Final Integration Plan

Hospital and Community Health Services

Integration - Haliburton County and the City of

Kawartha Lakes

A facilitated integration process of the Central East Local Health Integration Network

November 11, 2013

Integration Planning Team Membership

The Integration Planning Team membership was comprised of senior leadership representatives from the participating organizations supported by a Facilitator. Staff from the Central East LHIN served as project support.

Name Organization

Doreen Anderson-Roy, Manager of External Relations & Administration, Community Support Services

Victorian Order of Nurses -Peterborough, Victoria, Haliburton

Catherine Danbrook, Chief Executive Officer Community Care City of Kawartha Lakes

Varouj Eskedjian, President and CEO Haliburton Highlands Health Services

Brian Payne, President and CEO Ross Memorial Hospital

Gena Robertson, Executive Director Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Maureen Ruttig, Executive Director Community Care Haliburton County

Kate Reed, Team Lead, Implementation and Integration

Central East LHIN

Katie Cronin-Wood, Communications Lead Central East LHIN

Ritva Gallant, Team Lead, Financial and Risk Management

Central East LHIN

Laura Wise, Health Planner Central East LHIN

Lynn Huizer, Facilitator

Table of Contents Integration Planning Team Membership...................................................................................................... Table of Contents ......................................................................................................................................... Executive Summary ...................................................................................................................................... i 1. Preparing for Integration ............................................................................................................... 1

1.1 The Community Health Services Integration Strategy ................................................................... 1

1.2 Evolution of the Community Health Services Strategy .................................................................. 2

1.3 The Hospital and Community Health Services Integration Planning Process in Haliburton

County/City of Kawartha Lakes ...................................................................................................... 4

2. Demographics and Context for Haliburton County and City of Kawartha Lakes ............................. 6 2.1 Haliburton County .......................................................................................................................... 6

2.2 The City of Kawartha Lakes (CKL) .................................................................................................... 7

3. Current State of Hospital and Community Services ....................................................................... 7 4. Identification of Integration Opportunities .................................................................................. 10

4.1 Evaluation Criteria ........................................................................................................................ 10

4.2 Analysis Process.................................................................................................................................. 11

4.3 Developing the Models ................................................................................................................. 11

4.3.1 Governance Models ............................................................................................................ 11

4.3.1.1. One Entity in Haliburton County ..................................................................................... 12

4.3.1.2. Confirmation of Two Entities in the City of Kawartha Lakes ............................................ 13

4.3.2 Service Realignment Models ........................................................................................... 14

4.3.2.1 Hospice/Palliative Care Services ............................................................................................... 14

4.3.2.2. Adult Day Services and Acquired Brain Injury Day Services ..................................................... 15

4.3.2.3. Volunteer Coordination ........................................................................................................... 15

4.3.2.4 Strategic Alliance between HHHS and RMH .............................................................................. 16

4.4 Economic Impact.......................................................................................................................... 18

4.5 Future Integrated Governance and Service Delivery Model ........................................................... 19

5. Communications and Stakeholder Engagement .......................................................................... 22 6. Transition Planning ...................................................................................................................... 24 7. Conclusion.................................................................................................................................... 26 8. Appendices .................................................................................................................................. 27

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Executive Summary

This Hospital and Community Health Services Integration Plan provides the information required by the Boards of the six organizations who participated in the facilitated integration process in Haliburton County/City of Kawartha Lakes and the Central East Local Health Integration Network (Central East LHIN) Board to make an informed decision on the proposed integration measures impacting LHIN-funded hospital and community-based health services in these areas.

The six organizations participating in the facilitated integration process include:

Community Care Haliburton County (CCHC)

Community Care City of Kawartha Lakes (CCCKL)

Supportive Initiatives for the Residents of the County of Haliburton (SIRCH)

VON Canada, Ontario Branch, Peterborough Victoria Haliburton (VON)

Haliburton Highlands Health Services (HHHS)

Ross Memorial Hospital (RMH)

The six organizations based their work on the aims first articulated in the LHIN’s Community Health Services Integration Strategy that was launched in February 2012, specifically to design and implement cluster-based service delivery models 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 and, • make the best use of the public’s investment.

An Integration Planning Team (IPT), representing all participating organizations, was responsible for the development of the Integration Plan. A Terms of Reference (see Appendix A) and a set of Principles (see Appendix B) to guide the facilitated integration process were established at the onset of the process.

As part of the process, the IPT carried out their due diligence in understanding the history and current state of the participating organizations. Various models of “future state” governance and service delivery were explored and evaluated using a standard set of evaluation criteria. Boards of Governors were kept apprised of the planning work of the IPT and their feedback was solicited throughout the process. Targeted stakeholders and the broader community were also engaged to share their thoughts on a preferred DRAFT Integrated Governance and Service Delivery Model that proposed a “three-entity” model for the delivery of LHIN-funded hospital and community services in Haliburton County and the City of Kawartha Lakes.

Based on this due diligence and engagement, the IPT recommends the following integration opportunities:

One Entity in Haliburton County The creation of One Entity (one organization) in Haliburton County for the delivery of LHIN-funded hospital and community based services would be achieved through a voluntary merger between CCHC and HHHS. It would include the transfer into the One Entity of the accountability to deliver hospice/palliative care services currently provided by SIRCH and Adult Day Program services currently provided by VON. In addition, the accountability for coordinating Foot Care services in Haliburton County would be transferred from VON to the One Entity.

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Confirmation of Two Entities in the City of Kawartha Lakes In the City of Kawartha Lakes, two existing entities (two existing organizations) involved in the integration process –RMH and CCCKL – would retain their own governance and leadership as they continue to deliver their existing services. However, the accountability for delivering Adult Day Program services (primarily for seniors) in the City of Kawartha Lakes would be transferred from VON to CCCKL. Accountability for Adult Day Programming for individuals with an acquired brain injury would transfer to Four Counties Brain Injury Association from VON. A more formal Partnership/Memorandum of Understanding for any future hospice/palliative care services would be created between RMH and CCCKL.

Volunteer Coordination SIRCH would explore a new model for volunteer recruitment (VolunteerMatch) in Haliburton County. As a pilot project, SIRCH could be contracted by the One Entity (and other organizations) to recruit, screen and orient new volunteers and offer additional services to organizations coordinating volunteers, thus reducing duplication and leading to a "one-stop-shop" for volunteers.

Strategic Alliance between Haliburton Highlands Health Services and Ross Memorial Hospital HHHS and RMH already share a variety of services and have now created a Strategic Alliance that has resulted in the identification of a number of additional back office and leadership initiatives. Additional opportunities are continuing to be explored and opportunities to expand these kinds of initiatives to other community organizations will be investigated.

Small Rural Northern Hospital Transformation Fund (SRNHTF) Funding received from the government through the SRNHTF has supported the hospitals in realizing a number of initiatives that have now been included in this Integration Plan and could be used as a catalyst for future integration activities. The Strategic Alliance initiatives that have been supported by the SRNHTF are summarized below:

Information Technology/Management and Communications

A shared IT department and communications network would be established between the One Entity in Haliburton County and RMH.

Procurement The expansion of a shared inventory management system led by RMH would allow RMH to assume the responsibility for procurement for the One Entity in Haliburton County.

Pharmacy RMH would provide pharmacy services for the One Entity in Haliburton County to support the hospital and emergency departments.

Mental Health Services RMH and the One Entity in Haliburton County would jointly recruit a single Mental Health Director to establish a regionally integrated Mental Health program.

Diagnostic Imaging (DI) RMH would provide DI leadership to the One Entity to oversee the expansion of diagnostic imaging services in Haliburton County.

Cardiac Rehabilitation RMH is committed to working collaboratively with providers in Haliburton County, including HHHS and the Haliburton Highlands Family Health Team, in order to improve access to high quality cardiac rehabilitation programming.

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Adult Day

Programs

Long-Term Care

Supportive

Housing

Hospice/

Palliative

Services

Community

Support

Services

Hospital Inpatient and Outpatient

Services

Hospital Inpatient and Outpatient

Services

Community

Support

Services

Community

Health Centre

Supportive

Housing

Hospice/

Palliative

Services

Adult Day

Programs

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Future State – Services and Access

As the following diagrams illustrate, clients currently receive LHIN-funded services through a number of “doors.” In the proposed future state, the intent is to streamline the number of “doors” individuals need to enter in order to receive service. The expectation is that the patient/client experience would be improved through a better alignment of services, there would be improved access to high quality services through enhanced standardization, there would be a better understanding for the public and providers alike of what services are available and streamlined processes would be in place to assist with navigating the system. Ultimately, Haliburton County and the City of Kawartha Lakes would be better positioned to meet the needs of the residents into the future as demands for services increase.

CURRENT STATE

HALIBURTON

COUNTY

CITY OF

KAWARTHA

LAKES

Supportive Initiatives

for the Residents of

Haliburton County (SIRCH)

Victorian Order

of Nurses (VON)

Community Care

Haliburton County (CCHC)

Haliburton Highlands Health Services (HHHS)

Ross Memorial Hospital (RMH)

Community Care

City of Kawartha Lakes (CCCKL)

Victorian Order of Nurses (VON)

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Potential Savings for Reinvestment The IPT conducted a financial analysis of all possible integration opportunities as they developed their models and recommendations.

In the City of Kawartha Lakes, the confirmation of the two existing entities does not realize significant savings at the present time and in fact, an analysis of a potential merger between RMH and CCCKL revealed the significant cost that would be incurred if the two organizations merged into a new entity. However, it should be acknowledged that since 1985, significant integration, and the associated savings, improved access and efficiencies, has already occurred in the community sector in the City of Kawartha Lakes with the integration of Community Support Services, the Community Health Centre, Hospice Kawartha Lakes and Community Care Village Housing being merged under the leadership of CCCKL.

Under the models being recommended in this Integration Plan, the potential savings would be derived primarily through the integration of back office supports in Haliburton County. The IPT estimates that approximately $113,000 could be saved on an annual basis and reinvested, specifically in Haliburton County, should HHHS and CCHC voluntarily merge into One Entity and take on the accountability for hospice/palliative care and adult day programs currently delivered by SIRCH and VON respectively.

With the goal of retaining and leveraging the skills of existing staff, the implementation of the One Entity in Haliburton County will require using some of the savings to support equity in staff compensation, future training and development. The IPT recognizes that this investment would support the goal of providing consistent standards and high quality in the delivery of services to local residents. An expectation of the integration is that the current service levels would be maintained and wherever possible, additional savings would be invested in providing more front-line services.

Stakeholder Engagement

Throughout the facilitated integration process, the IPT ensured that they were updating their stakeholders on the process, outcomes achieved to date and next steps at every opportunity.

This included providing information to their stakeholders at all of their open board meetings, staff town halls, volunteer and client meetings. The Central East LHIN website was the central repository for monthly bulletins and the information was repurposed in each of the organizations newsletters and on their websites. News releases were distributed to the local media and updates sent to local elected officials to keep everyone informed.

Targeted engagement with health and social service partners assisted the development of a DRAFT Integrated Governance and Service Delivery Model. Broad engagement with staff, clients and their caregivers, local residents and other health service partners resulted in 111 survey responses.

Several common themes emerged including:

Change Management/Communications

Improved Access The importance of local decision making

Impact on Volunteers and Staff

In reviewing the feedback, the IPT recognized the importance of continuing to communicate and engage with local community residents, clients/consumers/patients and their caregivers, local

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government leaders, staff, volunteers, other health and social service providers and the media. This will be of critical importance during the transition planning required prior to implementation of the integration plan

Transition Planning

The IPT has identified several strategies to support the successful transition toward the creation of One Entity in Haliburton. The strategies include:

• Establishing an advisory committee with representation of all integrating

organizations to support the transition

• Developing principles to guide the transition • Creating a cohesive implementation and communication strategy to ensure Boards, staff,

volunteers and the larger community understand the integration and are kept informed of the process

• Determining a governance and service delivery structure for the One Entity

• Creating a strategic plan to integrate cultures

• Addressing human resources, labour harmonization and union transition issues

• Minimizing transition costs

In the City of Kawartha Lakes the transition of accountability for Adult Day Services will consider coordination with existing services with no service interruption. A clear communication strategy will be provided to ensure the community and clients are aware of how to access services when needed and to support community and client awareness of the change in service providers.

The IPT recognizes that one-time transition costs will be incurred, such as legal and human resources, as a result of the development of the One Entity in Haliburton County. It is anticipated that these costs will be minimal and, with more detailed transition planning, increased savings could be realized. Every effort will be made to implement the transition activities in a way that is timely and minimizes transition costs. Some of the transition costs could be funded by the Small Rural Northern Hospital Transformation Fund.

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1. Preparing for Integration

1.1 The Community Health Services Integration Strategy

On February 22, 2012, the Central East LHIN Board of Directors approved a Community Health Services (CHS) Integration Strategy to address demographic pressures, adjust to changing expectations of patients and families and to meet provincial expectations on improving access, quality and value for money.

The Strategic Aim for the Community Health Services integration was to design and implement a geographic-based service delivery model for Community Support Services (CSS) and Community Health Centre (CHC) agencies by 2015 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, and

• make the best use of the public’s investment.

Community Support Services (CSS) help clients maintain their safety and independence while living at home and are delivered in the home and /or in locations around a client’s community. CHCs provide primary health and health promotion programs for individuals, families and communities. CHCs work with individuals, families and communities to strengthen their capacity to take more responsibility for their health and wellbeing. In addition, some hospitals provide CSS programs in their hospital locations. This includes Haliburton Highlands Health Services.

In launching the strategy, the LHIN identified a number of Group 1 agencies that would be directed to participate in the facilitated integration process in each of the clusters. Group 1 agencies included those single or multi-service health service providers (HSPs) who provided services within a clearly defined region within the Central East LHIN (including LHIN services provided through municipalities.) The integration planning began with this group based on the LHIN’s determination that integration would most likely achieve the greatest return on investment.

Agencies that were categorized as Group 2 (HSPs with broader affiliations – cross LHIN, provincial, national) and Group 3 (serving multiple LHIN clusters or a specific client population) were to be included in later phases of the strategy although they could request to be included in the early timing. The Central East Community Care Access Centre, which has a single governance structure for the Central East region was not included in the CHS Integration Strategy.

The Community Health Services Integration Strategy recognized that in the Central East LHIN:

• The population is aging with increasing prevalence of chronic disease and mental illness;

• The consumer is informed and expects a customer-driven approach to the health care experience with attention provided to improving the client and caregiver’s healthcare journey;

• There is a shift in the healthcare delivery system to improve patient outcomes and access to care, and toward support for health promotion and wellness;

• The need to meet the healthcare needs of communities within available and sustainable resources - maximizing customer value for money invested;

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• The current service delivery system must change to achieve the objectives of the Excellent Care for All Act (2010), the Minister of Health and Long-Term Care’s Action Plan (January 2012), areas for improvement identified in the Drummond Report (February 2012) and the 2012 Ontario Budget (March 2012).

In addition, the integration strategy is intended to reduce risks currently facing the community health services sector such as:

Governance: Sustaining governance and succession of small organizations and enabling stronger system stewardship.

Management and Back Office: Stretched/sub-optimal operational supports to management (HR planning, IT investment) which limits the sector’s ability to identify, monitor and achieve improved performance.

Fundraising and Volunteering: Over-reliance on fund-raising and volunteerism puts key

services at risk. Significant infrastructure is required to support both.

Human Resources Planning: Challenges in recruitment and retention of the skill mix required

to deliver services.

Client Services: Challenges related to any of the above create direct challenges to client

services. This has been the consistent example of all of the Central East LHIN integrations to

date.

The implementation of the CHS Integration Strategy process started with 10 Durham Cluster agencies in April 2012.

In May 2012, the Haliburton County process began with participation from HHHS, SIRCH and CCHC. However, it was recognized that Haliburton County was unique to other parts of the Central East LHIN, because of its relative geographic isolation, distinct population and socio- economic realities and that these differences presented a unique opportunity in Haliburton County to create a comprehensive, integrated service delivery system that included primary care, hospital services, and community-based health care. As a result, two critical partners, the Central East Community Care Access Centre and the Haliburton Highlands Family Health Team were included on the Haliburton County IPT because of their significant contribution to service delivery to local residents.

1.2 Evolution of the Community Health Services Strategy

Just as governance and service delivery models were being contemplated by the Haliburton County IPT, developments at the provincial level required adaptation of the Central East LHIN Community Health Services (CHS) Integration Strategy. These developments included the introduction of Health Links and the Small Rural Northern Hospital Transformation Fund (SRNHTF).

Health Links In the summer of 2012, the province introduced a new model of care called “Health Links” where, at the clinical level, all providers in a community, including primary care, hospital and community care are charged with coordinating plans at the patient level. While Health Links will look different in every region, they will be based on a sound framework with specific principles consistent across the province to ensure provincial goals and outcomes are prioritized:

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• Person-centred planning with strong mechanisms in place for the patient voice to be heard; • Build on existing delivery organizations and leverage current capacity and best practices;

• Representation across sectors with joint accountability for attainment of results;

• Common targets and metrics; • Evaluation built in from the start; and

• Funding remains flexible to ensure resources are focused where they can be used to deliver results.

Small Rural and Northern Hospital Transformation Fund

In 2012-13, the government provided $20M in one-time funding to small, rural and northern hospitals across the province. In the Central East LHIN, $989,900 was allocated to the two designated small and rural hospitals - Campbellford Memorial Hospital (CMH) and HHHS.

The objective of the fund is to improve the collaboration between small and rural hospitals and community services to create integrated networks. The fund is intended to:

Ensure patient access to core acute care services, including Emergency Department, surgical,

medical and obstetrical care;

Ensure collaboration with community services, including primary care, home care, mental health and addiction services and community support services;

Respond to community needs for post-acute care and palliative services, as appropriate; and,

Improve the quality and safety of services for patients and ensure good value for money.

This funding provided an opportunity to support:

1. The CHS integration planning work, as well as

2. The hospital integration projects that were being initiated between RMH/HHHS. It also served as a catalyst to other integration opportunities by removing implementation cost barriers.

Hospital and Community Health Services Integration Strategy

The Health Links initiative and funding to support Small Rural and Northern hospitals precipitated the need to adjust the Community Health Services Integration Strategy. On November 28, 2012, the Central East LHIN Board of Directors approved a plan to combine all three complimentary initiatives - the Community Health Services Integration Strategy, Health Links, and the Small, Rural and Northern Hospitals Transformation Fund. The plan demonstrated how the three initiatives could converge and result in an effective execution strategy that would still achieve the LHIN’s goal and long-term vision of the redesign of the health care system.

An additional consideration that required an adjustment in the strategy was that the minimum population threshold for a Health Link requires that the City of Kawartha Lakes be included with Haliburton County. Clinical linkages without Community Support Services linkages could represent future obstacles for effective integration of clinical services. Consideration of Community Health Services integration should therefore include both Haliburton County and City of Kawartha Lakes.

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Therefore, the Haliburton County integration process was broadened to include the City of Kawartha Lakes and the IPT was reconstituted to include Community Care City of Kawartha Lakes, Ross Memorial Hospital and VON.

While the Central East Community Care Access Centre and Haliburton Highlands Family Health Team were no longer required to participate, it was recognized that their input as stakeholders was important in the development of any DRAFT models. The importance of the participation of these two partners in the establishment of a future Health Link in the area was also deemed critical.

In providing the Small, Rural and Northern Hospitals funding to HHHS, the Central East LHIN stipulated that the funds were available to promote the outcomes of the facilitated integration process, given the obvious synergies between the intent of the fund and the re-defined process that was now to be launched in Haliburton County/City of Kawartha Lakes.

