1: Planning and Pilot

Implementation

Year 3 - Year 4 Phase 2: Phased Implementation

Year 5 – Year 10 Phase 3: Full

Implementation

• Communication, Education, Training and Capacity Building

• Planning for Local Health Hubs, IDNs, and District Hospitals

• Financial Planning by sector • Early-adopter

implementation, including Regional Programs

• Ongoing analysis, evaluation and refinement

• Phased implementation of Local Health Hubs, District Hospitals and IDNs across LHIN

• Continued Implementation of Regional Programs

• Ongoing communication • Ongoing analysis,

evaluation and refinement

• Full Implementation • All IDNs • All Local Health Hubs • TBRH as Regional

Healthcare Centre • Regional Programs

• Ongoing communication • Ongoing evaluation,

analysis and refinement

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Work Underway Year 1

19 recommendations

we’ve already started work on

R1: Organize services at regional, district and local levels

R2: Collaboration across all HSPs at the Local Level

R7: Designate TBRHSC as the tertiary hospital

R8: Establish regional programs

R12: DoTB IDN to increase access to home care services

R16: DoRR IDN to increase access to home care services

R19: DoK IDN to improve access to designated MHA beds

R22: DoK IDN to increase access to home care services

R23: DoK IDN to increase access to post acute/ transitional care beds

R26: CoTB IDN to continue to evolve SJCG role in post-acute care

R29: CoTB to increase access to home care services

R30: CoTB IDN will investigate CCC and LTC settings for post-acute care

R25: CoTB IDN evolve relationship between TBRHSC & SJCG

R38: Northern IDN to ensure access to long term care services

R39: Northern IDN to increase access to post acute/transitional care beds

R41: Implementation of cNEO

R42: Expand tele-homecare and telemedicine

CCC: Complex Continuing Care cNEO: Connecting Northern and Eastern Ontario COTB: City of Thunder Bay DoK:: District of Kenora D0RR: District of Rainy River

DoTB: District of Thunder Bay HSP: Health Service Provider IDN: Integrated District Network LTC: Long Term Care SJCG: Saint Joseph’s Care Group TBRHSC: Thunder Bay Regional Health Sciences Centre

R9: Define District IDN Geographies

R44: Develop Health Human Resources Plan

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Anticipated Activity Year 2

11 recommendations

In addition to the work started in Year 1, we expect Year 2 will focus on another

R3: Development of District Networks

R4: Establish District IDN Steering Committee with Early Adopter(s)

R6: Designate District Health Campus Sites

R11: DoTB IDN to reduce MHA reliance on Emergency Departments

R20: DoK IDN to reduce MHA reliance on Emergency Departments

R21: DoK To implement models for substance misuse

R27: CoTB IDN to reduce MHA reliance on EDs

R28: CoTB IDN to implement models for substance misuse

R31 CoTB IDN increase access to rehab services

R43: Investigate Back Office Integration opportunities

R32: CoTB IDN implement alternatives to ED/inpatient for high impact programs

CCC: Complex Continuing Care cNEO: Connecting Northern and Eastern Ontario COTB: City of Thunder Bay DoK:: District of Kenora D0RR: District of Rainy River

DoTB: District of Thunder Bay HSP: Health Service Provider IDN: Integrated District Network LTC: Long Term Care MHA: Mental Health and Addictions SJCG: Saint Joseph’s Care Group TBRHSC: Thunder Bay Regional Health Sciences Centre 33

• Develop Clinical Service Delivery Model Decision Making Framework to align services to Local, District and Regional levels

• Incorporate leading practice care delivery approaches • Implement consistent approach to programming/costing

• Value Stream Mapping to improve transitions in care

• Align financial allocation to clinical services at Local, District and Regional levels

• Identify opportunities for improving value for money • Implement standardized costings

• Reflect expectations in Service Accountability Agreements

Implementing the Service Delivery Model: Approach

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Year 2 – Implementation • Early Adopter Implementation will commence Year 2 with implementation

across two Integrated District Networks • Align Integrated District Network Level with Health Links

• Introduce new model of care at the clinical level • All providers in a community or district will be included in the planning

network, and this will encompass primary care involvement, hospital, home and community care. The providers will be responsible for coordinating plans at the patient/client level.

