Engaging Primary Care Physicians in LHIN Processes:

Transcription

1 Engaging Primary Care Physicians in LHIN Prcesses: Primary Care Physician Engagement Resurce Guide & Tlkit December 2010

2 Table f Cntents INTRODUCTION... 3 BACKGROUND... 3 PURPOSE... 4 PRIMARY CARE PHYSICIAN ENGAGEMENT: CONCEPTUAL FRAMEWORK... 5 WHAT IS ENGAGEMENT?... 5 ENGAGEMENT PRINCIPLES... 5 LEVELS OF ENGAGEMENT... 6 RATIONALE FOR ENGAGING PRIMARY CARE PHYSICIANS IN LHIN PROCESSES... 6 OBJECTIVES OF PRIMARY CARE PHYSICIAN ENGAGEMENT... 7 PRIMARY CARE PHYSICIAN ENGAGEMENT RESOURCE GUIDE & TOOLKIT... 8 SCOPE OF ENGAGEMENT ACTIVITIES... 8 ENGAGEMENT APPROACHES & TECHNIQUES... 8 Infrm / Educate... 9 Cnsult Invlve Cllabrate Empwer IMPLEMENTATION STEPS KEY ENABLERS TO ENHANCE ENGAGEMENT STEPS TO BUILD AN EFFECTIVE ENGAGEMENT PLAN APPENDIX I I) ONTARIO MEDICAL ASSOCIATION (OMA) II) THE ONTARIO COLLEGE OF FAMILY PHYSICIANS (OCFP) APPENDIX I) HEALTH PROFESSIONALS ADVISORY COMMITTEE (HPAC) II) PHYSICIAN LHIN TRIPARTITE COMMITTEE (PLTC) APPENDIX I) PRIMARY CARE PHYSICIAN ENGAGEMENT ASSESSMENT WORKSHEET II) EVALUATION FRAMEWORK WORKSHEET REPORT AUTHORS REFERENCES... 29

3 Intrductin Effective primary care is essential t a high perfrming health system. Well integrated primary care mdels can achieve distinct health, service and system gals simultaneusly. Research indicates that imprvements in health care require direct and meaningful invlvement f physicians. Because f this central rle, engaging and wrking in cllabratin with primary care prviders is valuable fr the Lcal Health Integratin Netwrks (LHINs) t develp new, creative mdels f care delivery, imprve system integratin and achieve efficiencies. LHINs d nt have frmal funding r planning authrity fr mst primary care mdels, with the exceptin f primary care services prvided thrugh Cmmunity Health Centres which are directly funded by and accuntable t the LHINs. Hwever, bth LHINs and primary care physicians view physician invlvement in pririty setting, strategy develpment and health system planning as critical fr success. Engaging primary care physicians in LHIN prcesses is paramunt t achieving imprved linkages between primary care and the rest f the health system. T supprt achievement f utcmes LHINs have used a variety f appraches t engage with primary care physicians. LHINs recgnize that effective engagement is a strng enabler t creating an integrated health system and better experiences fr patients in Ontari. Current legislatin als requires LHINs t engage the primary care sectr. The legislatin relating t Ontari s LHINs, Lcal Health System Integratin Act, 2006, specifies three cmmunities t be engaged by the LHINs: Patients and ther individuals in the gegraphic area f the netwrk; Health service prviders and any ther persn r entity that prvides services in r fr the lcal health system; and Emplyees in the lcal health system. This legislatin has been lcally interpreted t determine what it means fr health planners, health rganizatins and health prviders. As a result there are n cnsistent guidelines, principles r methds n hw/when LHINs shuld engage primary care physicians in LHIN prcesses. A primary care physician engagement resurce guide serves t enhance cllabratin, imprve relatins, streamline methds f physician-lhin cmmunicatin and represents a psitive step twards enabling the prvisin f high quality care. Backgrund T infrm the develpment f an Engagement Resurce Guide and Tlkit, the LHIN Cllabrative (*LHINC) cnducted a survey f all 14 LHINs n current primary care physician engagement practices. The subsequent reprt, Engaging Primary Care Physicians in LHIN Prcesses 1 nted a variety f appraches that have been adpted by the LHINs t engage primary care physicians, each with varying degrees f effectiveness, and highlighted several gaps and challenges in current methds f engagement. A review f selected literature, including the Ontari Medical Assciatin reprt, Engaging Physicians in LHIN-Based Health System Planning, als highlighted the need fr guiding 1 Available at: 3

4 principles fr LHIN/Physician relatinships and best practice tls n when/hw t engage physicians fr advice. T further supprt and infrm the develpment f a Primary Care Physician Engagement Resurce Guide and Tlkit, LHINC established a primary care physician panel. The panel cnsisted f brad representatin f primary care physicians frm diverse gegraphical regins and clinical settings including: rural, urban, grup practices, Lng-Term Care, Cmmunity Health Centres and sl practitiners. Senir LHIN representatin was als included n the panel. The purpse f the panel was t prvide an pprtunity fr physicians t share their perspective n engagement in LHIN prcesses and t identify preferred mechanisms r tls fr effective engagement. The fllwing Primary Care Physician Engagement Resurce Guide & Tlkit is based n feedback received frm the LHINs, input prvided by the primary care physician panel and literature reviews based n best practice engagement methds in Ontari and ther jurisdictins. Best practice surces available n EPIC 2 and the Internatinal Assciatin fr Public Participatin 3 frm the basis f the engagement framewrk. (See Appendix A fr a cmplete listing f references). In additin, the dcument is aligned with the Guidelines fr Cmmunity Engagement develped by a pan LHIN Cmmunity Engagement prject team t supprt cnsistency in best practice engagement initiatives acrss the LHINs. The term primary care physician and the engagement prcesses cntained within this guide are aimed at family physicians that deliver cmprehensive family medicine and fcused practices that prvide cre cmmunity services. Purpse The Primary Care Physician Engagement Resurce Guide & Tlkit prvides a fundatin fr physician engagement effrts and a framewrk t guide future engagement activities. The dcument prvides LHINs with a range f preferred engagement techniques that can be used t strengthen physician relatins, cmmunicatin and partnerships. The purpse f the resurce guide is t: Enhance effective engagement f primary care physicians in LHIN prcesses Indentify guiding principles fr effective engagement Prvide a clear understanding f levels f engagement and engagement gals Identify the preferred scpe f engagement activities Identify preferred tls and methds fr engaging primary care physicians Recmmend steps t build an effective engagement plan fr primary care physicians 2 Engaging Peple Imprving Care (EPIC) an nline rganized cllectin f best practice resurces n cmmunity engagement (CE) fr the health field develped fr health prfessinals, health planners, gvernments, and health-related grups and rganizatins. 3 The Internatinal Assciatin f Public Participatin (IAP2) is an internatinal assciatin dedicated t prmting best practices assciated with public participatin and engagement in relatin t gvernments, institutins and ther entities that affect public interest. 4

