The Proceedings of the Vision 2020 Symposium: Partnering in the Quest for the Healthcare Gold Medal

Transcription

1 The Proceedings of the Vision 2020 Symposium: Partnering in the Quest for the Healthcare Gold Medal Hosted by the Ontario College of Family Physicians On September 24, 2010 Contact: M. Janet Kasperski, RN, MHSc, CHE Chief Executive Officer THE ONTARIO COLLEGE OF FAMILY PHYSICIANS 340 Richmond Street West Toronto, Ontario M5V 1X2 Phone: ϖ Fax: ϖ Website:

2 Vision THE MISSION STATEMENT OF THE ONTARIO COLLEGE OF FAMILY PHYSICIANS: PROMOTING THE QUALITY OF FAMILY MEDICINE IN ONTARIO THROUGH LEADERSHIP, RESEARCH, EDUCATION AND ADVOCACY

3 Vision ACKNOWLEDGEMENT The Board of the Ontario College of Family Physicians (OCFP) is grateful to the family physician leaders whose wisdom created the document: Vision 2020: Partnering in the Quest for the Healthcare Gold Medal. In addition, we wish to thank the 140 organizational and family physician leaders who joined us on September 24, 2010 to help light the way forward. We are especially grateful to the members of our two panels: Mr. Raymond Hession Mr. Paul Huras Chair of the Board of Directors, e-health Ontario CEO, South East LHIN Ms. Margaret Mottershead CEO, Ontario Association of Community Care Access Centres Dr. Carolyn Bennett Dr. Cal Gutkin Dr. Joshua Tepper Dr. Scott Wooder Mr. Tom Closson MP for St. Paul s and former Minister of Public Health Executive Director and CEO, College of Family Physicians of Canada AED, Health Human Resources, MOHLTC Honorary Treasurer, Ontario Medical Association President and CEO, Ontario Hospital Association We would also like to thank Dr. Sanjeev Goel and especially his patients for agreeing to provide us with an opportunity to hear directly their views of their family doctors. Last, but not least, we would like to thank Dr. Walter Rosser, Past-President of the OCFP who summarized the day s achievements. We hope that our 140 participants and all key stakeholders in the province will join us on our journey forward in keeping with the spirit of the Inukshuk.

4 Vision THE SIGNIFICANCE OF THE INUKSHUK THE INUIT INUKSHUK HAS EVOLVED INTO MORE THAN JUST A STONE MARKER. IT HAS BECOME A SYMBOL OF LEADERSHIP, COOPERATION AND THE HUMAN SPIRIT. EACH STONE IN AN INUKSHUK IS A SEPARATE ENTITY; HOWEVER, EACH ONE IS CHOSEN BECAUSE OF ITS ABILITY TO FIT EFFECTIVELY WITH EACH OF THE OTHER STONES. THE STONES ARE SECURED SIMPLY BY THE BALANCE THAT THEY ACHIEVE TOGETHER. EACH STONE SUPPORTS THE ONE ABOVE IT AND, IN TURN, IS SUPPORTED BY THE ONE BELOW IT. TOGETHER, THE STONES ACHIEVE STRENGTH THROUGH UNITY. THIS IMPORTANT MESSAGE CAN BE TRANSLATED INTO A PHILSOPHICAL APPROACH TO THE PRACTICE OF FAMILY MEDICINE AND THE HEALTHCARE SYSTEM IN GENERAL. THE MESSAGE FROM THE BUILDING OF AN INUKSHUK REFLECTS THE FACT THAT A GROUP OF FAMILY PHYSICIANS AND OTHER HEALTHCARE PRACTITIONERS CAN ACHIEVE GREATER SUCCESS THROUGH CO-OPERATION AND TEAM EFFORT THAN CAN BE ACHIEVED BY INDIVIDUALS WHO WORK INDEPENDENTLY. THE INUKSHUK STANDS FOR THE IMPORTANCE OF FRIENDSHIP AND REMINDS US OF OUR INTERDEPENDENCY ON ONE ANOTHER. TOGETHER, WE CAN CREATE THE HEALTHCARE SYSTEM THAT ONTARIANS WANT AND NEED. TOGETHER, WE CAN CREATE A LEGACY FOR OUR CHILDREN AND GRANDCHILDREN.

5 Vision INDEX Vision Executive Summary...10 Agenda Overview of the Vision 2020 Symposium Symposium Format Introductory Remarks and Keynote Speaker: Dr. Robert Algie, President of the OCFP Ms. Liz Sandals, MPP and Parliamentary Assistant to the Minister of Health and Long-Term Care Listening to the Public, Healthcare Leaders and Family Physicians Survey Results Ms. Jan Kasperski, CEO of the OCFP Fireside Chat: The Health of the Healthcare System Moderator: Dr. David Tannenbaum Panel: Mr. Ray Hession, Mr. Paul Huras, Ms. Margaret Mottershead and Dr. Carolyn Bennett Small Group Discussion: Key Trends in Healthcare: Opportunities and Threats Facilitated by Mr. Erik Lockhart Fireside Chat: Envisioning the Future of the Healthcare System Moderator: Dr. Anne DuVall Panel: Dr. Cal Gutkin, Dr. Joshua Tepper, Dr. Scott Wooder and Mr. Tom Closson Small Group Discussion: Planning a Healthcare System for Our Children/Key Recommendations Facilitated by Mr. Erik Lockhart Summary of the Day s Achievements and Closing Remarks Drs. Walter Rosser and Robert Algie...29 Appendix A: Opening Remarks by Dr. Robert Algie President of the OCFP Appendix B: Keynote Address by Liz Sandals, MPP for Guelph-Wellington and Parliamentary Assistant to the Minister of Health and Long-Term Care Appendix C: Survey Results Part I: Harris-Decima Public Survey 2010, Part II: Organizational Leaders Compared with Family Physicians Surveys 2010 Appendix D: Speakers Biographies Appendix E: Trends/Driving Forces and Recommendations on How to Create a Better Healthcare System To access the appendices, please visit our website:

