LHIN Service Change Planning Process Overview and Information Requirements for New, Expanded, Modified, Transferred, Reduced or Discontinued Health Services September 2018

Table of Contents Planning for Clinical Service Change LHIN Service Delivery Change Form LHIN Evaluation for proposed changes Summary of Process and Information Requirements Appendix: Supporting Material

Planning for Clinical Service Changes Background Planning Form Evaluation Summary Appendix

Planning for Service Changes Hospital Accountability Planning Submission (HAPS) Guidelines: The discussion and evaluation of possible service changes for inclusion in the HAPS should focus on the implications for patients/clients, the accomplishment of Ministry of Health and Long-Term Care (MOHLTC) and LHIN health system priorities, LHIN commitments to the Ministry-LHIN Accountability Agreement (MLAA), the contribution to development of the health care system in the LHIN and overall sustainability of the hospital. Community Accountability Planning Submission (CAPS) Guidelines: Access to community health services is an important priority for the government, LHINs and Health Service Providers (HSP). As a result, any proposed reduction, transfer or elimination of a service should be consistent with the overall goal of an integrated health system that provides access to high quality health services and coordinated health care in an effective and efficient manner. Background Planning Form Evaluation Summary Appendix

Driving Principles for Service Change Planning: Approach to be aligned with the Service Accountability Agreement Purpose of planning is to ensure that any proposed service changes result in coordinated, high quality care from a systems perspective Service changes need to ensure that resources follow the patient/client Patient/client/staff safety and quality of care should be maintained or improved Community engagement is actively integrated into the service change planning process Background Planning Form Evaluation Summary Appendix

Considerations for Transition to Another Provider When considering the transition of services to another provider, the following questions to be considered, based on the 2019/20 HAPS Guidelines: Does the service require the resources of a particular HSP to operate? 1 Could the service be assumed by other HSPs? Note that funding may need to be transferred to the assuming partner. 2 Has the HSP addressed collective agreement considerations prior to, during and after transfers? 3 Are services currently operating in the community similar in type (same care) or result (similar conditions and outcomes)? 4 Would provision of the service in the community free up human, financial, and physical resources that could be employed to improve core service delivery? 5 Would the patient’s experience and outcome be improved with the transfer? 6 Background Planning Form Evaluation Summary Appendix

Approach for Planning and Implementing Service Changes Once a Health Service Provider has decided to further explore a service change: 1. Notify LHIN of consideration of any proposal to start, expand, modify, transfer, reduce or eliminate service (can be in confidence) Carry out Community Engagement for change Approach impacted partners with proposed changes Define potential new model(s) of care for service collaboratively Assess resource requirements and risks of model(s) 2. Plan for change (Iterative Process) Resources must follow the patient – to be calculated in partnership based on costs of service. Service transitions may require education, training or other types or support/change management in order to maintain quality of care at the new provider. Communication Plan and Key Messages will be developed jointly with the LHIN. The LHIN will inform the Ministry of Health and Long-Term Care as appropriate. A joint work plan with key deadlines will be created for complex changes with significant impact to accountabilities. Determine how the impact of the changes will be measured and monitored. 3. Develop plan for new model (Iterative Process) 4. Submit final Service Delivery Change Form for acceptance (LHIN approval required before implementing proposed change) Background Planning Form Evaluation Summary Appendix

Approach for Planning and Implementing Service Changes (Responsibility Matrix) Activity (not necessarily sequential activity) HSP Lead HSP Partners LHIN Notify LHIN of consideration (can be in confidence) R I Carry out Community Engagement for change (see checklist) S Approach impacted partners with proposed changes and define potential new model(s) of care for service collaboratively Develop Communication Plan and Key Messages Agree Submit Service Delivery Change Form for acceptance (Before implementing proposed change) Approve R – Responsible S – Support I – Informed LHIN with work with other LHINs (if impacted) to determine appropriate action to support cross-LHIN changes LHIN will notify MOHLTC as appropriate (does not preclude HSP from communicating with MOHLTC) For very sensitive changes a joint meeting with the LHIN is suggested to evaluate and agree to courses of action Background Planning Form Evaluation Summary Appendix

