Haliburton Highlands Health Services – Integration Journey Presentation to Temiskaming Hospital

September 2015

Agenda

1. Haliburton County

2. Integration Journey – Phase 1 (Planning)

3. Integration Journey – Phase 2 (Transition / Implementation)

4. Integration Journey – Phase 3 (Longer Term / Future) 2

Haliburton County Geography

Most northerly region of CE LHIN Large rural geography (4000 sq. km.)

with dispersed small population (17,000)

The Haliburton Minden sub-cluster is made up of four Census Subdivisions defined by Statistics Canada: Algonquin Highlands Dysart et al Minden Hills Highlands East

Haliburton County Population • Smallest population sub-LHIN region but highest population

growth (as % of total population) within the North East Cluster of CE LHIN (including Peterborough, Kawartha Lakes and Northumberland County).

• Highest % of seniors, and the lowest proportion of individuals 0-24 in Central East LHIN; 28% proportion of seniors 65+ (above 15% LHIN and Ontario averages)

• Expected growth - residents aged 65+ are 36% by 2025 and 41% by 2035.

• 12% proportion of persons aged 75+ is also highest compared to other Sub-LHIN Regions of North East Cluster and Central East LHIN (10%) and Ontario Average (6%).

Haliburton County Population Health Status • Higher rate of arthritis, asthma, diabetes, high blood pressure, cancer,

and COPD than both CE LHIN and Ontario averages.

• The CE LHIN average is also higher than the Ontario average for all of these chronic conditions with the exception of cancer.

• Deaths per 100,000 are higher in Haliburton County and the North East Cluster for all conditions for which data is available on the CE LHIN, and Ontario. • This includes from cancers, circulatory diseases, ischaemic heart

diseases and respiratory diseases.

• Furthermore, while residents of the region have a self-perceived feeling of good health that is in line with the CE LHIN average, the average life expectancy is below both the CE LHIN and Ontario averages at birth and age 65.

Phase 1: CE LHIN Community Health Services Integration Strategy (2012)

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 County and Haliburton County/City of Kawartha Lakes planning processes 6

Phase 1: Haliburton / Kawartha Lakes Integration Planning 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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Phase 1: Integration Planning – Haliburton County /Kawartha Lakes January 2013: Integration Planning Team (IPT) formed to include

Executive Directors of CE LHIN-funded health services organizations in Haliburton County and City of Kawartha Lakes • Mandate to develop an integration plan

January – May 2013: Weekly meetings of IPT • Commissioned literature review of rural health models • Determined decision-making criteria to evaluate models • Evaluated models from status quo to single organization across the two

communities • Recommended model to include two health services providers in Kawartha

Lakes and “one entity” in Haliburton County June – July 2013: Community consultations with other health services

agencies (EMS, CMHA, Ontario Shores, CCAC, FHTs) and general public/clients

September 2013: Finalized draft Integration Plan October – November 2013: All Boards approve Integration Plan December 2013: Haliburton County / Kawartha Lakes Health Services

Integration Plan was presented and approved by the CE LHIN Board

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Current State – Future State

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Phase 1: Integration Recommendations Haliburton County Voluntary merger between Community Care Haliburton County

and Haliburton Highlands Health Services “One Entity” to deliver hospice/palliative services provided by

SIRCH and Adult Day Program services provided 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 agencies,

with their own boards, programs and services, but would no longer have an Accountability Agreement with the CE LHIN

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 10

Phase 1: Strategic Alliance between Ross Memorial Hospital and Haliburton Highlands Health Services Criteria for pursuing shared service opportunities included, quality

improvement, service enhancement and/or cost savings 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 • Exploring more back-office integration

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Phase 1: Benefits of “One Entity” in Haliburton County Local autonomy and local management over Haliburton

County health 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

Improved continuum of care and transitions of care 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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Phase 2: Transition Planning for Haliburton County January 2014: Discussions began between Community Care Haliburton County

and HHHS related to their amalgamation and more specifically about the governance structure for the amalgamated organization with decision to have HHHS be the “one entity organization

February 2014: 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 (weekly meetings) Integration transition project plan developed by Transition Team to address:

• Governance, • Communication • Human Resources • Volunteers • Clients • Finances/Budget and Fundraising • Facilities

April 2014: Directional Plan approved by all Boards May 2014: Transition Plan complete with October 1, 2014 set and approved as

Transition Date June 2014: Central East LHIN Board approved Transition Plan July – September 2014: Continued focus on project tasks leading to Transition

Date October 1, 2014: Staff, volunteers, clients, programs, funding and accountability

agreements transferred to HHHS

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Phase 2: 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 “One Entity” would be HHHS and Community Care Haliburton County would wind-down as a corporation following the transfer of the community services on October 1, 2014

To facilitate implementation of the Governance Plan, vacancies on the HHHS Board were 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

Recommended development of Community Advisory Committee to give a “Voice” to community support services providers and clients

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Phase 2: Governance Progress June 2014: HHHS Board (including nominated Directors from the