6 Vision Vision 2020: Every Ontarian has a family physician delivering comprehensive, coordinated, integrated care anchored in the principles of continuity of care and the Excellent Care for All Act with the assistance of an intra and interprofessional team. EMR/EHRs are a key enabler in the provision of excellent healthcare for all. They are required for patients and providers alike to facilitate information sharing, clinical decision-making, research, education, quality improvement, accountability and policy development. High quality, value-driven, safe clinical best practices are dependent upon providers having the right information at the point of care. System integration is dependent upon interconnected IT solutions. The public expects that 90% of their care will be delivered in family practices and in their own homes. Family medicine is seen as the vanguard of a healthcare system that is committed to an essential shift in focus to encompass health promotion and the prevention and management of chronic disorders. Attention needs to be paid to the social determinants of health to decrease demands on the system. Higher quality at decreased costs will be possible by integrating public health, primary care, community services, acute, chronic and long-term care. The Primary Care Sector is vital to the sustainability of the system. The implementation of a quality framework including quality indicators/performance measurement is needed to achieve value for money. A supportive infrastructure to implement the quality agenda, system integration, intra and interprofessional team development and health human resource planning are requirements for the successful transformation of the system. Easy and timely access to specialists and other adjunct services is needed (i.e. shared care and triage centres).

7 Vision Key Recommendations for Winning the International Healthcare Gold Medal In 2020: Rollout EMRs/EHRs Across the Province Invest in Primary Care Infrastructures Focus on Quality Improvement/Standardization of Performance Measurement Integrate the Healthcare System Invest in Interprofessional Team Development Focus on Primary Prevention/Health Promotion Develop a Health Human Resources Infrastructure Engage in Advocacy Every Person Needs a Family Doctor Focus on Improving the Determinants of Health Establish Triage Centres for Specialty and Adjunct Care Referrals Trends and Driving Forces: Opportunities and Threats The Implementation of an Integrated e-health Strategy Changing Demographics Sustaining the System Through a Lens of Quality and Value for Money Integration of the System Demands for Access to Care Disease Prevention and Health Promotion Economic Restraints and Accountabilities The Culture and Demographics of Family Physicians Quality Improvement/Evidence-Based Practices

8 Vision Vision 2020: The Ingredients of a Healthcare System in Ontario Worthy of an International Gold Medal in Healthcare By 2020, all Ontarians will be enrolled with a family physician that practices with a collaborative, interdependent, interprofessional team. The team will provide a patient-centred, family-oriented, comprehensive basket of services that will focus not just on healthcare, but also on keeping people as healthy as possible for as long as possible. The end result will be improved quality of life and health outcomes for Ontarians and a reduced need for care in the most expensive parts of the system, resulting in the sustainability of our healthcare system. The team collaborating with the family doctor would include other family physicians, focused practice physicians, specialist consultants, nurses, nurse practitioners, social workers, mental health workers, dietitians, pharmacists, CCAC case workers, home care providers, public health nurses, other healthcare professionals and administrative staff. Each patient s care will be recorded in an electronic health record that provides the right information, at the right time, to the right healthcare provider. The EHR will be an effective enabler of team-based care, patient and provider education, quality improvement, system planning, accountability and research. With healthcare providers having access to information when needed, poor quality care, gaps in care and duplications of care that add costs to the system will be reduced. Patients will be equal partners in care and accept responsibility for their own health and for the sustainability of the system. Supported by research garnered in Ontario, across Canada and internationally and based on their own personal experiences, the general public will recognize the excellent care they receive in family practices and throughout the primary care/community-care sector and will applaud the government for their wisdom in recognizing the value of this sector as a key investment in the sustainability of the healthcare system. The public will notice a dramatic improvement in their access to care since they will be able to see their own family physician and the members of their primary care team within 24 hours and usually on the same day. Family physicians will provide care throughout the system. The role of family physicians in hospital-based care will be recognized as an essential component of high quality care. Many encounters will not take place in family practices as technology becomes the norm to connect patients, their family physicians and their healthcare teams. Utilizing advanced technology will change the way patients interact with their family doctors and the healthcare system. Referral patterns for specialty care will be altered. Shared-care and collaborative care networks will bring knowledge, skills and expertise to family practices, reducing the need for most patients to seek care in a consultant s office or a specialty or outpatient clinic. Wherever possible, the services delivered by consultants and other