Both the Blueprint and Health Links identify and respond to the need for and importance of local partnership across providers to: • Deliver better value for money • Ensure higher quality of care • Improve access to care.

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Year 2 - Measurement and Monitoring

Improved health outcomes

Access, as close to home as possible

Continuous quality improvement

Well managed resources

Reduce ALC Rate

Reduce 30 day readmission to hospital

Reduce avoidable ED visits for patients with

conditions best managed elsewhere

Reduce average cost of delivery of health services without compromising the

quality of care

Primary care follow up within 7 days of discharge

Reduce unnecessary admissions to hospital

All complex patients have coordinated care plans

Reduce time from referral to home care visit

Enhance experience that patients with the greatest health care needs have

with the system

Reduce time from a primary care referral to specialist consultation

Increase the number of complex patients and seniors with access to

primary care

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Year 2 – Preliminary High Level Timelines for Early Adopters

Key Activity Q4 12/13

Q1 13/14

Q2 13/14

Q3 13/14

Q4 13/14

Readiness Assessment Business Case Implementation IDN/Health Link 1 Implementation IDN/Health Link 2 Ongoing Collaboration Ongoing Evaluation and Monitoring Value Stream Mapping Knowledge Exchange

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WHERE WE NEED YOUR HELP

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We Need You To…

Be visible, vocal,

champions of the

Blueprint

Encourage participation

in LHIN activities

Hold Senior Leadership

accountable to be visible, active change agents

Advocate change to achieve common

goals Pursue

innovative partnership

opportunities

Break from traditional ways of

doing things

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Equipping Your Organizations

• How to become increasingly more strategic as an organization

• How and why to align strategic plans with the Blueprint

• Accountability at a leadership level

• This isn’t just about your organization or clients - shift thinking to a community-based, integrated leadership perspective

Help to identify other Blueprint Champions, and work with them to: • Develop synergistic

partnerships; share best practice, identify opportunities for integration

• Prepare their respective organizations and communities for new ways of working

• The Blueprint, the burning platform and our goal of an integrated service delivery model

• What we mean by integration and the opportunities it presents

• Transformational change – what it is, how it’s different, and how to position it for success

Educate Coach Connect

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Your Leadership is Needed

This is exciting, it’s cutting edge and it’s absolutely necessary for health system sustainability

This is an opportunity to create a health care system that provides better access to health care than ever before

We need Board members to lead the transformation to a health care system for the future – not just for us, but for our children and

grandchildren

This is an opportunity to do something for your community, today and in the future

This is our opportunity to shape our local system – together – to create a

leading health care system

We’re the first LHIN to do this, and Board Members can play a

key role in making it happen This system change will help your

organization function more effectively through integrated care delivery - this

means improved client experiences and, ultimately, improved health for your client

population

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Questions

? 42

Health Links Initiative Plan Helen Angus

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This presentation can be accessed on the LHIN website: http://www.northwestlhin.on.ca/Page.aspx?id=2660

Networking Break

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Exercise #1

KPMG/All

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Exercise #1

Representatives will be divided into discussion tables.

Each group will work together to take the insights gained from the presentation by the North West LHIN and Ministry to respond to a series of questions regarding the implementation of the Health Services Blueprint recommendations.

Each group will be co-chaired by a Health Service Provider representative and LHIN Board member. In addition, a LHIN staff will be assigned as a recorder for each table.

Each group will report back to the plenary.

46

Exercise #1 Question 1:

How will the Local Health Hubs and the Integrated District Network (IDN) work collectively with the regional programs to address population health needs? Identify the action steps with timelines to make this happy over the next 2 years.

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As part of our governance deliberation we have confirmed many desired outcomes to be achieved over the next 10 years which include: • Strong focus on population health and improving health outcomes • Improving the patient care experience—right care, right time, right place • High quality care • Increased accountability and transparency • Increased communication, partnerships and integration • System sustainability • Value for money How will the Local Health Hubs and Integrated District Network (IDN) collaborate to meet the desired outcomes? Identify action steps that need to be taken by Health Service Provider boards and executive teams with timelines to initiate this in 2013/14.