5 Primary Care Physician Engagement: Cnceptual Framewrk What is Engagement? Engagement refers t the methds by which LHINs interact, share and gather infrmatin frm and with their stakehlders. The purpse f engagement is t infrm/educate, cnsult, invlve, cllabrate and empwer stakehlders in bth healthcare r health service planning and decisin-making prcesses t imprve the health care system. The methds r cmmunicatin tls used t engage individuals, rganizatins r entities can vary based n the desired bjectives and utcmes f the particular initiative. Engagement prvides an pprtunity t cmmunicate and/r partner with stakehlders n issues, ideas, challenges, mitigatin strategies, successes, and ther initiatives r activities. Engagement is nt abut achieving cnsensus, but rather enhancing interactins and imprving cmmunicatins with stakehlders. Engagement Principles Brad principles underpin engagement and a practical knwledge and adaptatin f these will increase the effectiveness f engagement activities. The key principles fr effective primary care physician engagement as develped frm LHIN and physician input and based n leading practice engagement principles can be clustered under five categries: 5

6 Levels f Engagement The fllwing spectrum f engagement demnstrates the varius levels f engagement LHINs may undertake with physician stakehlders. The spectrum shws the increasing level f physician impact as ne prgresses frm infrm thrugh t empwer. Infrm/Educate, Cnsult, Invlve, Cllabrate and Empwer are all terms that may be used t describe engagement activities. Hwever, each term refers t intrinsically different frms f engagement which are dependent n the verall bjectives. Lw level f invlvement and influence Mid level f invlvement and influence High level f invlvement and influence Infrm / Educate Cnsult Invlve Cllabrate Empwer Adapted frm the IAP Public Participatin Spectrum Ratinale fr Engaging Primary Care Physicians in LHIN Prcesses Engagement is a pledge, a prmise r cmmitment t wrk tgether, nw and in the future. The engagement f primary care physicians and LHINs cnnects bth partners with the prmise f a better result if they wrk tgether. N individual partner alne understands the culture f the ther and by wrking tgether in a mutually respectful manner effective changes will be implemented. Building n the input received frm the panel f primary care physicians and the LHINs, the ratinale fr engaging and cllabrating with primary care physicians can be summarized as fllws: 6

7 Objectives f Primary Care Physician Engagement Cmmitting t the fllwing three key bjectives will build primary care physician engagement prductively and effectively int the culture f all LHINs: 7

8 Primary Care Physician Engagement Resurce Guide & Tlkit The Primary Care Physician Engagement Resurce Guide & Tlkit ffers LHINs a range f preferred techniques that have been identified and endrsed as effective methds fr engaging primary care physicians in LHIN prcesses. The strategy recgnizes the unique characteristics f the LHINs and their lcal circumstances and therefre des nt suggest ne specific mdel but ffers a variety f best practice tls fr different situatins. It will be imprtant fr each LHIN t recgnize that they are able t draw upn the supprt, guidance and advice f bth the Ontari Cllege f Family Physicians (OCFP), the Ontari Medical Assciatin (OMA) and OMA Reginal Managers t facilitate the family physician engagement prcess (refer t Appendix I: OMA & OCFP Rles and Respnsibilities). Scpe f Engagement Activities LHINs are cmplex rganizatins that are ften wrking n dzens f initiatives at any ne time. Physician engagement can be a key success factr t many LHIN initiatives. The first task in develping an engagement plan is t review what the LHIN is trying t accmplish r achieve and t get clarity abut what specifically they need t engage physicians in. As a guideline, the fllwing areas have been identified as the prjects and initiatives in which the engagement f primary care physicians is extremely valuable. These activities can be used as a guide t direct engagement effrts but shuld nt be cnsidered as an exclusive listing. Equally imprtant is the need fr physician invlvement in determining the pririty areas that neccessitate engagement and the level f engagement required. Prjects and initiatives will change frm time t time and effective engagement prcesses shuld help t identify new initiatives that will further engage physicians. Strategic Planning: Integrated Health Service Plans (IHSP) & Annual Service Plans Primary care physicians invlvement in IHSP develpment and educatin n current LHIN pririties and hw their practices can impact these pririties (namely emergency rm & alternate level f care pressures, integrated diabetes care, and Mental Health and Addictin services) Health Service Planning / Prgram Planning Integratin Planning & Initiatives Quality f Care Imprvement and Patient Safety Initiatives Pandemic Planning Physician Recruitment & Wrkfrce Planning Develping Clinical Practice Guidelines Engagement Appraches & Techniques The fllwing sectin prvides examples f techniques that might be used under each level f engagement. The techniques suggested have been identified by the physician panel as the preferred methds fr effective engagement f primary care physicians and serve as a best practice guide r suggestin nly t enhance physician-lhin engagement effrts. While the tlkit prvides mechanisms t establish frmal engagement, it is imprtant that the LHINs als reach beynd limited membership advisry r cnsultative structures and fcus mre bradly t include the diverse primary care physicians practicing thrughut each LHIN. 8

