Giving Shape to the Vision:

Putting together the puzzle of planning and integration in the Central East LHIN

Planning Partners Symposium, June 5-7, 2007

James MelocheSr. Director, Planning, Integration and Community Engagement

Pause and reflect…

• Framework for Engagement and Planning• Extensive community engagement across the region• Detailed feedback and data collection to validate directions• Establishment of 9 collaboratives, 3 networks, 5 task groups• Integrated Health Service Plan and community consultations• IHSP work plan and feedback• New investments and projects launched• LHIN Board and organizational developmental start-up

A year ago we told you….

…that the path of change would be challenging and that there

would be bumps along the way

Today…

The Path travelled is clear. The Path ahead remains unknown. The journey of change continues….

Objectives of this PresentationFor Planning Partners

– Need: Planning partners (Networks, Collaboratives, Task Groups) are maturing as planned. As the LHIN develops, these teams are in need of a overview of how “the pieces fit together.”

– Objective: Give an overview of the planning flow that will ultimately lead to the provision of advice to the CE LHIN Board

For Health Service Providers (HSPs) & Other Stakeholders– Need: Enhanced capacity to work across organizational boundaries

to identify and implement health system improvements and integration.

– Objective: Outline CE LHIN planning & engagement framework and expectations regarding integration decisions; and provide HSPs an opportunity to leverage LHIN planning structures.

Objectives of this Presentation (2)For the CE LHIN Board

– Establish clear expectations on the processes used to gather local advice such that there is increased confidence that the community has been involved in creating solutions for Board decisions.

Context

• Local Health Integration Act• Central East LHIN Framework for Community Engagement

and Local Health Planning• Central East Integrated Health Service Plan & Work Plan

Presupposes future additional context of:• LHIN Decision Making Framework • Supporting tools and documentation that will provide

direction/assistance in planning and proposal development.

Commitment to Change and Engagement• The Central East LHIN is committed to on-going engagement.• Engagement provides an opportunity to unlock and leverage system

planning expertise from within the CE LHIN and overcome artificial barriers between providers

• On-going engagement allows for emerging trends to be identified in support of existing or future LHIN priorities and/or integration decisions.

• The focus on engagement is on improved access and performance through integration/realignment/establishment of health services.– It is not focussed on internal health service provider matters (i.e., operations)

that are the prime responsibility of a health service provider and its board. • Accountability for system performance lies ultimately with the

CE LHIN board and the local health provider boards. Engagement of planning partnerships does not displace this accountability – only strengthens it.

Other LHIN Interests

• Create Opportunities by through capacity building and/or removing traditional barriers

• Eliminate gaps in awareness and knowledge (i.e., surprises) and the friction that it creates.

• Redesign local health system based on cooperation and mutual interests (negotiation) rather than the failed approaches of command and control (provocation).

Caveats

• In addition to CE LHIN priorities, the Minister/Ministry of Health and Long Term Care set provincial priorities through its strategic plan and/or Ministry-LHIN accountability agreements (MLAA).

• Ministry direction may require the LHIN to implement without a fulsome engagement of local planning partnerships

• The CE LHIN may be required to exercise its authority at anytime and without consultation in the name of public interest.

• The CE LHIN Board and health service provider boards will work collaboratively in identifying and negotiating integration opportunities.

• This is learning process. Adaptations may be necessary.

Planning Partnerships

• 9 Collaboratives• 3 Priority Networks• Task Groups (5 current)• Health Professionals Advisory Committee (TBD)

• All are guided by a terms of reference outlining purpose and function.• All the scenarios presented here are consistent with existing

policy, terms of reference, and the requirements of LHIN legislation

Planning Partnerships: FunctionsExample: Collaborative as defined by the Terms of Reference

• Provide advice on the needs of the population of the Planning and Engagement Zone;

• Considering the Central East LHIN strategic priorities and objectives, work with healthcare providers, local and regional networks and consumers to identify local service gaps and opportunities for improved coordination and integration of health care services;

• Review LHIN-wide priorities and objectives against local strengths and gaps in capacity;

• Identify emerging local health needs and future health care priorities;• Advise on opportunities for improved health care efficiencies and cost

effectiveness;• If requested, assist Central East LHIN staff and local providers in the

implementation and monitoring of the Integrated Health Service Plan including assessing progress against action plans, identifying barriers to progress and advising on strategies to overcome barriers;

• When requested by the Central East LHIN and agreed to by the Collaborative as a whole, serve as a resource to local service providers/agencies in their planning and engagement needs.

Health System Planning & Integration

• The Integrated Health Service Plan (IHSP) sets the priorities and context for the local health system.

• Development and implementation of the IHSP, as well as addressing emerging system challenges and opportunities will require coordinated efforts of the LHIN, planning partners, and health service providers.– Scenario 1: Development of IHSP and strategic plans– Scenario 2: Identifying emerging local needs and opportunities– Scenario 3: Supporting health service providers and new planning expectations

• The IHSP and other local priorities will also generate opportunities for integration– Scenario 4: Facilitated or Negotiated Integration Decisions– Scenario 5: Required Integration Decisions– Scenario 6: Stopping Voluntary Integration

Supporting Planning

Scenario 1: IHSP Action for LHIN-wide implementation

LHIN

LHIN Priority NetworkOr Task Group

LHIN Collaborative

LHIN

Health Service Provider

• LHIN Board Approves IHSP and Work Plan

• Network/Task Group creates and/or advises on strategy that supports IHSP implementation

• Collaboratives and/or agencies provide local direction to strategy and advice on implementation back to Network.