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Lunch

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Transforming the System: Sense of Urgency and Bold Leadership

Janet Davidson

50


Setting the stage: What factors are creating urgency for system transformation?

Provincial

National

Global

51

Source: KPMG ‘Succeeding in a Changing World’ 2012

Transforming the System: Global Forces

Changing business operations to realize cost efficiencies

Improving cash and working capital management

Exploiting growth opportunities through successful transactions

Preparing your organization for major business model changes

Managing and retaining the right people within the organization

Addressing risk throughout the organization

Looking for growth in emerging markets

Innovation through product development

Adapting to take into account changing customer and stakeholder behavior

Using information to forecast response to uncertain times

Refinancing or seeking capital

Using technology as a strategic enabler, not just an operational facilitator

Embedding sustainability in the business model

Responding to regulatory change

Seizing opportunities offered by increasing public/private sector interaction

43%

32%

30%

25%

24%

21%

21%

20%

18%

15%

13%

12%

10%

10%

6%

3,000 CEOs from all industries can see the importance of transformational change but focus their attention on short term transactional efficiency.

Note: (a) Due to rounding up and down total figure may vary from 300%

Total adds up to 300% all

respondents had three votes(a)

52

Globally, transaction trumps transformation.

Source: KPMG ‘Succeeding in a Changing World’ 2012

27%

50%

15%

33%

15%

18%

18%

17%

20%

10%

12%

27%

17%

17%

5%

32%

43%

21%

30%

15%

25%

4%

21%

18%

12%

10%

24%

13%

20%

10% Healthcare Total

Healthcare

Improving cash and working capital management

Changing business operations to realize cost efficiencies

Addressing risk throughout the organization

Exploiting growth opportunities through successful transactions

Using information to forecast response to uncertain times

Preparing your organization for major business model changes

Seizing opportunities offered by increasing public/private sector interaction

Looking for growth in emerging markets

Adapting to take into account changing customer and stakeholder behavior

Using technology as a strategic enabler, not just an operational facilitator

Embedding sustainability in the business model

Managing and retaining the right people within the organization

Refinancing or seeking capital

Innovation through product development

Responding to regulatory change

Note: (a) Due to rounding up and down total figure may vary from 300%

Total adds up to 300% all

respondents had three votes(a)

53

Active strategies to cope are transactional.

• Question - Which strategies are providers likely to adopt to respond to these changes?

Source: Pre-conference survey Something to teach, Something to learn, KPMG Rome 2012

Major cost reduction

Lean and improvement methods

More focus and specialization

Investment in Health IT

New workforce models

85%

81%

82%

78%

74%

Extra income from existing payers 74%

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Active strategies to cope are transactional.

• Question - Which strategies are providers likely to adopt to respond to these changes?


Domestic new markets

International new markets

Vertical integration

Acquisitions in primary care

Acquisitions

22%

30%

30%

44%

52%

Mergers 56%

55

While payment systems are expected to focus more on quality, value and risk (but not cost!)

• Question - I expect payment systems to:


Become more integrated

Contain more quality incentives

Focus more on patient value

Share more risk with providers

Reduce prices & cap volumes

78%

78%

74%

74%

55%

Remain largely the same 11%

56

But they are still not yet fully ready for the change.

• Question - Providers are well equipped to respond to these changes:


Bundled payments

Increased risk sharing

Value based purchasing

Price reductions

26%

30%

52%

52%

Shifting care to new channels 58%

57

We are well aware of the challenges…


• Aging • Multi-morbidity • Rising expectations • Lifestyle diseases • Technology and devices

People and Products

Process

• Poor system and process design • Specialization • Organizational culture • Problems with economic model • Growing complexity

58

How Canada compares, globally.

Increasing obesity rates among the adult population in OECD countries, 1990, 2000 and 2009 (or nearest years)

Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.