9 Infrm / Educate Infrming / Educating dentes a ne way flw f infrmatin frm the LHIN t physician stakehlders. Purpse: T prvide primary care physicians with balanced and bjective infrmatin t assist them in understanding the prblem, alternatives, pprtunities and/r slutins. e.g., Infrming / Educating is used when a decisin has already been made and the bjective is t ensure that infrmatin is transmitted clearly t thse physicians wh might be affected. Engagement Techniques: Targeted educatin sessins Use targeted sessins as an pprtunity t educate physicians n specific LHIN activities r decisins. Demnstrate relevance. Tailr infrmatin t reflect the valueadd and / r impact t primary care practices and their patients. Hld sessins at times and lcatins that are cnvenient fr physicians and that minimize interruptins t their daily practice. Prvide advanced ntice t accmmdate physician schedules. LHIN Websites Websites can act as infrmatin repsitries lcatins where prject backgrund materials are available fr review and use by physician stakehlders. Web based repsitries make it easy t search fr dcuments with the help f the nline search engine. Websites need t be user friendly fr physicians dedicate a sectin fr physicians with infrmatin, educatin and reprts n relevant activities/initiatives. Use Websites as a mechanism t educate physicians n the services available in the LHIN. Leverage OMA and OCFP Link int existing OMA and OCFP cmmunicatin channels, newsletters and academic half days t share relevant infrmatin. Send cmmunicatins r ntices thrugh the OMA and OCFP t ensure distributin t the apprpriate sectins. Utilize OMA and OCFP bard representatives t distribute relevant infrmatin t the field. Explre the pssibility f bard mnthly messages cntaining regular features n LHIN activities and successful initiatives. Infrm / Educate Utilize existing venues, resurces, prcesses and available structures, ex. Physician / LHIN Tripartite cmmittee, OMA Outreach Members, existing Hspital Family Medicine structures, Health Prfessinals Advisry Cmmittee (HPAC) Ensure infrmatin prvided is: High quality Cnsistent Timely Apprpriately targeted Clear & easily understd Cmmunicate successes & share results! Infrm primary care physicians f initiatives that have achieved successful results. Fr example, hst physician led educatin sessins n the Partnerships fr Health prject t infrm physicians n hw this initiative has psitively influenced clinical practice. 9

10 Cnsult Cnsulting is a ne-way flw f infrmatin frm primary care physicians t the LHINs. Purpse: T cnsult primary care physicians n draft plans r n issues; feedback frm physician stakehlders has an influence n decisins. e.g., Cnsulting is used when the bjective is t gather infrmatin frm a variety f primary care physicians that the LHIN will use in making its decisin. Engagment Tls & Techniques: Surveys/Questinnaires Can be used t understand the pinins r preferences f a large grup f primary care physicians frm a variety f practice settings (sl and grup practices). Take advantage f OMA Reginal Managers and the OCFP t identify and btain input frm the physicians wh will be affected r impacted by the decisin and/r utcme. Cnsult Utilize existing MD meeting schedules as an pprtunity t gain input (ex. Medical Advisry Cmmittee, Family Practice Advisry Grup) Utilize multiple cmmunicatin channels t allw fr brad based feedback Ensure the purpse f cnsultatin is clear, including what is being cnsulted n and what is nn-negtiable Use Technlgy as a facilitating tl Virtual cmmunities/blgs/electrnic bulletin bards develp an nline frum fr nging cnversatins amng physicians and LHINs. Create cntext fr the frum each frum shuld be specific t a pririty, prject r initiative. Wiki Use a web based applicatin that will allw physicians t add cntent, as n an internet frum, but als allws ther physicians t edit the cntent that is psted. Wikis prvide an pprtunity fr LHINs t ask questins r seek clarity n specific tpics r issues relating t primary care, and in turn physicians can answer t the best f their knwledge r add t and imprve psted infrmatin. One-n-ne discussins r interviews Use ne-n-ne r small-grup fcused discussins t learn abut individual physician perspectives r t bring ut specific slutins/ ideas. Have specific bjectives fr the interview. Allw enugh time fr a respnse t cnsultatin requests Prvide feedback n the results f cnsultatin Ensure and demnstrate that the views f thse cnsulted are taken int accunt in the utcme Present all infrmatin simply and clearly Seek ut physicians by cnducting site visits where feasible. 10

11 Invlve Invlving is a tw-way flw f infrmatin between the LHINs and physician stakehlders. Purpse: T wrk directly with primary care physicians in planning and plicy prcesses t ensure their cncerns and aspiratins are cnsistently understd and cnsidered. e.g., Invlving is used when the decisin still rests with the LHIN, but the intent is t have active participatin frm physician stakehlders in develping slutins. Engagement Tls & Techniques: Fcus Grups / Expert Panels Hst a small grup facilitated discussin used t gauge physician pinins and t explre their attitudes in depth at the start f a prject r initiative. Fcus grups are a pwerful means t evaluate LHIN prpsals r test new ideas. Limit fcus grups t 8-10 physicians and LHIN representatives at the same time in the same grup. Wrkshps Useful fr LHINs and primary care physicians t wrk in small grups n a defined assignment and t fcus n prviding input that can feed directly int the decisin making prcess. Link in with OMA and/r OCFP hsted wrkshps. LHIN Cmmittee participatin (Prject r Task Grups) Invlve Cnduct physician t physician engagement where feasible Direct face-t-face engagement Access the OCFP staff and OMA utreach member services t crdinate and facilitate participatin Directly invlve CHC physicians n issues affecting primary care services at Cmmunity Health Centres Identify and engage with physician leaders and early adpters Maintain a cmmitment t enabling physician invlvement in the prcess Include physicians as members f prject teams r task grups that require primary care input r invlvement. Suggested membership includes representatives frm the OMA and OCFP. Demnstrate the value add r impact f the prject/initiative t primary care practices and their patients. Health Prfessinals Advisry Cmmittee (HPAC) Utilize HPAC and the primary care physician representatin. Establishing a defined scpe f practice fr HPAC that supprts the mandate f the cmmittee will enhance effectiveness f engagement activities. Set specific deliverables and accuntabilities fr the defined tasks. (See Appendix 2 fr a list f HPAC Recmmendatins) Cnsider carefully what prcesses and/r structures are apprpriate Avid misunderstanding and ambiguity by clearly establishing the basis fr membership and rles and respnsibilities at the utset Ensure adequate resurces are allcated t the prcess 11

