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
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."
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What is a LHIN?
Local Health Integration Network
Created by the Ontario government in March 2006
HNHB LHIN
• 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
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LHINs
•
Erie St. Clair
•
Central
•
SouthWest
•
Central East
•
Waterloo Wellington
•
South East
•
Hamilton Niagara Haldimand
Brant
•
Champlain
•
North Simcoe Muskoka
•
North East
•
North West
•
•
•
Central West
Mississuaga Halton
Toronto Central
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Snapshot of HNHB LHIN
•
6,500 km2
•
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
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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
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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
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Accountability
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Strategic Health System Plan
Strategic Aim
Dramatically improving the patient experience through Quality, Integration and Value.
Strategic Directions
Quality
Integration
Value
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
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Strategic Direction #1:
Dramatically improving the patient
experience by embedding a Culture of
Quality
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Creating a Quality System
“Everything is Quality and Quality is Everything”
• 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
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Strategic Direction #2:
Dramatically improving the patient
experience by Integrating Service Delivery
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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
Hospital
Long-Term Care Homes
Home Care
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
Community
Support
Services
Specialists
Allied Health
Professionals
Primary Care
Physicians
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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
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The Top One Per Cent
•
Heart failure
•
Chronic obstructive pulmonary disease
(emphysema)
•
Myocardial infarction
•
Pneumonia and urinary tract infections
•
Stroke
•
Hip fracture
•
Cancer
•
End of life care
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Strategic Direction #2:
Dramatically improving the patient
experience by Integrating Service Delivery
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LHIN-wide Integrated Programs
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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
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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)
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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
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We’re Reducing ER Demand
• Community Referrals 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.
• Nurse Lead Outreach Team visit Long-Term Care homes to provide
primary care assessments and treatments to residents and avoid transfer
to the ER.
• Rapid Response Transition Team – Nurses who facilitate hospital
discharges, prevent readmission and prevent or delay admission to longterm care homes.
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Strategic Direction #3:
Dramatically improving the Patient
Experience by evolving the role of the
LHIN to become Health System
Commissioners
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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
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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
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Mechanisms &measures for
meaningful provider and community
engagement
Residents state: “We have
confidence in our health care
system.”
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
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