9 Vision community-based healthcare professionals will be delivered in the patient s family practice. A triage system will be in place to facilitate referrals to specialists and other service providers. This will mirror work in the U.S.A. to create Medical Homes. Family physicians will continue to play important roles in their patients overall healthcare needs; however, when care is needed in other parts of the system, patients will have timely and seamless access to the required care by consultants, home care providers, other community-based service providers, hospitals and other institutions. Emergency Departments will see relatively few non-urgent patients and walk-inclinic physicians will have joined comprehensive family practices that provide excellent after-hours access. Admission and readmission rates for ambulatory sensitive conditions (i.e. subacute/chronic conditions) will be low or non-existent, given the excellent care provided in the community for patients with risk factors for chronic disorders or diagnosed with a chronic condition and the excellent support that family physicians receive from consultants to manage these patients effectively in the community. All high resource patients, and those on the slippery slope to becoming high resource patients, will be identified and surrounded in the practice by a specifically designed interprofessional team. The aging patient population will see themselves as living well with their chronic condition(s) and will have advanced care plans in place to ensure that the focus of care is on quality of life and not attempts to cure at all costs. Family practices will work in partnership with public health units. Family practices will not only address the health and healthcare needs of their practice population, but will also have the evidence-based information they need to advocate for changes in their communities that will improve overall health outcomes in local and regional populations. A Provincial Expert Panel will have reviewed and identified those tests, procedures and practices that have little or no positive impact on patient outcomes or the patient experience. The elimination of such practices will have freed up funds to provide high quality, value-driven healthcare. Funding will be based on patient needs and will follow the patient. Funding disincentives will have been eliminated. Healthcare human resources planning will be an ongoing process that will ensure we have the right number and mix of physicians and other healthcare professionals to address the changing needs of Ontarians. Family practices will be the hubs for interprofessional education and our academic Departments of Family Medicine will be well supported to fulfill this important role. Primary Care Councils will have been established in every region of the province to support quality improvement activities in family practices and the community sector in general. A primary care infrastructure is seen as vital to implementing the quality framework in primary care and in facilitating the integration of the primary care sector with the rest of the system. Effective data management systems will be in place and used to drive innovative improvements in the system. Incentives will be tied to a demonstration of quality outcomes. As family practices demonstrate (through the Quality in Family Practice Accreditation process) that they have matured, the healthcare system will include some practices and councils that have developed into trusts and are responsible for the judicious use of resources in the rest of the system.

10 Vision Work/life balance will have been achieved. Family physicians and their practice team members will be envied by other healthcare professionals for their achievements in finding ways to work smarter, not harder. They will express pride in their craft based on consistently high positive patient experience ratings. The practice and educational environments will demonstrate such a high level of support for family medicine that 45% of medical students will choose family medicine residency programs with the intention of practicing comprehensive care. Generalism will be highly regarded in academic health science centres and throughout the healthcare system. Faculty members and community-based preceptors in the Academic Departments of Family Medicine will be role models who demonstrate their expertise daily in all of the CanMeds-Family Medicine Competencies. The Northern Ontario School of Medicine, the rural streams and the distributed learning sites for the training of family medicine residents will have resolved the recruitment problems in the rural and small communities. Royal College residents will be afforded an opportunity to experience a block of time in a family practice. Family practices will be the hub of interprofessional, teambased learning for all healthcare learners. Family practices will receive financial support to ensure that family doctors and other healthcare professionals are able to access high quality continuing professional development programs to maintain and enhance their clinical, academic and leadership skills. Succession planning for the next generation of family physician leaders will begin in residency to ensure that each new family physician begins his/her practice with the knowledge and skills to provide excellent clinical care and develop into superb teachers, researchers and community leaders. All healthcare leaders in the province will work together to ensure that every Ontarian receives timely access to the care they need. As a result of their collaborative efforts, comprehensive, coordinated, integrated and interprofessional care, anchored in the principles of continuity of care, will be in place and Ontario will be a worthy contender for the international healthcare gold medal. Congratulations to the Ontario College of Family Physicians on Vision It came out at a critical point for healthcare. Mr. Tom Closson I believe in the delivery of family medicine as the vanguard of the healthcare system. It has advanced significantly in the past decade and is positioned to make significant gains in the near future. Mr. Ray Hession