12 Cllabrate Cllabrating invlves a flw f infrmatin nt just between the LHIN and physician stakehlders, but amng the primary care physicians themselves. Purpse: T partner with primary care physicians in each aspect f decisin-making (including develpment f alternatives and identificatin f the preferred slutin). e.g., Cllabrating is used when the LHIN wishes t wrk tgether in a jint prcess with physician stakehlders thrughut an entire initiative r decisin-making prcess. Engagement Tls & Techniques: Primary Care Physician Lead within each LHIN Explre the ptin f retaining a part time Primary Care Physician Lead n site Recmmend Leads be primary care physicians with established practices within their LHIN Suggested Purpse & Accuntabilities: Prmte an integrated apprach t primary care delivery and interact with: Knwn physician LHIN leads (see belw: LHIN Physician Cllabrative) Primary care physicians OMA, OCFP and Ministry representatives Supprt effective engagement f primary care physicians Facilitate primary care physician effrts at the LHIN level with patient attachment rate challenges Share primary care success initiatives and lessns learned acrss the LHINs Establish linkages with HPAC where apprpriate Primary Health Care Advisry Grups / Netwrks / Cuncils (a LHIN wide rganizatin f primary health care prviders) Suggested Purpse & Accuntabilities Develp a primary care strategy related t specific LHIN initiatives (ex. chrnic disease, emergency planning, quality imprvement, infrmatin management systems, screening and preventin) Prvide advice n IHSP pririties Serve as a cmmunicatin liaisn n primary health care issues Suggested Membership A crss sectin f primary care physicians: including representatin frm grup practices (ex. Family Health Teams, Family Health Organizatins, Family Health Netwrks, Family Health Grups), Cmmunity Health Centres, Hspitals, Lng-Term Care, and sl practitiners (recmmend 5-7 physician members maximum) Nn physician stakehlders, which may include: Nurse practitiners, Mental Health sectr representative, Lng-Term Care sectr representatives, Cmmunity Care Access Centre (CCAC) 12

13 sectr representatives, Physical Therapists and/r Occupatinal Therapists, Scial Wrkers, Public Health, and/r Pharmacists (recmmend 5-7 nn physician members maximum) LHIN Primary Care Physician Cllabrative (a LHIN wide rganizatin f physicians) Suggested Purpse & Accuntabilities: Share prgress n prvincial pririties Prmte an integrated apprach t primary care delivery Take n certain primary care initiatives that are accuntable t the LHIN CEOs Suggested Membership: Existing physician leads within the LHIN, which may include: Primary Care Physician Lead Critical Care Physician Lead Emergency Rm (ER) Physician Lead Cancer Care Ontari (CCO) Physician Lead Renal Netwrk Physician Lead Diabetes Physician Lead Hspital-based Family Medicine Department Heads OMA Representatin OCFP Representatin May include representatin frm primary care research rganizatins where feasible and apprpriate Cllabrate Develp a chesive physician vice build chesin within the physician grup in rder t prvide unified, inclusive perspectives There must be clarity abut the extent f decisin-making pwer that is delegated and, in particular, what is nt included Where frmal partnership arrangements are invlved, gvernance arrangements and membership need t be carefully cnsidered 13

14 Empwer Empwering dentes n difference in status between the LHINs and physician stakehlders invlved in the prcess. Purpse: T actively supprt primary care physicians in develping the prcesses and structures necessary t identify issues and t implement slutins. e.g., Empwering is used when there is a true partnership. The LHIN may be in a psitin t supprt that partnership by prviding skills, training r resurces, but has n greater vice in decisinmaking than any f the ther stakehlders. Engagement Tls & Techniques: Prvincial Primary Care Cllabrative Suggested Purpse & Accuntabilities Enhance crss LHIN cllabratins n prvincial pririties Prvide an pprtunity fr infrmatin sharing and planning acrss the LHINs Identify and share best practice ptins r initiatives acrss the prvince Infrm the develpment f a primary care strategy as it relates t prvincial pririties Establish linkages with the Physician-LHIN Tripartite Cmmittee (See Appendix 2) Suggested Membership Primary Care Physician Leads frm all 14 LHINs OMA representatin OCFP representatin Assciatin f Family Health Teams f Ontari (AFHTO) Assciatin f Ontari Health Centres (AOHC) and CHC physician leaders Ministry f Health and Lng-Term Care (MOHLTC) Other representatin as deemed apprpriate by the Prvincial Primary Care Cllabrative Empwer The listing f engagement techniques under invlve & cllabrate may als be used t empwer physicians at the lcal LHIN level Ensure clarity as t the scpe f shared pwer and/r decisin-making capabilities Ensure clarity abut rles and respnsibilities Issues invlving accuntability need t be carefully cnsidered Sufficient resurces need t be allcated t enable an empwerment apprach 14

15 Implementatin Steps Key Enablers t Enhance Engagement The fllwing is a list f key enablers identified by the panel f primary care physicians t ensure effective engagement practices and t prmte strng physician-lhin relatinships. * The OCFP shuld be cnsulted early t ensure that CME Mainpr credits are prvided t primary care physicians attending educatinal sessins. 15

16 5 Steps t Build an Effective Engagement Plan Early and meaningful invlvement f physicians, utilizing a physician engagement plan will imprve the prbability f psitive results and healthy physician relatins. The fllwing sequential steps (based n the Institute fr Healthcare Imprvement - Framewrk fr Engaging Physicians) are suggested fr LHINs t design and execute a plan fr imprved engagement f primary care physicians in LHIN prcesses. Key success factrs and underlying questins are illustrated fr each step. In additin, tw wrk sheets that can be cmpleted thrugh steps 1 t 5 have been prvided in Appendix 3: Primary Care Physician Engagement Assessment Wrksheet: Develped by the pan LHIN Cmmunity Engagement prject team the wrksheet has been adapted t help the LHINs assess the need fr primary care physician engagement in LHIN pririties and/r critical initiatives and the level f invlvement recmmended. (Cmplete during Steps 1-4) Evaluatin Framewrk Wrksheet: Develped by the pan LHIN Cmmunity Engagement prject team the wrksheet has been adapted t guide the LHINs in the evaluatin f their primary care physician engagement activities. (Cmplete during Step 5) STEP 1: Priritize the LHINs need fr primary care physician engagement based n the LHINs strategic plan and understanding f the critical initiatives in which physicians must be engaged. This will give the LHIN a gd sense f which initiatives the engagement plan must address, and which initiatives have the mst dependence n physician engagement. Key Success Factr Invlve physicians frm the beginning f the initiative 16

