Hamilton Niagara Haldimand Brant LHIN Strategic Health System Plan: Survey Report April 2012
Table of Contents Survey: Approach 4 Survey Design 4 Survey Launch 5 Survey Response 5 Survey Results 7 Demographic Information 7 Sector 7 Key Findings 8 Sub-LHIN Area 8 Key Findings 8 Sector and Sub-LHIN Area 9 Key Findings 9 Values 10 Values to Guide Transformation 10 Key Findings 10 Key Findings 12 Priority Populations for Transformation Focus 13 Key Findings 13 Key Findings 15 Trade-Offs 16 Optimal Allocation of Resources 16 Key Findings 16 Key Findings 17 Optimal Allocation Across Providers 18 Key Findings 18 Key Findings 19 Access 20 Priority Strategies 20 Key Findings 21 Key Findings 23 Page 2
Coordination 24 Priority Populations for Care Coordination Focus 24 Key Findings 24 Key Findings 25 Services to Optimize Hospital to Home Transitions 26 Key Findings 26 Key Findings 28 Value for Money 29 Priority Strategies to Increase System Efficiency and Effectiveness 29 Key Findings 29 Key Findings 30 Conclusion 31 Appendix I - Survey 32 Page 3
Survey: Approach Survey Design A survey was designed to elicit the perspectives of funded and non-lhin funded providers on both the current and future state of health services in the HNHB LHIN. The purpose of the survey was to inform the future state design, identify values and principles that should drive decision-making, and identify areas of priority for the LHIN to consider. The survey was targeted across sectors to include LHIN and non-lhin funded providers. Executive-level leadership for program/service delivery respondents were selected by the LHIN to complete the survey, and contact information was provided to PwC. Contacts included: Hospital Senior VP Patient Services Community Care Access Centre (CCAC) Senior Director Client Services Long Term Care Home Director of Care Community Support Services (CSS) Senior Management Non-Health Service Providers (similar level of seniority as HSPs) The survey was built using Vovici, an electronic survey tool used by PwC to administer the survey. The survey consisted of eleven mandatory close-ended questions and one optional opened-ended question (the responses to the open-ended questions are not within the content of this report), in the following five categories: Values Trade-Offs Access Coordination/ Integration Value for Money Please refer to Appendix I for the survey questions and potential responses. Page 4
Survey Launch The following table outlines the significant milestones for the provider survey: Milestone Date Description Survey Launch First Reminder Second Reminder Final Reminder Telephone Follow-Up Survey Close March 27, 2012 April 5, 2012 April 10, 2012 April 12, 2012 April 13, 2012 April 13, 2012 Initial introductory email sent from Donna Cripps, HNHB CEO, followed by the invitation from PwC containing the survey link. First reminder to complete the survey, sent by Donna Cripps. Second reminder to complete the survey, sent by Donna Cripps, followed by an email from PwC with the survey link. Final reminder to complete the survey, sent by Donna Cripps, followed by an email from PwC with the survey link. The LHIN contacted Community Support Services to encourage survey participation. PwC closed the survey at 6:00pm. Survey Response The following graph depicts the response rate for the survey. Of the 216 potential respondents, 155 completed the survey, resulting in a 72% response rate. When comparing the response rate for LHIN funded versus non-lhin funded organizations, a higher percentage of LHIN funded organizations completed the survey (75% vs. 52%). Survey Response Rate 61 Completed Survey (155, 72%) 155 Did Not Complete Survey (61, 28%) Page 5
Response Rate - LHIN Funded vs. Non-LHIN Funded LHIN Funded (75% Response Rate) Non-LHIN Funded HSPs (52% Response Rate) 16 31 139 185 0 50 100 150 200 # of Completed Surveys # of Targeted Respondents The following sections outline the analysis by question, and the corresponding survey findings. Page 6
Survey Results Demographic Information The following charts and data summarize the key demographic information pertaining to the respondents who completed the survey. Sector Respondents were asked to select the sector that best reflects their organization. The pie chart below represents the number of respondents, and the corresponding percentage of total respondents, by sector. Survey respondents self-selected which sector best reflects their organization, and as such, the number of providers by sector may not directly align with other publically reported figures. There is only one Community Care Access Centre (CCAC) within the LHIN, and as such there is only one response for this sector. For analysis purposes and to ensure anonymity, the CCAC responses are combined with the Community Support Services (CSS) findings for those areas that depict findings by sector. The tables and findings throughout the report reflect the incorporated results and are represented as CCAC/CSS. What Sector Best Reflects Your Organization? 17 7 20 Community Health Centre (7, 5%) Community Mental Health and Addictions (20, 13%) Community Support Services (48, 31%) 52 Community Care Access Centre (1, 1%) Hospital (10, 6%) 48 LongTerm Care (52, 34%) 10 1 NonLHIN Funded Provider (17, 11%) Page 7