11 Vision Executive Summary Close to 140 invited guests (organizational and family physician leaders) attended the Vision 2020 Symposium that was hosted by the Ontario College of Family Physicians (OCFP) on September 24 th, The Symposium was designed to build upon an early consultation event with family physician leaders that resulted in the crafting of the discussion document Vision 2020: Partnering in the Quest for the Healthcare Gold Medal ( The Board of the OCFP recognized that our Vision for the future of the healthcare system would only be realized by building upon the strengths of our partners throughout the system. As a result, we chose the Inukshuk as our symbol of the need to work together in harmony to create the healthcare system that Ontarians want and need. The Symposium was off to a great start with the welcoming remarks by the President of the OCFP, Dr. Robert Algie, followed by our keynote address by Ms. Liz Sandals, MPP for Guelph-Wellington and Parliamentary Assistant to the Minister of Health and Long-Term Care. The keynote address was followed by a presentation by Ms. Jan Kasperski who presented the results of the public survey conducted by Harris-Decima and a comparison of the results of the organizational leaders and family physicians. It was noted that 10% of the respondents did not have a family doctor including individuals with chronic disorders. Over 90% of the respondents expect to have the majority of their care delivered by their own family doctor and want care in the home if they or a loved one becomes frail. A moving testimony to family doctors by their patients was presented. The event included experts in the field who provided their perspectives on the healthcare system that exists today. A second panel provided a glimpse into the future of the healthcare system. Between panel discussions, the participants were divided into 14 small groups who discussed the key trends facing the healthcare system in the next 10 years and then brainstormed about the strategies that would move us forward to create a world-class healthcare system that would be a legacy that we leave behind for our children and grandchildren. The small groups identified a total of 28 trends. Facilitated by Mr. Erik Lockhart and information technology, the trends were discussed, merged and prioritized. Many of the trends are similar to those identified by the MOHLTC s External Expert Panel on Trends referred to in the Vision 2020 document. The prioritized trends or driving forces are as follows: The Implementation of an Integrated e-health Strategy The participants forecast that there would be an increased need for, and availability of, an integrated e-health technology system with connectivity throughout the system that would be used by patients and providers alike. Today, and increasingly in the near future, consumers will be using the web to access health and healthcare information. Moreover, our patients have an expectation that EMRs/EHRs will be used by all providers at the point of care, especially their family doctors, to increase safety and quality in the system. Family physicians will need EMRs to improve performance in their practices and to measure outcomes; however, they also will need to be connected in order to easily access evidence-based and practice informed data and to communicate effectively when

12 Vision their patients receive care in other sectors of the system. Research, patient and provider education, information sharing, quality improvement and system planning will all be enhanced by EMRs/EHRs and interconnected IT systems. Changing Demographics In the next ten years, we will be facing an increase in lifestyle risks and an earlier onset of chronic diseases amongst the general population. In addition, a growing and aging population will result in an inherent increase in the number of patients with chronic disorders and multiple medical problems. Demographic influences also include a decreasing tax base, a lowered standard of living, an increase in immigration and a changing workforce. The end result is potential increased costs as we deal with an increased burden of chronic disorders in the population and a strain on health human resources of all kinds and the healthcare system in general. Investments in Primary Care to Sustain the System Countries with strong primary care systems have better health outcomes with lower system costs. The necessity to contain cost acceleration in a climate of growing expectations means that further investments in the primary care sector will be needed. Those investments will need to buy changes that encourage a greater emphasis on health and wellness. Evidence-based practice and global information will be needed to guide system reforms, to improve the quality of care in the primary care sector, to ensure system-wide support for the primary care sector and to address the trend towards increased demands in an era of decreased resources. Integrating the System Siloization in the system was deemed to be increasing in spite of efforts to establish a collaborative care system. Silo planning and the delivery of care in silos are impacting negatively on continuity of care. A collaborative, team-based system of care including system integration will be required throughout the whole of the healthcare system (i.e. public health units, CCACs, hospitals and the primary care sector). There will be an increased demand for informed and participating system integration and coordination within and between each sector, supported by e-health. Demands for Access to Care The need to improve access to care will remain a driving force in the next 10 years. An aging population s wants and needs will interact with the capacity and desire of healthcare professionals to provide equity of care across the province (i.e. the most care for those most in need). In addition, the resources needed in some parts of the province to provide equitable care will impact upon our ability to deliver equal care for all. Family physicians will be challenged to investigate and manage urgent patient problems in the community expeditiously while managing the need to focus on the health and well-being of all their patients. Disease Prevention and Health Promotion The trend will be to change family practices from an illness-based system to a proactive practice focused on health promotion, disease prevention, early detection of diseases and chronic disease management. This may result in a clash between the need to invest time and resources in upstream care and downstream care.

13 Vision Economic Restraints and Accountabilities Given the recession, there will be a drive to economic restraints, new funding models and bureaucratic oversight of accountabilities. Unless there is a coordinated approach to ensure inter-connectedness, quality improvements and efficiencies, we will see erosions in the gains made in the last few years. The Culture and Demographics of Family Physicians We can expect a change in the culture and demographics of family physicians as an aging physician population retires and a sea change in practices as a new generation of family physicians used to working in teams and with technology takes on leadership roles in their practices and in the system at large. A Focus on Quality Improvement Poor quality costs money. An increased focus on quality improvement to ensure value for the dollars spent on healthcare will be required in each sector of the healthcare system. The participants forecasted that a better alignment of professional and patient expectations with the fiscal realities would be needed, as well. Quality outcome indicators would need to be addressed in a manner that educates patients to understand wants versus needs. With quality outcome indicators and patient satisfaction driving the system, there is a strong hope that we will see the influence of the media lessened, a reduced McDonald s mentality and a fear of death replaced by appropriate use of resources. The second small group session focused on the development of the top ten recommendations for strategies that are needed to be embedded in our Gold Medal winning healthcare system. The recommendations for strategies that will enable the implementation of VISION 2020 and ensure that Ontario is awarded the international Gold Medal in Healthcare are as follows: Rollout of Electronic Medical Records/Electronic Health Records A robust EMR/EHR system is needed for sharing information, for data collection to support the measurement of quality outcomes, and to support evidence-based and practiceinformed best practices. The EMR must be more than simply a digital paper record but must be able to function as a decision-support tool, a system for collecting meaningful data and metrics, as a patient education tool and as the enabling tool for system integration. The information in the electronic patient-centred chart must follow the patient throughout the patient s journey in the healthcare system. Patient portals with access through the EMR need to be available as we take advantage of this digital age to better support patient self-management of their own health and their various conditions. While EMRs are essentially tools to improve the quality of care for patients, care coordination and communications between interprofessional providers and organizations, it will take political will to accelerate the use of EMRs/EHRs across the continuum of care. While funding will be needed to invest in the e-health strategy, there also is a need to require IT system uniformity, integration and operability to replace the current systems that lack interoperability.

