South East Local Health Integration Network
Transforming Addictions and
Mental Health Services to
Better Serve Our Residents
South East LHIN Board
Meeting: AMH Redesign,
Pre-Reading
December 16, 2013
Table of Contents
Slide
Purpose of this Presentation
3
Agenda
7
Introduction and Objectives
9
Case for Change: Why are we doing this?
11
Vision, System Outcome Goals and Criteria for Evaluation
24
Principles, Individual Experience (including Service Features) and Elements of
the Redesign
39
Governance Structures for Integration
54
Redesign Options
63
Next Steps
84
Appendix A: Stakeholder Feedback
-
Appendix B: Literature Review
-
Appendix C: Project Plan
-
Appendix D: Visioning Session Summary Report
-
Appendix E: Communiqués
-
Appendix F: Frequently Asked Questions
2
Purpose of this Presentation
• The South East Local Health Integration Network (SE LHIN) has been collaborating with the
22 Addiction and Mental Health (AMH) providers to redesign the AMH sector.
• For the last seven months, the Redesign Task Force (12 nominated individuals representing
AMH agencies, Executive Directors, front-line staff, psychiatrists and a consumer
representative) have been focused on redesigning the current AMH sector and tasked with
creating options to create a system.
• A system where where we plan, work and collaborate together to meet the needs of
the residents of the South East region.
• This presentation provides details on the ‘case for change’, the features and elements of
the new AMH system and three governance options.
3
Purpose of this Presentation
Reminder of the LHIN’s Role
• As per the Local Health System Integration Act, 2006, the LHIN’s objects are (section 5):
•
To promote the integration of the local health system to provide appropriate,
coordinated, effective and efficient health services;
•
To engage the community of persons and entities involved with the local health
system in planning and setting priorities for that system, including establishing
formal channels for community input and consultation;
•
To ensure that there are appropriate processes within the local health system to
respond to concerns that people raise about the services that they receive;
•
To develop strategies and to co-operate with health service providers, including
academic health science centres, other local health integration networks, providers
of provincial services and others to improve the integration of the provincial and
local health systems and the co-ordination of health services;
•
To bring economic efficiencies to the delivery of health services and to make the
health system more sustainable;
4
Purpose of this Presentation
Expectations of the LHIN Board - Today
Today:
• The SE LHIN Board is asked to review and consider the documentation provided today and
to ask questions on the ‘case for change’, the Redesign process, the Individual Experience,
elements, the governance options and the stakeholder engagement processes.
• On April 23 2013, the LHIN Board confirmed that the status quo is not an option
• At the June 2013 Visioning Day Session, the South East LHIN Project Team guaranteed its
commitment to act to transform the system to meet the needs of clients and patients.
• SE LHIN governors are asked to focus on the client feedback for the ‘case for change’ and
to consider the impact on residents if we don’t transform the AMH sector.
• At this stage, the SE LHIN Board is NOT being asked to recommend a governance option.
A commitment has been made that there will be further engagement of AMH governors and
administrators.
5
Purpose of this Presentation
Expectations of the LHIN Board - February
January and February 2014:
• An opportunity for questions and clarification will be included on the agenda at the January
Board meeting.
• A final presentation and opportunity for questions will be included on the agenda at the
February Board meeting.
• The SE LHIN Board will be asked to provide a decision on the options for governance at
that time.
• Implementation planning will commence in March 2014.
6
Agenda
Agenda
1.0
Introduction and Objectives
3.0
Overview of the AMH Redesign
 Case for Change
 Vision, System Outcome Goals and Criteria for Evaluation
 Principles, Individual Experience and Elements of the
Redesign
 Discussion
Governance Structures for Integration
 Discussion
4.0
Redesign Options
 Discussion
5.0
Next Steps
2.0
Paul Huras
9:45 – 10.00
Sherry
Kennedy/
Jennifer
Payton
10:00 – 11:00
KPMG
11:00 – 11:30
KPMG
11:30 – 12:30
Sherry
Kennedy
12:30 – 12:45
8
Introduction and Objectives
Introduction and Objectives
Objectives:
• To obtain a full understanding of the ‘Case for Change’, Vision, Individual Experience,
Elements and Governance Options
• To understand the role of the LHIN and Governors and the decision required (and when)
• To understand the next steps in the process and provide advice as to any additional
information the LHIN Board may require in order to make a decision in February, 2014
10
Case for Change:
Why are we doing this?