Key Findings All sectors responded to the survey, however the response rate varied by sector. The response rate was 100% for Community Care Access Centres (1/155) and Hospitals (10/155). The majority of survey respondents represented CSS (31%), and Long Term Care Homes (34%). A total of 17/155 respondents (11%) were non-lhin funded providers. Sub-LHIN Area Respondents were asked to select the sub-lhin area(s) that their organization predominantly serves. Respondents could select multiple sub-lhin areas, therefore the total does not sum up to the total number of respondents (155). The pie chart below represents the number of respondents, by sub-lhin area. What Sub-LHIN Area Does Your Organization Predominantly Serve? 15 10 14 50 Hamilton (50) Niagara (59) Haldimand (22) 24 Brant (24) Burlington (10) Norfolk (14) 22 59 LHIN-Wide (15) Key Findings The largest number of respondents (59) serves the Niagara area, followed by Hamilton (50 respondents). All other sub-lhin areas had less than half the number of respondents. It should be noted that providers are not equally distributed across the LHIN, and some sub-lhin areas have a higher number of providers (e.g., Hamilton and Niagara). This should be considered when interpreting the aggregate findings. A total of 15 respondents stated that they serve the entire HNHB LHIN area. Page 8
Sector and Sub-LHIN Area The bar chart below represents the sector composition of responding providers by sub-lhin area. Respondents by Sector and Sub-LHIN Area Niagara Hamilton Brant Haldimand Norfolk Burlington LHIN-Wide 0 20 40 60 80 Community Health Centre Community Mental Health and Addictions Community Support Services Community Care Access Centre Hospital Long-Term Care Non-LHIN Funded Provider Key Findings Niagara had the largest number of Community Health Centres (CHCs) and Community Support Services (CSS) responses but had fewer respondents in the Community Mental Health and Addictions than Hamilton. (As previously stated, Hamilton and Niagara have a higher number of providers than other sub-lhin areas, which is reflected in their response rates). In every sub-lhin area, at least half of the sectors are reflected. Page 9
Values Values to Guide Transformation The establishment of common values will help ensure consistency, equity, and alignment for HNHB s health system transformation. Respondents were asked about what values should inform and drive this transformation. Respondents were asked to rank their top five values, out of a possible ten options. From there, weights were given to respondent rankings. The weighted ranking score reflects both whether the value was selected as a top five priority, and where it was ranked within the top five. The graph below represents two findings both the number of individuals that selected the ranking as one of their top five (the number bracketed with 155 being the highest possible value), and the weighted ranking of each value (the bar chart where the bar lengths represents the weighted ranking). Values to Guide Transformation Person-centred (147) Seamless service provision (95) Equitable access to services (91) Evidence-based (76) Outcome oriented (76) Builds on existing relationships/partnerships (71) Optimizes existing provider expertise in LHIN (63) Contributes to system sustainability (65) Value for money (54) Shared accountability for outcomes (37) 0 100 200 300 400 500 600 700 Weighted Rankings Key Findings The top ranking value was person-centred, and achieved a score over twice as high as the second ranking value. It was selected as a priority value by almost all respondents (147/155). The values of seamless service provision (95/155) and equitable access to services (91/155) were the second and third highest ranked values, both in terms of weighted ranking, and selection frequency. Value for money (54/155) and shared accountability for outcomes (37/155) ranked the lowest, both in terms of weighted rankings, and frequency. Page 10
The following table identifies how respondents in each of the sub-lhin areas ranked the 10 values (vertical columns). A ranking of 1 indicates that the value attained the highest score (based on the weighted rankings) within the sub-lhin area. The shaded cells indicate the top five choices and the white cells indicate the bottom five choices, within each sub-lhin area. The total column indicates the overall weighted rankings across all sub-lhin areas. Values Weighted Ranking (Total) Hamilton Niagara Haldimand Brant Burlington Norfolk LHIN-Wide Person-centred 1 1 1 1 1 1 1 1 Seamless service provision Equitable access to services 2 3 2 5 2 2 3 3 3 2 3 2 3 3 2 2 Evidence-based 4 5 4 3 5 9 4 4 Outcome oriented 5 4 5 6 4 4 5 5 Builds on existing relationships and partnerships Optimizes existing provider expertise within the LHIN Contributes to system sustainability 6 6 6 4 9 8 7 8 7 8 8 7 10 4 8 5 8 7 7 9 6 6 10 7 Value for money 9 9 9 10 7 6 9 9 Shared accountability for outcomes 10 10 10 8 8 10 5 10 Page 11
Key Findings Overall, there was some consistency in which five values were ranked as the top five (the shaded cells). All sub-lhin areas ranked person-centred as the number one value. Seamless service provision and equitable access to services were consistently second or third ranked for all sub-lhin areas except for Haldimand which ranked seamless service provision as the fifth priority. Evidence-based and outcome oriented were generally in the top five for all sub-lhin areas except for Haldimand and Burlington. Other values that appeared in the top five for some sub-lhin areas were builds on existing relationships and partnerships, optimizes existing provider expertise within the LHIN and shared accountability for outcomes. Contributes to system sustainability, and value for money were not ranked as in the top five for any of the sub-lhin areas. PwC Page 12