14 Vision Invest in Primary Care Infrastructures Funding is required to develop an infrastructure for the primary care sector in each LHIN that would plan and implement an integrated primary care sector. In order to improve system integration in communities and to support the adoption of best practices, an effective governance, administration and managerial structure is needed with the capacity to assess and evaluate the current system and the capacity to support he rollout of IT and CQI. The Australian Divisional System was identified as a potential model. While the infrastructure needs to be regionally based, it will require the MOHLTC, the LHINs, OCFP and OMA to be involved in setup and supporting the regional infrastructures. Each regional structure will need to use a participating governance model to give voice to family doctors and their practice team members to allow them to take collective responsibility and accountability for the care provided in the regional primary care sector. This organization would create system goals that are reflective of primary care but would require the input/support of each of the other sectors to accomplish each goal. Focus on Quality Improvement/Standardization of Performance Measurement In addition to an infrastructure to support the delivery of high quality care in the primary care sector, a system-level strategy is needed to standardize performance measurement and practice management of the quality agenda. The quality of care will be advanced in primary care by the provision of leadership training, quality improvement training, the identification of quality measures and coaching/mentoring for family doctors. Integrate the System A system that unifies primary care, Public Health Units, community-based services and hospitals is needed to improve health outcomes, to avoid gaps and redundancies and to improve access to needed resources for patients. The system should increase its concentration on health promotion and prevention from prenatal to palliative care and better organize access to services so that the emergency departments do not continue to be the main point of entry for vulnerable patients such as the frail elderly and individuals with mental health illnesses and addictions. Invest in Interprofessional Team Development Interprofessional team-based care requires a focus on issues of leadership, scope of practice and interdependent practice models to achieve the full benefits of team-based care. Focus on Primary Prevention/Health Promotion While investments are still needed in evidence-based secondary prevention, investments are greatly needed in the primary prevention of chronic diseases to decrease the incidence of disorders in the population. Develop a Health Human Resources Infrastructure Processes need to be developed to identify community needs and to ensure that health human resource planning is able to anticipate those needs and train the right healthcare professionals to meet those needs. The HHR infrastructure needs to support practitioners to develop knowledge and skills in quality improvement and change management to meet the changing needs of a population over the course of time.

15 Vision Engage in Advocacy Every Person Needs a Family Doctor Given the strong evidence of the importance of having a family doctor on the health of individual patients, the population at large and the reduced cost of the system of providing care in family practices, the OCFP must speak out strongly to ensure that every Ontario resident has a family doctor who is supported by an interprofessional team. Prompt access to teams providing comprehensive and continuing care is seen as key to the sustainability of the system. Invest in Improving the Determinants of Health The leadership and advocacy of all healthcare professionals and their organizations should be used to support all levels of government and the private sector to address the need to improve the social determinants of health. Establish Triage Centre for Specialty and Adjunct Care Referrals To accelerate access to specialty or adjunct care, a system should be created to help family physicians navigate specialty referral options. The triage centre providing guidance and support for referrals should be especially useful in our northern communities. Thanks to our speakers and the active and thoughtful participation of the invited guests, the Vision 2020 Symposium generated great ideas for moving forward with the implementation of Vision As we move forward in partnership with key stakeholders throughout the province, we are convinced that we have the building blocks in place and the drive to attain our goal the Healthcare Gold Medal in 2020.