17 Were physicians invlved in chsing this pririty r initiative? Determine the level f Physician impact and influence n utcmes Will primary care physicians be affected by the utcme f the initiative? T what degree can primary care physicians influence r affect change n the utcmes f the prpsed initiative? STEP 2: Define the prblem, pprtunity and/r decisin t be made. Clearly state the aim and desired utcme fr the key initiative fr which the LHIN is ging t build a detailed physician engagement plan and identify the level f primary care physician cncern r interest. Key Success Factrs Demnstrate hw the initiative will imprve patient utcmes. Is this initiative s aim framed and cmmunicated t physicians s that it is clear the LHIN is aiming t imprve patient utcmes? Demnstrate hw the initiative will imprve efficiencies fr physicians and/r their patients. Hw will specific aspects f this initiative reduce hassles and wasted time fr physicians? Hw will the LHIN measure imprvement in ways that are credible? STEP 3: Identify which physicians must ultimately be engaged in this initiative if it is t succeed and determine hw physician stakehlders can cntribute. Key Success Factrs Identify and activate champins Which physicians shuld be n the shrt list f ptential champins fr this initiative? Hw will the LHIN select ne r tw champins? What is the plan t supprt them? Wrk with the real leaders, early adpters Wh are the critical physicians mst relevant t this initiative? Hw can the LHIN invlve them? Wh are the physicians that are already ding mst f what is needed fr this initiative, and are always receptive t trying new things? Hw is the LHIN ging t wrk with them fr maximum effect? Educate and infrm structural leaders What will be the rle f existing structures r cmmittees in this initiative (ex. HPAC, Physician-LHIN Tripartite Cmmittee)? What will be presented, and when, t these cmmittee leaders? Determine hw physicians can cntribute What rle can physicians play in this prject and/r initiative? Can physicians help define the issue? Cntribute data? Help t establish decisin criteria? Help t develp ptins? Help t evaluate ptins? Make recmmendatins r decisins? 17

18 STEP 4: Design an apprpriate engagement prcess. Determine what level f engagement the LHIN requires and which techniques might achieve the LHINs gal and bjectives. Key Success Factrs Identify the engagement level Des the LHIN need t cnvey infrmatin? Des the LHIN want t get certain infrmatin frm primary care physician stakehlders? Is the LHIN striving t cllabrate tgether when making decisins? Determine the engagement gals and techniques Is the gal t share infrmatin? Cllect and cmpile input? Bring physician and LHIN leaders tgether? Is this a shrt term r lng term initiative? Hw ften d physicians need t be engaged? Make physicians partners Is the LHIN as an administratr ready t share infrmatin, pwer and resurces with physician leaders in this initiative? Are physician leaders ready t be accuntable partners? Hw will treating physicians as partners impact r enable this initiative? Develp prject management skills Des a physician need t be the prject leader fr this initiative? If s, hw will the LHIN train and supprt that physician s that the prject will be led effectively? STEP 5: Evaluate the techniques that have been identified fr their suitability. Determine if the plan is wrking as indicated by results. Evaluatin shuld reflect success relative t identified success factrs fr prcess, utcmes and impact f engagement. Onging evaluatin f engagement methds will help determine if the techniques emplyed are effective in meeting the desired engagement gals and bjectives. The evaluatin cmpnent will depend n a variety f inputs, but the best indicatrs are what the LHIN hears in nging infrmal cnversatins with physicians and asking physician leaders fr feedback n the level f physician engagement. Suggested evaluatin methds include: Team debriefs after activities, milestnes, prject and prcess Feedback frms Infrmal chats with physician participants Infrmal calls and meetings with key physician stakehlders Observatins at participatin activities Key Success Factr Demnstrate what has changed r imprved as a result f engagement and input received Cmmunicate candidly and ften What results frm this initiative is the LHIN planning t measure and cmmunicate; t whm, and hw ften? 18

19 Appendix I i) Ontari Medical Assciatin (OMA) Representing the Prfessin: The OMA represents the plitical, legislative, ecnmic, prfessinal and health plicy interests f the physicians f Ontari bth family physicians and specialists. As the legally recgnized representative f the medical prfessin in Ontari t negtiate Physician Services Agreements with the Ministry f Health and Lng Term Care (MOHLTC), the OMA is uniquely psitined t partner with gvernment in health system management thrugh the cnjint wrk f the Physician Services Cmmittee and its extensive cmmittee infrastructure. Althugh there are many vices and interests in the system, the OMA is the bdy that speaks cmprehensively fr the prfessin. Decisins taken in primary care will, necessarily, have an impact upn ther parts f medicine and it is therefre imprtant that the OMA be actively engaged in discussins and decisins that will have effects thrughut the system and the prfessin. Stemming frm the Physician Services Agreement with the MOHLTC, the OMA is party t the Physician LHIN Tripartite Cmmittee (PLTC) with the MOHLTC and representatives f the LHINs. The PLTC prvides all three Parties a frum t meet regularly t discuss, review, and respnd t matters f mutual interest fr the benefit f the health care system. Shaping Health Care: The OMA is gverned by a structure that cmprises representatives frm lcal physicians wh are gruped within medical scieties, academies, districts and sectins. There are currently 62 clinical sectins representing physicians wh share a cmmn specialty r area f clinical r practice interest, including the Sectin n General and Family Practice (SGFP). The representatives enhance the OMA s ability t engage with lcal physicians t shape decisin-making and ensure that patient care remains fremst in plicy decisins. This allws the OMA t bring tgether frnt line physicians with experts frm acrss the prvince t address imprtant clinical and legislative issues facing physicians and patients. Prgrams, discussin papers, and educatinal material arising frm the wrk f the OMA are imprtant cmpnents f the medical prfessin's cntributin t the develpment f public plicy n health care. Engagement: Thrugh its Member Outreach Services prgram, the OMA prvides supprt t lcal physicians in develping meaningful engagement with plicy makers, and dealing with matters related t the OMA. Seven Reginal Managers are reginally based and strategically lcated thrughut the prvince t actively participate in develping and supprting lcal activities by medical scieties, academies, districts, and physician representatives f the OMA. They help rganize and facilitate physician engagement activity including meetings, events, wrkshps, infrmatin sessins, etc, invlving a large number f physicians. A fcus f the prgram is facilitating physician engagement in health system planning prcesses at the reginal and lcal level by wrking with LHINs and ther health care rganizatins and partners t develp jint physician/lhin wrkshps and meetings in cmmunities thrughut the prvince. Reginal Managers are able t engage with lcal physicians t encurage and supprt their invlvement in LHIN activities and cmmittees. Reginal Managers are imprtant 19

