1. Working Together to Dramatically Improve the Patient Experience Presentation to the Canadian Assistive Devices Association Susan Gibson, Advisor, Access to Care Hamilton Niagara Haldimand Brant Local Health Integration Network September 18, 2014

2. Vision “A health care system that helps keep people healthy, gets them good care when they are sick, and will be there for our children and grandchildren." 2

3. L ocal H ealth I ntegration N etwork Created by the Ontario government in March 2006 14 not-for-profit corporations that work with local health providers and community members to determine the health service priorities for their regions Local Health Integration Networks (LHINs) plan, integrate, and fund local health services, improving access and the patient experience What is a LHIN? HNHB LHIN 3

4. LHINs Erie St. Clair SouthWest Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississuaga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West 4

5. Snapshot of HNHB LHIN 6,500 km 2 1.4 million+ people Brant, Burlington, Haldimand, Hamilton, Niagara, most of Norfolk Most seniors of any LHIN (230,000 ++ ) Compared to Ontario, HNHB LHIN has higher rates of: Smoking, drinking, obesity Premature death & hospitalization 5

6. Environmental Scan HNHB LHIN has lower population growth but the largest number of seniors HNHB residents are not as healthy as other Ontarians on many measures - most disturbing of these is the higher mortality rate and higher number of potential life years lost Age standardized data shows some utilization rates (cardiac bypass, hip and knee replacements, hysterectomy) above the provincial average. There is a higher prevalence of poor life style choices as shown by higher daily or occasional smoking, heavy drinking, and obesity (in adults) in the HNHB LHIN Higher rates of chronic conditions including arthritis, high blood pressure and asthma compared to Ontario rates 6

7. Health Service Providers in HNHB LHIN HNHB LHIN allocates $2.8 billion to the 234 health service providers HNHB LHIN operational budget is $5 million This means that the LHIN allocates 99.8% of all funding received to our health service providers 7

8. Accountability 8

9. 9 Strategic Health System Plan Strategic Aim Dramatically improving the patient experience through Quality, Integration and Value. Strategic Directions QualityIntegrationValue Dramatically improving the patient experience by embedding a culture of quality throughout the system Dramatically improving the patient experience by integrating service delivery Dramatically improving the patient experience by evolving the role of the LHIN to become a health system commissioner

10. Strategic Direction #1: Dramatically improving the patient experience by embedding a Culture of Quality 10

11. 11 Creating a Quality System Common LHIN-wide philosophy and approach to quality Reduce variation, increase standardization Drive quality, drive outcomes, drive value for money LHIN to provide leadership to: – Achieve better outcomes for their communities: lives saved, quality of life improved and disability decreased – Ensure a better experience for the people it serves. – Reduce disparities in quality measures across different groups in HNHB’s communities LHIN will work with provincial partners both at the Ministry of Health and Long -Term Care and at Health Quality Ontario to achieve these goals “Everything is Quality and Quality is Everything”

12. Strategic Direction #2: Dramatically improving the patient experience by Integrating Service Delivery 12

13. 13 Integration: Health Links A new practice of care where ALL providers in a community, including primary care, hospital, long-term and community care come together to create a plan for future care at the patient level Each Health Link will: Be led by those that live in the Health Links area Base programs on the needs and preferences of local residents Focus on the patient and their family through coordinated planning specific to each person’s needs and preferences Build services and programs around patients – the right care, at the right time, in the right place Hospital Home Care Community Support Services Primary Care Physicians Allied Health Professionals Specialists Long-Term Care Homes

14. The Relatively Few People with Complex Health Problems Account for the Majority of our Health Expenditures 5% of the population accounts for 66% of health care spending 14

15. Heart failure Chronic obstructive pulmonary disease (emphysema) Myocardial infarction Pneumonia and urinary tract infections Stroke Hip fracture Cancer End of life care 15 The Top One Per Cent 15

16. Strategic Direction #2: Dramatically improving the patient experience by Integrating Service Delivery 16

17. LHIN-wide Integrated Programs 17

18. 18 LHIN-wide Integrated Programs: What are we Trying to Fix? Unequal access to/availability of services (gaps) Long wait times for some surgery and diagnostic procedures Inefficient use of resources (duplication) Variation in the care delivery model Variation in quality and outcomes Unnecessary ED visits and admissions/ readmissions

19. 19 LHIN-wide Integrated Programs: What are we Trying to Achieve? Key concept: ‘one clinical program – multiple sites’ Goal: improved clinical processes and outcome consistency All residents across the LHIN should have access to a coordinated program, with: – same approach to care delivery – same quality standards System management of system level indicators – Ministry-LHIN Performance Agreement (MLPA)

20. Hospital Emergency Departments (EDs) Hospital EDs are the door to urgent/emergent hospital and ED services The number of admissions to the hospital through the ED is increasing LHIN considers metrics to evaluate hospital ED performance – two key metrics in LHIN Accountability Agreement with hospital: The number of people waiting in a hospital bed for an alternate level of care (ALC rate) Time people wait in the ED for admission to an inpatient bed The volume of ED visits and the number of people waiting in the ED for admission to an inpatient bed is a pressure for ED staff which can impact timely acceptance of admissions by ambulance 20

21. 21 We’re Reducing ER Demand C ommunity R eferrals by EMS --Paramedics observe clients in their home environment, and where appropriate, refer the client to CCAC. Early Intervention Screening Tool – pilot in community (family physicians) and two emergency departments to screen seniors aged 75+ to prevent functional decline by referring them to CCAC for follow-up. N urse L ead O utreach T eam visit Long-Term Care homes to provide primary care assessments and treatments to residents and avoid transfer to the ER. R apid R esponse T ransition T eam – Nurses who facilitate hospital discharges, prevent readmission and prevent or delay admission to long- term care homes.

22. Strategic Direction #3: Dramatically improving the Patient Experience by evolving the role of the LHIN to become Health System Commissioners 22

23. 23 Commissioning in the HNHB LHIN A complex process with responsibilities ranging from: Assessing population needs Prioritizing health outcomes Procuring products and services and; Holding health service providers accountable

24. 24 Measuring our Health System Improvements Key Performance Indicators Embedding a Culture of Quality Throughout the System Patients state: “I receive the care I need when I need it.” Reduction in variation Improved care transitions Staff ability to impact system Culture of quality Integrating Service Delivery Common Vision & Philosophy of Care Increased use and access to community services Reduced costs/wait times Improved percentage of funding directed to direct care activities Becoming Health System Commissioners Governance & management capacity developed Mechanisms &measures for meaningful provider and community engagement Residents state: “We have confidence in our health care system.”

25. Thank you! Hamilton Niagara Haldimand Brant Local Health Integration Network 264 Main Street East Grimsby, ON L3M 1P8 (905) 945-4930 (866) 363-5446 www.hnhblhin.on.ca Email: hamiltonniagarahaldimandbrant@lhins.on.ca HNHB_LHINgage www.youtube.com/HNHBLHIN www.hnhblhin.on.ca 25