1.3 The Hospital and Community Health Services Integration Planning Process in Haliburton County/City of Kawartha Lakes

With the re-launched process underway in January 2013, senior leadership from the following

organizations formed the Haliburton County/City of Kawartha Lakes IPT and began to meet on a weekly

basis to develop the integration plan:

Community Care Haliburton County (CCHC) Community Care City of Kawartha Lakes (CCCKL) Supportive Initiatives for the Residents of the County of Haliburton (SIRCH) VON Canada, Ontario Branch, Peterborough Victoria Haliburton (VON) Haliburton Highlands Health Services (HHHS) Ross Memorial Hospital (RMH)

To review the IPT Terms of Reference, see Appendix A.

The work of the IPT focused on understanding the current state of services, identifying gaps and barriers in service delivery, analyzing options for the design of integrated services, engaging governors, stakeholders and the community for input, identifying risks and mitigation strategies and the development and implementation of a communications and community engagement strategy.

Principles Guiding Integration

To support the facilitated integration, the Central East LHIN sought consensus with the six organizations on a set of foundational Principles to guide the integration process, dialogue and outcomes undertaken with the participating organizations. All parties recognized at the onset of the process that specific details, strategies and tactics supporting integration would evolve throughout the process and that the Principles were intended as foundational guides, subject to revision only with the support of all parties. The full set of Principles agreed to by all parties is included in Appendix B.

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Role of the Governors

The IPT members were supported by a board member from each organization. This “Governance Liaison” position was the IPT member’s central point of contact, from a governance perspective, for the integration process and participated as required in check-in meetings and was responsible for sharing the team’s progress with their respective boards.

Implementation Planning Team Process

The process of developing this integration plan proceeded along the following critical path:

Critical Project Path Date

Kick-Off for HSP Governors January 11, 2013

Develop Preliminary Project Schedule January 2013 Approve Principles, Establish Planning Team, Approve Terms of Reference February 2013

SRNHTF Plan and Submission to MOHLTC February 2013

Governors Update #1 February 2013

Literature Review April 2013

Current State Development April 2013

Options Analysis Apr 26, 2013

Governors Update #2 May 2013

Stakeholder/Community/Government Relations Engagement (Targeted and Broad) #1 June 2013

Integrated Model Options Determined June 21, 2013

Governors Update #3 July 2013

DRAFT Integrated Governance and Service Delivery Model August 2013

Governors Update #4 September 2013

Stakeholder Engagement (Targeted and Broad) #2 September- October 2013

FINAL Integration Plan November 11, 2013

Decision on Integration Plan –Boards and Membership

Up to and including December 5, 2013

Decision on Integration Plan – Central East LHIN Board December 18, 2013

SRNHTF Final Report to MOHLTC December 2013

Transition Planning and Implementation January 2014 – March 2015

Integration Implementation Complete April 1, 2015

Legend Approval Milestones Updates for Governors Central East LHIN/Planning Team Activities

Stakeholder Engagement

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Literature Review

As part of the facilitated integration process, the Haliburton County/City of Kawartha Lakes Integration Planning Team (in partnership with the Northumberland County Integration Planning Team) commissioned a literature review to document the evidence base on regional rural health service delivery models. Specifically, the team was looking for evidence that integration-type activities improve client access to high-quality services, create readiness for future health system transformation, and make the best use of the public’s investment. The review identified, analyzed and compared various service delivery models supporting small, rural hospitals and community integrations from other jurisdictions. All authors writing on the subject agreed that there are unique challenges to delivering health services in rural areas. These challenges “foster a prime environment for inventiveness,” and make it possible for smaller hospitals, community health centres and community support service providers to be “more innovative in overcoming the challenges of providing comprehensive and coordinated health care to residents.”

Some of the success factors for integration of rural health services include:

Effective Leadership

Financial Incentives - transitions and on-going

Information and Communication Technology, and mobile / point-of-service technologies

Flexibility among integrated institutions

Adequate workforce Localresources/expertise/support

Evaluation/measurement system

Implementation of change management strategies was seen as necessary for organizations to build trust as organizational cultures are not easily changed. Therefore, ensuring enough time is allowed to gain full commitment to patient-centered care is recommended with strong, committed leadership at all levels to address concerns/anxieties of the workforce. The full literature review and compendium documents can be found at:

http://www.centraleastlhin.on.ca/uploadedFiles/Public_Community/PRIVATE/Central_East_LHIN_L iterature_Review_Overview_of_Key_Findings.pdf

2. Demographics and Context for Haliburton County and City of Kawartha Lakes

2.1 Haliburton County

Haliburton County is comprised of several rural municipalities including Algonquin Highlands, Dysart et al, Minden Hills and Highlands East. According to the 2011 Census, Haliburton County has a population of 17,026. It is recognized that the population more than doubles in the summer months to over 40,000 with an influx of vacationers. Of the permanent population, approximately 50% are over the age of 50 with 25% of the population being over 65 years of age.

Haliburton County has two larger towns, Minden and Haliburton. The balance of the population is dispersed across the rest of the County. Given the County covers approximately 4,071 square kilometers, the population density is very low, creating challenges for accessing services. While many organizations “visit” the County to provide service, there are few that actually call Haliburton County their “home base.” This also creates some disparities in access to service.

2.2 The City of Kawartha Lakes (CKL)

The City of Kawartha Lakes also has a very geographically dispersed population of 73,214 people residing

across 3,067 square kilometres. Lindsay is the one large urban centre and is home to approximately 25% of

the CKL population. There are several small towns and communities within CKL including Bobcaygeon,

Fenelon Falls, and Omemee. Similar to Haliburton County, the summer sees an influx of a large number of

seasonal residents.

The residents of the City of Kawartha Lakes are slightly younger than Haliburton County with 42% of the

population over 50 years of age and 21% over the age of 65 years. Similar to Haliburton County, there

are challenges in accessing services.

3. Current State of Hospital and Community Services

Each of the six agencies involved in this facilitated integration process have a long and successful history of providing services to their local residents.

Together, they provide a wide variety of acute care, long-term care, primary care and community-based support services from locations across Haliburton County and the City of Kawartha Lakes and spend over $115 million annually to deliver services of which over 70% or $81 million is provided by the Central East LHIN. Other funding from provincial government programs, service billings, grants, fundraising activities and donations make up the funding difference. Below is an overview of the services provided by the organizations. For a more detailed description of services provided by each organization see Appendix C for the History of Organizations and the Current Service Summary.

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Refe

rral

So

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es

(L

ong

-Te

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are

, H

ospital, C

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The diagram below illustrates the “doors” that people currently go through to receive LHIN-funded hospital and community services delivered in Haliburton County/City of Kawartha Lakes. Clients can receive a range of hospital and community services through a variety of referral sources. The categories of services have been grouped into Adult Day Programs, Long Term Care, Supportive Housing, Hospice/Palliative Services, Community Support Services and Hospital Inpatient and Outpatient Services.

CURRENT STATE

HALIBURTON

COUNTY

Supportive Initiatives

for the Residents of

Haliburton County (SIRCH)

Victorian Order

of Nurses (VON)

Community Care

Haliburton County

(CCHC)

Haliburton

Highlands Health

Services (HHHS)

Adult Day

Programs

Long-Term Care

Supportive

Housing

Hospice/

Palliative

Services

Community

Support

Services

Hospital Inpatient and Outpatient

Services

Hospital Inpatient

and Outpatient Services

Ross Memorial

Hospital (RMH)

Community Care

City of Kawartha

Lakes (CCCKL)

Community

Support

Services

Community

Health Centre

Supportive

Housing

CITY OF

KAWARTHA

LAKES

Victorian Order

of Nurses (VON) Hospice/

Palliative

Services

Adult Day

Programs

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4. Identification of Integration Opportunities

4.1 Evaluation Criteria

As a first step in preparing for the analysis of options for integration, the IPT identified decision making criteria that could be used to evaluate any integration options by mapping the guiding Principles for the facilitated integration process to the PAN LHIN Priority Setting & Decision Making Framework Toolkit.

The PAN LHIN Priority Setting and Decision Making Framework is a common toolkit used across all LHINs and has a consistent set of criteria to facilitate transparency and accountability to support priority setting and decision making processes. For the full Pan LHIN Decision Making Toolkit, please visit the LHIN web site at www.centraleastlhin.on.ca. and click on “Resource Documents – Planning – Decision Making Framework/Health Equity Assessment.”

Below is the decision making criteria used by the IPT to evaluate the integration options. See Appendix D for the full evaluation criteria with explanations.

Decision-making Step Decision-making Criteria Description

Compliance Screen Legislative Barriers Are there legislative barriers that would prevent implementation? Compliance Screen Strategic Alignment Does the option align with the strategic direction of the Province

and the LHIN's Integrated Health Service Plan including: Community First Seniors: save 320,000 LTC days Vascular: 25, 000 more vascular days at home/ in the community Palliative: 12, 000 more palliative days at home/ in the community MH&A: 15, 000 more MH&A days at home/ in the community

Decision Criteria Economics & Cost Realignment Is the option going to increase value for the key stakeholders, the public? Will costs be reduced allowing for more efficient service provision and/or the movement of funds to front-line services?

Decision Criteria Quality Will HSPs continue to provide services that are of consistent standards and high quality to clients? Will quality decline?

Decision Criteria Service enhancement including: - increasing access -ensuring equitable access -improving population health -avoiding service redundancy -reducing a gap

Will changes improve/ equalize access to services, enhance the health of the population, result in the provision of services, fill an unmet need or reduce the number of providers offering a similar service? Would services decline?

Decision Criteria Client Experience & Continuity of Care Which option will best meet clients' needs and minimize service disruption? Will continuity across the continuum of care be improved or hampered?

Decision Criteria Autonomy Local governance that understand their communities will have the ability to influence service provision and their own destiny

Decision Criteria Adaptability and Sustainability Will service providers be able to sustain changes made and be enabled to adapt to future system changes?

Decision Criteria Implementable/Practical Realities Are there any major barriers that would prevent the proposed changes from being implemented successfully?

Decision Criteria Capacity to Engage the Community in: -Fundraising -Volunteering

Will the organization's ability to recruit local volunteers and fundraise be maintained/enhanced?

Final Screen Do no Harm Is there a risk that is so profound that it cannot be mitigated or managed?

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4.2 Analysis Process

The Planning Team adopted a four-part process to analyze the integration options:

• Part 1 was the identification of the applicable health service providers and type of integration the option is considering.

• Part 2 was the identification of pros and cons (advantages and disadvantages) for each option. • Part 3 was the identification of risks, an assessment of how likely a risk would occur, its impact

and potential mitigation strategies. This also includes identification of a risk threshold i.e. risks that are acceptable and those that are unacceptable.

• Part 4 was the identification of high-level estimates of savings for reinvestment and any associated one-time transition costs.

To access the Facilitated Integration Toolkit, please visit the Central East LHIN website at www.centraleastlhin.on.ca and click on http://www.centraleastlhin.on.ca/Page.aspx?id=96&ekmensel=e2f22c9a_72_206_96_3

4.3 Developing the Models

4.3.1 Governance Models

The IPT began their analysis by reviewing a variety of governance structures. Nine governance models were identified and assessed against the evaluation criteria. The models ranged from one single governing entity to six governing entities. Based on the analysis, the IPT narrowed the options to three possible governance models. See Appendix E for the full range of models reviewed. See Appendix F for the full analysis of all nine models. The IPT then prioritized three governance models for further consideration.

On May 31, 2013 the IPT met with governance representatives from the six organizations to seek their feedback on these three possible governance models: Two Entities by Geography; Three Entities; Four Entities. In the lead up to the meeting, each of the boards had met separately to consider the models and the meeting on May 31, 2013 provided the governance representatives with an opportunity to share the thoughts of their full boards.

As a result of the direction received at the May 31st meeting with Board representatives, the IPT spent additional time further developing the Three Entities model using Part 4 of the LHIN’s facilitated integration toolkit: Part 4 – identification of high-level estimates of savings for reinvestment into Front- Line services and any associated one-time transition costs.

Due diligence associated with Part 4 included a review of wage harmonization estimates and the impact that this would have on future organizational structures. The IPT also solicited opinions from legal experts in order to confirm risks and possible mitigation strategies.

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Board of Directors

Ross Memorial

Hospital

CEO

Board of Directors

Community Care

City of Kawartha

Lakes

CEO

Po

ten

tial S

ha

red

Ma

na

ge

me

nt S

tructu

res

Pictured below, The Three Entities by Geography model provides the foundational structure of the Integrated Governance and Service Delivery Model. The three entities represent one entity in Haliburton County and two entities in the City of Kawartha Lakes.

Board of Directors

Haliburton County

One Entity

CEO

Management

Structure

Management

Structure

Management

Structure

Hospital Services

& Community

Services

Hospital Inpatient

& Outpatient

Services

Community

Services &

Community

Health Centre

Haliburton County

Hospital and

Community

Services

City of Kawartha

Lakes Hospital

Services

City of Kawartha

Lakes Community

Services

Partnerships and collaboration opportunities to work together at the operational level e.g. shared/purchase service arrangements

4.3.1.1. One Entity in Haliburton County

The IPT is recommending one entity be created in Haliburton County through a voluntary merger

between CCHC and HHHS and the transfer into the one entity of the accountability for some services

currently provided by SIRCH and VON. SIRCH and VON would continue as existing entities but would

no longer have an Accountability Agreement with the LHIN to provide these LHIN-funded services in

the current locations.

Benefits to be realized include:

Haliburton County residents will maintain local autonomy and local management over

Haliburton County-specific services

There would be improved efficiency and effectiveness in coordination and oversight by the One

Entity through the streamlining of frontline and back office functions that would result in

potential cost savings for reinvestment

Access to the community support services currently delivered by the separate organizations

– HHHS, SIRCH, VON and CCHC – would be coordinated so that people would have “one

service delivery door” to walk through

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The recruitment, retention and management of volunteers supporting the One Entity could

provide more opportunities for local residents who want to support their local health care

organization.

Could lead to improved recruitment and retention of staff by providing equitable compensation and future training and development opportunities typically found in larger organizations

Offers several opportunities to improve access to services, streamline the continuum of care and create standardization for the delivery of services while maintaining local autonomy

Would provide clients and their caregivers with access to a broad range of services through a larger organization

Service volumes would be maintained and potentially enhanced by reinvesting savings identified.

One entity could provide a single point for administrative functions such as finance, human resources, payroll, information technology, procurement to name a few which could result in savings for reinvestment.

Risks and Mitigations considered by the IPT include:

Continuity of Service Provision was considered be an important area for the IPT to consider with

the integration of services in Haliburton County. The One Entity in Haliburton County will be a much larger organization and may not have the specialized skills that the smaller organizations have developed over many years of experience. A significant mitigation factor has been the existing commitment to quality service delivery by all the Haliburton County organizations involved in this integration. Through previous integration work the organizations have committed to maintain service delivery quality and levels so that the community and clients will see no disruption in services.

Organization Cultural Integration will occur with the voluntary merger of CCHC and HHHS into one

entity and the transfer of accountability of services from SIRCH and VON to the one entity. Haliburton County community members expressed a fear of loss of control of community services in that services could become more hospital focussed. The IPT plans to address these concerns through transition planning that could include representation from integrating organizations at different levels and stages of the transition planning and implementation. It should also be noted that HHHS already provides not only acute care but community support services as well. Change management strategies will be required to support staff and volunteers through the transition.

Labour Harmonization Costs will be incurred as HHHS, CCHC and VON are unionized

environments. The IPT completed a financial analysis that examined the potential costs for the creation of the one entity model. The analysis showed that non-labour costs saving could be used to offset the labour costs. The cost of the one entity model is not a significant enough risk to stop the integration.

4.3.1.2. Confirmation of Two Entities in the City of Kawartha Lakes

In the City of Kawartha Lakes, the two existing entities – RMH and CCCKL – would continue with their own governance and leadership. The accountability for some services would be transferred from VON to CCCKL and Four Counties Brain Injury Association.

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Benefits include:

City of Kawartha Lakes residents will maintain local autonomy and local management over

City of Kawartha Lakes-specific services

Two entities avoids the high cost of salary harmonization for RMH and CCCKL

Integration work lays the foundation for future growth

Recognizes the significant integration work already completed in the community

Risks and Mitigation:

The two entity model did not present any significant risks as services would be provided by two existing entities. The transfer of accountability of VON Adult Day Services did not present any risks.

In the City of Kawartha Lakes, the confirmation of the two existing entities does not realize any significant savings at the present time and in fact, analysis of a potential merger between RMH and CCCKL revealed the significant cost that would occur if the two organizations merged into a new entity. However, it should be acknowledged that since 1985 significant integration has already occurred in the City of Kawartha Lakes with the integration of Community Support Services, the Community Health Centre, Hospice Kawartha Lakes and Community Care Village Housing into CCCKL.

4.3.2 Service Realignment Models

Following their analysis of the most effective governance structure, the IPT began determining the services that could be realigned to the one entity. Using the agreed upon evaluation criteria the IPT assessed LHIN-funded services (excluding long –term care) being delivered in Haliburton County and the City of Kawartha Lakes. Based on the analysis the IPT agreed that the three areas with the most potential to reduce service duplication and transfer accountability into a multi-service provider in both geographies were Hospice/Palliative Care Services, Mental Health Services and Adult Day Services. Below is the summary of each of these services.

4.3.2.1 Hospice/Palliative Care Services

The accountability for delivering hospice/palliative care services in Haliburton County would be transferred from SIRCH to the One Entity. In the City of Kawartha Lakes, a formal Partnership/ Memorandum of Understanding for current and any expanded service delivery for hospice services would be created between RMH and CCCKL. This could then lead to better coordination of palliative care services, volunteer and staff training and public education between the One Entity in Haliburton County, RMH and CCCKL.

Several advantages could be realized by integrating hospice/palliative care services. The continuity of care could be improved between inpatient and community services. As well, primary care would be more involved with a potential further linkage to Health Links as it is implemented in Haliburton County and City of Kawartha Lakes in the next year.

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Volunteers are a critical part of hospice/palliative care service delivery. The IPT identified a change from a small community service organization to one larger entity could potentially impact the loyalty of volunteers. Engaging volunteers early in the transition process will support continued volunteer loyalty to hospice service delivery. This is anticipated to be part of the change management strategies.

4.3.2.2. Adult Day Services and Acquired Brain Injury Day Services

The VON would transfer the accountability and funding for Adult Day Services in Haliburton County to

the one entity. In the City of Kawartha Lakes, Adult Day Services in Lindsay would be transferred to CCCKL.

Benefits include:

Increase flexibility in programming of Adult Day Services in a larger multi-service

organization

Streamlining the number of providers offering the same service

Continued delivery of current service volume

The VON Acquired Brain Injury Adult Day Service would transfer to Four Counties Brain Injury Association. This is a highly specialized service and the IPT recognized the need to align this specialized program with an organization that has the expertise in delivering specialized ABI adult day programs.

Benefits include:

Continued delivery of current service volume

Strengthening expertise in delivering specialized programs

4.3.2.3. Volunteer Coordination

As part of the one entity model there is an opportunity to investigate a new model for volunteer recruitment (VolunteerMatch) in Haliburton County. As a pilot project, SIRCH could be contracted by the One Entity to recruit, screen, orient and train volunteers, thus reducing duplication and leading to a "one-stop-shop" for volunteers.

Volunteers are an important component of service delivery for CCHC, VON, and SIRCH and provide critical roles to support HHHS through two hospital auxiliaries. As well, Haliburton County has over 50 not-for-profit organizations that use volunteers with each doing its own recruitment of volunteers. While some organizations don't screen or train, those that do often vary greatly in their processes. Some have formalized structures and policies for these activities, with clear expectations and evaluation criteria. Others do not. Overall, however, a great deal of time, energy and resources are spent on recruitment, screening, training and maintaining files/data.