• CE LHIN considers strategy and negotiates implementation through Service Accountability Agreements (SAA) or facilitated integration decision with health service providers (Scenario 4)

• Health Service Providers implement strategy

Denotes potential referral back to LHIN

Health Service Provider

Scenario 2: Identifying Emerging Local Needs/Opportunities

Task Group/Networks

Networks / Task Groups

LHIN

Health Service Provider

• Collaborative, Network or Task Group identifies system need, service realignment and/or integration opportunity. Notifies and seeks direction from LHIN staff.

• Reciprocal engagement of relevant CE LHIN planning partners• Appropriate engagement of relevant providers• Networks/Task Groups/Collaboratives provide advice and

findings to the CE LHIN

• CE LHIN considers advice. May decide to • Approve, and negotiate with health service providers through the SAA or

negotiated integrated decision (Scenario 4)• Consider further engagement and planning or issue a required

integration order (Scenarios 1 and 5, respectively)• Defer decision

• Health service providers implement local strategy as outlined in SAA or integration decision.

LHIN Collaborative

LHIN Collaborative

Health Service Provider

Denotes potential referral back to LHIN

The Transition to LHINs:Supporting HSPs and New Planning ExpectationsAs of April 1, 2007 Health Service Providers are now expected

to• Align their strategic and service planning within the overall LHIN

framework, with specific reference to the priorities identified in the 2006-2010 Integrated Health Service Plan

• Implement the directions for integration laid out in the accountability agreements with LHINs

• Demonstrate continuous improvement in service integration, coordination and quality

• Play a role in informing the community and general public about opportunities for participate in LHIN initiatives

• Provide the input and necessary information for the development of LHIN plans

• Participate in LHIN planning exercises (e.g., utilize LHIN community engagement/planning partnerships)

Scenario 3: Supporting HSPs and New Planning Expectations

LHIN Collaborative

LHIN

• Local health service provider (s) identify to the LHIN• Integration opportunity• New program / services• Local barriers for improved performance

• Health service provider(s) engage local and LHIN planning partners for expert advice, information and/or support in the development of a business plan

• Health service providers may plan for voluntary integration (see Scenario 6).

• Health service provider submits business (with demonstrated engagement of LHIN planning partners) to the LHIN for further consideration.

• LHIN may implement plan through service accountability agreements (SAA) with service providers, or integration decisions (see below)

Health Service Provider (s)

Health Service Provider (s)

Task Group/Networks

Denotes potential referral back to LHIN

Informing Integration Decisions

Facilitated or Negotiated Integration Decisions under 25(2)(a)25 (2)  A local health integration network shall issue an integration decision when the

network,(a) facilitates or negotiates the integration of persons or entities where at least one of

the persons or entities is a health service provider or the integration of services between health service providers or between a health service provider and a person or entity that is not a health service provider and the parties reach an agreement with respect to that integration;

2(1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity.

Scenario 4:Facilitated or Negotiated Integration Decisions under 25(2)(a)

LHIN facilitates or negotiates integration

involving HSP(s)

Health Service Provider(s)(or other)

LHIN issues integration decision

Presupposes prior negotiation with Ministry of Health and/or engagement of health service provider, other entities and LHIN planning partners.

Ministry-LHIN Accountability Agreement

Scenarios 1, 2, 3 and/orBoard-to-Board Engagement

Required Integration Decisions under 25(2)(b)

25 (2)(b)  A local health integration network shall issue an integration decision when the network requires a health service provider to proceed with an integration under s. 26;

2 (1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity.

• Such instances may be a result of government action or policy, or public interest requiring expedited outcomes

• In all other instances, use of such authority signals a shortcoming by the LHIN in meeting its standards of collaborative planning

Scenario 5:Required Integration Decisions under 25(2)(b)

LHIN considers any submissions; may change or confirm original integration decision

LHIN requires integration by funded HSPs

Health Service Provider

LHIN issues proposed integration decision

LHIN issues final integration decision

Within 30 Days

No timeframe specified

Anyone may make submissions regarding

proposed decision, including

Task Group/Networks

LHIN Collaborative

Health Service Provider

Integration Decisions that Stop Voluntary Integrations under 25(2)(c)25 (2)(c)   A local health integration network shall issue an integration decision

when the network orders a health service provider not to proceed with an integration under s. 27;

2(1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity.

• Use of such authority by the LHIN signals a shortcoming by the health service provider(s) in providing early awareness of the issues and/or health service providers lack of participation in LHIN collaborative planning.

Scenario 6:Integration Decisions that Stop Voluntary Integrations under 25(2)(c)

HSP gives notice to LHIN that it wishes to integrated funded services

LHIN considers HSP noticeLHIN does not issue a proposed decision stopping integration

LHIN issues proposed decision stopping integration

LHIN Considers any submissions; may change or confirm proposed

integration decision

LHIN does not issue a final decision stopping integration

LHIN issues a final decision stopping integration

Integration may proceed

Integration may proceed Integration may NOT proceed

Within 60 Days

Within 30 days, anyone may make submissions regarding proposed decision, including

Task Group/Networks

LHIN Collaborative

Health Service ProviderWithin 30 Days

See Scenario 3 for generation of such opportunities

Together, we will deliver change!

The costs of competition are greater than….

…the costs of cooperation!

N = Network!!

• Identifying and implementing change is our collective responsibility

• Your LHIN is committed to removing the barriers that keep all of us from working and achieving together (that is, acting as a Network).

• To do so requires a plan and a commitment to building capacity for integration and cooperation across the system.

Look Around You – Feel Empowered!• You are members of new teams with new

mandates!

• Collectively, your talent and motivation is unparalleled!

• Replace self-doubt and permission-seeking with confidence and courage!

• Forget perfection – you are it!

Together, we are unstoppable!