South West LHIN Initiatives and Priorities Presentation to the Grey County Warden s Forum Michael Barrett, CEO, South West LHIN April 20 th, 2017
Overview of today s presentation Provide background on Local Health Integration Networks The Patients First Journey Offer details on the LHIN s priorities Listen to you Answer your questions 2
Local Health Integration Networks (LHINs) Established by the Ministry of Health and Long-Term Care in 2005 14 LHINs covering 14 geographic regions in Ontario 3
South West LHIN Overview One of the largest LHINs almost 22,000 km 2 924,000 people (7.5% of Ontario s population) Significant rural population with many small communities Large urban population within City of London Large proportion of seniors Small proportion of immigrants 5 First Nations communities French Language Services designation 4
Grey Bruce 3 Hospitals Grey Bruce Health Services Lion s Head Markdale Meaford Owen Sound Southampton Wiarton Hanover and District Hospital South Bruce Grey Health Centre Chesley Durham Kincardine Walkerton 1 Community Health Centre South East Grey 8 Community support services 19 Long Term Care Homes 5 Mental health and addictions programs 1 CCAC (for whole South West LHIN) 1 Public Health Unit 105 active family physicians 6 Family Health Teams 5
Overview - LHINs What s in? Hospitals Community Care Access Centre Community Support Service Agencies Mental Health and Addictions Agencies Community Health Centres Long-Term Care Homes What s out? Physicians and Clinics Ambulance Services (emergency and nonemergency) Laboratories Provincial drug programs Public Health Units 6
Health service providers in the South West LHIN 19 public hospitals (33 sites) and 1 private hospital 1 Community Care Access Centre 5 Community Health Centres 78 long-term care homes 52 agencies provide community support services 14 agencies provide assisted living supportive housing services 22 agencies provide mental health services 10 agencies provide addictions services 3 agencies provide acquired brain injury services Other providers Over 600 actively practicing family physicians 19 Family Health Teams 7 Public Health units 7
Facts to consider when planning in Grey Bruce Percentage of the population that is Indigenous (5.2%) is the largest proportion in the LHIN which is approximately 7,700 people and includes two First Nations. There is limited culturally safe primary care in Grey Bruce individuals must drive long distances for care. Significant Mennonite/Amish population. Transportation an ongoing challenge due to rurality. Providers have a strong Chronic Disease Prevention and Management focus. The sub-region has a strong, well organized Area Provider Table Many provider partnerships in existence (e.g. Information Network, Hospital/CCAC/Public Health Network). 67% of primary care physicians are affiliated with a team-based practice. Strong mental health and addictions agencies currently engaged in integration conversations. There is one Public Health unit in the sub-region. Historically, the public health unit has had a strong voice in the community. The Health Link approach to coordinated care planning is active across the 2 counties. 8
Patients First Journey 9
10
Consultation and engagement: key provincial themes Ministry and LHINs held engagement sessions with stakeholders, and gathered feedback and ideas on the proposal. More than 6,000 individuals and organizations were consulted in 6 ministry-led and nearly 250 LHIN-led regional sessions. The South West LHIN held 5 public engagement sessions in February 2016. 11
Five goals of health system transformation Effective integration of services and greater equity through sub-regions Timely access to and better integration of primary care More consistent and accessible home and community care Stronger ties to population and public health Services that address the needs of Indigenous people 12
How the Patients First Act, 2016 Supports Transformation Goals Legislative enablers More Effective Service Integration, Greater Equity Establishment of sub-regions LHIN objects Timely Access to Primary Care, and Seamless Links Between Primary Care and Other Services Designation of new health service providers Accountability mechanisms with primary care groups More Consistent and Accessible Home and Community Care Transfer of CCACs to LHINs Shared services entity to support backoffice functions Stronger Links Between Population & Public Health and other Health Services Formal linkage between LHINs and Boards of Health Establishments of Integrated Clinical Care Committee Physician resource reporting Expanded LHIN governance Establishment of sub-regions Services that Address Needs of Indigenous Communities Across Ontario Ontario is engaging Indigenous partners through a parallel process that will collaboratively identify the requirements necessary to achieve responsive and transformative change. 13 13