Case for Change
Summary
The Client Experience:
• Residents, clients/patients, providers and other stakeholders have said that while the care
received has been very good, there remain multiple and recurring problems:
• Duplication of services
• Duplication of assessments
• Difficulties in transitioning between providers
• Difficulties in accessing services
• Insufficient volume of services to satisfy demand
• Stigma often faced in accessing services
12
Case for Change
Summary
Demographics and Rising Utilization:
• The number of individuals requiring AMH services continues to increase. Given that we have
to work within the resources we have available in the South East region, the impact of the
increase in volume will put pressure on the existing capacity.
• 72% increase in individuals treated for substance abuse (2007 to 2011)
• 11% increase in volume of patients (2009 to 2011)
• In 2011, the South East LHIN had the 3rd highest rate for new referrals, 4th highest
number of individuals served, and the 3rd highest inpatient/resident days in the province
(per 1000 population).
• The number of patients re-admitted to the hospital for either addictions or mental health
related conditions continues to be very high. This indicator is a reflection on how well the
system is (or is not) working for patients.
• 18.4 - 22.5% re-admissions within 30 days for addictions related conditions from Q2
2011 - Q1 2013
• 17.1 - 19.7% re-admissions within 30 days for mental health related conditions for the
same timeframe.
13
Case for Change
Summary
• By working together collaboratively across the system to standardize processes and tools,
share resources, reduce duplication and increase knowledge of the services and programs
that are available, we can increase capacity and reduce readmissions.
• There is existing collaboration in the SE LHIN region. There is an opportunity to harness the
momentum and collaboration for the purpose of a system wide redesign, to more effectively
achieve improved outcomes.
• Local leaders are in the right position to focus on the client/patient perspective and to create
a system that meets the needs of the client/patient.
• Globally, and within Canada, the literature and practices underscore the need for
cooperation and collaboration at a system level between AMH providers.
• AMH is a priority for the Ontario government. The SE LHIN is operationalizing this priority
for the region’s residents which was highlighted in their Integrated Health Services Plan 3:
Better Integration, Better Health Care.
14
Case for Change
Clients have told us the system needs to change!
“I feel lost when I am in the system,
I don’t get told the information I
need to know and the coordination
between the hospital and
community doesn’t exist. I was left
with no support.”
“There needs to be more
access to services, to
psychiatrists and to
medication. We go to the ED
as there is no other accessible
service.”
“I would like more
proactive care and there
being more responsibility
for people with Addiction
and Mental Health. Stop
“dumping” us.”
“No matter where you live, I would
like everyone to have equal access
to support.”
15
Case for Change
Clinicians have told us the system needs to
change!
“Duplication and delay conditions
for decreased quality of service
exist NOW. The onus is on the
client to have to do multiple
consents, tell multiple stories, make
sure all pieces are connected,
navigate through the system
themselves.” - Psychiatrist
“By not having access to an
integrated record of history, by
having to wait for multiple
consents to be signed, the patient
is delayed in receiving treatment
and/or of receiving treatments that
have been tried before but have
not previously worked”. Psychiatrist
“It’s not that the system is broken
and we have to fix it, rather we do
not have a system in the first
place and need to create one.”
- Health Links Leads
“A circle of service encompassing
all is critical to ensure we have
conditions to be successful versus
the parallel system we have today”
- Psychiatrist
16
Case for Change
Clients have told us the system needs to change!
Client Video:
Note for pre-reading deck:
If the video link does not work by clicking on the image above, please access the video through
the following URL: http://www.youtube.com/watch?v=Esv037Vtr_4&feature=youtu.be
17
Case for Change
Clients have told us the system needs to change!
• The South East LHIN has held a number of engagement sessions in 2012 and 2013
across the entire LHIN Region. These sessions have provided a rich source of evidence
to inform the decision to redesign the AMH system.
Session
Who was engaged?
Integrated Health Services Plan 2012
IHSP engagement incorporated CSR feedback and
also included multiple stakeholder discussions over
the period of approximately June to December 2012.
Clinical Services Roadmap
Public engagement took place from March to May
2011.
Development of Project Plan: February 2013
Consumer Focus Group Session (12 individuals).
Representatives were present from Belleville, Madoc,
Picton, Trenton, Bancroft, Napanee and Kingston.
Visioning Session: June 17th
180 attendees, 40 of which were clients
Mental Health Support Network South East
Ontario Recovery Session: November 2013
Over 140 consumers were engaged on the individual
experience
AMH Redesign Survey: Closed November 2013
Completed by 49 Patients/Clients and 31 Family
Members or Caregivers
Validation Session: December 2nd
200 attendees, 30-40 of which were clients
18
Case for Change
Clients have told us the system needs to change!
Consistent areas for improvement were identified in:
• Access to care (e.g. lack of 24 hour access, inequitable access to psychiatric care based
on geography)
• Inconsistencies between services
• Multiple assessments and duplication
• Transitions especially between hospital and community
• Insufficient volumes of services
• Stigma often faced in accessing AMH services, and in accessing other health services.
