Working Together to Dramatically

Improve the Patient Experience

Presentation to the Canadian Assistive Devices Association

Susan Gibson, Advisor, Access to CareHamilton Niagara Haldimand Brant Local Health Integration Network

September 18, 2014

Vision“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."

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Local Health Integration Network

Created by the Ontario government in March 2006

• 14 not-for-profit corporations that work with local health providers and community members to determine the health service priorities for their regions

• Local Health Integration Networks (LHINs) plan, integrate, and fund local health services, improving access and the patient experience

What is a LHIN?

HNHB LHIN

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LHINs

• Erie St. Clair

• SouthWest

• Waterloo Wellington

• Hamilton Niagara Haldimand Brant

• Central West

• Mississuaga Halton

• Toronto Central

• Central

• Central East

• South East

• Champlain

• North Simcoe Muskoka

• North East

• North West

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Snapshot of HNHB LHIN• 6,500 km2

• 1.4 million+ people

• Brant, Burlington, Haldimand, Hamilton, Niagara, most of Norfolk

• Most seniors of any LHIN (230,000++)

• Compared to Ontario, HNHB LHIN has higher rates of:

• Smoking, drinking, obesity• Premature death & hospitalization

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Environmental Scan

• HNHB LHIN has lower population growth but the largest number of seniors

• HNHB residents are not as healthy as other Ontarians on many measures - most disturbing of these is the higher mortality rate and higher number of potential life years lost

• Age standardized data shows some utilization rates (cardiac bypass, hip and knee replacements, hysterectomy) above the provincial average.

• There is a higher prevalence of poor life style choices as shown by higher daily or occasional smoking, heavy drinking, and obesity (in adults) in the HNHB LHIN

• Higher rates of chronic conditions including arthritis, high blood pressure and asthma compared to Ontario rates

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Health Service Providers in HNHB LHIN

• HNHB LHIN allocates $2.8 billion to the 234 health service providers

• HNHB LHIN operational budget is $5 million

• This means that the LHIN allocates 99.8% of all funding received to our health service providers

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Accountability

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Strategic Health System Plan

Strategic Aim

Dramatically improving the patient experience through Quality, Integration and Value.

Strategic Directions

Quality Integration ValueDramatically improving the patient experience by embedding a culture of quality throughout the system

Dramatically improving the patient experience by integrating service delivery

Dramatically improving the patient experience by evolving the role of the LHIN to become a health system commissioner

Strategic Direction #1:

Dramatically improving the patient experience by embedding a Culture of

Quality

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Creating a Quality System

• Common LHIN-wide philosophy and approach to quality

• Reduce variation, increase standardization

• Drive quality, drive outcomes, drive value for money

• LHIN to provide leadership to:

– Achieve better outcomes for their communities: lives saved, quality of life improved and disability decreased

– Ensure a better experience for the people it serves.

– Reduce disparities in quality measures across different groups in HNHB’s communities

• LHIN will work with provincial partners both at the Ministry of Health and Long -Term Care and at Health Quality Ontario to achieve these goals

“Everything is Quality and Quality is Everything”

Strategic Direction #2:

Dramatically improving the patient experience by Integrating Service Delivery

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Integration: Health Links• A new practice of care where ALL

providers in a community, including primary care, hospital, long-term and community care come together to create a plan for future care at the patient level

• Each Health Link will:

• Be led by those that live in the Health Links area

• Base programs on the needs and preferences of local residents

• Focus on the patient and their family through coordinated planning specific to each person’s needs and preferences

• Build services and programs around patients – the right care, at the right time, in the right place

Hospital

Home Care

Community Support Services

Primary Care Physicians

Allied Health Professionals

Specialists

Long-Term Care Homes

The Relatively Few People with Complex Health Problems Account for the Majority of our Health Expenditures

5% of the population

accounts for 66% of health care

spending

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• Heart failure

• Chronic obstructive pulmonary disease (emphysema)

• Myocardial infarction

• Pneumonia and urinary tract infections

• Stroke

• Hip fracture

• Cancer

• End of life care

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The Top One Per Cent

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Strategic Direction #2:

Dramatically improving the patient experience by Integrating Service Delivery

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LHIN-wide Integrated Programs

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LHIN-wide Integrated Programs:What are we Trying to Fix?

• Unequal access to/availability of services (gaps)

• Long wait times for some surgery and diagnostic procedures

• Inefficient use of resources (duplication)

• Variation in the care delivery model

• Variation in quality and outcomes

• Unnecessary ED visits and admissions/readmissions

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LHIN-wide Integrated Programs:What are we Trying to Achieve?

• Key concept: ‘one clinical program – multiple sites’

• Goal: improved clinical processes and outcome consistency

• All residents across the LHIN should have access to a coordinated program, with:

– same approach to care delivery

– same quality standards

• System management of system level indicators – Ministry-LHIN Performance Agreement (MLPA)

Hospital Emergency Departments (EDs)• Hospital EDs are the door to urgent/emergent hospital and ED services

• The number of admissions to the hospital through the ED is increasing

• LHIN considers metrics to evaluate hospital ED performance – two key metrics in LHIN Accountability Agreement with hospital:

• The number of people waiting in a hospital bed for an alternate level of care (ALC rate)

• Time people wait in the ED for admission to an inpatient bed

• The volume of ED visits and the number of people waiting in the ED for admission to an inpatient bed is a pressure for ED staff which can impact timely acceptance of admissions by ambulance

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We’re Reducing ER Demand

• Community Referrals by EMS --Paramedics observe clients in their home environment, and where appropriate, refer the client to CCAC.

• Early Intervention Screening Tool – pilot in community (family physicians) and two emergency departments to screen seniors aged 75+ to prevent functional decline by referring them to CCAC for follow-up.

• Nurse Lead Outreach Team visit Long-Term Care homes to provide primary care assessments and treatments to residents and avoid transfer to the ER.

• Rapid Response Transition Team – Nurses who facilitate hospital discharges, prevent readmission and prevent or delay admission to long-term care homes.

Strategic Direction #3:

Dramatically improving the Patient Experience by evolving the role of the

LHIN to become Health System Commissioners

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Commissioning in the HNHB LHIN

A complex process with responsibilities ranging from:

• Assessing population needs• Prioritizing health outcomes• Procuring products and services and; • Holding health service providers

accountable

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Measuring our Health System Improvements

Key Performance Indicators

Embedding a Culture of Quality Throughout the System

Patients state: “I receive the care I

need when I need it.”Reduction in

variationImproved care

transitionsStaff ability to impact system Culture of quality

Integrating Service Delivery

Common Vision & Philosophy of Care

Increased use and access to community

services

Reduced costs/wait

times

Improved percentage of funding directed to direct care

activitiesBecoming Health System Commissioners

Governance & management capacity

developed

Mechanisms &measures for meaningful provider and community

engagement

Residents state: “We have confidence in our health care

system.”

Thank you!

Hamilton Niagara Haldimand Brant Local Health Integration Network

264 Main Street EastGrimsby, ON L3M 1P8

(905) 945-4930 (866) 363-5446

www.hnhblhin.on.caEmail: hamiltonniagarahaldimandbrant@lhins.on.ca

HNHB_LHINgage

www.youtube.com/HNHBLHIN

www.hnhblhin.on.ca

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