Sub-region geographies LHIN sub-regions are smaller geographies where LHINs will work with partners on a more coordinated and integrated system. Sub-regions have been identified based on Existing patterns of service provision and patient referral patterns Consultation with local health service providers and community partners Building on Health Links coordinated care planning approach to better serve residents with high care needs 14
76 Sub-Regions, by LHIN and population 2,000 6 Population (in thousands) 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0 6 126 43 59 72 108 211 5 89 114 445 146 157 4 93 145 138 397 6 383 63 111 114 194 552 5 7 120 142 41 292 262 306 319 201 210 92 74 65 5 270 220 76 374 510 143 199 433 306 233 262 7 72 135 89 288 320 435 178 5 124 148 61 132 35 5 197 189 432 263 151 5 5 7 63 234 53 80 140 222 117 62 103 5 22 20 128 43 18 15 15
Sub-Region Wills and Won ts LHIN Sub-Regions will Provide health system data and information for the population of the sub-region Bring together health system and community partners, as well as clinical leadership, at the local level in health system planning and improvement. Enable more focus on population health needs and service capacity. LHIN Sub-Regions won t Result in more bureaucracy. Subregions will utilize existing LHIN staff in more effective ways - no new organizations are being formed. Impede ministry or LHINs obligations to engage with provincial and regional partners and patients. These will continue. Infringe on traditions or established jurisdictions in the planning, delivery or improvement of health services. 16
Primary Care: the case for change While patient attachment rates have improved in the past decade, significant numbers of Ontarians are still seeking a primary care provider. There is also regional variation in patient attachment, especially in areas with a lower density of primary care providers. Physician retirements can leave thousands of Ontarians unattached to primary care if not properly planned. Succession planning for primary care practices would allow greater continuity of primary care for patients. Percentage of patients that are attached to a regular PCP ON SE NE 94% 98% 85% Difficulty getting same day/next day access 56.5% Having difficulty getting after-hours care 53% Waited five or more days to see their primary care provider 26% Not aware of after-hours services provided 66% 17 17
Relationships between LHINs and Boards of Health enabled through Patients First Act, 2016 A local health integration network shall ensure that its chief executive officer engages with each medical officer of health for any health unit located in whole or in part within the geographic area of the network, or with the medical officer of health s delegate, on an ongoing basis on issues related to local health system planning, funding and service delivery LHINs will incorporate population health approaches in health system planning LHINs will benefit from Public Health s population health assessments for local populations 18 18
Enhancing collaboration with Public Health 14 LHINs 36 Health Units # of LHINs Sharing the PHU LHIN boundaries 19 19
Examples of areas where LHINs and Boards of Health are collaborating Health equity impact assessments Community Planning Tables Sub-region population profiles Integrated planning for indigenous health Maternal/child health services planning Falls prevention Diabetes prevention/ chronic disease prevention Planning services for selected cultural and language groups Emergency planning Outbreak response (e.g. Ebola response) Good collaborative foundation to continue to enhance for improvements in population health. 20 20
Community Care Access Centres Integration with LHINs The Patients First Act, 2016 will transfer responsibility for service management and delivery of home and community care from Community Care Access Centres (CCACs) to the LHINs. The Transfer Order has been issued by the Minister and the date for the South West LHIN has been set for May 24 th, 2017. The name of the combined organization will be the South West LHIN. The focus is on patient care continuity resulting in very few changes and actions required for transition. On transition day, patients will continue to receive care from familiar faces from providers that know their stories, their preferences, and their needs. All phone and fax numbers will remain the same. CCAC staff will have a new email address. Current CCAC email address will remain active with an automatic forward to their new LHIN email address. 21 21
22