These areas for improvement have also been confirmed by:
• Psychiatrists
• Executive Directors
• Front line staff
• Physicians
• Other sector partners, such as housing, children and youth services
19
Case for Change
Clients have told us this before!
•
The areas for improvement noted earlier are consistent with those identified through
multiple studies, task forces and engagements since 1999. Some items of note include:
•
1999: Making It Happen
• Recommended comprehensive continuum of care, streamlined access to services
through a central referral, shared model of care, enhanced capacity through
adoption of best practices, system accountability and responsibility
•
2001: Berkeley Report
• Recommended district (HPE) wide governance structure, one Consumer Survivor
Initiative, common assessment and referral, specialty services managed districtwide but delivered locally, family network
•
2002: South East Mental Health Implementation Task Force
• The proposed model reflects a regional or district entity with 3 geographic councils
with common baskets of services
20
Case for Change
Clients have told us this before!
•
2006: Out of the Shadows at Last: Transforming Mental Health, Mental Illness
and Addiction Services in Canada
• Recommended the need for a recovery-oriented system, development of a more
responsive service, better integration of services, common basket of services
available across the lifespan
•
2009: Every Door Is the Right Door
• The most recent Ministry document on Addictions and Mental Health reform
•
2010: Select Committee on Mental Health and Addictions
• Recommendations include the consolidation of Addictions and Mental Health
programs and services, availability of a core basket of services, access to system
navigators, reflection of importance of housing, support for families and caregivers.
Clearly, we must stop planning and take action!
21
Case for Change
We have tried to move forward on a number of initiatives but have been challenged
• There is a regional network and the 22 AMH providers meet regularly. In total, there are
approximately 45 planning groups in the South East LHIN focused on a range of AMH
issues
• Local members have participated in planning since at least 1999
• There have been a number of sub-regional initiatives, spearheaded by community
members and the LHIN
• Our experience and the feedback we have heard is that these initiatives have been
challenged by geographical restrictions, by current capacity, consensus building
challenges, relationship challenges and a lack of accountability. Examples include:
• Common access form (CSR) took 18 months to gain agreement and launch
• Concurrent disorder study confirmed the opportunity for service improvement through
building staff capacity but has taken 3.5 years to move from study to recommendation
with minimal implementation
• Establishment of privacy and data sharing agreements in KFLA took over 12 months
22
Case for Change
The Role of the LHIN
• Residents have clearly identified a need for change
• The data clearly indicates that the need for AMH services for the population will
increase
• High readmission rates for AMH clearly shows that the current status quo is not
working for clients
• Similar opportunities for improvement have been identified as early as 1999, but
actions since then have obviously not delivered the desired improvement for
clients or clinicians.
• It behooves us as stewards of the South East local health care system to respond
and to transform the AMH sector for clients/patients, families, providers and the
residents of the LHIN.
23
Vision, System Outcome Goals and
Criteria for Evaluation
Vision, System Outcome Goals and Criteria for Evaluation
Overview
• The next section provides an overview of the SE LHIN’s vision, the provincial
government’s vision, our system outcome goals and draft evaluation criteria for
the SE LHIN Board to use when considering the AMH governance option
recommendation.
