Haliburton, Kawartha, Pine Ridge District Health Unit (HKPRDHU) Journey to Excellence Dr. Lynn Noseworthy Presentation to the CELHIN March 28, 2018
Change is the New Normal Multiple Changes Provincial changes new programs, requirements, protocols, guidelines, amended legislation and regulations Organizational changes - restructuring Strengthening connections with CELHIN
HKPRDHU Our Community Northumberland and Haliburton counties (multi-tier governments) and City of Kawartha Lakes (single-tier government) Population - 179,083, increases with large # of seasonal visitors Aging population with a declining population of youth One federally recognized First Nations Reserve, Alderville First Nation, with a registered on-reserve population of 316, and an off-reserve population of 837 (Total population 1,161 - includes population who live on other Reserves) (Indigenous and Northern Affairs Canada) (Population from 2016 Census is 495) 9,065 square kilometers Rural geographic area, low population density, limited public transportation
HKPRDHU By the Numbers 20 long-term care homes, 20 retirement homes, 27 licensed child care centres 3 correctional facilities 3 school boards operating 72 schools 47 (CKL & Northumberland (NTH)), 52 (Haliburton (HAL)) years average age of residents (2016 Census) Of the total population living in private households (2016 Census): - 1.4 (HAL), 2.1 (CKL), 3.5 (NTH) % - percentage of residents who identify as a visible minority - 2.7 (CKL), 2.9 (HAL), 2.7 (NTH) % - percentage of residents who identify as aboriginal (2016 Census) 11.6 (NTH), 13.1 (CKL), 17.2 (HAL) % - percentage of low-income households Lowincome Measure-After Tax (LIM-AT) (2016 Census)
Provincial Changes Modernization of Ontario Public Health Standards (OPHS) and Ontario Public Health Organizational Standards (OPHOS) Amendments to Health Protection and Promotion Act, 1990 and its Regulations
Modernization of Ontario Public Health Standards (OPHS) November 16, 2015 Correspondence from Minister of Health and Long-Term Care Announced a review and modernization of the Ontario Public Health Standards (OPHS) Advisory Committee to be convened to provide expert advice and make recommendations on a set of evidence-based standards, reflective of current accepted practice, that would support system accountability, transparency and demonstrate value for money
Modernization of OPHS & OPHOS Executive Steering Committee Strategic Leadership, oversight and guidance on the review of the OPHS and OPHOS Practice & Evidence Program Standards Advisory Committee Review and revise program standards for public health Accountability Committee (originally Organizational Governance Committee) Develop: an accountability framework for the public health sector; and associated requirements, which will build on the organizational standards and include requirements for monitoring and reporting such as metrics and performance indicators
Policy Framework for Public Health Programs and Services Goal: To improve and protect the health and well-being of the population of Ontario and reduce health inequities Population Health Outcomes: improved health and quality of life; reduced morbidity and mortality; and reduced health inequity among population groups Domains: Social Determinants of Health; Healthy Behaviours; Healthy Communities; Population Health Assessment
Scope shaped by considering: Essential public health functions; Standards for Public Health Programs and Services Health needs of the population from public health perspective and functions; Impact and effectiveness of current program standards; Most appropriate role for public health sector within an integrated health system; and Enhanced emphasis on responding to local needs and decreasing health inequities by addressing the needs of priority populations and planning programs to address identified local needs.
Modernized Ontario Public Health Organizational Standards (OPHOS) Develop an Accountability Framework for public health Support enhanced transparency and demonstrate value for money Review the tools and processes in place to support the Ministry s accountability for public funds
Modernized OPHS Includes Policy Framework for public health programs and services Four foundational and nine program standards Public health accountability framework with organizational requirements Draft public health indicator framework Draft transparency framework
Key Program Changes in Modernized OPHS New Health Equity Standard, which includes requirement to engage with First Nations and Indigenous Communities; New School Health Standard, which includes new requirement to provide visual health supports and vision screening services; New requirement to formally engage with the CEO from each LHIN within the geographic boundaries of the public health unit on population health assessment, joint planning for health services, and population health initiatives; and Increased emphasis on considering mental health promotion in planning public health interventions
Modernized OPHS Balance the need for standardization across the province with the need for variability to respond to local needs Standardization: Variability: - Specificity will remain for those programs and services where standardization is required to protect the health of the public; and - Where identified, protocols will be revised to reflect increased standardization - Greater variability will be accommodated in areas where there is an opportunity to plan programs to decrease health inequities and address needs of priority populations
Modernized OPHS Protocols & Guidelines Total of 42 Protocols (23) and Guidelines (19) either amended or new to support implementation of the new OPHS Protocols: Guidelines: - Provide direction on how boards of health must operationalize requirement(s) outlined in the Standards for Public Health Programs and Services. Anything referenced in statute will have a protocol. The aim is consistent implementation. - Provide direction on how boards of health must approach/apply requirement(s) outlined in the Standards for Public Health Programs and Services. The aim is consistent approach/application
Modernized OPHS Foundational Standards (Population Health Assessment, Health Equity, Effective Public Health Practice, Emergency Management) Program Standards (Chronic Disease Prevention and Well-Being, Food Safety, Healthy Environments, Healthy Growth and Development, Immunization, Infectious and Communicable Diseases Prevention and Control, Safe Water, School Health, Substance Use and Injury Prevention) Strengthened Accountability (Public Health Accountability Framework, Organizational Requirements (Four Domains: Delivery of Programs and Services, Fiduciary Requirements, Good Governance and Management Practices, Public Health Practice) Transparency and Demonstrating Impact)
Health Equity/Inequities Health Equity all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class socioeconomic status or other socially determined circumstance Health Inequities systematic differences in the health status of different population groups have significant social and economic costs both to individuals and societies
Bill 160 Strengthening Quality and Accountability for Patients Act, 2017 Legislation to amend 10 statutes including the Health Protection and Promotion Act, 1990 (HPPA) Proposed changes included: allowance for the regulation of recreational water facilities, including splash pads and wading pools, and personal services settings, such as barber shops, nail salons, and tattoo parlours, definition of immunization agents to ensure it is more comprehensive; list of health care providers who must report adverse events to the local medical officer of health following immunization; and, terms used throughout the HPPA.