Patient and Family Advisory Committee Advises, collaborates and co-designs with the LHIN on policies, practices, strategies, planning and delivery of patient and family-centred care. Two patient/family members from each integration table sit on the committee. This committee reports to the LHIN CEO. Key roles Develop a collective vision of patient and family-centred care Establish a strategy to increase meaningful patient engagement and advance the culture of patient and family-centred care Identify opportunities for improving quality of care Co-design strategies to actively partner with patients Develop draft policies or position papers that support patient and familycentred care Co-design public communications Review evaluation methods of planned system improvements 23
Recruitment for patients, family or caregiver partners LHIN is seeking community members to offer their perspectives on health care as patients, family members, caregivers and to be partners as part of the LHIN s three new groups. Anyone who has been a patient, a caregiver, or a family member of a patient, and who lives in the South West LHIN geography can apply to be considered for these groups. To apply, interested persons must complete and submit an Expression of Interest Recruitment will include print and digital advertisement as well as newsletter content, web content, and tools for partners to promote the process on the LHIN s behalf. Recruitment details and a link to the Expression of interest can be found on the LHIN s website. 24
Health System Renewal Advisory Committee Advises the LHIN on system-wide implementation of Patients First, the Integrated Health Service Plan and future South West LHIN strategic priorities. One patient/family member and two provider members from each integration table sit on the committee. This committee reports to the LHIN CEO. Sub-region integration tables Each table identifies, plans and makes recommendations for local priorities, and drives change locally through innovation and collaboration. Each table reports to the LHIN for shared objectives. The overall aim is to improve health, wellness; patient experience and outcomes; as well as value for money. 25
South West LHIN priorities 26
Optimized health at home, in long-term care, and in other community settings Home and Community Care One Sector Experience Community support services working in collaboration with the CCAC in each subregion. Working to create a seamless and streamlined client experience. Coordinating central intake and assessment and coordinating the right home and community supports and services. The lead agency responsible for coordinating community support services to enhance the home and community care experience in Grey Bruce is Home and Community Support Services of Grey Bruce. Enhanced residential assisted living supports for adults with complex needs Multi-year strategy for congregate/residential programming for young adults with complex needs has expanded to Owen Sound. Partners include Participation House Support Services, CCAC, and the hospital sector. 27
Optimized health at home, in long-term care, and in other community settings Assisted living and supportive housing VON Canada Grey Bruce Branch s reorganization of Meaford Assisted Living services into community hubs in 2015/16. Those who need supportive housing level of supports no longer have to move to a designed building in order to get it. The same level of support can be provided in their own home. The impact of this reorganization has touched every level of the organization. To date, VON Grey Bruce has received positive feedback on the new model and are committed to making ongoing improvements and looking to implement the community hub model in other areas of Grey Bruce. They are working with any clients who have concerns about their schedules to ensure their concerns are addressed. 28
Optimized health at home, in long-term care, and in other community settings Long-term care home redevelopment 47 out of 78 homes are expected to redevelop in the South West LHIN. 15 of 19 homes in Grey Bruce expected to be redeveloped. 29
Optimized health at home, in long-term care, and in other community settings Long-term care home redevelopment 9 of 11 homes are redeveloping in Grey County; Lee Manor and Grey Gables are not eligible for redevelopment Name of Home Location # of Beds Georgian Owen Sound 40 Maple View Owen Sound 29 Summit Place Owen Sound 119 Lee Manor Owen Sound 150 Country Lane Chatsworth 34 Meaford LTC Meaford 77 Errinrung Thornbury 60 Village Seniors Hanover 70 Hanover Care Hanover 41 Rockwood Durham 100 Grey Gables Markdale 66 30
Prevent and Manage Chronic Conditions Coordinated Care Planning in Grey Bruce Better care for people with many health care needs. Everyone involved in an individual s care knows what is important to him/her. Everyone involved in an individual s care knows what the plan is. There are approximately 7,420 people in Grey Bruce who might benefit from a coordinated care plan. In the last year, partners have worked together with 227 people to coordinate their care. 31 15