Potential volunteers in Haliburton County, who often are new retirees moving up to the area, have no idea what is available or where to go to find the information. They currently have to find out about and approach each non-profit organization individually to determine what they do, and apply to each one they are interested in -- a process which includes multiple intake processes, having references checked multiple times, filling in extensive amounts of paperwork and perhaps obtaining several police checks. Each agency orients the volunteer differently and separately. There have been concerns expressed by

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many not-for-profit organizations that there is duplication of service and competition for volunteers. VolunteerMatch will be a new program that could be funded in part initially by the Small Rural Northern Hospital Transformation Fund for the first two years. It is anticipated that VolunteerMatch will be financially viable with no base government funding within two years. Volunteer coordination will become a cost-effective way to maintain volunteers for member organizations. See Appendix G for the full proposal.

4.3.2.4 Strategic Alliance between HHHS and RMH

There are currently a number of integration activities that have been underway between RMH and HHHS for some time. Examples of the current integration activity are Laboratory Services, Medical Devices Reprocessing, and Shared Information Technology. The Small Rural Northern Hospital Transformation Fund was an enabler to support a further in-depth review of RMH and HHHS operational integration opportunities. See Appendix H for the full operationalreview pertainingtotheuseofSRNHTF.

This review:

1. Identified opportunities for operational integration between RMH and HHHS and

evaluate/prioritize viable opportunities. 2. Provided the IPT with an evaluation/prioritizing of each opportunity. 3. Expanded consideration of integration opportunities to other member organizations as

agreed by the IPT.

As a result, HHHS and RMH expanded their Strategic Alliance identifying a number of back office and leadership integrations that could be implemented by the two hospitals and possibly extended to the One Entity if it is created.

The Strategic Alliance is supported by a Master Agreement which sets out the parameters of the Alliance and includes individual service level agreements specifying the detail of the service provided and associated financial arrangements.

Service level agreements which currently exist or are in development include:

a. Mental Health Program Leadership

b. Information Technology/Management and Communications

c. Procurement

d. Pharmacy

e. Diagnostic Imaging

f. Cardiac Rehabilitation

a. Mental Health Program Leadership

Improved access to Mental Health Services was identified as a need in the Haliburton County/City of Kawartha Lakes communities. RMH and the One Entity in Haliburton County prepare to jointly recruit a single Mental Health Director to establish a regionally coordinated Mental Health program. This program would be delivered across both geographies.

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Benefits include:

Increased coordination and communication across Haliburton County and City of Kawartha Lakes leading to improved quality and consistency of acute and primary care mental health services across the two geographies

Better coordination with community-based Mental Health and Addictions providers as well as tertiary service providers.

An opportunity to increase linkages with other partners, including police and Emergency Medical Services

The SRNHTF will support 50% of the costs of this position, with the two hospitals contributing the other 50% through their respective mental health budgets. Future sustainability of the position will be addressed through a review of the outcomes achieved.

Implementation of Mental Health Leadership in Haliburton County and the City of Kawartha Lakes will involve many existing mental health and addictions service providers. Engaging these organizations will be key to supporting the building of more integrated mental health system.

b. Information Technology/Management and Communications

A shared IT department and communications network would be established for the One Entity in Haliburton County and RMH. While this initiative will not result in immediate savings, upgrades and IT projects in the longer-term will be less costly. Information Technology/Management and Communications also includes the implementation costs of extending a telephony system between HHHS and CCHC as they form the One Entity.

c. Procurement

The expansion of a shared inventory management system led by RMH would a l low RMH to take on

responsibility for procurement for the One Entity in Haliburton County s ince RMH receives better

pricing due to higher volumes. While there would be some additional fees for RMH for increasing

volumes to include the One Entity’s inventory, it is expected that the reduced cost of purchases will

result in savings for reinvestment for Haliburton County that will cover these costs.

d. Pharmacy

RMH would provide the One Entity in Haliburton County with Pharmacy services to support the hospital and emergency services through a single pharmacy program for both organizations. This would lead to cost savings for the One Entity in terms of drug acquisition and improved safety and quality as the hospital upgrades to the use of electronic medication cabinets.

e. Diagnostic Imaging

RMH would provide diagnostic imaging leadership to the One Entity in Haliburton County to oversee the expansion of diagnostic imaging services (e.g. ultrasound) and the potential introduction of mammography services in Haliburton County to minimize travel for Haliburton County residents.

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f. Cardiac Rehab

As a key partner in the establishment of a LHIN-wide cardiac rehabilitation program, RMH is committed to working collaboratively with providers in Haliburton County, including HHHS and the Haliburton Highlands Family Health Team, in order to improve access to high quality cardiac rehabilitation programming. This process is in the early stages with discussions amongst partners just recently initiated.

4.4 Economic Impact

Harmonization Costs A financial analysis was conducted of the costs of labour and non-labour associated with a single

governance model in Haliburton County. This option identified the voluntary merger in Haliburton

County between CCHC, HHHS, and the transfer of the accountability for some services at SIRCH and at

VON, Peterborough, Victoria and Haliburton to the One Entity in Haliburton County.

The analysis revealed a potential cost impact of $71,000 annually based on all additional expenses

including rent revenue loss, additional space requirements, salary and benefit harmonization. This is

an increase of approximately $18,000 from the earlier cost impact of $53,000 based only on salary

and benefit harmonization.

Potential Reinvestment Opportunity

The IPT estimated that approximately $113,000 could be saved on an annual basis and reinvested, specifically in Haliburton County, if HHHS and CCHC voluntarily merged into One Entity and took on the accountability for some of the services currently delivered by SIRCH and VON.

These savings are a result of expected efficiencies in back office and administrative functions in the One Entity model.

With the goal of retaining and leveraging the skills of existing staff, the implementation of the One Entity would require using some of the savings to support equity in staff compensation, future training and development. The IPT recognizes that this investment would support the goal of providing consistent standards and high quality in the delivery of services to local residents and that the balance of the savings, estimated at approximately $42,000, could be invested in providing more front-line services.

As noted previously, in the City of Kawartha Lakes, the confirmation of the two existing entities does not realize any significant savings at the present time and in fact, analysis of a potential merger between RMH and CCCKL revealed the significant cost that would be incurred if the two organizations merged into a new entity. The cost was a significant enough risk to not proceed with a full merger between these two organizations.

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4.5 Future Integrated Governance and Service Delivery Model

The Integrated Governance and Service Delivery Model could lead to a number of changes in how local residents would access the LHIN-funded health services currently delivered by the six organizations involved in this integration initiative.

The diagram on page 9 showed how people currently access services from the participating organizations. The diagram below illustrates how people would access services in the future. The “service delivery door” to existing LHIN funded services that are related to this process in Haliburton County would be the One Entity and the “service delivery doors” to existing LHIN-funded services related to this process in the City of Kawartha Lakes would continue to be RMH and CCCKL.

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Overview of Current and Future State Service Delivery Model

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5. Communications and Stakeholder Engagement

Throughout the facilitated integration process, the IPT ensured that they were updating their stakeholders on the process, outcomes achieved to date and next steps at every opportunity.

This included providing information to their stakeholders at all of their open board meetings, staff town halls, volunteer and client meetings. The Central East LHIN website was the central repository for monthly bulletins and the information was repurposed in each of the organizations’ newsletters and on their websites. News releases were distributed to the local media and updates sent to local elected officials to keep everyone informed. See Appendix I for the Summary of Stakeholder Engagement.

Regular updates with the governance liaisons provided the strategic check-in that the IPT required as they carried out their work.

In June 2013, the IPT began a process of targeted engagement, seeking input from their health care partners, local physicians and other social service agencies on barriers and opportunities that could be identified to improve service delivery, access and quality.

Using the Three-Entity model endorsed by the Boards, targeted engagement took place with:

Ontario Shores Centre for Mental Health Sciences

Emergency Medical Services

Central East Community Care Access Centre

Local Family Health Teams Canadian Mental Health Association of Peterborough, Haliburton, Kawartha, Pine

Ridge

Four Counties Brain Injury Association

This targeted engagement supported the development of a DRAFT Integrated Governance and Service Delivery Model and from September 16th – October 11th, the IPT undertook a process to ask local residents, patients, clients, their families and caregivers, staff and volunteers and other health service partners to provide their input on the proposed Model.

In addition to once again meeting with front line staff, physicians, union representatives, local media and local elected officials during this time period, the IPT also held five public meetings:

Lindsay – Village Housing – September 11, 2013

Coboconk – Municipal Hall – September 19, 2013

Haliburton – October 1, 2013

Minden – October 2, 2013

Lindsay – Ross Memorial Hospital – October 2, 2013

Using web-enabled and paper-based surveys, the IPT asked stakeholders to provide their feedback on the proposed DRAFT model.

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A total of 111 Surveys were received (51 from Staff and Partners and 60 from local residents) and common themes emerged including:

Change Management/Communications

Improved Access

The importance of local decision making

Impact on Volunteers and Staff

In reviewing the feedback, the IPT recognized the importance of continuing to communicate and engage with local community residents, clients/consumers/patients and their caregivers, local government leaders, staff, volunteers, other health and social service providers and the media. While the feedback did not impact the operational elements included in the FINAL Integrated Governance and Service Delivery Model, it will be an important consideration, after any Board decision, on possible transition planning and implementation.

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6. Transition Planning

One Entity in Haliburton County The following potential strategies have been identified to support the successful transition toward the creation of One Entity:

• Establish an advisory committee with representation of all integrating organizations

to support the transition.

• Develop principles to guide the transition • Create a cohesive implementation and communication strategy to ensure Boards, staff,

volunteers and the larger community understand the integration and are kept informed of the process.

• Determine a governance and service delivery structure for the One Entity.

• Create a strategic plan to integrate cultures. The elements of the strategic plan to

include:

o Knowledge transfer of service delivery best practices

o Culture and history of services

o Change management

o Communications and Marketing

• Address human resources, labour harmonization and union transition issues

• Minimize transition costs

Two Entities in City of Kawartha Lakes The transition of accountability for Adult Day Services will ensure coordination of existing services with no service interruption. A clear communication strategy will be provided to ensure the community and clients are aware of how to access services when needed and to support community and client awareness of the change in service providers.

One Time Transition Costs The IPT recognizes that one-time transition costs will be incurred such as legal and human resources as a result of the development of the One Entity in Haliburton County. It is anticipated that these costs will be minimal and with more detailed transition planning increased savings could be realized. Every effort will be made to implement the transition activities in a way that is timely and minimizes transition costs. Some of the transition costs could be funded by the Small Rural Northern Hospital Transformation Fund. The table on the next page is the preliminary schedule for transition.

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Transition Activities Target Date

Decision on Integration Plan –Boards and Membership December 5, 2013

Decision on Integration Plan – Central East LHIN Board December 18,2013

Stakeholder Notification December 20,2013

One Entity in Haliburton County

Create Advisory Committee January 2014

Engage Stakeholders and Community Partners February-March 2014

Prepare Transition Plan March – June 2014

Approve Transition Costs June 2014

Preparation for Activity July 2014 – March 2015

Implementation March 2015 – April 1, 2015

Adult Day Services in City of Kawartha Lakes

Create Advisory Committee January 2014

Engage Stakeholders and Community Partners February-March 2014

Prepare Transition Plan March – June 2014

Approve Transition Costs June 2014

Preparation for Activity July 2014 – March 2015

Implementation March 2015

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7. Conclusion

The Integration Planning Team is confident that the Integration Plan meets the strategic aims set out by the LHIN and will lead to improved client access to high-quality services, create readiness for future health system transformation and make the best use of the public’s investment.

The development of the Integrated Governance and Service Delivery Model has been supported by direction from the Boards of Directors of each of the organizations, the current state assessment work, targeted engagement with a number of other health care partners delivering care in Haliburton County and the City of Kawartha Lakes , the feedback collected from over 300 stakeholders – local residents, clients, caregivers and staff – during the first Haliburton County facilitated integration process in 2012 and the additional 111 stakeholders who reviewed this model in its DRAFT form.

It has also been supported by the historic and ongoing partnerships between all six organizations as they work together to care for the residents of their communities.

The team recognizes the significant partnerships that have developed over the years between HHHS, CCHC, SIRCH, VON in Haliburton County, between RMH, CCCKL and VON in the City of Kawartha Lakes, between all the community-based organizations and between the two hospitals and is in agreement that this Model takes these partnerships to the next level.

Opportunities contained in this plan to create reinvestment opportunities, specifically in Haliburton County, deliver Diagnostic Imaging services closer to home, develop a regional integrated Mental Health program, streamline the delivery of community-based services and much more are all beneficial to residents of the Haliburton County/City of Kawartha Lakes regions in the Central East LHIN and any risks can be managed through the appropriate mitigation strategies, through the Small Rural Northern Hospitals Transformation Fund, change management and ongoing communications and engagement.

The IPT also feels that the Integration Plan will strengthen the relationships between community- based providers, hospitals and primary care in these communities and positions the region to better support the Health Links model of care when it is implemented in this area of the LHIN.

The IPT would like to thank their staff, volunteers, Boards, patient/clients/consumers and caregivers for their patience and support during this process and looks forward to any next steps.

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8. Appendices

Appendix A: Haliburton Kawartha Lakes Terms of Reference Appendix B: Principles for Integration Planning Process Appendix C: Organization History and Current State Appendix D: Decision Making Criteria Appendix E: Proposed Governance Models Appendix F: Governance Models Integration Analysis Appendix G: Volunteer Match Appendix H: Small Rural Northern Hospital Transformation Fund Analysis Appendix I: Summary of Stakeholder Engagement

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Community Health Services and Hospitals Facilitated Integration Process

Integration Planning Team Terms

of Reference A Facilitated Process of the Central East LHIN

Authors: Kate Reed Version Number: 1.2

Status: Final Version Date: February 14, 2013

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Table of Contents

1. INTRODUCTION ................................................................................................................................................................. 3 1.1 Context .................................................................................................................................................................................................................................................. 3

1.2 Purpose ................................................................................................................................................................................................................................................. 4

1.3 ProcessImplementation ......................................................................................................................................... 4

1.4 ImplementationUpdateasofNovember2012 .......................................................................................................................................................................................................... 5

1.5 Scope.................................................................................................................................................................................................................................... 5

2. ROLES& RESPONSIBILITIESOF THEPLANNING TEAM ............................................................................ 6 2.1 RoleoftheIntegrationPlanningTeam ............................................................................................................................................................................................................................. 6

2.2 AuthorityoftheIntegrationPlanningTeam .................................................................................................................................................................................................................... 7

3. MEMBERSHIP& ROLES OFINDIVIDUAL PLANNINGTEAM MEMBERS .................................... 7 3.1 Membership–RequireNames ........................................................................................................................................................................................................................................... 7

3.2 Sponsorship ............................................................................................................................................................................................................................................................. 7

3.3 GovernanceLiaison–RequireNames .......................................................................................................................................................................................................................... 9

3.4 Linkages&Partnerships ........................................................................................................................................................................................................................................................... 9

3.5 DurationofService ................................................................................................................................................ 9

3.6 IndividualRolesofPlanningTeamMembers .............................................................................................................. 10

4. LOGISTICS AND PROCESSES ........................................................................................................................ 11 4.1 FrequencyofMeetings ......................................................................................................................................... 11

4.2 Decision-MakingProcess ...................................................................................................................................... 11

4.3 QuorumRequirements ........................................................................................................................................ 11

4.4 ProxiestoMeetings–RequireNames ........................................................................................................................................................................................................................ 11

4.5 InvitedGuests ............................................................................................................................................................................................................................................................................... 12

4.6 CentralEastLHINStaffParticipation.......................................................................................................................... 12

4.7 MeetingAgendaItems ......................................................................................................................................... 12

4.8 MeetingMaterials ................................................................................................................................................ 12

4.9 IssueResolution ................................................................................................................................................. 12

4.10 Confidentiality ........................................................................................................................................................................................................................................................ 12

4.11 DeclaringandManagingConflictsofInterest ............................................................................................................... 12

5. ACCEPTANCEAND SIGN-OFF ........................................................................................ 13

Appendix A Integration Planning Team Terms of Reference

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1. INTRODUCTION

1.1 Context

On February 22, 2012, the Central East LHIN Board of Directors approved a Community Health Services (CHS) Integration Strategy to address demographic pressures, adjust to changing expectations of patients and families and to meet provincial expectations on improving access, quality and value for money/investment.

The Strategic Aim for the CHS Integration Strategy is to:

Design and implement a cluster-based service delivery model for Community Support Service (CSS) and Community Health Centre (CHC) agencies by 2015 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; and, • Make the best use of the public’s investment.

The Strategy was intended to result in the identification of a preferred community health integration model for each of the Durham, Scarborough and the Northeast Clusters, to increase value from the client and caregiver’s perspective.

The Community Health Services (CHS) Integration Strategy recognizes that the Central East LHIN:

• population is aging with increasing prevalence of chronic disease and mental illness; • consumer is informed and expects a customer-driven approach to their health care

experience with attention provided to improving the client and caregiver’s healthcare journey;

• recognizes that it is necessary to shift the healthcare delivery system to improve patient outcomes and access to care toward support for health promotion and wellness;

• must meet the healthcare needs of communities within available and sustainable resources – maximizing customer value for money invested;

• current service delivery system must change to achieve the objectives of the Excellent Care for All Act (2010), the MOHLTC Minister’s Action Plan (January 2012), recognize areas for improvement identified in the Drummond Report (February 2012) and the 2012 Ontario Budget (March 2012).

The expectation is that the FORM of delivery organizations (Leadership and Governance) will follow the future state FUNCTIONs (front-line direct client services and supporting back-office functions). Exploration of a full range of service and integration options will be undertaken – the Status Quo is not considered a viable option.

It is the position of the Central East LHIN that integrated health services will improve ease of access and navigation for clients and will leverage governance, management, front-line service delivery, back office support, volunteerism and fund raising operations.

Appendix A Integration Planning Team Terms of Reference

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1.1Purpose

The purpose of the overall strategy is to develop and implement an Integration Plan in accordance with the approved Principles.

The Integration Plan will include:

1) A description of the proposed changes;

2) Details on how the services will be delivered (e.g. model);

3) Details on the activities required to transition the services;

4) Actions/measures to address any outstanding liabilities and risks; and

5) An accompanying shared Communications and Community Engagement Plan.

1.2 Process Implementation

To implement the strategy, the Central East LHIN began with the first grouping (Group 1) of CHS health service providers (HSP) for whom integration is most likely to achieve greatest return on investment.

• Group 1: Single or multi-service HSPs who provide service within a clearly

defined region within the Central East (includes LHIN services provide through municipalities).

• Group 2: HSPs with broader affiliations (e.g. Cross-LHIN, Provincial or

National Agencies).

• Group 3: HSPs serving multiple Central East LHIN Clusters, or a specific client population (Acquired Brain Injury, Services for the disabled).

The process was initiated in the Durham Cluster in April 2012 and was planned to roll out as follows to the other Clusters:

• Durham Cluster Start: April 2012 Finish: March 2014 • Scarborough Cluster Start: Nov 2012 Finish: Nov 2014 • Northeast Cluster Start: June 2013 Finish: March 2015

In addition, and through a parallel process with the Durham Cluster, a facilitated approach was undertaken in Haliburton County, intended to build upon the existing strengths of the health care partners while considering options for how to improve the system of care across the continuum of services currently provided by the participating agencies. In this process, the hospital was an equal partner along with the local Community Support Services (CSS). The Central East Community Care Access Centre (CECCAC) and Haliburton Highlands Family Health Team (FHT) also participated in the process.

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Appendix A Integration Planning Team Terms of Reference

1.3 Implementation Update as of November 2012

At their Open Board Meeting on November 28, 2012, the Board of the Central East LHIN passed a series of motions that will result in changes to the timing, sequencing and scope of the current Community Health Services Integration Strategy, first approved by the Board in April 2012 that is focused on improving client access to high-quality services, creating readiness for future health system transformation and making the best use of the public’s investment.