59


Health expenditure as a share of GDP, 1960-2009, selected OECD countries


60


Infant mortality rates, 2009 and decline 1970-2009 (or nearest year)


61



62



63



64

Transforming the System: National Forces

65

A Review of the 2004 Health Accord

Many of the factors that influence the health outcomes of Canadians lie beyond health care systems and are located in the social determinants of health

Reflected in the poorer health status of Aboriginal peoples and the challenges children and youth face with respect to mental health and obesity

Source: Time for Transformative Change: A Review of the 2004 Health Accord. Standing Committee on Social Affairs, Science Technology. March 2012. . 66

A Review of the 2004 Health Accord

Systemic change has stalled

When compared internationally, Canada is no longer seen as a model of innovation in health care delivery and financing

Need for specific mechanisms to promote the implementation of new practices in health care systems across the country

Health care reform can only be achieved by breaking down silos within health care systems Different health care sectors such as primary, acute, continuing

care and mental health services be integrated through common governance structures and funding arrangements and supported by seamless information systems

Source: Time for Transformative Change: A Review of the 2004 Health Accord. Standing Committee on Social Affairs, Science Technology. March 2012. . 67

How long can we enjoy B-player status?

Highest rating was a B+

Source: How Long Can We Enjoy B-Player Status? Brown, A.D. & Sullivan, T. Healthcare Quarterly. Vol 15 No.2, 2012 68

How long can we enjoy B-player status?

Worry that this B grade may seem good enough and discourage serious efforts to improve

Position as ‘B-player’ on quality risks encouraging an attitude of complacency, rather than motivating a leadership imperative to strive for excellence

B-player status will persist until we set improvement goals and link them to measures for our system, coast to coast

Time to set better goals for quality

Source: How Long Can We Enjoy B-Player Status? Brown, A.D. & Sullivan, T. Healthcare Quarterly. Vol 15 No.2, 2012 69

Measuring and reporting on health system performance in Canada: Opportunities for improvement

Health Council of Canada Improved performance reporting to enhance

accountability is a potential tool as governments and their health system planners look forward

Source: Measuring and reporting on health system performance in Canada: Opportunities for improvement. Heath Council of Canada. May 2012.

“The debate on health should no longer be about

structure and processes, but about principles and progress in health improvement for all”

- Equity and excellence: Liberating the NHS [England’s National Health Service], 2010

70

Towards a more rigorous approach to health system performance reporting in Canada.

All provinces and territories are actively developing strategic plans which include health system performance goals and objectives

The challenge remains to see if we can achieve the same, if not better, results in performance measurement and improved accountability at the pan-Canadian level

Globally, England: National Health Services Outcomes

Framework Australia: Council of Australia Governments

Agreements

Source: Measuring and reporting on health system performance in Canada: Opportunities for improvement. Heath Council of Canada. May 2012. 71

Measuring What Matters in Health Care: Cost vs. Value

Clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded

Recommendation 1: Align health system values with Canadians’ values

Recommendation 2: Align health system performance metrics and funding models with Canadian values

Recommendation 3: Re-examine health workforce values relative to the needs and values of Canadians

Source: Measuring What Matters: Cost vs. Values of Health Care. Snowdon, A., Schnarr, K., Hussein, A. & Alessi, C. Ivey Centre for Health Innovation. November 2012. 72

Fiscal Sustainability & The Transformation of Canada’s Healthcare System

Transformative action will require a shift in how policy makers think about and respond to changes in the healthcare system

This shift can be achieved through four concepts: 1. Use disruptive innovation as a framework

to understand changes in technology and service delivery

2. Recognize Moore’s Law – which suggests declining costs over time – applies to healthcare and recover productivity gains

3. Focus on improving quality and access as costs decline

4. Treat healthcare as a high-tech industry

Source: Fiscal Sustainability & the Transformation of Canada’s Healthcare System: A Shifting Gears Report. Falk, W., Mendelsohn, M. & Hjartarson, J. 2012. 73

Fiscal Sustainability & The Transformation of Canada’s Healthcare System

Five Transformative Reforms:

1. Modernize the organization of hospitals by disrupting clinical business models

2. Use virtualization to develop new roles for providers and patients

3. Widely deploy digitization in the second decade of Infoway

4. Devolve decision-making selectively and where appropriate

5. Reform the way health services are purchased

Source: Fiscal Sustainability & the Transformation of Canada’s Healthcare System: A Shifting Gears Report. Falk, W., Mendelsohn, M. & Hjartarson, J. 2012. 74

Transforming the System: Provincial Forces

Ministry of Health & Long-Term Care: Healthy Change: Ontario’s Action Plan for Health Care

Keeping Ontario Healthy Faster Access to Stronger Family Health Care Right Care, Right Time, Right Place

Excellent Care for All Act

Health System Funding Reform

Health Human Resources Planning

75

Transforming the System: Provincial Forces

Health Quality Ontario: Measuring Attributes of a High Quality Health System

Accessible

Patient Centred

Appropriately resources Integrated

Equitable

Effective Safe

Efficient

Focused on population

health

76


System challenges…

Aging population

Misalignment with values

Risk of complacency

Fiscal restraint

Rising expectations

Chronic disease management

Poor system and process

design

Technology

Aboriginal health

77


Now what?

Aging population

Misalignment with values

Risk of complacency

Fiscal restraint

Rising expectations

Chronic disease management

Poor system and process

design

Technology

Aboriginal health

78


79


Given this sense of urgency, how do we motivate radical change?

80

There are some ideas about what to do:

• Accountability for a defined population.

• Value based reimbursement.

• A rigorous focus on quality and safety.

• Reduce variation.

• Empower patients and carers.

• Focus on wellness.

• Work to reduce inequalities.

• Segmentation, stratification and personalization.

• Systemic, coordinated and evidence-based care.

• Underpin with information systems, measurement and feedback.

81

Providers responses: Four general strategies for change.

Continuing to grow the current model

Improving operations and

delivery

New approaches built on existing

models

Developing new models for new or current markets

82

Success requires tactical improvement simultaneously with strategic transformation.

Implementation and skills transfer

Clinical engagement

Financial and operational

grip

Tactical savings

acceleration

Strategic transformational

planning

83

Five propositions to address Health System Transformation.

Board Grip

Care System Redesign

Health IT Quality and

Margin Improvement

Strategy, Transactions & Financing

84

The leadership and governance mechanisms to address all these problems are poorly developed.

The problems with the organizational culture:

The dominance of professional autonomy: the tendency to reject

mechanisms of accountability. A reluctance to give or receive feedback or to share information

about performance. Emphasis on individual judgment and knowledge rather than on the

value of teams. Reluctance to accept the idea that clinical decisions have resource

consequences. A paternalist approach to care an inadequate involvement of patients

in their own care. Undervaluing and under investment in management and a divide between

clinicians and managers.

Leadership, not just better management

85


Health System Governance Challenges Identified by The Center for Healthcare Governance

1. Monitoring both collective and individual entity’s operating performance and accountability

2. Coordinating system and local boards to achieve system performance targets

3. Aligning strategy throughout the system 4. Clinical integration 5. Establishing system wide standards of care 6. Setting and overseeing accountability measures for subsidiary boards 7. Ensuring coordination among system level and local management 8. Putting in place infrastructure to support governance across multiple

entities.

86

1. Establishing a Sense of Urgency

2. Forming a Powerful Guiding Coalition

3. Creating a Vision

4. Communicating the Vision

5. Empowering Others to Act on the Vision

6. Planning for and Creating Short-Term Wins

7. Consolidating Improvements & Producing Still More Change

8. Institutionalizing New Approaches

Eight Steps to Transforming Your Organization

87

1. Establishing a Sense of Urgency

Examining market and competitive realities

Identifying and discussing crises, potential crisis, or major

opportunities


“Make the status quo more dangerous than launching into the unknown”

“When is the urgency rate high enough? When about 75% of a company’s management is honestly convinced that business as usual is totally

unacceptable.”