Amendments to Regulations under HPPA Approved December 2017 Reg. 199/03 - Control of West Nile Virus Reg. 318/08 - Transitional - Small Drinking Water Systems Reg. 428/05 - Public Spas Reg. 554 - Camps in Unorganized Territory Reg. 557 - Communicable Diseases General Reg. 562 - Food Premises
Amendments to Regulations under HPPA Approved December 2017 Reg. 565 - Public Pools - See 428/05 - Public Spas Reg. 566 - Qualifications of Boards of Health Staff Reg. 567 - Rabies Immunization Reg. 568 - Recreational Camps Reg. 569 Reports- Proposed changes modernize the information collected for reportable diseases
Amendments proposed to Regulations under HPPA December 2017 Reg. 95/03 Specification of Virulent Diseases, Reg. 558/91 Specification of Communicable Diseases and Reg. 559/91 Specification of Reportable Diseases - Proposed changes consolidate three regulations into one and re-classify virulent, communicable, and diseases of public health significance (formerly reportable ) into a single category. Other changes are proposed which reflect current evidence and best practice Reg. 553 Areas Comprising Health Units and Reg. 559 Designation of Municipal Members of Boards of Health - Proposed changes permit the merger of Elgin-St. Thomas Health Unit with Oxford County Health Unit and Huron County Health Unit with the Perth District Health Unit. Reg. 565 Public Pools - Proposed changes add requirements for recreational water settings (specifically splash/spray pads, water slide receiving basins and wading pools) and require operators to post inspection results conducted by a public health inspector. New Regulation Personal Service Settings - A new regulation is proposed to include provisions regarding infection prevention and control practices, prohibition against certain personal services, age restrictions, obtaining consent for invasive procedures and training of employees.
HKPR Challenges Financial constraints provincial share of cost-shared budget frozen at 2014 levels Change in management complement
HKPR Changes Fall 2016 Executive team began discussing organizational redesign May 2017 rolled out new structure to Board and staff September 2017 - January 2018 implemented new organizational redesign Goals Develop stronger, more resilient organization Needed to be compliant with new OPHS Responsive to addressing population health in context of fiscal constraints
What is a Strong Organization? Staff are fulfilled in their work Everyone treats each other with respect Psychologically safe staff feel supported and confident in their roles Common objectives are shared Inspires public confidence in our delivery of programs and services Resilient can withstand/recover quickly from difficult conditions
HKPR Redesign Moved to four divisions to better align with new OPHS Corporate Services (finance, communications, human resources, information technology) Health Promotion (healthy schools, communities and families) Health Protection (environmental health, sexual health, communicable diseases, vaccine preventable, infection prevention and control) Foundational Standards (health equity; effective public health practice (includes professional practice); program planning, evaluation and evidence-informed decision-making; research, knowledge exchange, and communication; quality and transparency)
HKPRDHU Organizational Chart 2017/2018
HKPRDHU Priorities for 2018 Implementation of new Organizational Structure; Implementation of Ontario Standards for Public Health Programs and Services; Implementation of Accountability Framework and Organizational Requirements; Implementation of National Standard of Canada for Psychological Health and Safety in the Workplace IPAC; CQI; Professional Practice; Emergency Management; Comprehensive Drug Strategy
Strengthening Connections with LHIN Continuing Regular Meetings with CEMOHS and CEO CELHIN Collaborating with CELHIN in development of Opioid Strategy Member of CELHIN Health Equity Working Group learning opportunity for our new Health Equity Coordinator Rapid Risk Factor Surveillance System (RRFSS) working with Health Unit leads and CELHIN to create additional modules for collection of data of interest to CELHIN across all four health units Providing input and consultation on teleconferences around flu outbreaks and hospital capacity HKPRDHU continuing to develop reports to provide insight into population health issues in the HKPRDHU area, which may be of interest to the CELHIN Sub-region Planning Tables
QUESTIONS?