20 partners that are ptimally psitined t supprt physician engagement in all 14 LHINs with varius health care rganizatins and partners. Cnnecting and Cmmunicating: Thrugh its 34,000 members the OMA receives and respnds t lcal issues affecting health care and the prfessin. It regularly and cntinuusly cmmunicates issues f imprtance and relevance t all its members. Its cmmunicatin and netwrking system accesses every licensed physician in Ontari. Cnversely, every physician in Ontari can access the OMA t be infrmed, t infrm, t participate in shaping health care and prvide slutins t issues affecting the prfessin. 20

21 ii) The Ontari Cllege f Family Physicians (OCFP) Missin Statement Prmting the Quality f Family Medicine in Ontari thrugh Leadership, Research, Educatin and Advcacy The Ontari Cllege f Family Physicians (OCFP) represents ver 9500 family physicians and is the vice f family medicine in the prvince f Ontari. The OCFP is the Ontari Chapter f the Cllege f Family Physicians f Canada. The Cllege was prvided a federal charter and a mandate t set standards f practice and educatin fr family physicians acrss Canada. As a Chapter f the Natinal Cllege, the OCFP wrks clsely with the six medical universities in Ontari t supprt primary care research and t versee the educatin f medical students and family medicine residents. Cre t the OCFP s mandate is the prvisin f cntinuing prfessinal develpment educatin prgrams fr family physicians and the accreditatin f prgrams develped by ther rganizatins. While the OCFP is well regarded fr its academic rle, the OCFP is als recgnized fr ur abilities t wrk cllabratively with gvernment, the LHINs and ther healthcare rganizatins. As a result f ur wrk t supprt and drive best practices thrughut the healthcare system, the OCFP is recgnized fr its many effrts t place a quality filter ver all plicy discussins. The Cllege was funded in 1954 t advance the needs f general practitiners, as they were knwn in thse days, in the wake f general shift twards specializatin. Since that time, the Cllege has gained a psitive reputatin as a driver f high quality care and educatin acrss the cuntry. The OCFP is seen as a strng leader in this regard. During the last ten years, the OCFP has received gvernment supprt t truly meet ur Missin t imprve the quality f family medicine in Ontari thrugh leadership, research, educatin and advcacy. T advance primary care research and the cntinuing prfessinal develpment f family physicians in Ontari, the OCFP has received mre than $35,000,000 in grants that have been used t prvide the framewrk fr the Primary Health Care Research Netwrk f Ontari and t develp internatinally recgnized innvatins in the educatin f family dctrs. Our Cllabrative Care Netwrk mdel is changing the relatinship f family dctrs and ur cnsulting specialists thrughut the prvince by bringing knwledge and skills t family practices rather than patients being sent fr specialty r emergency care. As the vice f family medicine in Ontari, gvernment, LHINs and the majr healthcare rganizatins lk t the OCFP fr guidance and advice in regards t health plicies that impact upn family physicians and their patients. Our ability t cnduct research, bring key stakehlders tgether and craft cnsensus papers is secnd t nne. (See Cmmunicatins sectin r ur website Our latest dcument Visin 2020: Partnering in the Quest fr the Healthcare Gld Medal is but ne example f the OCFP cnsultative apprach t the develpment f plicy and effective implementatin strategies. The OCFP as a Majr Supprt fr LHINs The OCFP was invited t becme a member f the LHIN Actin Grup and has been a strng supprter f the LHINs since their very cnceptin. Wrking with the riginal LHIN Bard Members and CEOs, the OCFP prvided an rientatin t the issues that had faced family dctrs in 1990s, the prgress made in addressing the issues and the strategies needed t cntinue t strengthen family medicine and the primary care sectr in general. The rientatin prcess was used t alert the CEOs f the willingness f the OCFP t assist them in their effrts t engage family dctrs. The OCFP s Bard/LHIN Structure The OCFP restructured its Bard in keeping with the LHIN bundaries. Our Bard is rganized int 7 regins with 2 LHINs in each regin. Within each regin, there are fur Bard Members, tw Reginal Bard Members frm ne f the LHINs and an Executive member and a Reginal Member in the ther 21

