1. PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES WHAT WE HEARD Highlights of Feedback from the Toronto Central LHIN’s Health Equity Symposium held on September 10 th, 2015

2. Dear Symposium Participants, You’ll remember that during the symposium afternoon session, all attendees were invited to offer advice to the Toronto Central LHIN about how we could encourage and support individuals and organizations in shared efforts to advance health equity in Toronto. Attendees were also encouraged to provide further input through an online survey distributed after the conclusion of the symposium. Thanks to everyone who shared their thoughts and advice. The feedback you provided will help shape Toronto Central LHIN’s health equity activities over the next three years, which will be documented in a new Toronto Central LHIN Health Equity Roadmap. After reviewing the input received to-date, the Toronto Central LHIN Health Equity Team wanted to share highlights from what we’ve been hearing. We have organized these highlights into the three pillars of our Health Equity Roadmap: Leadership and Culture Change, Data and Analytics, and Local Innovations. This document attempts to summarize what we have interpreted as the key messages emerging from the symposium‘s afternoon consultation. We realize that we may not have captured everything, and would encourage you to let us know if we’ve missed something important or if there are ways to improve our description of challenges and potential solutions. Thank you for your input and for your continued efforts to tackle health inequity in our city, The Toronto Central LHIN Health Equity Team PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES

3. Greater coordination between funders and policy makers would allow service providers to advance health equity more efficiently and effectively. Many participants want the Toronto Central LHIN to focus its efforts on aligning and coordinating the activities of funders and policy makers, including MOHLTC, other LHINs, HQO, other Ministries, and social service funders like the United Way. For example, these funders and policy makers might be brought together to coordinate their funding for a particular agency, population, set of services, or geographic area. Health system organizations, including the Toronto Central LHIN, should ensure that their internal practices support health equity. Hiring and promotion, in particular, were identified as tools for advancing a culture of health equity. A workforce that reflects the diversity of the population from the frontlines to the boardroom, will be better equipped to identify and address health inequities. Other internal organizational practices, such as living wage policies, were also suggested. The TC LHIN should promote (both internally and in the organizations it partners with) an organizational culture that values and systematically applies a health equity lens in all areas of work. Greater attention will be paid to health equity if the Toronto Central LHIN clearly signals its importance. It can do so by mandating that all HSPs achieve some standards with respect to serving the needs of marginalized populations and requiring the use of appropriate equity indicators and benchmarks. TC LHIN could offer incentives for initiatives and/or organizations who demonstrate a track record of working to reduce health inequities. The expansion of financial incentives concerning health equity would likely mean moving more resources out of acute settings and into the community. Culture change, as well as more effective services, can be achieved by directly engaging marginalized people in, program design, service delivery and evaluation, and organizational governance. The LHIN can do more to encourage and support Health Service Providers (HSPs) to carry out meaningful engagement with marginalized people and equity-seeking groups. The LHIN also has a role in engaging its communities directly. Equity-related training opportunities should continue to be made available for individuals at all levels of HSPs. Specific and targeted training for those in leadership positions could be developed so that those in positions of power are motivated to act based on an improved understanding of the economic and social benefits of applying an equity lens. PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES Leadership and Culture Change: We heard from participants that…

4. Data and Analytics: We heard from participants that… Participants supported the collection of equity data, and encouraged the sharing and use of data. Participants felt that organizations, especially smaller organizations, should be funded and trained to analyze health equity data in ways that will help them improve their programs and services. This training is required for many different groups including clinicians, registration staff, decision support, decision makers and administrators. Indicators and benchmarks can provide greater transparency of organizational efforts to reduce health inequities. HSPs should, at some point in the future, be mandated to collect and report on at least some health equity data and be held accountable for taking action to address the findings (potentially in Service Accountability Agreements and/or Quality Improvement Plans). This should be done in the spirit of shared learning and collective problem solving, and also be supported by appropriate financing. The design of data collection systems should keep in mind the varying IT capacities of organizations and work towards streamlined, low-cost methods of collecting and storing data. Working to integrate equity data into Emergency Medical Records may be a worthwhile long-term goal. Although participants identified a number of ways that equity data can be used, many felt that the Toronto Central LHIN should communicate the purpose of the health equity data initiative and demonstrate to organizations and individuals that the initiative will lead to useful results at multiple levels within the health care system. A clear explanation of how the data will be used by the LHIN and other system-level analysts, as well as information about how the data can be used by organizations and service providers when determining strategy, designing programs, and delivering services would be helpful. Data on the un-insured, people with disabilities and data to support cross-sectoral collaboration were also identified as priorities in the data collection process going forward. More clarification related to data sharing guidelines and governance would also be useful. PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES

5. More opportunities to share information and lessons about local health equity initiatives (those that have been successful and those that have encountered challenges) are needed. The LHIN can play an important role in creating avenues for organizations to learn from one another and discuss how to adapt promising practices from one setting to another. Innovation is already occurring, but a lack of appropriate funding and evaluation undercuts continuity and restricts progress. Funding from both Toronto Central LHIN and other organizations needs to allow organizations to experiment and adjust their approach based on changing circumstances. Long-term base funding for health equity initiatives would provide organizations with the flexibility to respond appropriately. Documented successes should lead to additional funding for the expansion of innovative programming. If health equity initiatives do not show promising results within expected timeframes, base funding should not be removed — instead organizations should be permitted to learn from their efforts and experiment with a different approach. Organizations and communities should have some flexibility in determining the most appropriate measures with which to evaluate innovative health equity programs. Different initiatives may require different metrics, and organizations need to be supported in designing and adapting appropriate evaluation processes for local innovations. “Local innovation” will often require collaborative problem solving amongst organizations in different sectors of the health system and with non-health service providers. The LHIN is well-positioned to bring attention to emerging system issues (such as service duplication or an underserved population group) and convene the appropriate organizations together to develop common solutions. The LHIN might also encourage greater collaboration on health equity through Service Accountability Agreements, or offering seed grants for partnership development. Communities and individuals are important sources of insight when seeking to develop local innovations. The LHIN can encourage and support the co-design of services in partnership with equity-seeking communities and underserved individuals. PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES Local Innovations: We heard from participants that…

6. Thanks to everyone who provided input at the symposium, and through the online survey. We continue to examine all feedback as we work to develop a new Health Equity Roadmap. We know that we may not have captured everything in our summary, and would encourage you to let us know if we have missed something. Feel free to get in touch: PUSHING THE BOUNDARIES: PARTNERING TO REDUCE LOCAL HEALTH DISPARITIES Further feedback welcome: Please get in touch… Jenny Acton Senior Strategy and Community Engagement Officer Toronto Central LHIN jenny.acton@lhins.on.ca 416-969-3594 Cynthia Damba Senior Planner and Epidemiologist Toronto Central LHIN cynthia.damba@lhins.on.ca 416-969-3280