Based on the motions passed by the Board the following changes are being instituted to the CHS Integration Strategy:

The Northeast Cluster process will be initiated January 2013

The Northeast Cluster process will proceed as three distinct processes rather than one large grouping. The three areas are a) Haliburton County/City of Kawartha Lakes, b) Peterborough City and County, and c) Northumberland County

Hospitals will now be included in the Northeast phase of the Strategy

There will be no change to the current CHS process in the Durham Cluster

The Scarborough process, which had been scheduled to start in November 2012, will be delayed until June 2013.

1.4Scope

“IN” Scope “OUT” of Scope

• Governance, management and operations of the following LHIN funded providers: (Haliburton Highlands Health Services, Community Care Haliburton County, Ross Memorial Hospital, Community Care City of Kawartha Lakes, Supportive Initiatives for Residents in the County of Haliburton)

• All opportunities for integration of services • Risks and liabilities of the providers and

the Central East LHIN • All communications and community

engagement activities related to the integration activities

• Development of an Integration Plan with integration recommendations, associated transition costs and ongoing operating budgets to be provided to participating Boards of Directors in November 2013.

• Presentation of the Plan to the Central East LHIN Board of Directors in December 2013.

• As required, the Plan will then be forwarded to the Minister of Health and Long-Term Care for approval of specified elements.

• Group 2 and Group 3 community health services and programs in any Central East LHIN cluster

• Health services currently provided by non-LHIN funded service providers

• Approval of the Integration Plan

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Appendix A Integration Planning Team Terms of Reference

“IN” Scope “OUT” of Scope

• Implementation will begin April 2014.

2. Roles & Responsibilities of the Planning Team

2.1 Role of the Integration Planning Team

The Implementation Planning Team (IPT) is the key group of individuals representing all participating agencies that meets on a frequent basis to move the integration process forward and converses with respective Boards of Directors accordingly. Its primary role is the development of the Integration Plan, including the presentation of the Integration Plan to the respective Boards of Directors for review and a decision in November 2013.

The work of the IPT will focus on understanding the current state of services, identifying gaps and barriers in service delivery, analysing options for the design of integrated services, engaging governors, stakeholders and the community for input, identifying risks and mitigation strategies and development of a communications and community engagement strategy. In this role the Integration Planning Team will:

• Support the facilitated and negotiated approach to integration; • Ensure governors are aware of their roles and responsibilities; • Regularly update governors on progress and solicit their input and feedback; • Engage stakeholders and the community for ideas and feedback; • Share and discuss information on the range of services and operations provided; • Describe the “current state”; • Identify a Value Statement from client, caregiver, staff and volunteer perspectives; • Identify service gaps and barriers to service; • Develop opportunities for integration; • Identify and analyse options for integrated services; • Identify associated risks and mitigation strategies;

• Liaise with other organizations to clarify information, test planning assumptions and receive feedback on proposed actions/measures;

• Create and receive recommendations from Back Office and Front-line Service Work Teams (as required);

• Ensure integrated services are aligned with the approved guiding principles; • Determine preliminary activities and costs to transition to integrated services; • With support of the Facilitator, write the Integration Plan; • Develop and maintain a Shared Communication and Community Engagement Plan;

• Recommend the Integration Plan to the respective Boards of Directors of the providers participating in the integration and the Central East LHIN;

• Recommend a governance/management structure to implement approved integration initiatives.

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Appendix A Integration Planning Team Terms of Reference

2.2 Authority of the Integration Planning Team

The IPT’s authority does not extend beyond the individual authorities of its members and their respective decisions and spheres of influence.

The Integration Planning Team does:

• Have the authority to share information about their organizations’ services, governance, management and operations;

• Have the authority to recommend, on behalf of their organizations, plans and actions associated with the integration of services;

• Have the authority to establish working groups, as required, to explore specific issues related to integration.

• Not have the authority to approve the Integration Plan as this is reserved for the Boards of Directors of each organization.

3. Membership & Roles of Individual Planning Team Members

3.1 Membership – Require Names

The Integration Planning Team membership will be composed of senior leadership representatives from the following organizations and integration staff from the Central East LHIN. A Facilitator will be appointed by the Central East LHIN.

Name Organization/Stakeholder Group

Varouj Eskedjian, President and CEO Haliburton Highlands Health Services

Maureen Ruttig, Executive Director Community Care Haliburton County

Brian Payne, President & CEO Ross Memorial Hospital

Catherine Danbrook, Chief Executive Officer Community Care City of Kawartha Lakes

Gena Robertson, Executive Director Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Lori Cooper, District Executive Director - Community Support Services

Victorian Order of Nurses, Ontario Branch

Kate Reed, Team Lead Integration/ Implementation

Central East LHIN

Katie Cronin-Wood, Communications Lead Central East LHIN

Ritva Gallant, Team Lead, Financial and Risk Management

Central East LHIN

Laura Wise, Health Planner Central East LHIN

Lynn Huizer, Facilitator

3.2 Sponsorship

The Integration Planning Team sponsors will be the Central East LHIN Senior Management Team through James Meloche, Senior Director, System Design and Implementation, and the Chairs of the Boards of Directors of the participating service providers. Sponsors assist the process as required in obtaining and sustaining support for the process from the respective broader organizations.

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Appendix A Integration Planning Team Terms of Reference

Key messages will be prepared for the sponsors by the Planning Team following each meeting and/or significant event.

3.3 Governance Liaison – Require Names

IPT members will also be supported by Governance Liaisons from each provider. The Governance Liaison will be each IPT member’s central point of contact, from a governance perspective, for the integration process. Opportunities to “check-in” with these Governors will be built into the process’s Critical Path.

Name Organization/Stakeholder Group

Len Logozar, Board Chair Haliburton Highlands Health Services

Jeanne Anthon, Board Chair Community Care Haliburton County

Laurie Davis, Board Chair Ross Memorial Hospital

Glenn Wilcox, Board Chair Community Care City of Kawartha Lakes

Wendy Ladurantaye, Board Chair Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

3.4 Linkages & Partnerships

The IPT may seek input from a wider group of subject matter experts in the design of integrated health services. These subject matter experts may include other health service providers, primary care providers, mental health and addictions service agencies and networks, Central East CCAC, other hospitals, etc.

3.5 Duration of Service

To enable a greater degree of success, it is recommended that the IPT remain active until the completion, review and decisions related to the Integration Plan. The Planning Team may continue, following approval of Integration Plan, to oversee and monitor integration activities.

New members of the Planning Team may be added, in consultation with the Team, from time-to- time to address a perspective and set of skills of benefit to the integration process.

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Appendix A Integration Planning Team Terms of Reference

3.6 Individual Roles of Planning Team Members

Name Individual Role

LH

IN H

SP

s

Varouj Eskedjian, Haliburton Highlands Health Services

Represent their respective agency and have operational decision making authority. Provide advice and educate the team on the services, operations, management and governance of their respective agencies. Identify opportunities and contribute to the analysis of options and the design of integrated services. Act as the primary liaison with their respective agency governors and bring forward any concerns of issues about the process raised by governors.

Maureen Ruttig, Community Care Haliburton County

Brian Payne, Ross Memorial Hospital

Catherine Danbrook, Community Care City of Kawartha Lakes

Gena Robertson, Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Lori Cooper, Victorian Order of Nurses, Ontario Branch

Facili

tato

r

TBD Lead and facilitate the work of the Integration Planning Team. Manage the planning process, keep the team on- track and focused on the tasks, timelines and deliverables. Identify issues and risks to the process and recommend strategies. Ensure due diligence is completed and the spirit of the guiding principles are followed. Provide overall project support to the team including leading the development of the Integration Plan and supporting team members in engaging their governors.

Centr

al E

ast LH

IN Kate Reed

Ritva Gallant Laura Wise

Provide advice and guidance on the integration (risks, performance, process and operational matters, etc.) to ensure the deliverable is met.

Katie Cronin-Wood Provide advice and guidance on communications, stakeholder and community engagement matters. Lead the development of the Shared Communication and Community Engagement Plan and coordinate the messages to all stakeholders, including government relations stakeholders and media.

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Appendix A Integration Planning Team Terms of Reference

4. Logistics and Processes

4.1 Frequency of Meetings

The Integration Planning Team will have some flexibility around the meeting schedule but should plan on weekly (half day) meetings occurring on a pre-determined day at a location that is best suited for all members to ensure timely preparation of the Integration Plan. In-person meetings are preferred for conducting business of the Planning Team, however, under certain circumstances teleconference, video conference and/or webinar meetings may be an acceptable alternative.

4.2 Decision-Making Process

Team decisions will be guided by the Principles established at the outset of the integration process. The preferred approach to decision making will be through consensus. However, when consensus cannot be reached, a vote of the members will be called and based on a majority of votes the course of action/recommendation will be carried forward. Only providers are eligible to vote and will have one vote each. Central East LHIN staff is encouraged to provide their system-wide perspectives and ideas related to each course of action or recommendation before the Team. Team decisions will be recorded and reflected in the meeting notes and members will speak with one voice on these decisions.

4.3 Quorum Requirements

All Planning Team members (or designated proxies) are committed to attending Team meetings. To constitute a formal meeting, the Facilitator, one representative from each participating provider and one member from the Central East LHIN must be present. Decisions or actions taken in the absence of a quorum are not binding on the Team.

4.4 Proxies to Meetings – Require Names

Due to the sensitive nature of the activities of the IPT, proxies or substitutions for Team members will not generally be accepted. However, each Planning Team member has identified the following alternate in the event they are unable to attend a meeting:

Team Members Designated Proxy

Varouj Eskedjian, President and CEO, Haliburton Highlands Health Services

Debbie Watson, Chief Nursing Officer, Haliburton Highlands Health Services

Maureen Ruttig, Executive Director, Community Care Haliburton County

Sherry Mulholland, Financial Administrator, Community Care Haliburton County

Brian Payne, President & CEO, Ross Memorial Hospital

Carol Smith Romeril, Vice President, Patient Care, Ross Memorial Hospital

Catherine Danbrook, Chief Executive Officer, Community Care City of Kawartha Lakes

Joan Skelton, Director, Community Support Services, Community Care City of Kawartha Lakes

Gena Robertson, Executive Director, Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Marilyn Rydberg, Manager, Hospice Services, Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Lori Cooper, District Executive Director - Community Support Services, Victorian Order of Nurses, Ontario Branch

Doreen Anderson-Roy, Manager of External Relations & Administration, Victorian Order of Nurses, Ontario Branch

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Appendix A Integration Planning Team Terms of Reference

It is appreciated if Team members notify the Facilitator 24 hours in advance of the meeting if they are unable to attend. Team members and/or their proxies who are absent for more than two consecutively scheduled meetings will be contacted by the Facilitator to determine how the process can support their participation.

4.5 Invited Guests

The Facilitator, in conjunction with the Team members, will determine attendance by invited guests on a meeting-by-meeting basis.

4.6 Central East LHIN Staff Participation

From time to time, additional Central East LHIN staff can be expected to attend meetings to observe the process as part of their work at the Central East LHIN. Central East LHIN staff who is not a member of the Planning Team will have no formal responsibilities with respect to the subject integration planning process and as such, will contribute only when specifically asked to do so by the Facilitator or Central East LHIN Team members.

4.7 Meeting Agenda Items

Every effort will be made to prepare and distribute meeting agendas and related materials no less than three business days in advance of Planning Team meetings.

4.8 Meeting Materials

The preparation and distribution of meeting materials will be the responsibility of the Facilitator. The Planning Team will use a secure Central East LHIN collaborative workspace for all meeting materials related to work of the Planning Team.

4.9 Issue Resolution

Issues that cannot be resolved by the Integration Planning Team will be escalated to the respective Sponsors and/or Governance Liaison for resolution.

4.9Confidentiality

In order to maintain the integrity of the process, all IPT members are asked to, unless otherwise agreed upon, keep discussions conducted at Team meetings and all materials prepared for use by the Planning Team and stored on the Central East LHIN collaborative workspace as confidential. Items can be shared with respective organization sponsors/Governance Liaisons when agreed to by the Planning Team.

These Terms of Reference may be amended as agreed to by all members.

4.10 Declaring and Managing Conflicts of Interest

Full transparency is required in order to effectively support and inform the integration process. Therefore, all IPT members are asked to identify and declare potential and or current conflicts of interest. When decision making arises, members must declare their conflicts and immediately remove themselves from decision making.

Appendix A Integration Planning Team Terms of Reference

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5. Acceptance and Sign-Off

The following signatures represent acceptance of these Terms of Reference.

Organization - Program Approved by Team Member: Oringinally

Signed by:

HHHS

Varouj Eskedjian, President and CEO

RMH Brian Payne, President & CEO

CCCKL Catherine Danbrook, Chief Executive Officer

CCHC Maureen Ruttig, Executive Director

SIRCH Gena Robertson, Executive Director

VON Lori Cooper, District Executive Director - Community Support Services

Facilitator

Lynn Huizer, Facilitator Signature Print Name Date

Central East LHIN

Kate Reed, Team Lead Integration/ Implementation Signature Print Name Date

Central East LHIN

Katie Cronin- Wood, Communicatio ns Lead

Central East LHIN

Ritva Gallant, Team Lead, Financial and Risk

Central East LHIN

Laura Wise, Health Planner Signature Print Name Date

Appendix B: Principles for Integration Planning process

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Principles Supporting the Central East Local Health Integration Network’s Community Health Services and Hospitals Facilitated Integration Process for Haliburton County and the City of Kawartha Lakes

Purpose

The purpose of this document is to establish a set of foundational principles, to be agreed to by the parties, to guide discussions and actions related to the facilitated integration process being undertaken with Health Service Providers (HSPs) in the County of Haliburton and the City of Kawartha Lakes, within the Central East LHIN’s Northeast Cluster.

All parties recognize at the onset of the process that specific details, strategies and tactics supporting integration will evolve throughout the process and that the Principles are intended as foundational guides, subject to revision only with the support of all parties.

Central East LHIN Strategic Aim

On February 22, 2012, the Central East LHIN Board of Directors approved a Community Health Services Integration Strategy to address demographic pressures, adjust to changing expectations of clients/patients and families and to meet provincial expectations on improving access, quality and value for money/investment. The Strategic Aim for the Community Health Services Integration Strategy was to:

Design and implement a cluster-based service delivery model for Community Support Services (CSS) and Community Health Centre (CHC) agencies by 2015 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 and, • make the best use of the public’s investment.

This strategy resulted in the commencement of an integration planning process in Haliburton County in April 2012, exploring opportunities for an improved system of care across various sectors of health care continuum (i.e. vertical integration).

At their Open Board Meeting on November 28, 2012, the Board of the Central East LHIN passed a series of motions that resulted in changes to the timing, sequencing and scope of the current Community Health Services Integration Strategy, first approved by the Board in February 2012.

Based on the motions passed by the Board, the following changes are being instituted to the CHS Integration Strategy:

The Northeast Cluster process will be initiated January 2013

The Northeast Cluster process will proceed as three distinct processes rather than one large grouping as initially planned. The three areas are a) Haliburton County/City of Kawartha Lakes, b) Peterborough City and County, and c) Northumberland County

Hospitals will now be included in the Northeast phase of the Strategy

Appendix B: Principles for Integration Planning process

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There will be no change to the current CHS process in the Durham Cluster The Scarborough process, which had been scheduled to start in November 2012, will be

delayed until June 2013.

Every effort will be made to utilize the tremendous wealth of knowledge that was gleaned through the Haliburton County process from May – November 2012.

Central East LHIN Role

It is the LHIN’s mandate to promote integration opportunities that enhance both the client experience and achieve greater value for money (e.g., efficiency). It is also the position of the Central East LHIN that integrated health services will improve ease of access and navigation to services for clients and will leverage governance, management, front-line service delivery, back office support, volunteerism and fund raising operations. As such, the Central East LHIN will commit staff resources to support the process from a planning, communication and community engagement perspective.

Health Service Provider Role

Health Service Provider staff and governors will actively participate in the integration planning process. This will directly include the following agencies:

• Haliburton Highlands Health Services

• Community Care Haliburton County

• Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

• Ross Memorial Hospital

• Community Care City of Kawartha Lakes (including the Community Health Centre)

• Victorian Order of Nurses (VON)

Participation and input from other parties such as primary care providers, the Central East Community Care Access Centre and mental health and addictions services will be sought in a variety of ways throughout the planning process.

Legislative Due Diligence

Under legislation (LHSIA), the LHIN, the Minister of Health and Long-Term Care and health service providers themselves can integrate in several ways.

1. Coordinate services and interactions between different persons and entities 2. Partner with another person or entity in providing services or in operating 3. Transfer, merge or amalgamate services, operations, persons or entities 4. Start or cease providing services 5. Cease to operate or to dissolve or wind up the operations of a person or entity

It is important to note that the LHIN does not have the authority to integrate by “Ceasing to operate or to dissolve or wind up the operations of a person or entity” (#5). This authority is reserved for the Minister of Health and Long-Term Care and/or voluntarily by the persons/entities involved. In other words, aside from the Minister, only HSPs can decide to dissolve their own corporate entity.

Appendix B: Principles for Integration Planning process

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In order to facilitate or execute integrations, the LHSIA provides several tools for the LHIN, the Minister and Health Services Providers to integrate, as outlined in the following table.

Integration Type Description

LHIN Funding LHSIA S.19

The LHIN uses its funding authority to promote integration of services with/between HSPs.

Facilitated and Negotiated Integration LHSIA S.25

The LHIN and/or HSPs explore appropriate integration strategies and the LHIN facilitates or negotiates integration with the HSPs.

Required Integration LHSIA S.26

The LHIN orders HSPs to integrate services.

Voluntary Integration LHSIA S.24 & 27

A HSP at their own initiative plans to integrate services funded by the LHIN.

Minister’s Order LHSIA S.28

The Minister orders a HSP to integrate i.e. cease to operate, dissolve, wind-up its operations, amalgamate or transfer operations.

With specific reference to Health Service Providers designated as hospitals (Ross Memorial Hospital and Haliburton Highlands Health Services) under the Public Hospitals Act, certain changes affecting a hospital’s corporate structure, operations, additions, or sales, that may be recommended as a result of integration discussions, require approval of the Minister of Health and Long-Term Care prior to implementation.

Public Hospitals Act Description

Approval of Articles S.4.1

No articles shall be filed under the Not-for-Profit Corporations Act, 2010 in respect of a hospital until the articles have first received the approval of the Minister.

Approval of Incorporation, Amalgamation, Amendment S.4.1.1

No application to incorporate a hospital or amalgamate two or more hospitals under a private Act or to amend a private Act in respect of a hospital shall be proceeded with until the application has first received the approval of the Minister.

Approval S.4.2

No institution, building or other premises or place shall be operated or used for the purposes of a hospital unless the Minister has approved the operation or use of the premises or place for that purpose.

Approval of Additions S.4.3

No additional building or facilities shall be added to a hospital until the plans therefor have been approved by the Minister.

Approval of Sales S.4.4

No land, building or other premises or place or any part thereof acquired or used for the purposes of a hospital shall be sold, leased, mortgaged or otherwise disposed of without the approval of the Minister.

Integration Process and Principles

To support these integration discussions and actions the Central East LHIN has provided a Facilitated and Negotiated Integration Process and Requirements Guide which outlines the key process steps, best practices and documentation requirements associated with obtaining Central East LHIN approval of a facilitated and negotiated integration. This Guide will be utilized in Haliburton County/City of Kawartha Lakes process.

Appendix B: Principles for Integration Planning process

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The Haliburton County/ City of Kawartha Lakes Community Health Services and Hospitals Facilitated Integration process will commence January 11, 2013 and will lead to the development of an Integration Plan for review and decision by the respective HSP Boards of Directors in November 2013. The Plan will then be presented to the Central East LHIN Board in December 2013. As needed, the Plan will be submitted to the Minister of Health and Long-Term Care in December as well. Implementation of the approved Plan will be initiated April 2014.