25
Vision, System Outcome Goals and Criteria for Evaluation
Vision for the Addictions and Mental Health System
Provincial Vision
• An Ontario where every person enjoys good mental health and well-being
throughout their lifetime, and where all Ontarians with mental illness or addictions
can recover and participate in welcoming, supportive communities. (Open Minds,
Healthy Minds, Ontario’s Comprehensive Addiction and Mental Health Strategy)
South East LHIN Vision
• Ensure patients receive the right care at the right time in the right place, enhance
capacity of providers and the system, and reduce stigma. (South East LHIN
Integrated Health Services Plan: Better Integration, Better Health Care, 20132016)
26
Vision, System Outcome Goals and Criteria for Evaluation
Project Structure
LHIN vision
(aligns with
Province and
Providers)
System
Outcome
Goals
Ensure patients receive the right care at the right time in the right place, enhance capacity of providers and the
system, and reduce stigma
Access to equitable,
consistent and quality care
Improved patient
experience
The health of the
population is improved
PLAN
REDESIGN
IMPLEMENT
Plan for the redesign of the Mental
Health and Addiction sector
Redesign of the Mental Health and
Addiction sector
Implementation of the redesigned
Mental Health and Addiction System
Develop Project Plan through review
of existing work and stakeholder
engagement (KPMG)
South East LHIN and Mental Health
and Addiction providers work
collaboratively to redesign the sector
using the Project Plan as guidance
South East LHIN and Mental Health
and Addiction providers work
collaboratively to implement the new
model for the system
Phase
Process
Timing
Sustainability of the
system
Complete by March 2013
Complete by February 2014
Implementation Plan Complete
by June 2014
Implementation : FY 2014/15 - 2015/16
Transform from a Sector to a System where we plan, work and collaborate together for the purpose of our
residents
27
Vision, System Outcome Goals and Criteria for Evaluation
Project Structure
1. Visioning
Phase 1
Phase 2
REDESIGN
IMPLEMENT
2. Options
Development
3.LHINBoard
approval of
redesign
Model
April–June
2013
1. Develop Implementation Plan
for the redesign of the system
2. Implement redesign of the
system
February – June 2014
JulyNovember
2013
July 2014–
2015/16
February
2014
Each Phase will be supported by the Project Plan
28
Vision, System Outcome Goals and Criteria for Evaluation
Project Structure
South East LHIN
Board
South East LHIN
Management
Expert Panel
Redesign Task Force Members:
•
Cate Sutherland: ED, Addictions Centre
•
Michelle Murray: ED, Lennox & Addington Addiction and
Community Mental Health Services
•
Laurie Dube: ED, Leeds and Grenville Mental Health
•
Linda Peever: Director of Mental Health, Brockville
General Hospital
•
Mae Squires: Program Operational Director, Critical Care
and Mental Health Programs, Kingston General Hospital
•
Karin Carmichael: Program Administrative Director,
Providence Care
•
Dr. Susan Finch: Psychiatrist
•
Dr. O’Brien: Clinician
•
Garry Laws: Consumer
•
Lucille Zuikier: Consumer
•
John Ostrander: Tri County Addictions Services
(Brockville)
•
Siobhan Andress: Frontenac Community Mental Health
and Addiction Services
•
Dr. Roumen Milev: Psychiatrist
Project Manager
Redesign Task
Force
Line of Reporting
Collaborative
working
relationship
Expert Panel
provides advice to
Project Manager
and Redesign
Task force
29
Vision, System Outcome Goals and Criteria for Evaluation
Project Structure
South East LHIN
Board
Expert Panel
South East LHIN
Management
•
Ruby Brown: Principal, Mandala Management (former
Chief Transition Office to realign mental health services
within Alberta)
Project Manager
•
Janet Davidson: Deputy Minister of Health, Government
of Alberta
•
Nick Kates: Acting Chair and Professor, Department of
Psychiatry and Behavioural Neurosciences at McMaster
University
•
Dr. Ken Le Clair: Professor and Chair of the Division of
Geriatric Psychiatry at Queen’s University
•
Donna Rogers: ED, Four Counties Addiction Service
Team
Redesign Task
Force
Line of Reporting
Collaborative
working
relationship
Expert Panel Members:
Expert Panel
provides advice to
Project Manager
and Redesign
Task force
30
Vision, System Outcome Goals and Criteria for Evaluation
Outcome Goals for the Future State System
1. Access to equitable, consistent and quality care across the South East LHIN
2. Improved patient experience - The system is reflective and responsive to the
legitimate expectations and needs of the population
3. Health outcomes – The health of the Addiction and Mental Health population is
improved
4. Sustainability of the system - Accountability at an organizational level shifts to
accountability at a regional level
31
Vision, System Outcome Goals and Criteria for Evaluation
How Will the Board Assess Governance Options?
• The SE LHIN Board must ensure decisions are reflective of a balance of effective
and efficient use of public resources and provide a high standard of service to the
public.
• Governance option evaluation criteria for each outcome goal was presented at the
last Board meeting.
• In response to feedback, this criteria has been defined and weighted to enable the
Board to rank the governance options for consideration in February.
• Note the criteria is ONLY to evaluate the governance options. The intention of the
redesign is that regardless of the option chosen, the elements and the individual
experience will be operationalized.
• The South East LHIN Board will not be making a decision/recommendation
today.