16 Vision VISION 2020: PARTNERING IN THE QUEST FOR THE HEALTHCARE GOLD MEDAL Friday, September 24, 2010 ( hrs) Hyatt Regency Hotel 370 King Street West Room - King I, Mezzanine Level Toronto, ON M5V 1J9 Facilitator: Mr. Erik Lockhart AGENDA Registration and Breakfast Welcoming Remarks Dr. Robert Algie President, OCFP 2. Keynote Address Ms. Liz Sandals, MPP Parliamentary Assistant to the Minister of Health and Long Term Care 3. Listening to the Public, Healthcare Leaders and Family Physicians Survey Results Jan Kasperski Chief Executive Officer, OCFP 4. Fireside Chat: The Health of the Healthcare System Moderator: Dr. David Tannenbaum, Board Chair, OCFP Panel: Dr. Carolyn Bennett, MP Raymond Hession, Chair, Board of Directors, ehealth Ontario Paul Huras, CEO, South East LHIN Margaret Mottershead, CEO, OACCAC Nutrition Break Small Group Discussion: Erik Lockhart Key Trends in Healthcare Opportunities or Threats 6. Consolidating the Group Discussion: Erik Lockhart Maximizing Opportunities, Minimizing Threats Lunch Fireside Chat: Envisioning the Future of the Healthcare System Moderator: Dr. Anne DuVall, President-Elect, OCFP Panel: Dr. Calvin Gutkin, ED and CEO, CFPC Dr. Joshua Tepper, ADM, MOHLTC Dr. Scott Wooder, Honorary Treasurer, OMA Tom Closson, President and CEO, OHA 8. Small Group Discussion: Erik Lockhart Planning a Healthcare System for our Children and Grandchildren 9. Consolidating the Group Discussion: Erik Lockhart Key Features of the Future Healthcare System 10. Summary of the Day s Achievements Dr. Walter Rosser Past-President, OCFP ( ) 11 Closing Remarks Dr. Robert Algie

17 Vision ) Overview of the Vision 2020 Symposium During the 1990s, many developed countries began to invest heavily in their primary care sectors and in information technology. Meanwhile, in Canada cost-containment strategies were being imposed upon our healthcare system. As a direct result of those strategies, family medicine was in crisis. In Ontario, we simply had too few family physicians available to deliver the comprehensive family medicine services that people want and need. Given the crisis in family medicine and with the encouragement of the public who were intolerant of a healthcare system that had created a new classification of patients the orphaned patient population, the Ontario College of Family Physicians (OCFP) began a year-long consultation process aimed at identifying the solutions to the problems facing family doctors in their practices and in the system in general. The consultation process culminated in a description of our vision of what family medicine should look like in the future. The results of that year-long consultation process were captured in the document Family Medicine in the 21 st Century: A Prescription for Excellent Healthcare ( The document was an important vehicle in developing public policy in Ontario, and indeed, across Canada. The process of gaining consensus on the issues, the solutions and the vision proved to be a key factor in the implementation of the various strategies to strengthen family medicine and the primary care sector in Ontario during the last ten years. Much progress has been made; however, much more is needed if we are to achieve the positive outcomes seen in other countries. As a direct result of our lag time in investing in family medicine, the primary care sector in general, and in information technology, our health outcomes have been deemed inferior to many other countries and our per capita costs are higher. Given the progress made to date, we have all the building blocks in place in Ontario not only to catch up with other countries, but to create a world-class healthcare system worthy of a gold medal by To that end, the OCFP began a second consultation process in February of this year. The Executive Committee s retreat in February of this year set in place the groundwork for a retreat held in March attended by our full Board and key family physician leaders. The deliberations during that day-long retreat were captured in the document Vision 2020 Partnering in the Quest for the Healthcare Gold Medal ( While the Board retreat was an important milestone, our experience in 1999 reinforced the need to conduct a further consultation process to engage the public, our Members, and other healthcare leaders in a similar dialogue. In addition to conducting surveys over the course of the summer, the OCFP invited a number of acknowledged healthcare leaders from government, the LHINs, CCACs, hospitals, etc. to gather with family physician leaders on September 24, With 140 participants at the Vision 2020 Symposium, the dialogue was rich and meaningful.

18 Vision ) Symposium Format 2.1) Introductory Remarks and Keynote Speaker Dr. Robert Algie, President of the OCFP, warmly welcomed the participants to the Symposium, noting the importance of their participation in the day and providing an overview of the purpose for the day and the OCFP s expected outcomes. (See Appendix A). Part of what we are looking for today is to rebuild a sense of a community of care and provide the people of Ontario with a well coordinated system of care. Functional small communities still provide that. It is difficult to walk away from a colleague or patient in need. There is not a lot of anonymity in rural Ontario. Sometimes, I think we should divide the province up into blocks of 25,000 people and attach the required healthcare personnel to them to provide most of their care needs, including out-of-hours care and hospital coverage, as well. This will not happen so we need to find ways to expand inter- and intradisciplinary care to a greater number of patients and do so in a cost-efficient manner. Dr. Robert Algie Dr. Algie introduced the Keynote Speaker for the day, Ms. Liz Sandals, MPP for Guelph-Wellington and the Parliamentary Assistant to the Minister of Health and Long-Term Care. Ms. Sandals provided a positive start to the day by reminding participants of the system in place in 2003, the progress made to date and the challenges we currently face in sustaining the system. Ms. Sandals overview of the Excellent Care for All Act reminded the participants that quality and value go hand-in-hand. Participants were informed that the legislation will achieve change in the system through new funding models and incentives; improved organizational accountabilities and governance; and better supports for providers to deliver evidence-based care. Ms. Sandals concluded her remarks by reminding participants that together, we can build a system which puts patients first and produces quality care which improves lives. (See Appendix B). The Excellent Care for All Act is the first step towards better quality and value in Ontario s healthcare system. Our legislation means that investments in health must produce evidence-based results and improved patient care. This must be centred on the needs and choices of the patient and they must produce value. Ms. Liz Sandals 2.2) Listening to the Public, Healthcare Leaders and Family Physicians Survey Results Ms. Jan Kasperski, CEO of the OCFP provided an overview of the results of three surveys conducted during the summer months. Ms. Kasperski noted that Ontario is going through a tough time; however, tough times, as challenging as they are, often produce opportunities for needed changes. While tough times result in a magnification of fears and anxieties, they also allow new and exciting ideas to rise to the surface. She reminded participants that if you are an optimist and good at listening, you will be able to hear those great ideas and act upon them.