Priority Populations for Transformation Focus There are many competing priorities in health system transformation. Respondents were asked what populations the LHIN should focus on. The graph below represents the total number of respondents who selected each priority population. Participants were asked to select five priority populations out of a total of ten options. The number at the end of the bar chart indicates that number of individuals who selected that population as a priority. What Populations Should the LHIN Focus On? 0 20 40 60 80 100 120 140 160 High Risk Seniors Mental Health and Addictions Population with Complex Medical Conditions Frequent Hospitalization/ ED Visits Broad Population End of Life/Palliative Population with Barriers to Access Infant/Youth Low Volume/High Cost 25 49 61 65 72 141 129 120 113 Key Findings A greater number of respondents felt that the LHIN should focus on high risk seniors (141/155), followed by persons with mental health and addictions (129/155) and persons with complex medical conditions (120/155). Other populations were selected by fewer respondents, with infant/youth (49/155), and low volume/ high cost (25/155) populations achieving the lowest scores. PwC Page 13
The following table below breaks down the number of respondents that selected each population, by sector (vertical columns). The shaded cells represent the populations that were selected with the highest frequency (top five), and the white cells represent the populations that were selected with the lowest frequency. The total column indicates the total number of times a population was selected. Population All CHC CMHA CCAC/ CSS Hospital LTC Non-LHIN Funded High Risk Seniors 141 7 16 45 9 50 14 Mental Health and Addictions 129 5 20 38 8 47 11 Population with Complex Medical Conditions 120 6 14 39 9 39 13 Frequent Hospitalization/ ED Visits 113 2 13 34 9 41 14 Broad Population 72 5 7 24 2 24 10 End of Life/Palliative 65 1 6 19 4 32 3 Population with Barriers to Access 61 6 10 22 2 13 8 Infant/Youth 49 2 10 14 3 10 10 Low Volume/High Cost 25 1 4 10 4 4 2 Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. PwC Page 14
Key Findings The identification of priority populations was relatively consistent across the sectors for four population groups: All sectors identified high risk seniors, mental health and addictions, and populations with complex medical conditions as priority populations. All sectors except one (CHCs) identified frequent hospitalization/ ED visits as a priority population. There was variability across the sectors for the remaining five populations: Three sectors each identified broad population as a priority population. Two sectors identified palliative/end of life, populations with barriers to access and infant/youth as priority populations. Only one sector (Hospital) identified low volume/high cost as a priority population. PwC Page 15
Trade-Offs Optimal Allocation of Resources Respondents were asked what the optimal allocation of resources should be assuming that the LHIN had an approximate total annual budget of 100 dollars. Assuming a total budget of $100, the two graphs below compare the current allocation of LHIN funding to the suggested allocation of LHIN funding. The suggested allocation represents the average allocation across sectors from all respondents. (The legend identifies the change in funding, in dollars, from current to suggested.) Current Allocation of LHIN Resources ($100) Suggested Allocation of LHIN Resources ($100) 1 9 3 2 9 7 4 Hospital (68 to 51) LTC (16 to 19) 16 10 51 CCAC (9 to 10) CSS (3 to 9) 68 19 CMHA (2 to 7) CHC (1 to 4) Legend: CCAC = Community Care Access Centre, CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CSS = Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. Key Findings The allocation suggested would shift current resources (17%) from hospitals to all other sectors. The greatest increases in resources were allocated to Community Support Services (6%) and Community Mental Health and Addictions (5%). (These two sectors were among the most highly represented within the survey responses.) CCACs, Long Term Care Homes and CHCs received relatively smaller increases. PwC Page 16
The table below identifies how each sector suggested the funds be re-allocated (vertical columns). The dark shading reflects a suggested decrease in funding (e.g., Long Term Care suggested that hospital funding should decrease from $68 to $51), and the light shading reflects a suggested increase in funding (e.g., Long Term Care suggested that Community Mental Health and Addictions funding should increase from $2 to $6). White cells represent no suggested changes to funding. Cells that are underlined and bold identify how each sector thinks their own budgets should be re-allocated. Respondents Sector Current Allocation Average Suggested Allocation CHC CMH&A CCAC / CSS Hospital LTC Non-LHIN Funded Provider Hospital 68 52 52 52 50 58 51 49 LTC 16 18 16 17 17 17 24 16 CCAC 9 10 11 9 10 12 9 11 CSS 3 8 7 6 12 5 7 13 CMH&A 2 7 7 10 7 7 6 6 CHC 1 5 7 6 4 2 4 5 TOTAL 99* 100 100 100 100 101* 101* 100 *Note: figures do not equal 10o due to rounding. Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. Key Findings Overall, all sectors felt that hospitals should receive a smaller portion of the LHIN budget, which should then be redistributed amongst the other providers. The suggested redistribution varied highly across sectors, with most sectors allocating the largest suggested increase in resources to themselves: Hospitals - All sectors suggested a decrease in hospital funding, with non-lhin funded organizations suggesting the highest decrease ($68 to $49). Hospitals were the only sector to suggest a decrease in their own funding (by $10). Long Term Care (LTC) - All of the sectors suggested an increase in funding to LTC, with the highest increase recommended by LTC themselves (increase of $8). Community Care Access Centres (CCACs) Four sectors suggested that funding to the CCAC should increase, and two suggested that it remain the same. Community Support Services (CSS) - All of the sectors suggested an increase in funding to CSS, with the highest increase recommended by CCAC/CSS (from $3 to $12) and non-lhin funded providers (from $3 to $13). Community Mental Health and Addictions (CMH&A) - All of the sectors suggested an increase in funding to CMH&A, with the highest increase recommended by CMH&A themselves (an increase of $8). PwC Page 17
Community Health Centres (CHCs) - All of the sectors suggested an increase in funding to CHCs, with the highest increase recommended by CHCs themselves (an increase of $6). Optimal Allocation Across Providers Health systems need to be responsive to changing needs and demographics. Respondents were asked how they would allocate investments if the LHIN were to receive an additional ten dollars. The graph below identifies what percentage of the additional ten dollars should be allocated to each sector, based on the aggregate responses across all respondents (e.g., if the LHIN received an extra $10, 19% of it should go to Community Support Services, as illustrated in the following graph). Suggested Allocation forfunding Increases Community Support Services Long Term Care Home Community Mental Health & Addictions CCAC Community Health Centres Primary Care Hospital Emergency Medical Services Public Health 5% 6% 9% 9% 9% 8% 19% 18% 18% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% Key Findings Based on all responses, CSS, Long Term Care Homes and Community Mental Health and Addictions organizations should receive the largest share of the additional funding (approximately 20% each) which together accounts for over half of the total increase in funding. It is important to note that these three groups had the highest representation in survey responses. It is noteworthy that CHCs are a model of Primary Care and should the two be considered together, the resulting funding increase of 18% would be the equivalent of the funding increases suggested for Long Term Care Homes and Community Mental Health and Addictions. CCACs, CHCs, Primary Care and Hospitals would receive similar shares of the additional funding, approximately 10% each. Emergency Medical Services and Public Health would receive the lowest share, together representing just over 10% of the additional funding. It should be noted that the LHIN does not currently fund these services. PwC Page 18
The province s current and projected fiscal environment will require that difficult allocation decisions be made. Respondents were asked from which sector(s) they would find savings if the LHIN budget was reduced by ten dollars. The graph below identifies what percentage of the additional ten dollars should be taken from each sector, based on the aggregate responses across all respondents (e.g., if the LHIN s funding was reduced by $10, 42% of the savings should be derived from hospitals, as illustrated in the following graph). Suggested Allocation for Funding Decreases -42% Hospital -13% -12% -9% -7% -5% -5% -4% -3% Public Health CCAC Primary Care Community Health Centres Long Term Care Home Emergency Medical Services Community Support Services Community Mental Health & Addictions -45% -40% -35% -30% -25% -20% -15% -10% -5% 0% Key Findings Based on all responses, the majority of the funding decreases should be derived from Hospitals (42%), Public Health (13%) and CCACs (12%). Public Health is not currently funded by the LHIN. T he rest of the savings could be derived from CHCs (7%), Long Term Care Homes (5%), Emergency Medical Services (5%), CSS (4%), and Community Mental Health and Addictions (3%), representing less than 10% of the savings each. PwC Page 19
Access Priority Strategies Health system transformation is a complex issue that will require consideration of a variety of strategies. Respondents were presented with ten strategies and asked to rank their top five in order of priority. Respondents were asked to rank their top five strategies, out of a possible ten options. From there, weights were given to respondent rankings. The weighted ranking score reflects both whether the strategy was selected as a top five priority, and where it was ranked within the top five. The graph below represents two findings both the number of individuals that selected the ranking as one of their top five (the number bracketed with 155 being the highest possible value), and the weighted ranking of each value (where the length of the bar represents the weighted ranking). Priority Strategies for Health System Transformation Where cost effective and safe, more health care services should Strengthen the relationship between hospitals and community Focus and target funding to programs and services that address Facilitate the integration of program and services that will result Optimize health care workers roles and productivity (82) Transition additional inpatient hospital services to an outpatient Expand the range of services and professionals currently offered Sharing of evidence-based pathways, processes & training Consolidate the provision of specialized care into centres of The use of telemedicine should be expanded (28) 0 50 100 150 200 250 300 350 400 450 500 Weighted Rankings PwC Page 20
