May 7, 2014 Haliburton Highlands Health Services Changing Governance Structures

1930 Request to Red Cross

1936 3-Bed Hospital Opens

1950 12-Bed Hospital

1971 New 12-Bed Hospital $2.2 Million

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Haliburton County

• 17,000 residents increases to 30,000

• 27% of population over the age of 65

• Low income, high poverty levels

• Million $ cottages

• Where is the money? 4

1984

Hospitals in Minden and Haliburton

operated by Red Cross

Ownership transferred to Sisters of St.

Joseph, Peterborough

Community Advisory Committee established 5

1985 - 30 long-term care beds allocated to

Haliburton

1991 - Haliburton Directional Study commissioned

1993 - Options for redevelopment of acute and

long-term care beds

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Proposed a new system of health care delivery in Haliburton An integrated health system

30 new long-term care beds in Haliburton

Minden acute care beds moved to 90 bed home for the aged

Continue to operate two Emergency Departments

A NEW governing Board

To own and operate all health services

Board to be comprised of Haliburton residents

Sisters of St. Joseph to transfer ownership to a new Haliburton

Board 7

Challenges of Forming a New Haliburton Board

Communities are competitive Rivalry

County Council - to give up control of the new

home for the aged

Convince Ministry of Health to form a new

hospital Board

Balance of power on the Board

Skills based Board 8

1994 – New Haliburton Highlands Health Services Board formed

1995 – First CEO hired

1996 – HHHS Foundation formed

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Haliburton Site

• Emergency • 12 acute care beds • 30 long-term care beds

Minden Site

• Emergency • 2 holding beds • 62 long-term care beds

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1995 Capital Redevelopment Plan

$20 million capital redevelopment plan

$10 million from Ministry of Health

$5 million from Federal Government

$5 million from local fund raising

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1996 Mental Health services added

Proposed ambulance services – not approved

Proposed CCAC – not approved

1998 Supportive Housing – several locations throughout

County

Diabetes Education added

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Total HHHS Revenues

$-

$5,000,000.00

$10,000,000.00

$15,000,000.00

$20,000,000.00

$25,000,000.0019

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

0920

1020

1120

1220

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Total RevenueMinistry Revenue

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1996 - HHHS Foundation Formed

$-

$200,000.00

$400,000.00

$600,000.00

$800,000.00

$1,000,000.00

$1,200,000.00

$1,400,000.00 $1,244,169.00

$1,007,536.00

TOTAL FUNDS RAISED

Total raised = $10 million

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HHHS Foundation

• Raised over $1 million from its

community

• In 1998, $30,000 in bequests

• In 2013, over $500,000 in bequests 15

Lessons Learned…

1) Governance is important

2) Board structure is critical – balance of power –

skills based

3) Foundation – Fundraising

4) Vision – A Vertically Integrated Health System

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December 2102 - CE LHIN Community Health Services Integration Strategy Cluster-based service delivery model through integration of

front-line services, back office functions, leadership and/or governance to:

improve client access to high-quality services, create readiness for future health system transformation make the best use of the public’s investment

Hospitals were included in the Northumberland and Haliburton

County – City of Kawartha Lakes Processes 17

HKL Integration Planning Team Organizations • Community Care City of

Kawartha Lakes • SIRCH Community Services • Community Care Haliburton

County

• Victorian Order of Nurses, Ontario Branch

• Ross Memorial Hospital • Haliburton Highlands

Health Services

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Convergence of Central East LHIN/Provincial Priorities

Coherent, Coordinated, Sustained Integration Strategy

Health Links

Small Rural Hospital

Transform-ation

Funding Initiative

Community Health

Services Integration

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Decision-making Criteria

Articulates goals for integration Aligned with:

• Local Needs & Priorities • The CHS Integration Guiding Principles • Central East LHIN 2013-2016 Integrated

Health Services Plan • The pan-LHIN Decision-making Toolkit

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Governance Models Evaluation Criteria Legislative BarriersStrategic AlignmentEconomics & Cost RealignmentQualityService enhancement including:

- increasing access-ensuring equitable access -improving population health-avoiding service redundancy-reducing a gap

Client Experience & Continuity of CareAutonomyAdaptability and SustainabilityImplementable/Practical RealitiesCapacity to Engage the Community in:

-Fundraising-Volunteering

Do no Harm

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Prioritized Governance Models Nine Governance Models were evaluated

against the Decision-making Criteria

Governance Models ranged from one single organization to six organizations

Each model was designated as Green, Yellow, Orange or Red for each decision-making criteria

Three Governance Models were prioritized for further consideration

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Two Entities by Geography

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Three Entities

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Four Entities

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What was proposed? • The creation of One

Entity (one organization) in Haliburton County, with a single board of governors, accountable for providing the LHIN-funded hospital and community services.

• Confirmation of two existing entities in the City of Kawartha Lakes, Ross Memorial Hospital (RMH) and Community Care City of Kawartha Lakes (CCCKL), who will continue to provide the LHIN-funded hospital and community services currently delivered by their organizations

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Current State – Future State

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One Entity in Haliburton County Voluntary merger between Community Care Haliburton County

and Haliburton Highlands Health Services One Entity to deliver hospice/palliative services currently

provided by SIRCH and Adult Day Program services currently provide by VON.

Accountability for coordinating Foot Care services would also be transferred from VON to the One Entity.

SIRCH and VON would continue to exist as ongoing entities, with their own boards, programs and services but would no longer have an Accountability Agreement with the CELHIN

Volunteer Co-ordination – SIRCH would investigate piloting a new model (Volunteer Match) that could be used by the One Entity in Haliburton County to recruit, screen, orient and train volunteers

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Strategic Alliance between Ross Memorial Hospital and Haliburton Highlands Health Services Established to facilitate existing and future shared services

opportunities, including: Laboratory Services Medical Device Reprocessing Medical Records Transcription Shared Information Technology Department Inventory Management System and Procurement Pharmacy Services Mental Health Leadership Cardiac Rehabilitation Diagnostic Imaging Management Document Management System for Policies and Procedures

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Benefits of the One Entity in Haliburton County local autonomy and local management over Haliburton

County-specific services potential cost savings for reinvestment local residents would not have to go through as many

“doors” and would have access to a broad range of services

streamlined volunteer opportunities for local residents who want to support their local health care organization.

more opportunities for staff in a larger organization “one voice” with an understanding of the health needs

of the residents of Haliburton County to advocate for/apply for new funding

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Transition Planning for Haliburton County Haliburton Kawartha Lakes Health Services Integration Plan

was presented to the CE LHIN Board for approval on December 18, 2013

The CE LHIN Board approved the Integration Plan and requested a 6-month status report on the implementation of the Plan

Discussions began between Community Care Haliburton County and HHHS related to their amalgamation in early January 2014, and more specifically about the governance structure for the amalgamated organization

A Transition Team, with executive representation from HHHS, CCHC, SIRCH and VON, was formed to begin planning for the implementation of the Integration Plan in Haliburton County

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Governance Plan Although the Integration Plan called for the formation of

a new Health Services Entity for Haliburton County, discussions were initiated with Community Care and HHHS since the governance of only these organizations were to be impacted

The two Boards agreed that the “new entity” would be HHHS and Community Care Haliburton County would wind-down as a corporation following the transfer of the community services on September 30, 2014

To facilitate the Governance Plan, vacancies on the HHHS Board would be held for Community Care Board members who wanted to move to the HHHS Board and would do so as of the HHHS Annual General Meeting on June 26th, 2014

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Role of the CEO is critical Chief Communicator

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Next Steps…

Family Health Team

Ambulance Services

CCAC

Other 40 health and social service agencies

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Conclusions 1. Think BIG and act SMALL 2. Talk to your neighbour 3. Governance is important 4. Take advantage of opportunities 5. Fundraising is important 6. CEO role 7. Foundations must work with Hospital

Boards

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