32
Vision, System Outcome Goals and Criteria for Evaluation
LHIN Board Governance Option Evaluation Criteria
System Outcome Goals
Accessibility
Patient Experience
Health Outcomes
Sustainability
Access to equitable, consistent
The system is reflective and
The health of the Addictions and
Accountability at an
and quality care across the South
responsive to the legitimate
Mental Health population is
organizational level shifts to
East LHIN
expectations and needs of the
improved
accountability at a regional level
population
 Reducing or eliminating
 System responsiveness to
 Reduction in 30-day repeat
 Improved capacity within the
barriers to access (e.g.
meet client needs at the
Emergency Department visits
system with the resources
translation, transportation,
initial point of contact with
(both Addictions and Mental
currently available (e.g.
childcare etc.)
the sector
Health clients)
reducing duplication of
 Same basket of services
 Coordination of services and  Reduction in 30 day readmits
services, improving processes
offered across the LHIN
knowledge exchange among
for Addictions and Mental
and patient flow
 Standardized process for
care/service providers
Health issues
improvement, etc.)
accessing services
 Client satisfaction with their  Reduction in patients
 Accountability agreements
 Reduction in waitlist for
journey to access system and
designated as ALC due to
include regional perspective
Addictions and Mental Health
with care provision
challenging behaviours
clients
 Reduction in stigma –social
 Reduction of unnecessary
acceptability
hospitalization related to lack
 Minimizing gaps in transition
of service coordination or
or issues with transition
provision
 Reduction in crisis
intervention needed for
existing Addictions and
Mental Health clients
Vision, System Outcome Goals and Criteria for Evaluation
LHIN Board Governance Option Evaluation Criteria: Accessibility
Criteria
Accessibility
5 Point
3 Point
1 Point
Weight
Access to equitable, consistent and quality care
This option will reduce
or eliminate barriers to
access
This option will
considerably simplify
and standardize the
AMH system for clients
This option will allow
us to offer significantly
more services closer to
home
This option will allow
us to provide equitable
access to tertiary and
specialty services
across the region
This option will
increase access
but not
consistently
across the region
This option will
moderately
simplify and
standardize the
AMH system for
clients
This option will
allow us to offer
moderately more
services closer to
home
This option will
have minimal or
no impact in
eliminating
barriers to access
This option will
feature minimal
simplification/
standardization of
the system for
clients
This option will
allow us to offer a
minimal number
of services closer
to home
4
This option will
allow us to
provide
moderately
equitable access
to tertiary and
specialty services
across the region
This option will
allow us to
minimally provide
equitable access
to tertiary and
specialty services
across the region
1
3
2
Score = Pts
X Weight
Vision, System Outcome Goals and Criteria for Evaluation
LHIN Board Governance Option Evaluation Criteria: Patient Experience
Criteria
5 Point
Patient Experience
3 Point
1 Point
Weight
The system is reflective and responsive to the legitimate
expectations and needs of the population
This option will
considerably enhance
the patient’s experience
and satisfaction
This option will
considerably improve
patient flow and allow us
to work together to
better refer patients,
manage patients and
transfer patients
This option will somewhat
enhance the patient’s
experience and satisfaction
This option will minimally
enhance the patient’s
experience and
satisfaction
This option will moderately
This option will have a
improve patient flow and
minimal impact or no
allow us to work together to
impact on patient flow
better refer patients, manage and allow us to work
patients and transfer patients together to better refer
patients, manage
patients and transfer
patients
This option will
This option will moderately
This option will minimally
significantly allow for
allow for meeting
allow for meeting
meeting management of management of the complex management of the
the complex issues
issues presented by clients
complex issues
presented by clients
across the continuum of care presented by clients
across the continuum of (beyond health sector)
across the continuum of
care (beyond health
care (beyond health
sector)
sector)
This option will enable
This option will enable
This option will minimally
significantly better
moderately better
impact coordination of
coordination of services coordination of services and
services and knowledge
knowledge exchange
exchange
and knowledge
exchange
This option will
This option will somewhat
This option will minimally
considerably enhance
enhance service delivery staff enhance service delivery
experience and satisfaction
service delivery staff
staff experience and
satisfaction
experience and
satisfaction
5
4
3
2
1
Score = Pts
X Weight
Vision, System Outcome Goals and Criteria for Evaluation
LHIN Board Governance Option Evaluation Criteria: Health Outcomes
Criteria
Health Outcomes
5 Point
3 Point
1 Point
Weight
Improves patient safety by optimizing clinical expertise and
standardizing clinical practice
This option will
significantly
reduce 30-day
repeat ED visits
This option will
moderately reduce
30-day repeat ED
visits
This option will
minimally reduce
30-day repeat ED
visits
1
This option will
significantly
reduce
unnecessary
hospitalization
related to lack of
service
coordination or
provision
This option will
moderately reduce
unnecessary
hospitalization
related to lack of
service
coordination or
provision
This option will
minimally reduce
unnecessary
hospitalization
related to lack of
service
coordination or
provision
2
Score = Pts
X Weight
Vision, System Outcome Goals and Criteria for Evaluation
LHIN Board Governance Option Evaluation Criteria: Sustainability
Criteria
Sustainability
a regional level
5 Point
3 Point
1 Point
Weight
Accountability at an organizational level shifts to accountability
This option will lead This option may lead to a
to a financial stable financially stable and
and sustainable AMH sustainable AMH system
system
This option will not
lead to a financially
stable and
sustainable AMH
system
3
2
This option will
This option will moderately This option will
significantly improve improve efficiencies and
moderately improve
efficiencies and direct direct resources from
efficiencies and direct
resources from
administration to service resources from
delivery
administration to
administration to
service delivery
service delivery
This option will allow This option will allow for a This option does not 1
for regional
balance of regional and
allow for regional
accountability
local accountability
accountability
Score = Pts X
Weight
at
Vision, System Outcome Goals and Criteria for Evaluation
Discussion
• Are there any questions on the ‘Case for Change’?