Key Findings Five strategies were selected by over 50% of respondents to improve access: The top ranking strategy selected by almost all respondents (121/155) was where cost effective and safe, more health care services should be provided at home. Strengthen the relationship between hospitals and community providers to enable more timely patient transitions was identified as the second most important strategy, both by weighted ranking and selection frequency (110/155). Facilitate the integration of program and services that will result in more direct care was the fourth highest ranked strategy according to the weighted rankings, but the third highest in terms of frequency of selection (100/155). Focus and target funding to programs and services that address the population with high priority health needs was ranked third according to the ranked averages, and had the fourth highest frequency of response (94/155). Optimize health care workers roles and productivity was the fifth highest ranking value, both in terms of weighted ranking and frequency of response (82/155). The remaining five strategies were selected by less than 50% of respondents. The strategies with the two lowest weighted rankings and frequency of responses were: consolidate the provision of specialized care into centres of excellence in hospital or free standing clinics (47/155) and the use of telemedicine should be expanded (28/155). PwC Page 21
The following table identifies how respondents in each of the sectors ranked the 10 strategies (vertical columns). A ranking of 1 indicates that the value attained the highest score (based on the weighted rankings) within each sector. The shaded cells indicate the top five choices and the white cells indicate the bottom five choices, within each sector. The total column indicates the overall weighted rankings across all sectors. Strategy Aggregate CHC CMHA CCAC/ CSS Hospital LTC Non-LHIN Funded Where cost effective and safe, more health care services should be provided at home. Strengthen the relationship between hospitals and community providers to enable more timely patient transitions. Focus and target funding to programs and services that address the population with high priority health needs. 1 4 1 1 2 1 1 2 3 2 2 1 2 3 3 1 4 3 5 4 5 Facilitate the integration of program and services that will result in more direct care. 4 9 5 4 3 3 2 Optimize health care workers roles and productivity. 5 8 8 5 8 5 7 Transition additional inpatient hospital services to an outpatient setting. 6 5 3 6 6 9 9 Expand the range of services and professionals currently offered in primary care. Sharing of evidence-based care pathways, processes and training should occur across organizations in order to optimize standardization of care and reduce variability. Consolidate the provision of specialized care into centres of excellence in hospital or free standing clinics. 7 2 6 8 10 7 4 8 6 7 7 4 6 6 9 7 10 9 6 8 8 The use of telemedicine should be expanded. 10 10 9 10 9 10 10 Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. PwC Page 22
Key Findings All sectors ranked the following three strategies in their top five: where cost effective and safe, more health care services should be provided at home, strengthen the relationship between hospitals and community providers to enable more timely patient transitions and focusing and targeting funding for populations with high priority needs. With the exception of one sector (CHCs), all sectors identified the integration of program and services will result in more direct care. No respondent ranked the provision of specialized care into centres of excellence, or the expanded use of telemedicine as one of the top five strategies to improve access. PwC Page 23
Coordination Priority Populations for Care Coordination Focus Care coordination efforts that focus on hand-offs/ transitions have been linked to improved quality and reduced costs. Respondents were asked which populations should be the focus of the LHIN's care coordination initiatives. The graph below represents the total number of respondents who selected each priority population. Participants were able to select five priority populations out of a total of ten options. The number to the right of the bar indicates the number of individuals who selected that population as a priority (out of a possible 155). What Populations Should the LHIN Care Coordination Efforts On? 0 20 40 60 80 100 120 140 160 High Risk Seniors Mental Health and Addictions Population with Complex Medical Conditions Frequent Hospitalization/ED Visits End of Life/Palliative Broad Population Population with Barriers to Access Infant/Youth Low Volume/High Cost 34 43 60 57 73 144 130 123 111 Key Findings High risk seniors were selected as the recommended prime focus for the LHIN, in terms of care coordination efforts. The next three target populations were identical to those for the transformation focus, namely: mental health and addictions, population with complex medical conditions and frequent hospitalizations and/or ED visits. The low volume/ high costs population was selected by the least number of participants. PwC Page 24