22 LHIN. This rganizatinal change was made t ensure that there were tw Bard members in each LHIN wh serve as a liaisn between the LHINs and the OCFP. Structuring f Our Membership List The OCFP rganized its current membership list f 9500 family dctrs t reflect LHIN bundaries as well. This rganizatin f ur list has made it easy and straight frward fr the LHINs t cntact ur Members in their specific LHINs. T this end, mst LHINs have taken advantage f the OCFP s ffer t serve as an infrmatin dept fr the LHINs. We have been using ur list serve and ur staff t ntify members f the activities f specific LHINs and t facilitate their attendance at LHIN functins. In additin, LHIN representatives have used the OCFP s Annual Reginal Meetings and ur many educatinal activities t meet with ur Members. Leadership Cnnect Many LHIN CEOs and their staff, indeed healthcare rganizatinal leaders in general, believe that their access t family dctrs is a daunting task given the number f practice sites in the prvince. Cmmunicating directly with s many physicians in the cmmunities in Ontari has been hampered in s many respects by this perceived barrier. The OCFP was prvided with funds t develp the Leadership Cnnect. The Leadership Cnnect cnsists f Chiefs f Family Practice at each f the Hspital, the Physician Leaders f each FHG, FHN, FHO and FHT, the Academic Leaders f the six medical universities and ur Bard. Each f these leaders has direct and persnal access t ur family physicians. Since they are pinin leaders, they are able t influence their peers. The OCFP s is able t supprt the LHINs t access these leaders in their wn LHINs. LHIN leaders are als able t interact with them when they meet at the prvincial level with the OCFP during ur cnsultatin sympsiums and ther meetings. The facilitatin rle f the OCFP supprts access t the physician leaders wh can prvide tw-way cmmunicatin with the LHINs. CME-n-the-Rad/CPD Prgram Develpment The OCFP prvides ver 150 CME wrkshps in small, medium and large cmmunities acrss the prvince each year. LHINs have used ur prgrams t meet with ur Members when they gather in LHIN cmmunities. In additin, as prgram changes r as emphasis is made n imprving care in specific areas, the OCFP is able t wrk with the LHINs t develp specific educatinal prgrams t meet identified needs. Summary The OCFP sees itself as a valued partner f the LHINs in prviding access t quality care in each cmmunity in every LHIN thrughut the prvince. Our jint effrts t engage family physicians in planning and delivering Excellent Care fr All will serve ur patients well, nw and in the future. 22

23 Appendix 2 i) Health Prfessinals Advisry Cmmittee (HPAC) A Health Prfessinal Advisry Cmmittee (HPAC) was established in each LHIN in 2007 and is cmprised f members frm a range f health services prfessins. The rle f this multidisciplinary cmmittee is t serve in an advisry rle t the LHIN CEO and prvide advice t the LHINs n hw t achieve patient centered health care. Membership was mandated t include fur members f the Cllege f Physicians and Surgens f Ontari, including ne member wh is authrized t practice in the area f family medicine and wh practices in the cmmunity. In early 2009, OMA Reginal Managers initiated discussins with physician HPAC members. At the time, it was identified that sme physicians d nt have a clear understanding f the mandate f the HPAC, sme are unclear regarding the issues they have been asked t address, and sme are unsure f the pwer given t the cmmittee, given the legislated frequency f meetings. In rder t begin enhancing and imprving HPACs t the benefit f LHINs, physicians made the fllwing practical recmmendatins: Meeting times t be determined at the beginning f each calendar year and cmmunicated t all cmmittee members; Agendas shuld be apprved by the CEO and the HPAC Chair prir t the subsequent meeting; HPAC members shuld have input int the agenda f each subsequent meeting; Minutes shuld be kept and circulated with agenda prir t each subsequent meeting; Chair f HPAC shuld have the pprtunity t address a LHIN Bard meeting at least nce a year; Chair f HPAC shuld develp a persnal/prfessinal wrking relatinship with the CEO t accmplish the abve initiatives; and On an annual basis, the CEO/Bard shuld survey HPAC members with the gal f evaluatin and quality imprvement. Feedback btained thrugh the LHINs and Primary Care Physician Panel suggests HPAC has the ptential t be an effective methd fr primary care physician engagement, but it has nt been utilized t its full ptential. Additinal suggestins include establishing a clear mandate fr HPAC, and develping specific gals and bjectives with clearly defined timelines fr this cmmittee. 23

24 ii) PHYSICIAN - LHIN TRIPARTITE COMMITTEE (PLTC) Mandate The Parties understand that the significant changes t the Ontari health care system require new multilateral and cllabrative appraches. The Physician LHIN Tripartite Cmmittee (PLTC) will prvide a frum fr the OMA, the MOHLTC and representatives f the LHINs t meet regularly t discuss, review, and respnd t matters f mutual interest fr the benefit f the health care system. Areas f Respnsibility The PLTC will: Prvide a mechanism thrugh which the parties can btain input frm each ther abut prpsed planning, funding and service delivery decisins that affect physicians; Prvide a mechanism thrugh which the parties can receive early ntice abut activities/initiatives that invlve physicians and may have implicatins fr the ther Parties; Establish and mnitr prgrams and targets fr the LHIN Physician Cllabratin Incentive Funds established in Sectin 9 f this 2008 Physician Services Agreement; Discuss effective strategies fr cmmunicating with physicians and engaging physicians in LHIN initiatives; Cllectively identify and address issues f prvincial significance; Address any specific issue directed t it by the parties; Cnduct reviews identified in the 2008 Agreement: HOCC; CHC. Membership Each party will appint 3 representatives, fr a ttal f 9 members. Each party will identify a C- Chair. C-Chairs Meetings f the Cmmittee will be facilitated by an agreed upn neutral facilitatr. The C- Chairs will set the agenda. Reprting The PLTC reprts t the parties. Frequency f Meetings The Cmmittee will meet every 2 mnths r mre ften as agreed t by the parties. 24