• Are there any questions on the evaluation criteria?
38
Principles, Individual Experience
and Elements of the Redesign
Principles, Individual Experience and Elements of the Redesign
AMH Redesign Principles
• These principles are a reflection of the work of the Redesign Task Force and the
engagements to date. They have been cross-referenced to the principles in Ontario’s Open
Minds, Healthy Minds and Ontario’s Comprehensive Addiction and Mental Health Strategy to
ensure alignment.
• Individuals have access to equitable, consistent and quality care across the South East LHIN.
• Legitimate local needs will be considered when planning for services and supports.
• Services will address the socioeconomic determinants of health.
• There will be outreach into the communities (i.e. in the workforce and schools).
• All transitions within the AMH system will be experienced as an internal transfer.
• A competency-based framework will support the AMH workforce.
• Communities and services will work together to eliminate stigma and discrimination.
• Individuals and their families will have choice and the opportunity to make informed decisions about their
personal care and support.
40
Principles, Individual Experience and Elements of the Redesign
AMH Redesign Principles (cont’d)
• Social inclusion will support the individual throughout their journey.
• Services will improve quality of life in a sustainable way – the system will be supported by continuous
evaluation and Providers will be held accountable for the value of care they provide.
• The AMH Redesign recognizes biopsychosociocultural inter-dependent and diverse aspects of the
individual experience.
• The AMH redesign will create a system in which regardless of a person’s age, cultural or linguistic identit,y
they will be provided the services and supports to enable recovery and a state of well-being that fits
with their expressed choices or needs.
41
Principles, Individual Experience and Elements of the Redesign
• The Redesign Task Force has developed the
individual experience, the “elements” to bring to
life the individual experience and provided their
collective wisdom and insight on the governance
options
Individual
Experience
Change Management and
Evaluation
Means to
bring to life
individual
experience
AMH Redesign Model
Foundational
structures
42
Principles, Individual Experience and Elements of the Redesign
Individual Experience
South East LHIN Addictions and Mental Health Redesign - Individual’s Experience
Employment
Children &
Youth
AMH Services
and Support
Primary
Care
Housing
Police &
Justice
Developmental
Services
Immediate
Access and
Re-entry
Seniors
Services
Municipal
AMH Services and
Supports
Addictions
& Mental
Health
I will work
with you to
support you
along your
journey
Central Service
Access
I will reach out to you in your
community (i.e. workplace,
school) to work with you to
bring you into the AMH system
Individual
AMH Role
I will work with you
to connect you to
the right services
and supports
Family & Friends
Screening
and brief
intervention,
support
and relapse
management
Short-term
clinical
intervention,
support
and relapse
management
Longer-term
treatment,
support and
rehabilitation
Promotion/Prevention
Specialized
treatment,
rehabilitation
and
associated
supports, and
relapse
management
43
Principles, Individual Experience and Elements of the Redesign
Features of the AMH Redesign
• Service users have centralized access to AMH system AND there is also an outreach
element to pull users into the system
• Service users are tethered to the system such that they have easy and simple access to reenter the system as needed
• Service users can access a common basket of services in their region (standard across the
South East Region)
• Triaging of needs so that service users who have complex requirements receive transitions
supports (i.e. dual diagnosis, with housing and employment etc)
• Seamless transitions between acute and community and vice versa (services are natural
integrators)
• Coordinated and integrated service delivery within AMH with formal connections to primary
care, housing, children and youth, justice, employment programs
44
Principles, Individual Experience and Elements of the Redesign
Features of the AMH Redesign
• AMH services and supports model “One team, one plan”
• Intentional Peer Supports available to service users throughout their experience in the AMH
system
• The system is designed to support linguistic and cultural needs (i.e. Francophone,
Indigenous) of the residents of the South East LHIN
• Individuals and their families will have a voice as essential partners in system design, policy
development, and program and service provision, and the opportunity to make informed
decisions about their personal care and support
• AMH system to focus on continuous quality improvement and there will be capacity to
support training and education
45
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Overview
• The next six slides are a synthesis of the ideas the Redesign Task Force provided on
processes, structures, collaboration and leadership (termed “elements”) that will be required
to “bring to life” or deliver on the “ideal experience”.