The following Principles will guide the process:

System Level Principles

Value Creation for Clients – Integration process will be guided and motivated by a continuous focus on how to best meet client and caregiver needs. The outcome will be to re-engineer the delivery system to support the values of patients and communities.

Return on Investment – Integration must be focused on increasing value to shareholders of the health care system… the public.

Leverage the Local – Community services are best supported by local governance that understand their communities, and by local management that can take advantage of local volunteers and fundraising opportunities. Clients, patients and caregivers should have maximal close-to-home access to community services. This does not preclude opportunities for broader regional approaches that support health care delivery and coordination (e.g., back office supports).

Service Delivery Principles

Consumer Centred – The integration process will be guided and motivated by a continuous focus on how to best meet the health needs of clients. Efforts will be made by all parties to minimize service disruptions during any integration transition that may occur as a result of this process.

Quality Services – Health Service Provider agencies and the Central East LHIN will design sustainable integrated services that provide consistent standards and high quality to clients.

Regional Access – Integrated services must be accessible to all clients in the geographic area.

Leveraging the Local – The Central East LHIN believes that community health services are best supported by an understanding of the communities being served and by local management that can maximize the use of local volunteers, fundraising opportunities and other community supports.

Process Principles

Do No Harm – The Central East LHIN will work with all parties to ensure that any integration opportunity does not result in new risks or pressures (legal, financial, operational, reputational) to any party to the integration. The Central East LHIN will also be responsive in working with HSPs in supporting the resolution of both foreseen and unforeseen risks that may arise following the implementation of any integration. It is understood that HSPs must continue to provide services throughout the integration planning process, however, caution should be used to ensure no new commitments are made that may limit consideration of integration opportunities.

Transparency or “No surprises” – The Central East LHIN and all parties will provide full disclosure of information required to support the integration process, notwithstanding personal information that is protected by law.

Appendix B: Principles for Integration Planning process

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Respectful – All parties will conduct the integration process in a manner that does no harm to the reputation of the board, management, staff, volunteers and donors of HSPs and the Central East LHIN.

Employee Commitment and Skills – It is recognized that the current employees of HSPs are highly committed to supporting their clients and have been instrumental in meeting the needs of their clients based on their skills and knowledge. HSP employees will be asked for their ideas and feedback throughout the integration planning process and their contributions will be valued in the design, transition and implementation of any new model of integrated health services.

Communication – During the integration process the Central East LHIN and HSPs will agree to a shared communication strategy and messages as coordinated by the Central East LHIN.

Timing – HSPs will engage in meaningful discussions on opportunities for integration in a timely manner. The Central East LHIN’s Community Health Services and Hospitals Facilitated Integration Strategy requires an Integration Plan for review and decision by the respective Boards of Directors by October 2013.

Legislative Ascendance – The principles and process as laid out in this document are guides agreed to by the parties. In no way can these principles limit the authority of the LHINs, health service providers and the MOHLTC as set out in legislation, namely the Local Health System Integration Act (LHSIA) and The Public Hospitals Act.

Community Engagement – The Central East LHIN expects HSPs to engage their stakeholders (clients, staff, organizational partners, donors and other funders) and consider their input in decision-making processes respecting services in Haliburton County and the City of Kawartha Lakes.

Confidentiality – The parties agree to keep the content of discussions confidential until such time as there is agreement to share information as set out in a shared communications and community engagement plan. The Planning Team can discuss matters related to the integration initiative confidentially with their respective sponsors and/or Board of Directors.

End State Principles

Central East LHIN Funding – The LHIN anticipates that all the funding currently directed to HSPs will continue to be provided.

Integration – Any proposed integration will rationalize back office supports provided the needs of the participating organizations are adequately met. Where appropriate, administrative overhead and infrastructure should be reduced and savings redirected to front-line service delivery.

Continuum of Care – HSPs will work with the LHIN and other health service providers – notably the primary health care system, the Community Care Access Centre and mental health & addictions agencies – in any redesign of health services to promote the optimal integration of services within the region and to ensure services are fully integrated into the area’s continuum of care.

Flexibility & Innovation – Within the combined financial resources, and considering the existing service and operational infrastructure, HSPs may redesign services to meet the needs of clients. There is no assumption that existing delivery practices must be maintained, however, all parties agree at a minimum to maintain current service delivery targets and service levels and minimize service disruption for current clients. Any redesign of health services should consider a variety of options, meet the strategic aims of the Central East LHIN and consider the impact on HSP staff and volunteers.

Appendix B: Principles for Integration Planning process

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Governance – The Board of Directors of HSPs will be reminded of their fiduciary responsibilities to their organizations and clients and to their obligations to support the integration of the health system as set out in the legislation (LHSIA) and the SAA agreements. Clear lines of governance will be established for any integrated services.

Accountability – SAA agreements with the LHIN will be revised to address any integrated services and related performance expectations. HSPs agree to live within the means made available by the LHIN, other government sources of funds and/or local fundraising.

Transfer – The terms of the transfer of any assets and liabilities is dependent upon the nature of the integration i.e. merger/amalgamation of entities, transfer of services, coordination of services, etc. Any transfer does not automatically include existing staff or board members. Every effort will be made to ensure continuity of any volunteer pools and local fundraising donations. To this end, all parties will work together to secure continuity of funding support from third parties to the integration service provider(s).

Appendix B: Principles for Integration Planning process

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Approvals

The following signatures represent acceptance of the foregoing Principles by the respective parties to guide integration activities of the Haliburton County/City of Kawartha Lakes process.

Organization Approved by Board Chair/President Approved by Senior Leader

Central East Local Health Integration Network

Signature:

Name:

Date

Signature:

Name:

Date

Haliburton Highlands Health Services

Signature:

Name:

Date

Signature:

Name:

Date

Community Care Haliburton County

Signature:

Name:

Date

Signature:

Name:

Date

Supportive Initiatives for Residents in the County of Haliburton (SIRCH)

Signature:

Name:

Date

Signature:

Name:

Date

Ross Memorial Hospital

Signature:

Name:

Date

Signature:

Name:

Date

Community Care City of Kawartha Lakes

Signature:

Name:

Date

Signature:

Name:

Date

Victorian Order of Nurses

Signature:

Name:

Date

Signature:

Name:

Date

Appendix C: History of the Organizations and Current Service Summary

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History of Haliburton Highlands Health Services (HHHS) HALIBURTON HIGHLANDS HEALTH SERVICES CORPORATION started with two small Red Cross

Hospitals, located in the villages of Haliburton and Minden with oversight provided by St. Joseph’s

Hospital in Peterborough. Through the support and assistance of many community committees,

government organizations, studies, plans and fund-raising initiatives and following a lengthy 10 year

process of ups and downs for the community, HHHS became incorporated on February 19, 1996.

That year, a Master Plan and Preconstruction Operation Plan were developed to provide a

framework for facility renovation and redevelopment. In May 31, 1996 St. Joseph’s Health Centre

officially conveyed property and responsibility to HHHS. By June 2000, two state-of-the-art health

facilities were opened, one in Haliburton and one in Minden that provides the integrated services of

Emergency & Ambulatory Care, Acute Care, Long Term Care and community programs under the

umbrella of the Haliburton Highlands Health Services. The County of Haliburton officially conveyed

property and responsibility of Hyland Crest Long-Term Care Home to HHHS on December 31, 2000.

With the assistance of the Haliburton, Kawartha and Pine Ridge District Health Council, community

programs were developed and established under the authority of HHHS as part of the integrated

model of health services envisioned by HHHS founders. These services include

Haliburton Highlands Community Mental Health Services, began in 1996 following the

establishment of these services in Haliburton County by SIRCH

Haliburton Highlands Supportive Housing Services, established in 1997 (providing services in Minden and Haliburton, which expanded to Wilberforce in 2011)

Haliburton Highlands Diabetes Education Network, established 1998

The HHHS proposal for a Community Healthcare Centre (CHC) or a Primary Care Centre (PCC) was,

over time, redeveloped in association with the Haliburton Family Medical Centre leading to the

implementation of a Family Health Team in 2005. The Municipality of Dysart constructed a medical

building next door to the HHHS which houses the Family Health Team, a Vision Centre, and Life Lab

services. Telemedicine units were installed at HHHS and the Family Health Team in 2004-05.

Currently, proposals to the LHIN and MOHLTC are awaiting approval for an extended Hospice /

Palliative Care area to augment the one Palliative Care bed (introduced in 2011) that is currently

available. As well, a C.T. proposal has been submitted to the MOHLTC, with funds already raised by

the HHHS Foundation.

Today, with the assistance of the Minden Health Care Auxiliary, the Haliburton Hospital Auxiliary,

and the HHHS Foundation, equipment and furniture continues to be upgraded and refurbished in

the hospitals and long-term care homes.

HHHS has 90 full time staff and 101 part time staff with 381 volunteers. Funding is provided by the Ministry of Health and Long Term Care (through the Central East Local Health Integration Network), fundraising, donations from the public, and client fees for some programs.

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48 | P a g e

History of Ross Memorial Hospital (RMH) ROSS MEMORIAL HOSPITAL officially opened its doors on November 20, 1902, thanks to James

Ross, a civil engineer from Montreal and a former resident of Lindsay. In 1901, Ross purchased the

present land, and then built and equipped the Hospital, which he donated to the community, in

memory of his parents, John and Mary Ross. At the time of its opening, Ross Memorial Hospital

had a bed capacity of 23, and a nursing staff that consisted of a lady superintendent, a head nurse

and four nurses in training. On May 22, 1903, Ross Memorial was incorporated under the Laws of

the Province of Ontario.

In 1931, the “Victoria Wing” was constructed, increasing the total capacity to 60 beds, and in 1960, a

further addition brought the Hospital’s capacity up to 139 beds. An $8.8 million expansion in 1975

replaced the 1902 and 1931 buildings. The 1960’s addition, now referred to as the “East Wing”, and

the 1975 addition (West Wing) remain in use today. In 1997, a $4.5 million self-funded

redevelopment of Ross Memorial included the reconstruction of the Maternal/Newborn Unit,

Paediatrics Unit and the Intensive Care Unit.

In 2002, construction began on a $49 million dollar expansion, which doubled the size of the

Hospital and increased bed capacity from 156 to 218 beds. Construction included a new Continuing

Care wing. This expansion accommodated the introduction of new programs including a new Mental

Health Program, Rehabilitation and Palliative Care. The project also included a major expansion of

the Emergency Department, more than doubling the size of the previous ER and a new CT suite.

In 2006, the Hospital received approval from the Ministry of Health and Long Term Care to plan the

construction of a 15-station Dialysis Unit. This unit was completed in the summer of 2008.

In 2011, the Hospital completed an expansion of the Diagnostic Imaging Department that included a

new 128-slice CT unit and the addition of MRI services. In July 2011, the Hospital received Ministry

approval to complete a $10 million infrastructure renewal project. The project involves replacing the

air handling units supporting the operating rooms and the central processing department where

surgical/medical tools are sterilized and a building system retrofit of the 1960’s wing involving heating

and ventilation systems, electrical services, plumbing systems and life safety upgrades.

Currently, the hospital has 446 full time and 409 part time and casual staff with 62 active physicians

and 350 volunteers. Funding is provided by the Ministry of Health and Long Term Care (through the

Central East Local Health Integration Network), other provincial sources, and client fees for some

programs.

History of Community Care Haliburton County (CCHC) In 1979, the Haliburton Social Planning Council was endeavoring to plan services for the needs of Haliburton County. The Ministry of Community and Social Services was made aware of the founding members and an initial grant was received to open the first office in the Dysart et al Municipal Building, Haliburton Village, in April 1980.

Community Care Haliburton County was incorporated under the Companies Act of the Ministry of

Consumer and Commercial Relations in September 1980. One of the first projects undertaken was a

Needs Assessment (funded by a New Horizons grant). This resulted in many services being

successfully instituted including: Meals on Wheels, Wheels to Meals, Friendly Visiting, Phone-a-

Friend (Security & Reassurance Checks), Home Help, Transportation, Drop-In Centre, Trips, and

Assistance in filling out Government Forms. In the late 80’s the organization started to provide

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49 | P a g e

Alzheimer's Support, without any forthcoming funds from the Ministry. The Emergency Response

System Program and Hearing Testing/Infra-Red System were introduced in 1989 with the assistance

of an Ontario Trillium Foundation Grant.

A second Needs Assessment was conducted in 1986 to determine if further services would be

required and if present services were effective and utilized to the fullest extent. A third Needs

Assessment was completed in the summer of 1992. CCHC continues to do need assessments with

clients and volunteers every 2-3 years.

In the spring of 2005, the agency undertook the “Benchmarks of Excellence for Community Support

Organizations” sponsored by Capacity Builders of its provincial body, the Ontario Community

Support Association. This process was designed to help organizations better understand, measure,

celebrate and build organizational excellence. The evaluation process reconfirmed areas of strength,

was a good educational opportunity for respondents and led to some areas that could be

strengthened.

CCHC currently operates out of its main office in Haliburton village, with 7 full time staff and 130 volunteers. Funding is provided by the Ministry of Health and Long Term Care (through the Central East Local Health Integration Network), Haliburton County, fundraising, donations from the public, and client fees for some programs.

History of Supportive Initiatives for Residents in the County of Haliburton (SIRCH) In 1989, the Haliburton Social Action Committee (a social planning body) formed a not-for-profit organization (SIRCH Community Services) to be an administrative body to oversee programs that were to be created. The mandate was to look for gaps in social and health services and to address those gaps. Typically, that meant evaluating what the needs in the community were, searching for funding, then setting up programs or finding other ways to ensure that residents got the services they needed.

SIRCH has brought literally dozens of programs and services to Haliburton County! SIRCH excels at program creation and multi-level collaboration in Haliburton County. Once programs are created, SIRCH may continue to deliver them, or may divest them to another organization with an appropriate mandate. And occasionally programs are closed due to the changing landscape of health and social services or the changing needs of the county.

Just a few of the services "incubatored" by SIRCH:

Parent Support Services Divested to Family Services of Haliburton County (now Point in Time)

Telecare Closed as more help lines available Haliburton County Counselling (adult mental health) Divested to HHHS

Community Action Program for Children (CAPC) Operating under SIRCH’s umbrella Community Hospice Program Operating under SIRCH’s umbrella Crisis Assistance Program (CAP) Divested to a community group

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Counseling for Women Divested to the YWCA & Women’s

Health Care

Volunteer Dental Outreach Divested to its own corporation

CAPC-CPNP CKL/Northumberland Counties Sponsored by SIRCH; operated by Ontario Early Years Centre HVB, and NCDC (Child Development)

Food Security/Healthy Children Programs Operating under SIRCH’s umbrella

SIRCH is a multi-service agency providing a variety of programs and services, of which Hospice is one. SIRCH has 4 full time staff, 7 part time staff and over 100 volunteers. Two part time staff are dedicated specifically to Hospice. Volunteer recruitment, screening, training, admin, finance, human resources, fundraising and management are shared services. SIRCH funding comes from all levels of government, grants and fundraising.

History of Community Care City of Kawartha Lakes (CCCKL) COMMUNITY CARE CITY OF KAWARTHA LAKES is a not-for-profit charitable organization founded in 1985 as an agency delivering Meals on Wheels to isolated seniors in the then Victoria County. Since its inception, Community Care has focused on being a leader in advocacy, co-ordination and delivery of health and community support programs and services.

In 2010, CCCKL celebrated 25 years of working to improve the health and well-being of the community. CCCKL has grown and developed into a well-established and comprehensive community health and support organization. Today, CCCKL offers a full range of community services delivered by a diverse team of professionals. CCCKL employs approximately 120 staff, engage more than 800 volunteers and operate 20 distinct and integrated services that touch on the factors that most impact health and well-being.

Funding is provided by the Ministry of Health and Long Term Care (through the Central East Local Health Integration Network), the United Way for the City of Kawartha Lakes, fundraising, donations from the public, and client fees for some programs.

The CCCKL community model is accessible and community-based. CCCKL clients are at the centre of everything the organization does. CCCKL understands that many clients have challenges accessing community health care and services. That is why CCCKL staff takes the time to work collaboratively with community members, partner agencies, hospitals and others to ensure that programs and services are responding to expressed need and have a positive impact on the health of the communities we serve.

CCCKL has 4 key program areas that serve seniors, children and youth and special populations. Below is a list of services with examples of the types of services provided in the program areas.

1. Community Health Services

Primary Health Care

Wellness Programs such as Stroke Survivor Support Group, blood pressure monitoring

clinics, Good Food Box program

Health Promotion Community Development / Participation

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2. Community Support Services

Meal Programs

In-home respite/personal support

In-home maintenance and support

Adult day programs

Transportation

3. Hospice Services

Palliative and grief support in homes, schools, long-term care homes and Ross Memorial

Hospital

Grief and bereavement programs for all ages

Advocacy, Consultation and Support (palliative and bereavement)

Support for Caregivers

Lending Library Information and Education Services Children and Youth Programming

4. Dental Clinic

Affordable dentistry services, geared to low-income individuals and families in the City of

Kawartha Lakes.

Serving clients who are eligible under: Ontario Works, Healthy Smiles Ontario, Ontario

Disability Support, Children in Need of Treatment (CINOT)

The uniquely diverse range of community health professionals enables CCCKL to address both primary health and social support issues in an integrated and cost-effective manner. CCCKL provides a full range of quality health and social services to families and individuals who live or work in the City of Kawartha Lakes. Care is delivered in many ways: one-on-one services, groups, and community level involvement.

The CCCKL model focuses on prevention, early intervention, health promotion and community- based health care. As one of a few integrated community health organizations in Ontario, they are able to address the holistic aspects of health including physical, mental, social, financial and environmental. Through active community engagement, CCCKL strives to respond to local needs and deliver tailored services. CCCKL plays a vital role in promoting healthy lifestyle strategies and skills for individuals and families. CCCKL believes in an integrated approach to care that is holistic, non- discriminatory, caring and innovative. Collaboration is imperative. By working together, CCCKL can make it easier for clients to navigate the healthcare network.

CCCKL has 52 full time staff and 73 part time staff with 726 volunteers. Funding is provided by the Ministry of Health and Long Term Care (through the Central East Local Health Integration Network), the United Way for the City of Kawartha Lakes, fundraising, donations from the public, and client fees for some programs.

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History of Victorian Order of Nurses – Peterborough, Victoria, Haliburton THE VICTORIAN ORDER OF NURSES FOR CANADA is a national, charitable, not-for-profit health care organization with almost 14,000 staff and volunteers in sites across the country. VON was established in 1897 in response to the desperate need for health care services in both the remote areas of early Canada and the rapidly growing towns and cities. A comprehensive overview of the organization’s history from its establishment at the turn of the century, to current day is available at www.von.ca. Locally, the VON - Peterborough, Victoria and Haliburton site was established in 1946 and since 2006 operates as part of the Victorian Order of Nurses for Canada, Ontario Branch – the legal entity for the Ontario region of the national VON Canada organization. VON Canada Ontario is a funded Health Service Provider of the Central East LHIN as well as 11 other LHINs across the province. VON is also a contracted service provider of many Community Care Access Centres (CCAC) across the province including the Central East CCAC. VON Canada Ontario has 3,245 employees and over 6,000 volunteers and provides a wide array of programs and services funded by the MOH, LHINs, CCACs, our local VON Community Corporations as well as other sources such as other ministries, Veteran’s Affairs Canada and private pay arrangements.

VON Canada Ontario had revenue of $127 M in fiscal 2012 with 36% of that funding representing community program and services revenue from a variety of sources including LHINs, other ministries, grants, fund raised dollars and client fees. In the Central East LHIN, revenue for community based programming (excluding Home Care) amounts to $5.5 M. Within the CE LHIN, VON delivers a number of Community Support Services including Adult Day Programs at eight sites, ABI Day Services, In-Home Respite Services, Overnight Respite, Assisted Living Services for High Risk Seniors, Volunteer Visiting, Blood Pressure Checks as well as the SMART exercise program for seniors. Nursing Services include Community Nursing, Foot Care Services, Wellness and Immunization clinics, Mental Health Nursing, nursing support to the Developmental Sector as well as Nurse Practitioner services and an inter-disciplinary Nurse Practitioner-Led clinic.