25 Appendix 3 i) Primary Care Physician Engagement Assessment Wrksheet Assessing Impact & Outcmes : At the time f preparing this initial assessment, in the view f the prject lead r planning team, hw will primary care physicians be affected by the prject, if implemented? Impact n primary care physicians can be categrized as lw, mderate, high r unknwn at this stage f planning. Level f Outcmes impact: indicates the degree t which yu anticipate primary care physicians will be affected by the utcme, if implemented, f the idea yu prpse (i.e. by the decisin being made, service being changed etc.). Level f Influence n utcmes: indicates the degree t which yu anticipate primary care physicians may influence r affect change n the utcmes yu prpse if yur idea is implemented. Fr example, d primary care physicians have t agree t the change? Is their cperatin imprtant t successful implementatin? Level f Cncern r interest: indicates the degree t which primary care physicians are aware r care abut hw they are impacted by the utcmes f yur prpsed idea, if implemented. Will they knw hw they might be affected r perceive themselves t be adversely r psitively affected? Are the utcmes aimed at imprving patient utcmes r imprving efficiencies fr primary care physicians and their patients? Issue f greatest cncern r pprtunity: Building n what is identified as the level f cncern r interest n the part f primary care physicians, what is the single greatest idea, cncern r cncept t require cmmunicatin? Lw Impact/Influence: Primary care physicians are unlikely t be aware f hw they may/will be impacted, if implemented and are unlikely t shw interest in influencing the directin f the idea r prject as judged by prject lead r planning team at time f writing. Mderate High Impact/Influence: Primary care physicians will be aware and will knw/feel the impact n themselves and wuld have interest in influencing the direct f the idea r prject, t varying degrees as judged by prject lead r planning team at time f writing. Unknwn Impact/Influence: Mre wrk needs t be dne by the prject lead r planning team t understand the ptential impact, influence r level f cncern that primary care physicians may have in relatin t the prject under cntemplatin. This may be explred by cnnecting with cntacts in the cmmunity, rganizing a fcus grup, cnducting a survey r ther creative means. 25

26 Pririty and/r Critical Initiative/Prject 1. Level f Physician Outcmes, Impact and Relatinship t Prject Nne*, Lw, Md, High, Unknwn Pstive? Negative? Level f Physician Influence n utcmes Nne*, Lw, Md, High, Unknwn Level f Physician Cncern r Interest Nne*, Lw, Md, High, Unknwn Issue f greatest cncern r pprtunity t Physicians Which Physician Stakehlders need t be invlved and hw can they Cntribute? Help define the issue? Cntribute data? Help t establish decisin criteria? Help t develp ptins? Help t evaluate ptins? Make recmmendatins r decisins? Level f invlvement recmmended Educate/Infrm (i.e. prvide balanced and bjective infrmatin t assist with understanding the prblem, alternatives, pprtunities and/r slutins) Cnsult ( i.e. btain feedback n analysis, alternatives and/r decisins) Invlve (i.e. wrk directly thrughut the prject t ensure that cncerns and aspiratins are cnsistently understd and cnsidered) Cllabrate (i.e. partner in the decisin prcess including the develpment f alternatives and identificatin f preferred slutins) Empwer (i.e. t prmte shared decisin-making)

27 ii) Evaluatin Framewrk Wrksheet Hw yu will evaluate the success f yur engagement activities? Evaluatin shuld reflect success relative t identified success factrs fr prcess, utcmes and impact f engagement. Prcess measures will lk at whether the methd(s) used were the mst apprpriate t gain the invlvement f primary care physician stakehlders. Outcmes measures will lk at whether the engagement activity achieved its desired utcme. Impact measures will lk at hw the utputs f the engagement activity cntributed t the final results. (Hw will primary care physicians wh cntributed t this prcess see themselves reflected in the prject plan r decisin?) Stakehlder Engagement Methd Key Objective Prcess Measures Prcess Evaluatin Outcmes Measures Outcmes Evaluatin Impact Measures Impact Evaluatin What are the factrs fr success? Hw will yu assess yur success? What are the factrs fr success? Hw will yu assess yur success? What are the factrs fr success? Hw will yu assess yur success? 27

28 Reprt Authrs Bryn Hamiltn Prject Cnsultant, LHIN Cllabrative Liane Fernandes Senir Cnsultant, LHIN Cllabrative The fllwing members f the Primary Care Physician Panel are acknwledged fr their input and cllabratin n develping the Resurce Guide & Tlkit. LHIN Members Primary Care Physician Panel Membership Paul Huras, CEO, Suth East LHIN (Chair) Mimi Lwi-Yung, CEO, Central West LHIN Greg Stevens, Senir Cnsultant, Funding & Allcatins Trnt Central LHIN Janine Hpkins, Senir Directr, Cmmunity Engagement & Crprate Affairs Trnt Central LHIN LHINC Members Bryn Hamiltn, Prject Cnsultant Primary Care Physician Members Lee Dnhue, MD, MHSc, CCFP Chair and Physician Lead Cnnexin FHT, Ottawa District 8 representative t the OMA Sectin f General & Family Practice OMA Bard, Directr General & Family Practice Assembly Dr Kevin Mardell MD CCFP FCFP Family Physician, West Elgin Cmmunity Health Centre Chair, OMA Sectin f CHC and AHAC Physicians. Assciate Prfessr, Schulich Schl f Medicine and Dentistry, UWO. Dr James Edney Medical Directr, Castleview Wychwd Twers, Medical Crdinatr, City f Trnt, hmes and services fr senirs, President, Ontari Lng-Term Care Physicians Dr Tim Nichlas Family Practice, Suthlake Academic Family Health Team, Aurra Dr Itamar Tamari MD CCFP FCFP Stnegate Cmmunity Health Centre Kelly Gillis, Senir Directr Planning, Integratin & Cmmunity Engagement Suth West LHIN Dr Jennifer Eversn,BScN,MD,CCFP,FCFP Physician Lead,Clinical Planning and Integratin HNHB LHIN LHIN Liasn,McMaster University Faculty f Health Sciences. Liane Fernandes, Senir Cnsultant Dr Rss Male Family Practice, Terrace Hill Family Health Grup, Brantfrd Assistant Clinical Prfessr DeGrte Schl f Medicine, McMaster University Chair, Sectin f General and Family Medicine, OMA Dr Sean Blaine Lead Physician, STAR Family Health Team Stratfrd, Ontari Member, Bard f Directrs, Ontari Cllege f Family Physicians Dr Pauline Pariser M.ASc. M.D. C.C.F.P. F.C.F.P. Chair and Physician Lead, Taddle Creek Family Health Team, Trnt Chair, HPAC Dr Jnathan Kerr, BScH, MD, CCFP Belleville Queen's University Family Medicine Centre Member, Bard f Directrs, OCFP Dr Stan Lfsky Willwdale 28