Research Agenda on Issues of IntegrationThe Change Foundation

Gail Donner, Board ChairCathy Fooks, President and CEO

Discussion with the LHIN CEOs

November 15, 2007

Rebranded Foundation

• Foundation has rebranded its mission and work focus

• Now a policy think tank focused on key issues important to Ontario’s health system

• Three strategic directions:– Integration is first priority– Quality improvements for community services is second– Informing public debate is third

Why Are We Here Today?

• We are here today to:

– Review our progress to date – Get your feedback and comments – is this relevant to your

mandate?– Explore potential opportunities for collaboration

Our Take Thus Far• No commonly accepted definition of integration• Many potential indicators of integration but no core set that

actually measures progress (proxies for other things)• Not yet a focal point for accountability agreements • Cultural shift as important as governance and measures

• Integration is instrumental rather than an end in itself• It supports the achievement of system and population health

goals

Existing Efforts on Form

• Generally, two ways to do this (based on lit review)

1) Structural integration – develop service based goals, consolidate authority and budgets, streamline reporting relationships

2) Functional integration – focus on actual working relationships and proximities which may cut across structures

• It is possible to have functional integration without full-fledged structural integration but more commonly there is structural integration with persistent functional fragmentation

Message for us: lets get a framework to shape discussion

Existing Efforts on Measurement• Great deal of effort on performance measures in general• Integration often, not always, a category• But, measuring actual integration has proven difficult• Some combination of looking at structures and transitions

between along with assessment of experiences • Experiential has been more provider focused than patient• Difficult to draw conclusions on perceptions and a small number

of limited variables

Message for us: gaps to be filled

Existing Congruence on Values

• Success or failure of strong organizational culture depends very much on the presence or absence of shared values

• Would be surprising if new organizations attempting to unify a diverse and somewhat competing range of interests found a ready-made culture willing to embrace integration

• Suspect LHINs are struggling with this

Message for us: attempt to identify the convergence and divergence of values – could help realign incentives

Initial Work on Framework

1) Foundational paper – can we get to the same language?• What are we talking about?• How does it compare to others?• What can we learn from others?

Status: underway

Timeline: final draft in February

Potential collaboration: interested LHINs reviewing and providing feedback

Initial Work on Framework and Measurement

2) Focus Groups with Users of the System• Perspective on integration• Perspective on transitions• Assist with development of what we should measure to assess

integration

Status: RFP being developed

Time line: initial results for June 2008

Potential Collaboration: interested LHINs as partners?

Initial Work on Measurement• Creating a measurement collaborative with ICES, Ontario

Health Quality Council, Cancer Care Ontario

Status: Initial discussions to understand each other’s work and interest - Next discussion to divide up work

Timeline: Foundation to produce an annual integration report each June – could contain some of this work

Potential Collaboration: linkage with LHINs performance measurement work?

Initial Work on Lessons Learned

• First event in a new Series titled “Meeting of the Minds”

• Focus on what can be learned from others – session with former RHA CEOs, Deputy Ministers and provider CEOs

• What would they do again and what would they avoid?• Invitational and closed door

Status: underdevelopmentTimeline: March 2008

Potential collaboration: interested LHINs participating

Potential Year Two Activity

• Series of surveys to deal with values questions

• Populating an integration indicator framework (with others)

• Slicing up the pie – looking at whether upstream investments have increased in regionalized systems