Prevent and Manage Chronic Conditions Patient Story: Coordinated Care Planning An 84-year-old widow was living in a retirement home with multiple chronic conditions: diabetes, hypertension, congestive heart failure, atrial fibrillation, arthritis, and dementia. She was identified for coordinated care planning and was transitioned to long-term care with the primary goal of improving her pain control. The long-term care home and several providers from the community participated in the plan: family physician, the director of care, pharmacist, and physician from the long-term care home, as well as the CCAC Care Coordinator. There was a need to better understand the treatment options that had been explored and trialed in the past to inform potential options for medication in her new home. The impact was a strong hand-off and transition from a community care team to a long-term care home. The plan also allowed for a candid discussion about the most ideal pain management and intervention, with the least negative impact to her wellbeing and overall health. 32
A Rehabilitative Approach Work continues to improve outcomes for people with stroke and transient ischemic attack Work is well underway to realign acute and rehabilitative inpatient stroke care from 28 hospitals to seven hospitals to improve patient outcomes after they have had a stroke or TIA. The realignment is expected to finish in 2017. When fully implemented, acute stroke and inpatient rehabilitation stroke care in Grey Bruce will be provided by Owen Sound Hospital. For all patients with a suspected stroke in Grey County, EMS will bypass local hospitals regardless of whether they are inside or outside of the window for tpa treatment and take them directly to either the District Stroke Centre at GBHS in Owen Sound, or to the Regional Stroke Centre at London Health Sciences Centre. 33
Timely Access to Hospital Based Care Emergency department wait times The South West LHIN ranks second of the 14 LHINs for Emergency Department Wait Times for Complex Patients Admitted Time for Patients in ED @ 90 th Percentile Registration in ED to Left ED (in hours) 34 34 Source: ER Fiscal Year Reports14/15,15/16 and 16/17 (Accessed through Directory of Network, Ministry of Long Term-Health and Care
Timely Access to Hospital Based Care Emergency department wait times Admitted Time for Patients in ED @ 90 th Percentile Registration in ED to Left ED (in hours) - complex and minor 35 35 Source: ER Fiscal Year Reports14/15,15/16 and 16/17 (Accessed through Directory of Network, Ministry of Long Term-Health and Care
Timely Access to Hospital Based Care Markdale Hospital The project involves the redevelopment of the Markdale facility on a Greenfield site. The Ministry approved the Grey Bruce Health Services Markdale Hospital Redevelopment Stage 2 Capital submission in November 2016. Grey Bruce Health Services is preparing Stage 3 (Design) submission. 36 36
Community Paramedicine Pilot Projects The Ministry of Health and Long-Term Care officially transferred responsibility for decisions about community paramedicine pilot projects to the LHINs as of April 1, 2017. The South West LHIN received funding for the pilot projects in our LHIN: o Middlesex-London EMS Community Paramedicine Program funded at $166,900 annually. o Expending Paramedicine in the Community (EPIC) Program (Grey County) funded at $254,600 annually. The LHIN will continue to fund each pilot project for six months (effective April 1, 2017) using the same accountability and funding parameters established by the Ministry when the projects transitioned to the LHIN. As the LHIN has not been a direct partner in either pilot project, the six month period will provide the LHIN and pilot partners the time needed to better understand the program so that the LHIN can make informed decisions on each pilot project. 37
Strengthening Mental Health and Addictions Services Specialized Behavioural Support Units Lee Manor Lee Manor in Owen Sound has been identified as the Grey Bruce location to establish a 16-bed specialized unit for people living with responsive behaviours (physical or verbal aggression, depression, inappropriate behavior, etc.). The LHIN is working with partners in Grey Bruce area to develop a proposal for designation of a unit at Lee Manor. The proposal is expected to be ready for submission to the Ministry by summer 2017. Units are subject to designation by the Ministry 38
Strengthening Mental Health and Addictions Services Peer Support Strategy Peer support programming within the Grey Bruce area is provided by Hope Grey Bruce Mental Health and Addiction Services. The existing model within the Grey Bruce area has served as a best practice example within the South West. While the peer support program has not been offered through a stand-alone peer run agency, there has been significant peer leadership and support to enable an effective grass roots approach that has been well received by consumers of mental health and addiction services. The South West LHIN continues to explore opportunities to strengthen programming within this already integrated model of service delivery. Hope Grey Bruce Mental Health and Addiction Services remains the MH&A lead agency for this sub-region. 39 27