VON has a well-developed Communities of Practice (COP) framework that allows for development and dissemination of best practices across the province for each of its programs and services. An example of the work of a COP is the development of medication monitoring policies and procedures that have ensured that staff within programs such as Adult Day Programs, safely and successfully support high needs clients within their scope of practice. Leveraging the diverse experience within VON allows for the provision of clinical support to all programs as required.

In Haliburton County and the City of Kawartha Lakes the CE LHIN funds VON to coordinate Foot Care services in Haliburton County, to provide senior-focused Adult Day Programs in both Haliburton County and the City of Kawartha Lakes as well as Acquired Brain Injury Adult Day services in Kawartha Lakes. VON has 5.4 full time staff and 30 volunteers supporting these programs within Haliburton County and CKL. Funding is provided by the Ministry of Health and Long Term Care (through the Central East Local Health Integration Network), fundraising, donations from the public, and client fees for some programs.

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53 | P a g e

Category Community Health Services and

Community Support Services Hospital Community Support Services

Community Care City of

Kawartha Lakes Ross Memorial Hospital Haliburton Highlands Health

Services Community Care Haliburton

County SIRCH Community Services VON Peterborough Victoria

Haliburton

Mission Community Care City of Kawartha

Lakes is a leader in the

collaborative design and delivery

of integrated and responsive

health and support services that

respect individual choice, dignity

and independence.

To provide quality acute and

continuing care services to the

residents of the City of Kawartha

Lakes and adjacent

communities. In fulfilling this

mission, RMH is committed to: •

Anticipating and responding to

the health needs of the

community • Improving the

health of our population •

Working in partnership with

community and regional health

service providers

Haliburton Highlands Health Services, working with partners

and accountable to our

community, promotes wellness

and provides access to essential,

high quality health services

including: primary care, hospital

and long-term care, and

community programs.

To enable seniors and adults with disabilities and / or illnesses and

their caregivers to remain

independent at their place of

residence for a longer period of

time.

To co-operate with others in the

County to create an awareness of

client needs and enhance the

quality of their life.

SIRCH provides innovative and

accountable services that

encourage and support

individuals, families and

communities through:

Community Services

Consulting and Training

Resource Development

Research and Evaluation

Social Planning

VON works in partnership with Canadians for a healthier society:

VON, a charity guided by the

principles of primary health care,

works in partnership with

Canadians for a healthier society

through: Leadership in

community-based care. Delivery

of innovative, comprehensive

health and social services.

Influence in the development of

health and social policy.

Primary

Geography

Served

City of Kawartha Lakes and

adjacent communities City of Kawartha Lakes and

adjacent communities Haliburton County and adjacent

communities Haliburton County Haliburton County City of Kawartha Lakes,

Haliburton County and

Peterborough City and County Clients Served

(2012/13) Primary care (incl. OTN) 1,868

Dental (6mo) 1,360

Hospice 600

Wellness program 5,702

Support services 5,208

Supportive housing 91

One way transportation 64,348

Meals delivered 29,339

Diners club attendees 10,172

Adult day program 62

Supp. housing days 10,526

Hospital to home Coordination

Friendly visiting, lifeline and

Home help 2,957

Income tax assistance 720

Acute (Pall, Med, Surg) 5,007

Newborn 307

Complex Continuing Care 277

Rehab 255

Mental Health 441

Outpatient Activity

Emergency Room 46,172

Surgical Day Care 6,277

Clinics 22,678

Diagnostic Imaging 38,435

CT Scan 7,528

MRI 4,461

Emergency Dep’ts 26,775

Acute Care (Discharges) 363

Diag. Imaging (Exams) 10,995

Physiotherapy (Visits) 1,942

Mental Health Program 545

Supportive Housing (Clients) 45

Diabetes (Active Clients) 847

All Functional Centres 1,410

Transportation 418

Emergency Response 222

Meals on Wheels 264

Social & Congregate Dining 242

Service Arrangement/Co-ordination

149

Visiting Social & Safety 31

Case Management 81

Number of Units provided per Service

Transportation 11,146

Emergency Response 2,292

Meals Delivered 15,779

Social Dining 2,861

Service Arrangements 200

Visiting Social & Safety 2,192

Case Management 44.5

Clients at home 55

Clients at HHHS 10

Cancer Support 22

Bereavement 10

Family Members 187

CKL/Haliburton Only

Footcare (Funded for coordination in

Haliburton County only) 94

Adult Day Services 80

ABI Day Services 11

SMART Exercise 49

Organization

Type not-for-profit corporation and

registered charity not-for-profit corporation and

registered charity not-for-profit corporation and

registered charity not-for-profit corporation and

registered charity not-for-profit corporation and

registered charity not-for-profit corporation and

registered charity Funding $M March 31,2013 6,947,000 86,000,000 21,000,000 695,000 166,000 382,000

CKL/Haliburton portion only CELHIN/

MOHLTC

5,044,000

68,000,000

17,500,000

561,000

140,000

296,000

Gov’t Canada 25,000 Other Prov. 5,000 2,500,000 Municipalities 179,000 15,300 United Way 15,000 Fundraising 500,000 29,000 23,000 11,000 Fees/Recov. 1,679,000 15,500,000 3,000,000 90,000 75,000 Staffing

FTE 52

73 PT 446 FTE

409 PT/CASUAL 90 FT

95PT/69 CASUAL 7 2.6 5.4

Volunteers 726 350 381 130 63 30

Appendix D: Decision Making Criteria

54 | P a g e

Decision-making

Step Decision-making Criteria Description Guiding Principles Decision-making Framework

(pages 6-9)

Compliance Screen Legislative Barriers Are there legislative barriers that would prevent implementation? Is the option aligned with LHSIA, the Public Hospitals Act, etc.?

Legislative Ascendance - In no way can these principles limit the authority of the LHINs, Health Service Providers and the MOHLTC as set out in legislation.

Compliance Screen System Alignment

Compliance Screen Strategic Alignment Does the option align with the strategic direction of the Province and the LHIN's Integrated Health Service Plan including:

Community First Seniors: save 320,000 LTC days Vascular: 25, 000 more vascular days at home/ in the community Palliative: 12, 000 more palliative days at home/ in the community MH&A: 15, 000 more MH&A days at home/ in the community

Flexibility & Innovation – "... any redesign of health services should consider a variety of options, meet the strategic aims of the Central East LHIN and consider the impact on HSP staff and volunteers.”

Compliance Screen System Alignment

Appendix D: Decision Making Criteria

55 | P a g e

Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Economics & Cost Realignment Is the option going to increase value for the key stakeholders, the public? Will costs be reduced allowing for more efficient service provision and/or the movement of funds to front-line services?

Value Creation for Clients – Integration process will be guided and motivated by a continuous focus on how to best meet client and caregiver needs. The outcome will be to re- engineer the delivery system to support the values of clients/patients and communities. Return on Investment – Integration must be focused on increasing value to shareholders of the health care system… the public.

Efficiency: Extent to which program/initiative contributes to efficient utilization of health services, financial, and human resources capacity to optimize health and other benefits within the system. Partnerships: Degree to which appropriate levels of partnership and/or appropriateness of partnerships, both LHIN funded and non-LHIN funded, will be achieved in order to ensure service quality enhancement, improved comprehensiveness, optimal resource use, minimal duplication, and/or increased coordination. Cost Benefit Analysis Step

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Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Quality Will HSPs continue to provide services that are of consistent standards and high quality to clients? Will quality decline?

Quality Services – Health Service Provider agencies and the Central East LHIN will design sustainable integrated services that provide consistent standards and high quality to clients.

Quality: Extent to which program/initiative improves safety, effectiveness, and client experience of health services(s) provided. Partnerships: Degree to which appropriate levels of partnership and/or appropriateness of partnerships, both LHIN funded and non-LHIN funded, will be achieved in order to ensure service quality enhancement, improved comprehensiveness, optimal resource use, minimal duplication, and/or increased coordination.

Appendix D: Decision Making Criteria

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Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Service enhancement including: - increasing access -ensuring equitable access -improving population health -avoiding service redundancy -reducing a gap

Will changes improve/ equalize patient access to services, enhance the health of the population, result in the provision of services, fill an unmet need or reduce the number of providers offering a similar service? Would services decline?

Regional Access – Integrated services must be accessible to all clients in the geographic area. Consumer Centred – The integration process will be guided and motivated by a continuous focus on how to best meet the health needs of clients. Efforts will be made by all parties to minimize service disruptions during any integration transition that may occur as a result of this process.

Access: Extent to which program/initiative improves physical, cultural, linguistic and timely access to appropriate level of health services for defined population(s) in the local health system. Equity: Impact on the health status and/or access to service of recognized sub-populations where there is a known health status gap between this specific population and the general population as compared to current practice/ service. The absence of systematic and potentially remediable differences in one or more aspects of health across populations or population groups defined socially, economically, demographically, culturally, linguistically or geographically. Population Health: Determines contribution to the improvement of the overall health of the population. Partnerships: Degree to which appropriate levels of partnership and/or appropriateness of partnerships, both LHIN funded and non-LHIN funded, will be achieved in order to ensure service quality enhancement, improved comprehensiveness, optimal resource use, minimal duplication, and/or increased coordination. Population Health: Determines contribution to the improvement of the overall health of the population

Appendix D: Decision Making Criteria

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Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Client Experience & Continuity of Care Which option will best meet clients' needs and minimize service disruption? Will continuity across the continuum of care be improved or hampered?

Value Creation for Clients – Integration process will be guided and motivated by a continuous focus on how to best meet client and caregiver needs. The outcome will be to re- engineer the delivery system to support the values of patients and communities. Consumer Centred – The integration process will be guided and motivated by a continuous focus on how to best meet the health needs of clients. Efforts will be made by all parties to minimize service disruptions during any integration transition that may occur as a result of this process. Continuum of Care – HSPs will work with the LHIN and other health service providers – notably the primary health care system, the Community Care Access Centre and mental health & addictions agencies – in any redesign of health services to promote the optimal integration of services within the region and to ensure services are fully integrated into the area’s continuum of care.

Client-Focused: Extent to which program/initiative meets the health needs of a defined population and the degree to which patients/clients have a say in the type and delivery of care. Integration: Extent to which program/initiative improves coordination of health care among health service providers, including LHIN funded and non-funded providers and community providers to ensure continuity of care in the local health system and provision of care in the most appropriate setting as determined by patient/client's needs. Community Engagement: Level of involvement of target population and other key stakeholders in defining the project and planned involvement in evaluating its impact on population health and key system performance. Population Health: Determines contribution to the improvement of the overall health of the population

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Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Control Local governance that understand their communities will have the ability to influence service provision and their own destiny

Leverage the Local – Community services are best supported by local governance that understand their communities, and by local management that can take advantage of local volunteers and fundraising opportunities. Clients, patients and caregivers should have maximal close-to-home access to community services. This does not preclude opportunities for broader regional approaches that support health care delivery and coordination (e.g., back office supports).

Decision Criteria Adaptability and Sustainability Will service providers be able to sustain changes made and be enabled to adapt to future system changes?

Flexibility and Innovation - Within the combined financial resources, and considering the existing service and operational infrastructure, HSPs may redesign services to meet the needs of clients. There is no assumption that existing delivery practices must be maintained, however, all parties agree at a minimum to maintain current service delivery targets and service levels and minimize service disruption for current clients.

Sustainability: Impact on health service delivery, financial, and human resources capacity over time. The health system should have enough qualified providers, funding, information, equipment, supplies and facilities to look after people’s health needs. Innovation: Impact on generation, transfer, and /or application of new knowledge to solve health or health system problems; encouraging leading practices and innovation, building on evidence and application of leading practices.

Appendix D: Decision Making Criteria

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Decision-making Step

Decision-making Criteria Description Guiding Principles Decision-making Framework (pages 6-9)

Decision Criteria Implementable/Practical Realities Are there any major barriers that would prevent the proposed changes from being implemented successfully?

System Readiness Step

Decision Criteria Capacity to Engage the Community in: -Fundraising -Volunteering

Will the organization's ability to recruit local volunteers and fundraise be maintained/enhanced?

Leveraging the Local – The Central East LHIN believes that community health services are best supported by an understanding of the communities being served and by local management that can maximize the use of local volunteers, fundraising opportunities and other community supports.

Community Engagement: Level of involvement of target population and other key stakeholders in defining the project and planned involvement in evaluating its impact on population health and key system performance.

Final Screen Risk Is there a risk that is so profound Do No Harm – The Central East that it cannot be mitigated or

managed? LHIN will work with all parties to ensure that any integration

opportunity does not result in new risks or pressures (legal, financial, operational, reputational) to any party to the integration.

Appendix E: Proposed Governance Models

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Option A: One Entity

Board of Directors

CEO

Management

Structure

Hospital Services Community

Services

Appendix E: Proposed Governance Models

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Option B1: Two Entities by Service, Single Management

Board of Directors

Hospital

Board of Directors

Community

CEO

Management

Structure

Hospital Services Community

Services

Appendix E: Proposed Governance Models

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Option B2: Two Entities by Service

Board of Directors

Hospital

Board of Directors

Community

CEO CEO

Management

Structure

Management

Structure

Hospital Services

Option to work together & purchase

services

Community

Services

Appendix E: Proposed Governance Models

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Option B3: Two Entities by Geography, Single Management

Board of Directors

Haliburton County

Board of Directors

City of Kawartha

Lakes

CEO

Management

Structure

Haliburton County

Community and

Hospital Services

City of Kawartha

Lakes Community

and Hospital

Services

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Option B4: Two Entities by Geography

Board of Directors

Haliburton County

Board of Directors

City of Kawartha

Lakes

CEO CEO

Management

Structure

Management

Structure

Haliburton County

Community and

Hospital Services

Option to work together & purchase

services City of Kawartha

Lakes Community

and Hospital

Services

Appendix E: Proposed Governance Models

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Option C: Three Entities

Board of Directors

Organization A

Board of Directors

Organization B

Board of Directors

Organization C

CEO CEO CEO

Management

Structure

Management

Structure

Management

Structure

Services

A

Services

B

Services

C

Appendix E: Proposed Governance Models

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Option D: Four Entities

Board of Directors

Organization A

Board of Directors

Organization B

Board of Directors

Organization C

Board of Directors

Organization D

CEO CEO CEO CEO

Management

Structure

Management

Structure

Management

Structure

Management

Structure

Haliburton County

Hospital Services

City of Kawartha

Lakes Hospital

Services

Haliburton County

Community

Services

City of Kawartha

Lakes Community

Services

Option to work together & Option to work purchase services together & purchase services

Appendix E: Proposed Governance Models

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Board of

Directors

CCHC

Board of

Directors

SIRCH

Board of

Directors

RMH

Board of

Directors

CCCKL

Board of

Directors

VON

Option E: Six Entities

Board of

Directors

HHHS

CEO CEO CEO CEO CEO CEO

Management

Structure

Management

Structure

Management

Structure

Management

Structure

Management

Structure

Management

Structure

Service and Back-office Re-alignment

Appendix E: Proposed Governance Models

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CEO

Management

Structure

Option F: Hybrid

Board of Directors Organization A

Board of Directors Organization B

Board of Directors Organization C

CEO

Management

Structure

City of Kawartha Lakes Hospital

Services

Haliburton County Community &

Hospital Services

City of Kawartha Lakes Community

Services

Appendix F: Governance Model Analysis

70 | P a g e

Option A - One Entity

Pros Cons Risks Overall

It is feasible that MOH could approve this model for hospitals and LTC

A negative public reaction and the resulting political response is a consideration

Integration consistent with the IHSP

Savings on the cost of CEOs Benefit from some management realignment (e.g. HR)

Trade-offs with savings from lower CEO costs include the possibility of higher travel, IT and upper management costs Impact on small hospital could be larger as it could lose the benefits of a small rural hospital

Labour harmonization will be a challenge and would be costly. Community and Hospital would need to be aligned for salary and benefits Union implications for merging organizations

Overall standardization may result in an improvement Economies of scale could be improved the level of expertise

Potential to reduce service gaps Potential for service enhancement Planning would look to increase service standards to the highest standard and equitable access

Risk that access issues will result in a service decrease (maybe hidden) Risk that one organizations priorities will reduced service for some

Continuity across the continuum of care should improve

Responsiveness may be reduced with a larger organization

Staff may have challenges understanding local context if expected to work across tow geographies

LEGEND Meets all Criteria

Meets more than 7 Criteria

Meets less than 5 Criteria

Meets less than 5 Criteria with a high risk

Appendix F: Governance Models Integration Analysis

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Option A - One Entity

Pros Cons Risks Overall

A larger organization may have a stronger voice on a system level

Loss of autonomy in Haliburton County with centralized control outside of the geography

Decision making becomes centred on one area and not take in the sublets of local needs Future risk that control will be more broadly based than this option (e.g. CE RHA)

A larger organization is less vulnerable when there are macro-level changes and increased administrative demands (e.g. reporting requirements)

High change management demands (community cultures, organizational cultures will need to change) There are likely to be concerns from the HSPs' Boards, and communities as this is very radical change Currently provincial administration is divided by sectors, manageable through management structure The board would need to be structured in a way that allows for the management of multiple agendas

Very high risk of losing volunteers Presently there is competition for fundraising in each geography. It is unclear what the impact could be with more centralized fundraising

Fundraising expertise could be shared High change management demands to maintain volunteers and fund-raising as people tend to support a location or a cause in their own geography

Appendix F: Governance Models Integration Analysis

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Pros

Option B1 - Two Entities by Service, Single Management

Cons Risks

Overall

Horizontal integration consistent with the IHSP

See Option A Trade-offs with savings from having only one CE include the possibility of higher travel, IT and upper management costs Impact on small hospitals as for Option A

Labour harmonization will be a challenge and would be costly. Community and Hospital would not need to be aligned for salary and benefits Union implications for merging organizations

Focus of Boards will be on their respective sector as a result the risk of one sector being overtaken by another is lessened. There is greater potential for quality improvement as a result. Opportunity for standardization within each sector

Possibility that continuity across sectors will be limited. However, the single management structure may mitigate this risk

Opportunity to address gaps within each sector

Same as above Risk that access issues will result in a service decrease (maybe hidden) Risk that the priorities of only one organization (larger organization )will reduced service for some

Single management structure can mitigate risks to service and quality levels that are inherent in having two entities organized by services (see above)

Local needs may not be addressed again focussing on larger organizations needs

Appendix F: Governance Models Integration Analysis

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Pros

Option B1 - Two Entities by Service, Single Management

Cons Risks

Overall

Political risks less than option A but still significant governance agendas of two boards and potential for conflict

A larger organization would be less vulnerable to external factors

-CEO reporting to two boards with two different agendas and issues would be extremely challenging

A negative public reaction and the resulting political response is a consideration Potential conflict between the boards such as culture and guiding principles

Opportunities arise from shared fundraising capacity/ expertise within sectors Volunteers tend to be interested in a particular sector thus their engagement is less at risk than it is with Option A.