46
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Process (1/2)
Processes












Clear knowledge of available services and how to access them
Clear and consistent common service access processes
Service access coordinated with housing and other providers
Clear roles and responsibilities for all ‘professionals’ to provide seamless, coordinated and
appropriate services and supports
Formal processes for referrals/transfer and/or communicating changes in plan
Formal processes for complex individuals (e.g. ED diversion strategies)
Evidence-based care, services and supports
Standardized tools, protocols and pathways (e.g. medication algorithms and clinical
pathways)
Formal processes for peer support for MHA
Formalized knowledge transfer and exchange (to share current and leading practices)
Centralized workload management
Wait list management (i.e. web-based, bed board)
47
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Processes (2/2)
Processes









Focus on housing
Social inclusion processes
Transportation Support
Employment support
Formal processes to support immediate re-entry/access when required
Formal processes to include re-entry plan, safety plan, fast-track re-entry for clients
Formal processes to identify and respond to decline in functioning and provide client
and/or family appropriate services/supports
Regional decision making framework on transitions
Consistent pre-screening tools (i.e. in family physician offices, schools, health units)
48
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Structures (1/2)
Structures







Centralized/streamlined service access model (no duplication)
Comprehensive range of services and supports across the continuum (i.e. safe housing) to
capture biopsychosocial spectrum (Service Inventory)
Best practice models (i.e. wrap around, collaborative care, case management) – Services
that go to where the client is
Model includes community-based programs such as ‘Clubhouse’, broad programs,
vocational, volunteer, and drop in (i.e. after hours programming)
System Advisors and Navigators
Formalized agreements (MOUs and protocols) to support shared service – includes
strategies for conflict resolution
Resource and referral system to match capacity and resources to needs across the LHIN
49
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Structures (2/2)
Structures










Workforce optimization with collaborative care approaches – virtual integrated team for
client
Competency based workforce
Resources mobile at local level
Integrated structures (with housing, employment, etc.)
Joint/funding mechanisms
Communication structures
One team, one plan
Support experience of receiving hospital care in the home
Policy development in collaboration with clients
Therapeutic Transitional Housing, i.e. Emergency Shelters
50
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Leadership
Leadership







System leadership that drives accountability such as a regional agency focused on:
 Quality and continuous improvement,
 Ensures integration and coordination,
 Maximizes resources, and
 Ensures data quality in Addiction and Mental Health services
Build upon transformational leaders across front-line, management and governance levels
Leadership supports access to specialist(s) or specialized team(s)
Leadership supports system transformation – manages risk and resolves conflict
Service overlap with partners
‘System’ ownership of the client, not ‘organization’ ownership
Transparency and support for people who provide services
51
Principles, Individual Experience and Elements of the Redesign
Elements of the Redesign – Collaboration
Collaboration






Formalized collaboration across the MHA continuum and transitions as well as across
sectors (i.e. Cancer Care Ontario model)
 Build upon relationships
 Trust
 Respect
 Communication
 Willingness to collaborate
Formalized collaboration across the MHA continuum and transitions as well as across
sectors (i.e. strong linkages with primary care, social services, supportive housing,
community health, municipalities)
Collaboration as foundational to supporting client, family and community
Inter-agency collaboration
Shared responsibility
Communication, trust, respect and accountability
52
Principles, Individual Experience and Elements of the Redesign
Discussion
What questions or comments do you have on the individual experience, features or
the elements?
53
Governance Structures for
Integration
Governance Structures for Integration
The Ideal System: Defined Twenty Years Ago…
• Networks of organizations that provide, or arrange to
provide, a coordinated continuum of services to a defined
population and who are willing to be held clinically and
fiscally accountable for the outcomes and the health status
of the population being served
• Organized delivery systems typically embrace all levels of
care – primary, secondary, tertiary, restorative/rehabilitative
and long-term
• The key characteristics of an organized delivery system are the
organization’s breadth, depth and geographic dispersion
• Intake and assessment model (i.e. Central intake) – One client
One Record
• Equitable access to a continuum of services and supports,
regardless of where one lives
• 24/7 access (web or telephone) which includes crisis services
• Service Delivery Models: Recovery, Case Management, Wraparound, Collaborative Care etc.