19 Vision Participants were reminded that family physicians are good listeners and have many opportunities to listen throughout the healthcare system. Ms. Kasperski Family doctors listen carefully to their noted that the organization that patients in their offices where they are represents 9500 family doctors is also a good listener. She stated that last spring the OCFP listened to family physician leaders and, over the course of the summer, listened to patients, the public, healthcare organizational leaders and family physicians. A video provided an overview of what patients had to say about their family doctors. Ms. Kasperski then provided an overview of the results of the public, organizational leaders and family physicians surveys. Main themes in the public survey demonstrated that referred to as my doctor, not the doctor. They are also able to listen in hospitals where they are the emergency physicians and the hospitalists. They deliver babies; they are Medical Directors of Long-Term Care Facilities, the Physician Advisors to the CCACs, the HIV-Aids and Palliative Care physicians, the GP Psychotherapists, the GP Oncologists, the Sports Medicine Doctors, etc., etc., etc. They are the canaries in the mineshaft. They know what is working in the system and what is not. Ms. Jan Kasperski the public wants more doctors, more nurses and other healthcare professionals, shorter wait-times and more money spent on healthcare. They want 90% of their care provided in their family practice or at home if they or a loved one becomes frail. The concerns of the organizational leaders and family doctors in regards to the sustainability of the system and the changes that need to occur to increase quality and decrease costs will prove challenging in light of increased patient expectations. The surveys were used to support the small group discussions that followed each Fireside Chat. (See Appendix C). 2.3) Fireside Chat: The Health of the Healthcare System Dr. David Tannenbaum, Chair of the Board of the OCFP, introduced the purpose of the Fireside Chat, namely, to listen to four experts describe the current state of the healthcare system from their perspectives and provided an introduction to each of the speakers. (See Appendix D). Mr. Ray Hession, Chair of the Board of e-health and former Chair of the Board of the Ontario Health Quality Council, expressed his respect and admiration for the Members of the Ontario College of Family Physicians. He stated that, while his comments may seem critical of the status quo, he believed in the delivery of family medicine as the vanguard of healthcare. It has advanced significantly in the past decade and is positioned to make significant gains in the near future. Mr. Hession reminded the participants that the 1990s were a period of costcontainment and underfunding of the system and discussions about primary care reform that were not well understood by the public. In contrast, the past decade created an avalanche of change driven by the Health Results Team including Family Health Teams, Local Health Integration Networks, an increase in the number of Long-Term Care Facility beds, OntarioMD/EMRs and the Wait-Time Strategy. An emphasis on performance measurement and reporting came into

20 Vision being during this period and set the stage for this current decade that can be characterized by continuing quality improvement and accountability. Mr. Hession then provided an overview of today s healthcare system and the policy/program responses in the last five years. In conclusion, Mr. Hession noted the work of Dr. Ross Baker who scanned the world to find the best processes for delivering healthcare. The message is a clear one based on quality by design. Our delivery processes, integrating the various sectors in the system and evidencebased practices by teams and networks supported by IT will achieve the results anticipated by the Excellent Care for All Act; however, effective execution is needed in the form of clear directions, clear plans, organized and resourced approaches and controls. In Mr. Hession s words Everything is about execution. There is a lot of hand waving, a lot of rhetoric but it all comes down to execution with appropriate controls through reporting to the public. TODAY S PICTURE Access: No change in the past 3yrs in the number of Ontarians who do not have a family doctor 50% of 730,000 actively looking 9/10 think they wait too long for appointment 53% see their doctor on the same or next day when sick Wait Times: Still too high for CT/MRI scans ALC: 16% of hospital beds worse in past three years CDM: Only 1/2 of diabetes patients have eyes/feet examined; less than 1/2 are getting the medication needed improvement over the past 6yrs EMR Adoption: 26% in 2007 to 43% in 2009 (Australia, UK and Netherlands have 95 to 99% HHR: increased supply of family physicians over period and more NPs yet only one NP per every 10 physicians Population-Based Health: Improvements ; lost ground lack of exercise; smoking; drinking; 25% avoiding pap tests, mammography and flu shots Mr. Ray Hession POLICY/PROGRAM RESPONSES SINCE 2005 Increased number of FHGs, FHNs, FHOs, FHTs. Nurse Practitioner-Led Clinics and 22 new and 17 satellite CHCs. Advanced access and office redesign Quality Improvement/Quality by Design Health Care Connect Strong growth in the use of telemedicine Excellent Care for All Act and Ontario Health Quality Council s mandate expanded e-health and EMR/EHRs as an enabler of team-based care, patient and provider education, quality improvement, system planning, accountability and research Mr. Ray Hession