The table below illustrates the number of respondents by sector that selected each population. The shaded cells represent the populations that each sector selected as the top five. The white cells are those that were not selected as the top five. (For example, out of all respondents from hospitals, nine felt that high risk seniors should be a priority population for care coordination). The total column indicates the total number of times a population was selected. Population All CHC CMHA CCAC/ CSS Hospital LTC Non-LHIN Funded High Risk Seniors 144 7 18 46 9 49 15 Mental Health and Addictions 130 6 19 40 8 44 13 Population with Complex Medical Conditions 123 6 12 41 10 41 13 Frequent Hospitalization/ED Visits 111 4 11 34 9 39 14 End of Life/Palliative 73 2 8 23 5 30 5 Broad Population 60 3 7 19 2 23 6 Population with Barriers to Access 57 6 11 17 1 13 9 Infant/Youth 43 0 8 13 3 10 9 Low Volume/High Cost 34 1 6 12 3 11 1 Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. Key Findings All sectors selected the same top four populations: high risk seniors, mental health and addictions, population with complex medical conditions and frequent hospitalizations / ED visits as priority populations for care coordination focus. The first three are the same population groups selected as a focus for transformation. Sectors were varied in the fifth priority population they selected, with three sectors selecting end of life / palliative and three providers selecting population with barriers to access. No sector felt that low volume/high cost populations should be prioritized for care coordination efforts and only non-lhin funded providers selected infant/youth. PwC Page 25
Services to Optimize Hospital to Home Transitions Respondents were asked to identify what services should be prioritized in order to enable successful transitions from hospital to home. The graph below represents the total number of respondents who selected each service. Participants were able to select any number of services out of a total of ten options; therefore, the number of responses does not equal the number of respondents (155). The number indicates that number of individuals who selected that service as a priority. Services to Optimize Hospital to Home Transitions 0 20 40 60 80 100 120 140 Home-Based Health Services Transitional Support Services Assisted Living Programs/Supportive Housing Mobile Health Teams Transportation to Medical/Health Appointments Care Coordinators/Navigators CCAC Case Management Services Home Set Up Congregate Care Settings Specialized Out-Patient Clinics Ontario Telemedicine Network Telehomecare 20 17 40 40 38 53 72 70 116 106 104 99 Key Findings Home-based health services were selected by most responders (116/155) as a priority followed closely by transitional support services (106/155) and assisted living / supportive housing programs (104/155). Mobile health teams, transportation to medical/ health appointments and care coordinators/ navigators were also selected as high priorities, with over 70 responses each. Ontario Telemedicine Network and telehomecare were selected as the lowest priority services, with 20 responses or less. PwC Page 26
The table below indicates the number of respondents that selected each service, by sector (vertical columns). The shaded cells represent the services that were selected as the top five. In cases where there were ties, more than 5 cells are shaded. The white cells are those services that each sector did not select as the top five. (For example, out of all respondents from Hospitals, eight felt that transitional support services should be a priority to optimize transitions from the hospital to home). The total column indicates the total number of times a service was selected. Services All CHC CMHA CCAC/ CSS Hospital LTC Non-LHIN Funded Home-Based Health Services 116 4 15 46 4 33 14 Transitional Support Services 106 5 11 39 8 33 10 Assisted Living Programs/Supportive Housing 104 5 15 35 7 30 12 Mobile Health Teams 99 3 13 30 6 38 9 Transportation to Medical/Health Appointments 72 2 12 22 1 26 9 Care Coordinators/Navigators 70 7 11 23 8 14 7 CCAC Case Management Services 53 3 4 9 5 23 9 Home Set Up 40 3 4 11 1 15 6 Congregate Care Settings 40 0 4 14 2 17 3 Specialized Out-Patient Clinics 38 3 5 8 3 17 2 Ontario Telemedicine Network 20 0 5 4 2 7 2 Telehomecare 17 0 1 4 3 7 2 Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. PwC Page 27
Key Findings All sectors selected transitional support services, assisted living programs / supportive housing and mobile health teams in their top five priorities services. All sectors, except for Hospitals, identified home-based health services in their top five priority services. All sectors, except for LTC, selected care coordinators/navigators or CCAC Case Management Services as a top 5 priority. Sectors were varied in the remaining services they chose to prioritize. PwC Page 28