Person and Family Centered Palliative Care To improve our ability to support people to die in the setting of their choice, the South West LHIN has increasingly demonstrated an active commitment to planning for an integrated hospice palliative care system. Four out of every five palliative care patients in the South West LHIN are being discharged from hospital to home-based settings with supportive care. The South West CCAC is supporting an increasing number of complex palliative clients; an increasing proportion of these clients are dying in home and community settings. Community-based palliative care secondary level outreach consultation teams are fully operational in Grey Bruce, Oxford and Elgin sub-regions. In Grey Bruce 88 per cent of patients supported by the outreach team in 2017-17 died in their place of choice. The majority of referrals to outreach are made for symptom and pain management. 40
Person and Family Centered Palliative Care Currently 6 beds at Residential Hospice of Grey Bruce. As announced in October 2016, the Residential Hospice of Grey Bruce has received funding for two additional beds. When construction is complete in spring 2017, the hospice will have a total of eight beds with a four bed satellite site operating in southern Grey-Bruce. The Grey Bruce Collaborative has established a residential hospice subcommittee to begin developing a sub-region solution to expand residential hospice. The communities interested in residential hospice capacity in Grey Bruce (ie. Kincardine, Hanover, and Walkteron) have been working collaboratively to produce a discussion document that focuses on building on the current capacity located in Owen Sound. 41
Indigenous Cultural Safety Training Training is available at no cost and approximately 3,600 health care providers in Ontario have completed the Indigenous Cultural Safety training program. Feedback from participants has been very positive. Aside from more direct outcomes (such as improving relationships among Indigenous patients and health care providers) the training improves the Indigenous patient experience and access to overall primary care. The South West LHIN covers the cost of the training for Health Service Providers funded by the South West LHIN. https://www.aohc.org/indigenous-cultural-safety-training. You are also welcome to contact Vanessa Ambtman-Smith, Indigenous Health Lead at 519-640-2610, or by email at vanessa.ambtman@lhins.on.ca. 42
43
Additional data 44
Timely Access to Hospital Based Care Grey Bruce: ED Length of Stay for minor/uncomplicated patients (in hours) 2.5 2.7 2.7 3.0 3.8 4.4 2.7 2.6 2.8 3.2 3.6 4.3 2.8 2.7 3.0 3.4 3.6 4.3 2.8 3.3 3.1 3.1 3.7 4.2 Better Source: Access to Care 45 22
Timely Access to Hospital Based Care Grey Bruce: MRI completed scans 54% 30% 40% 37% 27% 42% 34% 29% 38% 40% 28% 39% Better Source: Access to Care 46 Note: Only Owen Sound Hospital provides MRI services among the Grey Bruce Health Services Hospitals. 23
Timely Access to Hospital Based Care Grey Bruce: Completed hip replacements 97% 68% 80% 58% 54% 78% 46% 50% 78% 57% 62% 80% Better Source: Access to Care 47 Note: Only Owen Sound Hospital provides hip replacements among the Grey Bruce Health Services Hospitals. 24
Timely Access to Hospital Based Care Grey Bruce: Completed knee replacements 70% 69% 78% 59% 69% 76% 57% 75% 66% 75% 41% 44% Better Source: Access to Care 48 Note: Only Owen Sound Hospital provides knee replacements in among the Grey Bruce Health Services Hospitals. 25
Strengthening Mental Health and Addictions Services Grey Bruce: Wait times for mental health (in days) 32 29 40 22 25 42 18 26 43 36 33 43 Better Source: ConnexOntario Health Services Information 28 49
Capital Projects: Grey-Bruce Project Type Description Status Grey Bruce Health Services Markdale site Hospital The project involves the redevelopment of the Markdale facility on a Greenfield site. Grey Bruce Health Services is preparing Stage 3 (Design) submission Grey Bruce Health Services Southampton Site Hospital Emergency and Laboratory Capital Redevelopment Project at the Southhampton site of the Grey Bruce Health Services involves a combined 9,700 square foot renovation and new addition. Under construction South Bruce Grey Health Centre Kincardine Site Hospital Project includes critical infrastructure upgrades and remediation, in addition to renovations and changes to existing space to prepare the building for continued operations and to respond to potential future program and service changes. Pre-Capital (Concept) submission under MOHLTC review 50