21 Vision The Health of the Healthcare System There is more money than ever before available for healthcare (almost 50% of the Provincial budget) There is less bureaucracy 14 LHINs replacing 16 DHCs and 7 Regional Offices The healthcare system (including LHINs) is more accountable than it ever has been. Ontario s healthcare is becoming more coordinated around an integrated system of accountabilities which ensures providers are aligned with LHIN priorities, and LHINs are aligned with provincial priorities. For the first time, healthcare delivery is being measured; measurements are being used to set targets; and targets are being met (people in the SE wait seven months less for a hip or knee replacement; for four consecutive quarters ALC levels have decreased; today 96% of the SE residents report they have access to a family doctor compared with 80% three years ago, etc.) Regardless of whether one believes that $46B is enough money to provide healthcare to 13,000,000 people or whether it is just the realization that the large deficits and mounting debt is limiting growth, more and more it is being recognized that solving our healthcare problems is no longer a revenue game, but instead it is about a focus on whether or not we are maximizing the value of our $46B investment. Leaders are beginning to understand that they can not be a leader if they say I have a problem, give me more money. We still use the acute care and the long-term systems inappropriately, with some patients inappropriately placed in these institutions. This is the system s missed opportunity to drive quality. If we want a strong acute system, if we want a strong long-term care system, then we need a strong community care system and a strong primary care system. Family physicians could be better linked to acute care, through an e-referral system to provide more choice to patients re: specialists. Discharge summaries should all be available to family physicians electronically. Primary healthcare should function more like a system within regions, with FHTs and CHCs and other groups and solo practices sharing allied healthcare resources. For the most part, primary care is not aligned with LHIN priorities. We have spent much time trying to achieve targets in ER wait times and alternative level of care numbers and patient days, but without focusing on how primary care could support these priorities. Family physicians are not being engaged to the extent they should be. Engagement is needed to understand what is working and what is not working. If family physicians are the canaries in the coal mine, then we better engage them to hear what is happening. Engagement is also needed to ensure they are contributing to redesigning the system. Many groups are realizing this and making efforts to improve family physician engagement. Some LHINs are developing innovative ways to engage family doctors and the LHIN Collaborative has appointed an expert panel to develop a tool box for LHINs to share best practices for engaging family doctors. All LHINs need a family doctor as a primary care lead, similar to their Cancer Care Leads and ER Leads. Family practices and public health units need to be accountable to LHINs. This is not about power; this is about achieving alignment. We have Service Accountability Agreements with hospitals, CCACs, the Community Services Sector, LTCs, Mental Health and Addiction Services, and even with CHCs, but there is great need to have primary care aligned with the changes that are happening throughout the system. Mr. Paul Huras

22 Vision Mr. Paul Huras, CEO of the South East LHIN, reminded the participants that today was a very important engagement session. He stated that he was informed on his very first day on the job as a LHIN CEO that even though family practices were not accountable to the LHINs, each LHIN needed to work with the primary care sector. Mr. Huras noted that the healthcare system is more accountable than ever before with targets being set, measured and met. In order to sustain the system, leaders need to understand that they will not be called a leader if they say: I have a problem; I need more money. Mr. Huras noted that, while the healthcare system is pretty strong and in fairly good shape, better alignment of family practices with the rest of the system and enhanced engagement with the LHINs is needed to make the system even stronger. Mr. Huras provided the Symposium participants with a detailed overview of the Health of the Healthcare system displayed on page 19. Ms. Margaret Mottershead, CEO of the Ontario Association of Community Care Access Centres, noted that many healthcare providers have not yet recognized the significance of the changes that have taken place in the last few years. The most significant of these was the creation of the Local Health Integration Networks to help plan, fund and create integrated systems of care for their regions. At the same time, the CCACs were also restructured and aligned with the LHIN boundaries with the specific intent of being the instruments for integration. The CCACs were given a mandate to help people navigate the system, to assist We do the linking, the matching and the connecting. In addition to overseeing the services provided in the home, our case managers are working in hospitals, especially medical units and emergency departments to facilitate the discharge planning, as well as in the community to continue the journey for patients needing care in other settings. M M t M tt h d them to receive the care they need and also to make certain that they get care in their own homes and communities. As part of this continuity of care, case managers have become an important and supportive component of Family Health Teams. Ms. Mottershead noted that, while family physicians based on survey results - emphasize the trusting patient-physician relationship, the core DNA of the CCACs is the trusted quality care connector. Ms. Mottershead emphasized the changing role of CCACs in the near future as new responsibilities are added and different service models roll out in the upcoming year. In addition to responsibility for placement in long-term care homes, CCACs have the ability to match people to the most appropriate place for their ongoing care like supportive housing and assisted living. CCACs are adopting a population-based service model that will triage patients into different streams of care, navigation and support based on conditions and health status (complex, chronic, stable chronic, acute and well). This approach will diversify, and in the case of the complex populations, intensify coordination and navigation, resulting not only in better organized support to patients/clients so that they remain in their homes as long as possible, but also in optimization of other services necessary to support family practices.