Transfer of Funding When an HSP starts, expands, modifies, transfers, reduces, or eliminates a service, a new or additional service demand is often placed upon another HSP. If the recipient HSP can provide equivalent or better care at a lower cost (e.g. the recipient hospital has a superior economy of scale or lower cost LTC home placement for ALC patients), the transferring agency may be able to retain some of the funds associated with the displaced service. Any transfer of funding will need to be reviewed and approved by the LHIN, in consultation with the transferring and recipient HSP(s) on a case-by-case basis. Background Planning Form Evaluation Summary Appendix

Service Delivery Change Form Example Background Planning Form Evaluation Summary Appendix

Service Delivery Change Form Example (cont’d) Background Planning Form Evaluation Summary Appendix

Community Engagement Checklist Reference: Community Engagement Toolkit for Health Service Providers   Background Planning Form Evaluation Summary Appendix

LHIN Evaluation of Submissions (Must meet all criteria) 1. All required information submitted: Additional information/evidence may be requested 2. Suggested guidelines adhered to 3. Community Engagement Process Followed 4. No negative impact to other LHIN decision-making framework criteria (see reference next slide) Background Planning Form Evaluation Summary Appendix

Sample LHIN Decision-Making Framework Criteria Domain Criteria (including definitions) System Alignment Alignment: Degree of impact on advancing IHSP and/or ABP goals and priorities. Strategic Fit: Alignment with provider system role. Extent to which program/initiative is consistent with HSP mandate and capacity compared to other providers in Ontario. System Performance 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. 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 Quality: Extent to which program/initiative improves safety, effectiveness, and client experience of health services(s) provided. System Values Access: Extent to which program/initiative improves physical, cultural, linguistic and timely access to appropriate level of health services for defined population(s). 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. Efficiency : Extent to which program/initiative contributes to efficient utilization of clinical, financial, and human resources capacity to optimize health and other benefits. Client-Focused: Extent to which program/initiative meets the health needs of defined population(s) and involves patients/clients in determining the type and delivery of care. 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. Partnerships: Degree to which appropriate level of partnership and/or appropriateness of partnerships will be achieved in order to ensure service quality enhancement, improved comprehensiveness, optimal resource use, minimal duplication, and/or increased coordination. 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 Health status (clinical outcomes & QOL): Impact on health outcomes for the patient/client, including risk of adverse events, and/or impact on physical, mental or social quality of life, as compared to current practice/ service. Prevalence: Magnitude of the disease/condition that will be directly impacted by the program/initiative as measured by prevalence (i.e., # of individuals with the condition in the population or subpopulation at a given time). Health promotion & disease prevention: Impact on illness and/or injury prevention and promotion of health and well-being as measured by projected longer term improvements in health and/or likelihood of downstream service. Background Planning Form Evaluation Summary Appendix

Summary Proposals to change services must take into account the implications for patients/clients, the impact on system-wide priorities, and the overall goal of an integrated health system that provides access to high quality health services and coordinated health care in an effective and efficient manner. LHINs are responsible for approving all proposed service changes, and are engaged in the process of considering changes through: Support for costing analysis. Facilitation of discussions with other LHINs and the Ministry. Support for the development of a Communication Plan and Key Messages. Background Planning Form Evaluation Summary Appendix

Appendix Background Planning Form Evaluation Summary Appendix

Reference: 2019/20 HAPS Framework for Making Choices Background Planning Form Evaluation Summary Appendix

Reference: Context for Making Choices Background Planning Form Evaluation Summary Appendix

Transfer of Funding Example Hospital A provides 1000 units of service at a cost of $1M. Hospital A would like to transfer these 1000 units of service to community provider B. Community provider B can provide 1000 units of service at an anticipated cost of $800K (reflective of their current model of care). The hospital and the community provider will determine the appropriate amount of money to transfer and will then provide formal notice to the LHIN (as per the LHSIA). If no agreement can be reached and the proposed transfer is acceptable to the LHIN, the LHIN will determine the final transfer amount. Background Planning Form Evaluation Summary Appendix