HNHB Strategic Health System Plan: Survey Findings Value for Money Priority Strategies to Increase System Efficiency and Effectiveness There is growing demand to demonstrate value for health care spending. Respondents were asked to rank the opportunities to improve the efficiency and effectiveness of service provision. Respondents were asked to rank each of the seven options. From there, weights were given to respondent rankings. Higher ranking scores reflect higher rankings of each strategy. Priority Strategies to Increase System Efficiency and Effectiveness Maximize scope of practice for health service providers Community based health service integration by geography Increased accountability for improved client/ system outcomes Enhanced use/sharing of evidence-based practice Clinical program integration Community based health service integration by sector Back office integration 0 50 100 150 200 250 300 350 400 450 Weighted Rankings Key Findings The greatest number of respondents suggested that in order to increase system efficiency and effectiveness, the scope of practice for health service providers should be maximized. The following strategies were also selected by a high number of respondents: community based health service integration by geography and increased accountability for improved client / system outcomes (almost equally), and enhanced use / sharing of evidence-based practice and clinical program integration (almost equally). The two strategies community based health service integration by sector and back office integration were identified as lower priorities by respondents. PwC Page 29
The following table identifies how respondents in each of the sectors ranked the seven strategies (vertical columns). A ranking of 1 indicates that the value attained the highest score (based on the weighted rankings) within the sector. The shaded cells indicate the top five choices, and the white cells indicate the bottom five choices within each sector. The total column indicates the overall weighted rankings across all sectors. Strategy All CHC CMHA CCAC/ CSS Hospital LTC Non-LHIN Funded Maximize scope of practice for health service providers Community based health service integration by geography Increased accountability for improved client/ system outcomes Enhanced use/sharing of evidence-based practice 1 1 2 2 2 1 3 2 2 4 1 6 5 3 3 4 5 4 3 2 2 4 3 1 5 3 3 5 Clinical program integration 5 5 5 5 1 4 1 Community based health service integration by sector 6 7 2 3 7 6 6 Back office integration 7 6 7 7 5 7 7 Legend: CHC = Community Health Centre, CMH&A = Community Mental Health and Addictions, CCAC/CSS= Community Care Access Centre/ Community Support Services, LTC = Long Term Care, Non-LHIN Funded = Non-LHIN Funded Providers. Key Findings The strategy that each sector selected in their top five is "to maximize scope of practice for health service providers. Responses were highly varied by sector, which highlights the different focuses by sector on how to improve efficiency and effectiveness. PwC Page 30
Conclusion The survey was designed to elicit the perspectives of LHIN-funded and non-lhin funded health service providers on both the current and future state of health services in the HNHB LHIN. Through the use of an electronic survey tool and timely reminders from both the LHIN and PwC, a 72% response rate was achieved. Response rates differed by sector (e.g., higher responses for LHIN-funded organizations including Long Term Care and Community Mental Health and Addictions), and sub-lhin area (e.g., higher response rates for Niagara and Hamilton). This may be attributed to the level of distribution of service providers across the LHIN, and should inform the interpretation of survey responses. Organized by the five question categories (values, trade-offs, access, coordination/integration, and value for money) the survey findings were presented at an aggregate level, and by sub-lhin area/ sector when meaningful for interpretation. Overall, the survey achieved its intended purpose to elicit input from HNHB health service providers on the identification of values and principles that should drive decision-making, and identification areas of priority for the LHIN to consider. PwC Page 31
Appendix I - Survey PwC Page 32
A.C.T.I.O.N. - A Call To IntegratiOn Now Demographics 1) What sector best reflects your organization type? Hospital Long Term Care Community Care Access Centre Community Support Services Community Mental Health and Addictions Community Health Centre Non-LHIN Funded Provider 2) Which sub-lhin area(s) does your organization predominately serve? (Select all that apply) Hamilton Niagara Haldimand Brant Burlington Norfolk LHIN-Wide (If LHIN-Wide - please select only this option) PwC Page 33
Values 3) The establishment of common values will help ensure consistency, equity, and alignment for HNHB s health system transformation. What are the values that should inform and drive the transformation? Instructions: Of the ten values below, please rank your top five, in order of priority (drag your top five items to rank them in your preferred order, with 1 being the best): a) Person-centred b) Optimizes existing provider expertise within the LHIN c) Seamless service provision d) Builds on existing relationships and partnerships e) Evidence-based f) Outcome oriented g) Shared accountability for outcomes h) Contributes to system sustainability i) Equitable access to services j) Value for money 4) There are many competing priorities in health system transformation. What populations should the LHIN focus on? Instructions: Of the nine populations outlined below, please select the five populations the LHIN should focus on. Broad Population (all LHIN residents) High Risk Seniors Mental Health and Addictions Low Volume/High Cost Frequent Hospitalization/Emergency Department Visits End of Life/Palliative Infant/Youth Population with Barriers to Access (e.g., rural, Aboriginal, Francophone) Population with Complex Medical Conditions (multiple chronic conditions) PwC Page 34