Local loyalties may be undermined again with centralized focus of board

Appendix F: Governance Models Integration Analysis

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Option B2 - Two Entities by Service

Pros Cons Risks Overall

No Legislative Barriers

Horizontal integration consistent with the IHSP

Small savings anticipated in administration costs with a decrease from 6 organizations to 2 LHIN managed organizations. VON and SIRCH will continue to provide services. VON will not be in Haliburton County and SIRCH will not have LHIN funding

Impact on small hospital funding See Option A Labour harmonization will be a challenge and would be costly. Community and Hospital would not need to be aligned for salary and benefits Union implications for merging organizations

Focus of Boards will be on their respective sector as a result the risk of one sector being overtaken by another is lessened. There is greater potential for quality improvement as a result of increased standardization within each sector

Possibility that continuity across sectors will be limited. However, the single management structure may mitigate this risk

Opportunity to address gaps within each sector Focus of the CEOs on their respective sectors could help to improve service within sectors

Two CEOs focusing on a variety of sectors may not improve continuity as there may be no focus in service delivery

Local needs may not be addressed with pressures to manage a wider range of services and more diverse needs across the geography

Appendix F: Governance Models Integration Analysis

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Option B2 - Two Entities by Service

Pros Cons Risks Overall

A larger organization would be less vulnerable to external factors

Work load and issues management would be manageable for each CEO as they would each be serving only one board

A negative public reaction and the resulting political response is a consideration

Local loyalties could be undermined as services will be aligned differently Local expertise could be lost

No Anticipated harm

Appendix F: Governance Models Integration Analysis

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Option B3 - Two Entities by Geography, Single Management

Pros Cons Risks Overall

HHHS has expertise in managing hospital and community sectors that could be shared with City of Kawartha Lakes

Hospital boards have specific compliance requirements that are very different from community services boards. Alignment of boards may be challenging to ensure all organizational needs are meet.

This aligns with vertical integration and strategic direction

Labour harmonization will be a challenge and would be costly. Community and Hospital would not need to be aligned for salary and benefits Union implications for merging organizations

Labour harmonization is significant cost for alignment of unionized and non-unionized employees

Quality not anticipated to decline

-With a single CEO there are opportunities to address gaps and for service enhancement across locations.

One management structure with locally focused boards would improve continuity of care

Appendix F: Governance Models Integration Analysis

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Option B3 - Two Entities by Geography, Single Management

Pros Cons Risks Overall

Local governance for each geography supports maintaining local needs

There could be a loss of control for the community sector as attention could become focused on the hospital sector over time

A larger organization would be less vulnerable to external factors

There would be significant challenges for a single CEO who is serving two locations and two boards Potential for the single management structure to favour one sector over another

This option could provide new opportunities for volunteers within their own communities

No harm anticipated

Appendix F: Governance Models Integration Analysis

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Option B4 - Two Entities by Geography

Pros Cons Risks Overall

There is a philosophical distinction between a hospital board that is responsible for other activities and a regional board that is responsible for a hospital's activities. Corporate structure and governance would have to change to ensure compliance with the Public Hospitals Act etc. Legal advice is required.

Aligns with strategic direction

Potential for efficiencies There will be one time implementation costs as well as labour harmonization

Labour harmonization is significant cost for alignment of unionized and non-unionized employees

Potential for improvement The opportunity for coordination and cooperation within the hospital sector may be less although a working relationships between hospitals is an area to be explored.

Changes could have a negative impact on organizational culture

No implicit impact In Haliburton County potential to increase access and ensure equitable access and avoid service redundancy.

High potential for improvement greater than models that would combine organizations within sectors

Appendix F: Governance Models Integration Analysis

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Option B4 - Two Entities by Geography

Pros Cons Risks Overall

Local control resides within the county which is important in Haliburton

City of Kawartha Lakes has done significant integration in the community sector through CCCKL. Community reaction to further. Integration may not be favourable. It may be seen as the hospital taking over the geography.

A larger organization would be less vulnerable to external factors

More manageable workload for CEOs There may be more challenging to manage a combination of sectors. Engagement of governors and staff in the full scope of work will be required

This model leverages local loyalty Potential for consolidation of fundraising, volunteer recruitment and coordination expertise

The community sector raised a significant proportion of program funding. This could be lost with a merger as volunteers are loyal to organizations and causes. Continuity to engage volunteers and the community will need to be managed

No harm anticipated

Appendix F: Governance Models Integration Analysis

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Option C - Three Entities

Pros Cons Risks Overall

HHHS has expertise in managing hospital and community sectors that is a strength for Haliburton County

Aligns with Strategic Direction

Potential savings of back office costs from merger of organizations

There will be one time implementation costs as well as labour harmonization

Labour harmonization risk is lower as only Haliburton County would be merging organizations

Would result in fewer organizations thus providing continuous care

Opportunities for coordination Haliburton County with one entity

Potential to leverages local loyalty Potential consolidation of fundraising, volunteer recruitment and coordination expertise in Haliburton County

The community sector raised a significant proportion of program funding. This could be lost with a merger as volunteers are loyal to organizations and causes. Continuity to engage volunteers and the community will need to be managed

No harm anticipated

Appendix F: Governance Models Integration Analysis

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Option D - Four Entities

Pros Cons Risks Overall

Very similar to status quo

Minor shifts

No value added

No decline in quality anticipated

The option to coordinate service provision/ realign services is still an opportunity that is available

Haliburton County may not have access to a full range of services that would be available in options where Haliburton County and Kawartha Lakes organizations are combined

Status Quo

Status Quo

The option to coordinate service provision and realign services is still an opportunity that is available

Similar to status quo, funding pressures will not be resolved

Status Quo Status Quo

Status Quo

Appendix F: Governance Models Integration Analysis

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Option E - Six Entities

Pros Cons Risks Overall

Very similar to status quo

Potential to making changes to service and back- office realignment

No value added

No decline in quality anticipated

The option to coordinate service provision/ realign services is still an opportunity that is available

Haliburton County may not have access to a full range of services that would be available in options where Haliburton County and Kawartha Lakes organizations are combined

Status Quo

Status Quo

The option to coordinate service provision/ realign services is still an opportunity that is available

Similar to status quo, funding pressures will not be resolved

Status Quo Status Quo The IPT organizations have a made a

commitment to develop an integration plan, if there is no significant integration stakeholders may not be in support of status quo

Status Quo

Appendix F: Governance Models Integration Analysis

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Option F - Hybrid

Pros Cons Risks Overall

No legislative barriers

Aligns with strategic direction

Small hospital stays small hospital as autonomous corporate entity

Sharing across hospital sites. CCCKL already integrated similar to status quo

Consistent with three entities model

Improved continuity in Haliburton County. VON services would be impacted in City of Kawartha Lakes

A potential loss of focus on community and change in organizational culture required. CEO may be very hospital driven with responsibility for 2 hospitals. Potential of loss of focus on community is larger risk than in other models.

Haliburton County would maintain autonomy If CEO drives the board autonomy could be compromised for smaller organizations.

Adaptable model

High level of complexity for management across sectors Balance of community and hospital needs

Coordination of two boards with one CEO and multiple service needs will represent a significant workload

Haliburton County would maintain local community support for fundraising and volunteers

No harm anticipated

Appendix F: Governance Models Integration Analysis

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Summary of Evaluation

Model Evaluation

Decision-Making Criteria Optio

n A One

Entity

Option B1

Two Entities by Service, Single Management

Option B2

Two Entities by Service

Option B3 Two Entities by Geography, Single

Management

Option B4

Two Entities by Geography

Option C Three

Entities

Option D

Four Entities

Option E

Six Entities

Option F Hybrid Two Entities by

Geography with Three Boards

Legislative Barriers

Strategic Alignment

Economics & Cost Realignment

Quality

Service enhancement including:

- increasing access -ensuring

equitable access -improving

population health -avoiding service

redundancy -reducing a gap

Client Experience & Continuity of Care

Autonomy

Adaptability and Sustainability

Implementable/Pract ical Realities

Capacity to Engage the Community in:

-Fundraising -Volunteering

Do no Harm

Appendix G: Volunteer Match

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Introduction

The Integration Planning Team (IPT) for Haliburton County/City of Kawartha Lakes has developed a

model of integration that would merge or transfer LHIN funded health and community services to

"One Entity" in Haliburton County. There is an opportunity to pilot a new way of recruiting, screening,

orienting and navigating volunteers, not only for the One Entity, but for any not-for-profit organization

delivering services in Haliburton County. If successful, the program, called VolunteerMatch Haliburton

County would reduce funding currently spent on volunteer recruitment, and greatly improve the

process and experience for volunteers.

Current Situation

Haliburton County has over 50 not-for-profit organizations. Each does its own recruitment of

volunteers. While some organizations don't screen or train, those that do often vary greatly in their

processes. Some have formalized structures and policies for these activities, with clear expectations

and evaluation criteria. Others do not. Overall, however, a great deal of time, energy and resources

are spent on recruitment, screening, training and maintaining files/data.

Organizations administered out-of-county do not have as high a profile, which makes it harder to

recruit and retain volunteers. It may mean that Haliburton County volunteers have to go to Lindsay or

Peterborough or elsewhere to get orientation and training. Organizations that do not have a position

responsible for volunteer management may not have the resources to effectively recruit, and train

volunteers.

Potential volunteers in Haliburton County, who often are new retirees moving up to the area, have no

idea what is available or where to find out. They currently have to find out about and approach each

non-profit organization individually to determine what they do, and apply to each one they are

interested in -- a process which includes multiple intake processes, having references checked multiple

times, filling in extensive amounts of paperwork and perhaps obtaining several police checks. Each

agency orients the volunteer differently and separately. There have been concerns expressed by many

not-for-profit organizations that we all are recruiting – in other words there is duplication of service

and competition for volunteers.

There is an opportunity to provide this county with a one-stop shop for volunteers, and a central

location where member agencies can go to acquire fully screened and oriented volunteers who are a

match to the volunteer positions they have available.

Appendix G: Volunteer Match

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Drivers for Change

In 2012 five organizations -- Haliburton Highlands Health Services (HHHS), Community

Care Haliburton County (CCHC), SIRCH Community Services (SIRCH), Haliburton

Highlands Family Health Team (FHT)), and the HKPR CCAC went through an extensive

Haliburton County Integration Planning facilitated by the LHIN. A proposed model of

integration included one entity for HHHS, CCHC with Hospice services from SIRCH

moving to that entity. However unique to the model was the development of a

"Volunteer Bureau" with responsibility for common recruitment, screening, orientation

and common training – a one-stop shop for potential volunteers and a ready resource

for member agencies.

In November 2012 that process was expanded to a larger LHIN-facilitated Integration Planning process, with the membership being HHHS, CCHC, SIRCH, Victorian Order of Nurses (VON), Community Care City of Kawartha Lakes (CCCKL) and Ross Memorial Hospital. At this point in the process, the Planning Table members have re-visited and supported the concept of One Entity (governance) for Haliburton County. With the proposed One Entity model merging Community Care and HHHS, and transferring programs from SIRCH and VON, there is an opportunity, and support, to further explore a "volunteer bureau" model in this community.

Proposed Solution

SIRCH is proposing a pilot that will be called VolunteerMatch Haliburton County. Having a centralized, one-stop volunteer matching program will enable all member agencies to focus their energies on program delivery and to reallocate resources as it is expected the contracting and/or membership rates of VolunteerMatch will be less than staffing costs currently required to manage these tasks. VolunteerMatch will provide volunteer facilitation/navigation and will focus on best practices in volunteer recruitment and common areas of training. Additional training in interesting subjects and workshops with great speakers can be offered to all volunteers, along with mentoring opportunities. The skills inventory and database will provide the ability to enter and continuously update volunteer metrics. This real time access will provide excellent matching criteria, reduce errors, and will provide an easy, consistent way of collecting volunteer statistics. Data will be available specific to member agencies, as well as aggregated for all members. This data, in turn, will be helpful in reporting to funders and the community, applying for grants, and in fundraising efforts. VolunteerMatch would also develop tools and services to help member agencies successfully manage and support volunteers.

Appendix G: Volunteer Match

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Objectives

1. Volunteers have a "one-stop shop" to find volunteer opportunities;

2. Duplication (of recruitment, screening, orientation, and some training) is reduced;

3. Some financial resources (for volunteer recruitment) can be reallocated;

4. All volunteers receive a consistent foundation through common training modules;

5. Volunteers can move between organizations and volunteer "jobs" without re-doing paperwork, screening, etc, reducing volunteer burnout;

6. Support and supervision of volunteers is tracked, increasing accountability

7. Volunteers have a "third party" person (facilitator) to go to if they encounter difficulties or conflicts that cannot be resolved within the organization they volunteer for, reducing volunteer stress and/or disengagement

8. Organizations focus staffing and resources on program delivery.

The VolunteerMatch Model

VolunteerMatch Haliburton County, would be piloted by SIRCH and modelled after their recent restructuring of volunteer recruitment, screening, orientation, placement and training. Recruitment would be based around the skills and attributes needed for the volunteer job, not the job itself. Potential volunteers could contact VolunteerMatch (via phone, email, via website/Facebook, or in person) and the following process would take place:

Step 1 – Intake

Potential volunteers would connect with a VolunteerMatch facilitator who would assist

them to complete an intake form and a Skills Inventory (the Skills Inventory copyrighted

by SIRCH for Need a Hand is attached. SIRCH would adapt this for VolunteerMatch.)

They would be asked to provide three letters of recommendation/references and the

facilitator would also fill in an application for a Vulnerable Sector Police Check (SIRCH

has a protocol with the Ontario Provincial Police which simplifies the process for

volunteers).

Step 2 – Data Input

A staff person would input the data into a complex data base which cross-references all

data, keeps track of timelines, assignments, comments etc. It would be the intent to

develop web based forms and reporting processes so volunteers can provide

information online if preferred.

Step 3 – Orientation

Volunteers would attend an orientation which speaks to volunteer culture, as well as

types of opportunities with member organizations. Member agencies would be

welcome to be part of the orientation, however the facilitator would be very familiar

with the types of volunteer opportunities and able to describe them accurately and

effectively should members not be present.

Appendix G: Volunteer Match

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Step 4 – Matching

Based on the Skill Inventory, preferences of the volunteer, time available and other factors, the facilitator will do a database search to match the volunteer with potential volunteer jobs that this person would be suited for. Depending on the skills identified, the volunteer may be suitable for more than one organization or program. For example if a volunteer had checked off all activities under "Care, Respite & Caregiver Support" on the Skills Inventory, then s/he could be considered for hospice, friendly visiting, respite, a mentor to a new mom, a big brother/sister etc. In addition they may have indicated they'd like to participate in fundraising events, or on an advisory committee. The facilitator would meet with the volunteer to discuss the options, and his/her availability, and if there is a greater need from one of the programs/organizations could encourage the volunteer to select that opportunity first.

Step 5 – Training

Training needs for each volunteer job would be discussed with the member

organizations. Generic training would be made available through VolunteerMatch.

Once the volunteer selects one or more options, the facilitator will assess the training

that the volunteer may already have against the needs of the organization's volunteer

job. All jobs would require training on confidentiality, ethics, and customer/client

service. Additional generic training would also be available, such as values and

ethics, solution-focused communication, effects of "risk factors" (poverty, literacy etc),

teamwork etc. Each member organization would determine which generic modules

were needed prior to the volunteer starting his or her volunteer position with the

organization. The organization would then provide the more specific or in-depth

training required.

In the pilot it is expected that initially training will be in person (and some, like communication skills, will continue in that format). However, other training could be put into a web-based or DVD format to provide flexibility. Volunteers may take any of the training provided by VolunteerMatch at any time. The database would track what training each volunteer had, and periodically the facilitator would meet with the volunteer to discuss future training needs.

Step 6 – the Hand-off Once the volunteer has selected his or her job choices, the facilitator would do a hand-off to the appropriate agency/program staff. For example, the facilitator would contact the Hospice Manager, provide some initial information about the volunteer, provide copies of CPICs or other information, then schedule a meeting for the volunteer and Manager (which the facilitator may or may not attend).

The VolunteerMatch facilitator will contact the volunteer quarterly to discuss satisfaction with the placement, training needs, other opportunities (if appropriate). Should the volunteer want to take a break from his or her placement, then the facilitator would meet with the person and determine if a break or a different volunteer position was in order.

Appendix G: Volunteer Match

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Step 7 – Ongoing Tracking The database would be key to VolunteerMatch. It would not only track the initial intake process, training taken and volunteer position chosen, but would allow for ongoing monitoring. A secure portal would be available to the supervisor of each volunteer (from the organization s/he volunteers for) which would allow the supervisor to enter dates the volunteer was supervised, any comments/commendations, awards given etc. That information would be password protected and only available to authorized individuals within the organization and within VolunteerMatch.

Stakeholders

SIRCH would develop and pilot VolunteerMatch. The One Entity in Haliburton County would assist in piloting. Other not-for-profit organizations would be approached as well to see if they would like to participate in the pilot. It is expected that particularly out-of-county non-profits may wish to take this opportunity.

Prioritized Requirements (High Level) This pilot will require stakeholders of the IPT to participate in defining the need and skill requirements. Stakeholders need to have significant involvement in the planning process, as their input is critical to establishing a clear understanding of their needs.

Assumptions

The pilot provides an opportunity to test some assumptions:

1. VolunteerMatch will be financially viable with no base government funding within two years;

2. VolunteerMatch will be able to meet the need for volunteers

required by member organizations;

3. Volunteers will respond positively to having one place to go for volunteer

opportunities and a facilitator to assist them through the process, resulting in

increased numbers of volunteers;

4. Screening, orientation and support received from VolunteerMatch are exemplary;

5. VolunteerMatch services are cost-effective for member organizations;

6. Funding is available for a two-year pilot;

7. Funding is available for purchasing hardware/software for web-based system;

8. Project has executive-level support and backing from stakeholders.

Financial Viability

For this model to work, it must not only be financially sustainable after the pilot, but reduce the cost of staff time for the One Entity, allowing it to reinvest those resources. We would retain a consultant to research, assess and present various revenue models that would allow VolunteerMatch to meet those criteria. For example, the consultant would need to determine how to ensure that the fee reflects fairly the number of volunteers recruited, training taken, ongoing program needs vs one-time etc.

Appendix G: Volunteer Match

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Software Development* & licenses 7,000

Computer equipment (computer and monitor for coordinator) 1,000

Website hosting and development 5,000

Total 13,000

Validation and approval would be required from the stakeholders, where all parties

have agreed on the overall need and the actual requirements to address the

assumptions above. Unless a viable financial model could be agreed upon, the pilot

would not proceed.

Major Project Milestones

The following are the major project milestones identified at this time. As the project

planning moves forward and the schedule is developed, the milestones and their

target completion dates will be modified, adjusted, and finalized as necessary to

establish the baseline schedule.

Milestones/Deliverables Target Date

Pilot Funding Approval September 30, 2013

Project Kickoff October 1, 2013

Phase 1 Complete December 31, 2013

Phase 2 Complete June 30, 2014

Phase 3 Complete June 30, 2015

Phase 1 of the Pilot would include development and analysis of the financial model

(done by a consultant)

Phase 2 would include hiring a coordinator for the project, recruiting additional

member agencies for the pilot, developing memoranda of understanding, setting up a

website, development and testing of the database*, developing processes, protocols

and forms, initial recruitment and orientation of volunteers.

* (Note: this presupposes that the database developed for SIRCH's Need a Hand is the

basis for VolunteerMatch – if not the timeline would be significantly extended.)

Phase 3 would be operationalizing the model, testing it over a 12 month period, and

completing an analysis and evaluation prior to the end of the fiscal year.

Budget Capital Costs:

*This presupposes that the database will be an extension of the one built for SIRCH's Need a

Hand program. If developing a new database system, the cost would be $12,000-15,000

and the timelines would need to be

extended.