88

2. Forming a Powerful Guiding Coalition

Assembling a group with enough power to lead the change effort

Encouraging the group to work together as a team


“Efforts that don’t have a powerful enough guiding coalition can make apparent progress for a while. But sooner or later, the opposition gathers itself together

and stops the change.”

89

3. Creating a Vision

Creating a vision to help direct the change effort

Developing strategies for achieving that vision


“Without a sensible vision, a transformation effort can easily dissolve into a list of confusing and incompatible projects that can take the organization in the

wrong direction or nowhere at all.”

90

4. Communicating the Vision

Using every vehicle possible to communicate the new vision and

strategies

Teaching new behaviors by the example of the guiding coalition


“Use every possible channel, especially those that are being wasted on nonessential information”

“Learn to walk the talk – consciously attempt to become the living symbol of the

new corporate culture”

91

5. Empowering Others to Act on the Vision

Getting rid of obstacles to change

Changing systems and structures that seriously undermine the vision

Encouraging risk taking and nontraditional ideas, activities and actions


“In the first half of the transformation, no organization has the momentum, power or time to get rid of all obstacles. But the big ones must be confronted

and removed.”

92

6. Planning for and Creating Short-Term Wins

Planning for visible performance improvements

Creating those improvements

Recognizing and rewarding employees involved in those improvements


“Real transformation takes time, and a renewal effort risks losing momentum if there are no short-term goals to meet and celebrate.”

“Commitments to produce short-term wins help keep the urgency level up and

force detailed analytical thinking that can clarify or revise visions.”

93

7. Consolidating Improvements: Produce Still More Change

Using increased credibility to change systems, structures and policies

that don’t fit vision

Hiring, promoting, and developing employees who can implement the

vision

Reinvigorating the process with new projects, themes and change

agents


“Until changes sink deeply into a company's culture, a process that can take five to ten years, new approaches are fragile and subject to regression.”

“It is the premature victory celebration that kills momentum.”

94

8. Institutionalizing New Approaches

Articulating the connections between new behaviors and corporate

success

Developing the means to ensure leadership development and

succession


“Change sticks when it becomes “the way we do things around here.”

95

Health System Transformation requires Board Accountability and Board Leadership

• Difficult decisions are

ahead!

• Courage and bold leadership are required

• Focus on: the consumer and value for money.

• Embrace what you need to do …

Be visible, vocal,

champions of the

Blueprint

Encourage participation

in LHIN activities

Hold Senior Leadership

accountable to be visible, active change agents

Advocate change to achieve common

goals Pursue

innovative partnership

opportunities

Break from traditional ways of

doing things

96

Questions? Comments?

97

Exercise #2

KPMG/All

98

Exercise #2

The representatives will return to their respective discussion tables to address a series of questions regarding their role as health system leaders in moving forward transformational change.

Each group will be co-chaired by a Health Service Provider representative and LHIN Board member. In addition, a LHIN staff will be assigned as a recorder for each table.

Each group will report back to the plenary.

99


Within the G2G survey, you identified the steps/changes that your organization has taken towards system transformation to ensure alignment with the North West LHIN strategic plan/directions. Identify the enablers and the barriers to these transformational steps. What can be learned from the enablers and how did you mitigate the barriers?

100


Within the Pre-reading #2: Leading Change: Why Transformation Efforts Fail, Harvard Business Review (Kotter, 2007), you have considered the 8 change leadership steps. As a governor or executive leader, identify the 3-4 steps that you can take within the next 6-12 months to lead transformational change within your Integrated District Network (IDN).

101


Other comments or suggestions for transformational leadership in the North West LHIN:

102

Pulling it All Together: Summary of Action Items for the Day

KPMG

103

2012/13 Q4

2013/14 Q1/2

2013/14 Q3/4

2014/15 Q1/2

2014/15 Q3/4

2015/16 Q1/2

2015/16 Q3/4

• Summary of Steps Year 1 • Summary of Steps Year 2 • Summary of Steps Year 3

Pulling it All Together: Summary of Action Items for the Day

104

Closing Remarks Joy Warkentin and Laura Kokocinski

105

Thank you

106

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