Community Care Board) held a Strategic Planning session, as part of the process to develop a new Plan, to determine HHHS priorities for 2014/17

August 2014: Full-day Board orientation session held for all HHHS Board, including the new Directors from the Community Care Board, with an agenda to educate all about HHHS services and the new transferred services: • HHHS Governance – Model, Committee Structure, Policies • CE LHIN / Ministry of Health and Long-Term Care – Mandates, Priorities,

Relationship to HHHS, Capital Process, Governing Legislation • Financial Management – Budgeting, Reporting, Financial Statements, Capital

Budgets • Overview of Hospital Services – ED, Acute and Palliative Care, Physiotherapy,

OTN • Overview of Long-Term Care Services – Hyland Crest, Highland Wood • Overview of Community Services – Supportive Housing, Diabetes Education,

Community Support Services, Hospice, Adult Day Programs, Mental Health Services

• HHHS Partners – Ross Memorial Hospital, Family Health Team, CCAC, EMS Note: The afternoon of the Board Orientation day was a follow-up session for Strategic Planning to present the draft Strategic Plan (and then a social at a Board member’s cottage since we are located in cottage country)

September 2014: Strategic Plan 2014-2017 was approved

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New STRATEGIC PLAN 2014-2017 Integration Opportunities Improve Care Coordination IT Integration

Community Engagement & Communication Plan Community Advisory Committee (CAC)

Recruitment & Retention Enhance Communication

Seasonal Residents Plan Long Term Plan Annual Operating Plan

Improve the quality of services and access across the continuum

Phase 2: Governance Progress

Phase 2: Governance Lessons Learned Local autonomy and local management over Haliburton County Health

services (versus governance and management from Kawartha Lakes) was important for the all Haliburton County Boards, so it became a common rallying point • Development of a Strategic Alliance and operational integration initiatives

between Ross Memorial Hospital and HHHS was supported by the HHHS Board because it did not impact on local autonomy

Recognition that HHHS was perceived as the large hospital with a medical culture that would swallow up the small community agencies in Haliburton County, so bent over backwards to be respectful of the differences of approach to governance and accommodating to the input of the smaller community agencies throughout integration

Bringing on members from the Community Care Board to the HHHS Board facilitated the transition of services

Full Board orientation was important to educate HHHS Board members about the community services being transferred into the organization, as well as for the new members from Community Care about HHHS services

The creation of the Community Advisory Committee as a sub-committee of the Board was perceived favorably by community agencies and the public

Ongoing support to CEO and leadership team regarding integration

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Phase 2: Integration Lessons Learned Leadership: critical to success; need positivity, commitment, persistence and focus

on what is best for community from the Board(s) and executives

Project Management Resources: should include dedicated project management support, if possible, rather than adding stress to operational responsibilities of CEO and Management Team

Communication/Community Engagement: should be done regularly and consistently (never enough) with all internal and external stakeholders who would be directly impacted as well as general public, using a detailed Communication Plan

Change Management: integration is not easy and one must not underestimate organizational anxiety and upheavals that may result, including staff/management departures; so need to have a comprehensive change management plan that includes significant communication, education

LHIN Direction and Support: strong and ongoing support is needed from the LHIN to initiate and facilitate integration planning, including providing additional resources if required

Integration Has Benefits: alignment to LHIN / Provincial strategies yields organizational benefits; for example, Community Services Enhancements and funding

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Phase 3: Long Term / Future Planning The 2014/2017 Strategic Plan highlights Health System Integration as

one of five strategic directions for HHHS over the next several years to build on the community services integration

HHHS will strive to further develop as a comprehensive Rural Health Hub over the next several years to become the model for the Province CCAC Services? FHT? EMS?

HHHS will leverage its integrated organizational structure and continue to improve quality, transitions of care and enhance the range of services to meet the needs of full-time and seasonal residents and visitors of Haliburton County

Palliative / End-of-Life Care is first integrated program which includes: Single Manager for Palliative / Hospice Care Inpatient Palliative Care Suite (planned expansion to 2 palliative rooms and

family areas) Palliative Care Community Team Community Hospice Program Palliative Steering Committee which includes HHHS, HHFHT, CE CCAC,

contracted CCAC providers, regional Palliative Pain and Symptom Control Coordinator

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Phase 3: Long Term / Future Planning

HHHS has set an objective to develop a Master Program and Master Plan for the next 5-10-15 year timeframe to meet the needs of a proportionately large and growing seniors population that has higher than average complex health issues • Master Program will define what programs and services will be

required to meet the future health needs • Master Plan will determine what facilities, including alterations,

additions and rationalization across sites, may be required to carry out the Master Program

Discussions have been initiated with the Board and local municipal leaders about Master Programming and Master Planning The CE LHIN has been approached to support Phase 3 of our

integration journey 20

Minden Hospital / Hyland Crest Long-Term Care Home

Haliburton Hospital / Highland Wood Long-Term Care Home

Community Support Services

Supportive Housing Offices:

Haliburton, Minden, Wilberforce

What we have become…

Mental Health Services

Leaders in Innovative Rural Health Care

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Questions

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