Trade-Offs 5) Assuming the LHIN has an approximate total annual budget of 100 dollars, the following chart outlines the current allocation of resources. Sector Allocation of LHIN Budget to Health Service Providers Hospitals $68 Long Term Care Homes $16 Community Care Access Centre $9 Community Support Services $3 Community Mental Health and Addictions $2 Community Health Centres $1 What do you think the optimal allocation of resources should be? Instructions: Allocate the $100 budget across each of the providers, as you feel appropriate: Hospitals Long Term Care Homes Community Care Access Centre Community Support Services Community Mental Health and Addictions Community Health Centres PwC Page 35
6) Health systems need to be responsive to changing needs and demographics. If the LHIN received an additional ten dollars, where do you think it should be invested? Instructions: Allocate the additional $10 budget across some/all of the providers, as you feel appropriate (you only have $10 to allocate): Hospitals Long Term Care Homes Community Care Access Centre Community Support Services Community Mental Health and Addictions Community Health Centres Public Health Primary Care (e.g., Family Health Teams) Emergency Medical Services (i.e., ambulance services) 7) The province s current and projected fiscal environment will require that difficult allocation decisions be made. If the LHIN budget was reduced by ten dollars, from which sector(s) would you find the savings? Instructions: Allocate the reduction of $10 across some/all of the providers, as you feel appropriate (totalling $10 worth of savings): Hospitals Long Term Care Homes Community Care Access Centre Community Support Services Community Mental Health and Addictions Community Health Centres Public Health Primary Care (e.g., Family Health Teams) Emergency Medical Services (i.e., ambulance services) PwC Page 36
Access 8) Health system transformation is a complex issue that will require consideration of a variety of strategies. What strategies should the LHIN prioritize? Instructions: Of the ten strategies below, please rank your top five, in order of priority (drag your top five items to rank them in your preferred order, with 1 being the best): a) Where cost effective and safe, more health care services should be provided at home. b) The use of telemedicine should be expanded. c) Optimize health care workers roles and productivity. d) Expand the range of services and professionals currently offered in primary care. e) Transition additional inpatient hospital services to an outpatient setting. f) Strengthen the relationship between hospitals and community providers to enable more timely patient transitions. g) Consolidate the provision of specialized care into centres of excellence in hospital or free standing clinics. h) Sharing of evidence-based care pathways, processes and training should occur across organizations in order to optimize standardization of care and reduce variability. i) Focus and target funding to programs and services that address the population with high priority health needs. j) Facilitate the integration of program and services that will result in more direct care. PwC Page 37
Coordination 9) Care coordination efforts that focus on hand-offs/ transitions have been linked to improved quality and reduced costs. What should the focus of the LHIN's care coordination initiatives be? Instructions: Of the nine populations outlined below, please select the five populations where the LHIN should focus their care coordination efforts. Broad Population (all LHIN residents) High Risk Seniors Mental Health and Addictions Low Volume/High Cost Frequent Hospitalization/Emergency Department Visits End of Life/Palliative Infant/Youth Population with Barriers to Access (e.g., rural, Aboriginal, Francophone) Population with Complex Medical Conditions (multiple chronic conditions) PwC Page 38
10) If the LHIN were to focus on transition points, what services should be prioritized in order to enable successful transitions from hospital to home. Instructions: Of the twelve services outlined below, please select the five that the LHIN should prioritize. Transportation to Medical/Health Appointments Telehomecare (e.g., Follow-Up Phone Calls From Heart Failure Clinics) Ontario Telemedicine Network (OTN) Mobile Health Teams (e.g., Nurse Led Outreach Teams, Psycho Geriatric Outreach Teams, Rapid Response Nursing Teams) Assisted Living Programs/Supportive Housing Transitional Support Services (e.g., Programs Like Assess & Restore / Convalescent Care That Enable Patients to Go Home, as Opposed to Long Term Care) CCAC Case Management Services (In Emergency Departments, Hospitals, Community And Primary Care Settings) Home Set Up (e.g., Stairs, Doorways, Equipment) Home-Based Health Services (e.g., PSW, Nursing, Therapy Services) Specialized Out-Patient Clinics (e.g., General Internal Medicine Clinics, Heart Failure Clinics) Congregate Care Settings (e.g., Nursing Clinics, Rehab Clinics) Care Coordinators/Navigators PwC Page 39
Value for Money 11) There is growing demand to demonstrate value for health care spending. What are the opportunities to improve the efficiency and effectiveness of service provision? Instructions: Prioritize the following seven strategies for increased efficiency and effectiveness (drag each item to rank them in your preferred order, with 1 being the best): Clinical program integration Community based health service integration by geography Community based health service integration by sector Back office integration Maximize scope of practice for health service providers Enhanced use/sharing of evidence-based practice Increased accountability for improved client/ system outcomes 12) From the list above, identify and briefly describe specific quick win opportunities that you would suggest. PwC Page 40