Appendix G: Volunteer Match

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Fiscal Year 1 (October 1, 2013 – March 31, 2014)

Professional Fees (Consultant) 10,000

Salary 1.0 fte Coordinator ($50,000/year x 3 months) 12,500

Benefits (15%) 1,875

Legal Advice 5,000

Staff Travel ($300/month) 900

Rent ($400/month) 1,200

Marketing and Promotion (logo, brochures, website design) 6,000

Total 37,400

Fiscal Year 2 (April 1, 2014 – March 31, 2015)

Salary .8 fte Coordinator ($50,000/year) 40,000

Benefits (15%) 6,000

Admin/data entry (purchased from SIRCH) 8,000

Staff Travel ($300/month) 3,600

Rent ($400/month) 4,800

Marketing and Promotion (print/web) 5,000

Total 67,400

Fiscal Year 3 (April 1, 2015 – June 30, 2015)

Salary 0.8 fte Coordinator ($50,000/year x 3 months) 10,000

Benefits (15%) 1,500

Data Entry (purchased from SIRCH) 2,000

Staff Travel ($300/month) 900

Rent ($400/month) 1,200

Marketing and Promotion (print, web) 1,500

Total 17,100

Note: SIRCH is prepared to assume some of the in-kind expenses associated with this pilot,

such as supervision, audit, IT support, office supplies, photocopying etc.

It is assumed that VolunteerMatch would switch to a fee-for-service financial model as of July 1,

2015 for the One Entity in Haliburton.

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Opportunities

Current State / Need

Conclusion of Potential

Priority and Enabling Factors

Benefit

Reinvestmen t Savings

Other Partner Opportunities

Risks

Likelihood

Impact

Information Technology and Communications

RMH provides IT support and applications for HHHS sites.

1. Move to a single Network for both organizations. 2. Move to a single IT department. (Both initiatives should proceed concurrently)

PRIORITY - H 1. The current Service Level Agreement needs to be amended to specify enhanced support/services and a cost sharing agreement reached for (1) and (2). 2. Standardize policies and procedures across hospitals. 3. A facilitator is needed to plan and oversee move to single department. One-time costs to facilitate these include $15,000 for the design of the future common network, $30,000 for the development of a joint ICT Strategic and Implementation Plan and $65,000 for systems infrastructure implementation. An additional $26,000 is required to implement the common telephony system at HHHS and $5,000 to implement the system atCCHC

The Integration of these Information Systems are: 1. Migration to common IT platforms will further be developed. The linkages will become one single network leveraging many opportunities, like common telephony, Bring Your Own Device, (iPhone, Blackberry) Connections to CGTA and Lakeridge Health. 2.The leveraging of RMH expertise and support for HHHS. 3. Patient information like Lab Tests and DI reports are immediately available. 4.Increases HHHS Electronic Medical Records Adoption

No savings. However, costs of moving forward with IT initiatives will be less than separately.

There is potential for Telephony projects, IT support and to be extended outside of the two organization s

Minimal risks of not achieving shared IT department

L L Not required

Appendix H: Small Rural Northern Hospital Transformation Fund Analysis

Appendix H: Small Rural Northern Hospital Transformation Fund Analysis

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ood

Back Office

Opportunities Current State / Need

Conclusion of Potential

Priority and Enabling Factors

Benefit Reinvestment Savings

Other Partner Opportunities

Risks Likelihood Impact Mitigation

Strategies

Procurement Both RMH and HHHS are currently using COHPA for procurement. HHHS is not currently satisfied with their arrangement with COHPA.

1. RMH will manage all COHPA procurement for HHHS. 2. RMH will manage JIT supplies for HHHS. 3. RMH will provide Product Evaluation outcomes to HHHS. (All three initiatives should proceed concurrently)

PRIORITY - H 1. A service level agreement and cost sharing agreement is needed for (1) and (2). 2. Acquire hand held devices (cost of $1500 x 6 = $9000) to facilitate JIT implementation. An additional $16,000 is required to facilitate the implementation of the procurement processes and the building of data files for supplies and supply carts by RMH for HHHS

The benefit to HHHS will be: 1. Improvement of procurement and contract management business processes at HHHS. 2.Marshalling of JIT carts can be set up for HHHS and managed by RMH. This will organize all deliveries in a standard process. 3. The Costs of supplies will be lowered due to management of JIT, by reducing non catalogue purchases, and by utilizing RMH contract pricing.

The costs savings for HHHS leveraging RMH contract pricing, can be reinvested.

The Family Health Team has shown interest in JIT supplies through RMH.

Minimal risks of not proceeding with arrangement to have RMH procure supplies for HHHS

L L Involved COHPA and have their approval to proceed. Financial arrangemen t between RMH and HHHS covers increased COHPA member fees incurred by RMH for additional supplies purchased on behalf of HHHS.

Finance HHHS requires backup for Accounting, Finance, OHIP Billing if there is a need due to vacation, illness or succession.

1. Back up for financial services and accounting (MIS) by RMH for HHHS - not feasible, particularly without common systems. 2. The creation

PRIORITY - MEDIUM 1. HHHS to move to RMH ORMED finance system. License fees to be incurred. 2. Service level agreement and cost sharing agreement is needed for single service

Appendix H: Small Rural Northern Hospital Transformation Fund Analysis

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Back Office

Opportunities Current State / Need

Conclusion of Potential

Priority and Enabling Factors

Benefit Reinvestment Savings

Other Partner Opportunities

Risks Likelihood Impact Mitigation Strategies

of a single Finance Services across both organizations (requires common systems).

arrangement.

Human Resources HHHS has one individual for Human Resources.

1. Initially, opportunity to enhance HR services on an as needed/fee- for-service basis. Goal of standardization across both organizations including HRIS, WSIB management, Occupational Health and Safety. 2. Create a single Human Resource service across both organization (longer term objective).

PRIORITY - MEDIUM 1. Establish a fee- for-service agreement. 2. A service level agreement and cost sharing agreement is needed for single service arrangement. 3. Transition plan to move toward a single department. 4. Licensing fees for WSIB and HRIS software.

Medical Device Reprocessing

RMH currently provides MDRD service to HHHS.

Nothing further

Dietary Services HHHS has on occasion had the need for Registered Dietician Services

RMH to provide these services - not feasible

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Clinical Opportunities Current State /

Need Conclusion of Potential

Priority and Enabling Factors

Benefit Reinvestment Savings

Other Partner Opportunities

Risks Likelihood Impact Mitigation Strategies

Mental Health RMH has an upcoming vacancy in MH leadership. HHHS would benefit from integrated leadership.

Create a single MH service, recruiting a joint MH leadership position.

PRIORITY - H 1. Position descriptions to be created. 2. Establish a service level agreement and cost sharing agreement for single services. To develop the regional mental health program and build the linkages to all mental health partners a mentalhealth leader is required for a 2-year period. The costs for bringing on the leadership position include one time recruitment costs of $3,000 (through an executive search firm) and 50% of the costs for that individual ($75,000/year). HHHS and RMH will fund the remaining 50% of remuneration ($75,000/year) for the position through their respective mental health budgets.

The mental health program integration enhances the collaboration between community mental health programs at RMH and HHHS and the Schedule 1 Day Hospital and Inpatient ProgramsThe potential to share a position regionally, can provide both RMH and HHHS a resource to ensure success in outpatient Mental Health Services and tying them to the Inpatient Services offered at RMH.

Some efficiencies are potential through improved management of regional resources.

Community Partners will be included in the planning for this position as it relates to services offered by both HHHS and RMH.

Sustainable funding beyond 2- year period

M M RMH and HHHS need to include annualized salary expense into operating budgets by year 3

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Clinical Laboratory RMH is currently

providing Laboratory service to HHHS. Lab reporting needs to be electronically integrated.

RMH will electronically integrate Lab information fL.

PRIORITY - H The electronic integration will be funded through the LHIN.

1. HHHS will have electronic reporting with shorter turn around times and improved access to patient information. 2.The integration of lab services will improve the quality, improvement of turnaround times and information available for decision- making by physicians on the disposition of patients in the Emergency Department and Inpatient areas

Minimal risk of not moving forward with Lab IT integration

L L Funding provided by CELHIN to cover costs of implementin g electronic integration to improve fL of lab information from RMH to HHHS

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Clinical ECGs HHHS is

currently not billing OHIP for ECGs.

RMH will provide ECG billing for HHHS.

PRIORITY - H Funding required for the implementation of this electronic process. Establish a fee-for-service agreement for billing service.

The ability to refer through RMH Internal Medicine Group, can bill the technical and professional fees. The specialist referrals can benefit patients from HHHS.

The costs savings for HHHS leveraging RMH services, can be reinvested.

This will benefit the patients who present to HHHS and rostered patients of the FHO.

Minimal risk of not moving forward with RMH billing HHHS ECGs

L L RMH internal Medicine Group have agreed to billing process.

Pharmacy HHHS has a need for hospital pharmacy services. PRHC is ending their pharmacy relationship with HHHS.

1. RMH to provide HHHS with unit dose medications. 2. RMH to provide Pharmacist services to HHHS. 3. Create one pharmacy program across both organizations.

PRIORITY - H 1. Establish a fee- for-service agreement for unit dose and Pharmacist services options. 2. Establish a service level agreement and a transition plan for single program option. Implementation costs for the pharmacy integration include $30,000 to build the medication librairies for the medication administration units/cabinets and $15,000 for the implementation of the project by 0.2 FTE Pharmacy Technician.

The benefit to HHHS will be: 1. The cost of drugs to HHHS will be Ler than retail pharmacy suppliers (value fo rmoney). 2. Quality and patient safety will be enhanced at HHHS through the use of unit dose and Medselect cabinets. 3. Barcoding technology will provide positive identification and lessen waste and costs.

The costs savings for HHHS leveraging RMH contract pricing, patient safety and waste can be reinvested. The management of inventory will be lessened dramatically.

This initiative will be isolated to HHHS (Acute Care).

Legal risks associated with RMH providing pharmacy services for HHHS

L H Legal Counsel has advised re,. Risks and mitigation strategies , including Pharmacist to have oversight of pharmacy service arrangment

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Clinical Diagnostic

Imaging RMH currently provides Dictation Service for HHHS. The current ultrasound vendor has asked to increase time/volume for ultrasonography. HHHS has concerns with the services being provided.

1. Voice recognition software to be implemented at HHHS. 2. RMH to provide management assistance for HHHS on the development of an HHHS independent Ultrasound service. (OR) 3. RMH to provide ultrasound services on behalf of HHHS. Feasibility at this time is not resolved.

PRIORITY - H Establish a service level agreement and cost sharing agreement for ultrasound services. The one-time cost of implementating the Front-end Voice Recognition System at HHHS is $70,000.

1. The implementation of a front-end voice recognition system will improve turnaround times for DI reports to be available to HHHS physicians for decision- making within the Emergency Department and inpatient areas.

TBD TBD Minimal risk of not proceeding with Front-end Voice Recognition System implementation. RMH/HHHS to explore joint management of DI

L L The Voice Recognition project which involves RMH, HHHS, and PRHC and CMH is moving forward as designed. DI Director of RMH developing a cost neutral approach to DI Managemen t for HHHS.

Sleep Lab HHHS patients travel outside of the county for sleep studies and experience long wait times.

RMH is soon to provide Sleep Lab services with short wait times.

PRIORITY - H Obtain support of the Family Health Team for referrals.

This service at RMH can provide Haliburton County a shorter wait time for these services.

Although there may not be a reinvestment for the organizations, the ability to access services will be of advantage to Haliburton County patients who have to travel further.

Referrals from Family Health Teams are welcome.

Minimal risk assoicated with development of Sleeb Lab services by RMH to be marketed for Haliburton County residents through HHHS and HHFHT

L L .

Sleep Lab is operational

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Clinical Cardiac Rehab Cardiac Rehab at

RMH has a robust program that has funding to provide services to HHHS patients. Some HHHS patients are serviced by a smaller group in Peterborough.

This service can be provided by leveraging OTN technology.

PRIORITY - H Obtain support of the Family Health Team for referrals.

Minimal risk of not proceeding with RMH providng cardiac rehab services to Haliburton County residents through partnership with Haliburton Highlands Family Health Team and HHHS

L L Service expansion to Haliburton County residents to utilize OTN technology at HHHS and HHFHT

Opportunities

Current State / Need

Conclusion of Potential

Priority and Enabling Factors

Benefit Reinvestment Savings

Other Partner Opportunities

Infection Control RMH has two certified Infection Control Practitioners. HHHS has a staff member responsible for IC and other duties.

1. RMH to provide Infection Control advice on a regular (monthly) and as needed basis. 2. There is a need to establish a policy and procedure standardization across both organizations.

PRIORITY - MEDIUM 1. Establish a fee- for-service agreement for advice/support arrangement. 2. Implement tools currently being used by Infection Control at RMH for HHHS (i.e. MEDITECH reporting).

Chief of Staff HHHS has a part- time Chief of Staff and RMH has recently hired a Physician Vice President and Chief of Staff.

Create a joint Chief of Staff leadership position.

PRIORITY - MEDIUM 1. Position description would have to be created. 2. Establish agreement for Chief of Staff time/remuneration.

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Clinical Education There is a need

for education in several areas at HHHS including: (1) Triage Training (2) CPR and ACLS Training (3) Preop Teaching

1. RMH to provide triage training for HHHS. 2. This is currently sourced by a local provider. The Heart and Stroke have indicated that there is a need the Medical Director on site. RMH has a Medical Director who could certify HHHS for ACLS. RMH to provide CPR/ACLS training. 3. RMH to provide OTN based Preop teaching.

PRIORITY - MEDIUM 1. Establish a fee- for-service agreement for triage training. 2. Establish a fee- for-service agreement for CPR and ACLS training. 3. There will be an agreement between RMH and HHHS for this process.

Appendix I Summary of Stakeholder Engagement

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Local Resident Survey – 60 responses 1. Do you think it will be easier for you to find what you need, if the proposed DRAFT model is

implemented?

Yes – 28 people – 46.67%

No – 19 people – 31.67%

No opinion – 13 people – 21.67%

Comments – Themes – General Statements:

Concerned about increased bureaucracy, red tape in a larger organization

Things need to be clearly communicated so caregivers can navigate system

Keep the current physical locations

Easy to navigate now

Will a larger organization be able to take on increased roles

Why aren’t CCCKL and RMH integrating

Make sure no cutbacks

Make sure still a live person answering the phone

Keep the expertise of people currently delivering the services

Remains to be seen

Bigger not better, keep the hands on connection

Need to make sure people know that the CCAC is the way into the services

Where will I get home care? Who will pay?

Keep the existing volunteers

See the value of keeping things local, any improvement is welcome

Good that Haliburton and CKL are being kept separate

A central number with a live person would be beneficial

Communication of changes will be vital and imperative

Make sure there are links with primary care providers who refer clients to these services

2. We think there are a lot of benefits to the proposed DRAFT model if it is put in place. Do you agree?

Yes – 23 people – 38.33%

No – 21 people – 35%

No opinion – 16 people – 26.67%

Comments – Themes – General Statements:

Don’t understand the benefits – could there be a trial period to the integration

Will identities be lost – will CSS get lost in the hospital

Things are confusing and not easy to understand

Will we lose the personal touch

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Can this be a template for how to build better service model for people who require care

Why fix what isn’t broken

Recognize that change will be challenging for clients/patients and their family/caregivers

Will cost of programs increase

Location, relationship with existing staff

Why didn’t take the next step in integrating other agencies into model, CCCKL with CCHC, etc.

Volunteer match – need to recognize that some specific training still to be done in each agency

Live person to answer the phone

Will any b/o savings go into front line?

Wouldn’t be happy with job loss. Wouldn’t want to go through volunteer bureau – want to go

direct to agency

Glad that HC stays separate – make sure communication is clear

Need more palliative care beds, one stop shopping for access will help

Success rests on volunteers – need more homemaking services

Can only see political benefit for LHINs/province – not the clients

What will the new service provider look like – can I still get access, someone to talk to?

Are the savings enough to justify any changes.

Trust that the boards understand the challenges and will make the new model work

Volunteer bureau good idea for streamlining opportunities

What will the new entity look like – bylaws, board composition

Don’t lose the trust in the existing relationships between providers and clients

Staff and Partners – 51 responses 1. Do you think it will be easier for your clients or patients to access hospital or community-based

services if the proposed DRAFT model is implemented?

Yes – 25 people – 49.02%

No – 17 people – 33.33%

No opinion – 9 people – 17.65%

Comments – Themes – Rolled Up:

Change Management/Communication

o Clients don’t like change – you’re going to have to explain it to them

o Bigger is not necessarily better

o Advertise and make it visible so people understand the change, prominent marketing

campaign

o Need more info/details

Improved Access

o Easy for seniors/clients/caregivers who can now make one call, will be delighted

o Will be easier in Haliburton

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o Removed duplicity (duplication), less “players”

o One stop shop support navigation

o Make sure the phone is answered by a live body

o Good to have all CSS services in one organization

o Transportation still a challenge

o Decreased stress and patient flow should be enhanced

Seems to be the same

o Still have to call CCAC

o Duplicate systems CCAC and CSS running side by side

o Getting rid of administration doesn’t improve access, can still have challenges inside a

single organization

Should have gone farther

o Merge CCCKL and RMH, merge CCHC and CCCKL

o Why aren’t other partners at the table - CCAC

o Have everything under one entity

Local Decision Making

o Appreciate that Haliburton is a separate entity from CKL

2. Do you think you will be better able to serve your clients or patients, if the proposed DRAFT model is

implemented?

Yes – 17 people – 33.33%

No – 21 people – 41.18%

No opinion – 13 people – 25.49%

Comments – Themes – Rolled Up:

Change Management/Communication

o Not sure how this will impact me or my clients

o Can’t see it yet – sounds good in principle but how will it affect me

o Need to maintain visibility in whatever context services are delivered

o Volunteer match not understood – needs to be explained

o Not sure how it will impact my job

o Be careful of impact on fundraising

Staff Retention

o No guarantee I’ll retain my job

o Government didn’t think this through

o Does my job exist in receiving agency?

o Hate to see staff lose their jobs

o Will there still be volunteer co-ordinators

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o Will more co-ordinators be hired to support navigation?

Integration

o Good that RMH, HHHS and CCHC will be linked to share ideas

o Back office integration will result in savings

o Makes sense to me

Impact on Clients/Volunteers

o Change will be hard for clients, will quality and standards change?

o Why change what’s already working?

o People will be confused

o ABI model doesn’t fit

o Flow thru should improve

Should have gone farther

o Simplier access methods in other parts of the province, why not here

o Still have to talk to multiple people

o Should have merged RMH into the one entity

3. We think there are a lot of benefits to the proposed DRAFT model if it is put in place. Do you agree?

Is there something missing? Additional comments?

Yes – 27 people – 52.94%

No – 14 people – 27.45%

No opinion – 19.61%

Comments – Themes:

Access

o Like to call one number to get help for my clients

Implementation

o Hopefully will have one set of policies and procedures

o Transition team/future board to be balanced, have multiple perspectives

o Need to ensure equity and harmonization between staffs, should have gone further with

bringing everyone in CSS to CCAC levels

o Don’t lose value of programs when accountability is transferred to different

organization

o Still more to be done – more integration – should have integrated CSS with acute in CKL

– would have led to more wage harmonization

o Make sure is cost effective and timely, make sure services are retained

o Don’t use one size fits all – communities are very different

o Recognize value of volunteers are ensured they are integrated into new model

o Ensure that people understand how to continue donating funds to their designated

choice

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Appendix I Summary of Stakeholder Engagement o Consider palliative care needs

o Consider transportation needs

o Where will services be located and delivered

o Can see how plan will improve communication, ease referrals, improve services for seniors,

improved standardization

- Change Management/Communication

Consider impact on clients

Explain the costs – how will things improve, will services be disrupted, will clients lose

relationships with existing providers, will staff have equivalent positions

Will it really improve the patient experience?

Make sure people understand role of CCAC in reaching the service delivery door

Make sure people receive info in format/time that best meets their needs

Don’t lose the name “community” in the new entity

Explain the role and responsibilities of Volunteer Match

Explain the ongoing existence of VON and SIRCH entities with continued non-LHIN funded

responsibilities

Why is Public Health not in the model?

A strong communication plan will be required to ensure that health service providers,

stakeholders and consumers understand the changes.

- Impact on Staff

Don’t want people to lose their jobs