• Regional structure to establish service delivery model requires structures, processes, leadership
and a culture of collaboration
55
Governance Structures for Integration
Comparison of Integrated Delivery Systems with Regional Health Authorities
(Leatt, Pink & Guerriere, 2000)
Typical Characteristics of an Integrated Delivery
System
Typical Characteristics of a Regional Health Authority
Membership is defined by consumer choice
Membership is defined by geography
Consumers can choose among multiple systems in large
urban centres
Consumers have no choice of system
Money follows the consumer
Money does not follow the consumer
Competition among systems for consumers
No competition for consumers
IDS manages all essential health issues
RHA does not manage physicians, drugs and other services
System revenue is determined by capitation payment for
each enrolled consumer
RHA revenue is based on historical provider budgets or capitation
for geographically defined population
Practitioner payment mechanism is primarily capitation
Practitioner payment mechanism is primarily fee-for-service
Financial incentives to providers for good performance –
quality of care, clinical outcomes, productivity and
consumer satisfaction
No financial incentives to providers for good performance
System-wide and provider-specific information systems
Provider-specific information systems only
Widespread adoption of clinical guidelines and pathways
that transcend providers
Variable adoption of clinical guidelines and pathways that are
provider-specific
Primary care focus
Ad hoc focuses
56
Governance Structures for Integration
Leading Practices: Network Governance
(Suter et al., 2007)
The delivery of addictions and mental health services and support is too complex for a
one-size-fits-all solution. It is important for decision makers to understand the principles
and processes of successfully integrated health care systems in order to customize a
model which is the best fit for their particular organization or to choose an optimal set of
complementary models according to patient needs across the system.
• There is no single best model for health and human systems integration.
• Multiple models have been proposed at the system level as well as the program level that
might guide practice.
• System level models focus on change management and key system dimensions.
• Program level models focus on care processes such as case management, co-location,
home care, population health management, and primary care.
• Progressive or sequential models are adaptable to both system level and
program/services level. These models propose several steps to achieve increasing levels
of integration.
57
Governance Structures for Integration
Principles of Successfully Integrated Health Systems
(Provan et al, 2007)
• Strong governance structure that includes community and physician representatives; members have
input to planning and operations
• Autonomous not-for-profit corporate organization that is independent of government and accountable
to its rostered members, providers and government
• System-level strategic planning and decision making which encompasses both the financing and
delivery of medical services
• Flatter and more responsive organizational structure that utilizes the skills and talents of employees
to a greater degree
• Centralization of only those functions that offer substantial savings or coordinate advantages
• Accountability for the health status of the defined population
• Linkages with external stakeholders, government, and the public
• Organizational structure promotes coordination; integration of leadership and management; single
care-management structure which manages care across settings and levels of care; clear
communication processes
• Introduction of management structures and financial incentives to influence providers’ attentiveness
to the costs and quality of services rendered; performance oriented
58
Governance Structures for Integration
Overview of Design Characteristics
Design
Characteristics
Sub-regional Lead Organization
Structure
• Distinct administrative entity set up to
manage the network (not a “service
provider”) - manager is hired
Optimal Number of
Members
• Many
Decision-Making
• Mixed
Advantages
• Efficiency of day-to-day management,
strategic involvement by key members,
sustainable
Problems
• Perception of hierarchy, cost of
operation, complex administration, loss
of local perspectives
Network members that are collectively involved
in network governance
Stronger relationship
Weaker relationship
59
Governance Structures for Integration
Overview of Design Characteristics
Design
Characteristics
Sub-regional Lead Organization
Structure
• Administrative entity (and sub-regional
lead organization) is a major network
member/service provider
Optimal Number of
Members
• Many
Decision-Making
• Centralized
Advantages
• Efficiency, clear network direction
• Retains local perspectives
Problems
• Domination by lead organization, lack
of commitment by members
Network members that are collectively involved
in network governance
Stronger relationship
Weaker relationship
60
Governance Structures for Integration
Overview of Design Characteristics
Design
Characteristics
Sub-regional Lead Organization
Structure
• Distinct administrative entity set up to
manage the network (not a “service
provider”) - manager is hired
Optimal Number of
Members
• Many
Decision-Making
• Mixed
Advantages
• Efficiency of day-to-day management,
strategic involvement by key members,
sustainable
Problems
• Perception of hierarchy, cost of
operation, complex administration, loss
of local perspectives
Network members that are collectively involved
in network governance
Stronger relationship
Weaker relationship
61
Governance Structures for Integration
The South East Region AMH Providers
• There are 22 community Addiction and Mental Health service providers/programs that are funded by the
South East LHIN, providing a range of programs and services. The LHIN may not be the sole funder of
these providers/programs.
• Addictions Centre Hastings and Prince Edward
• Brockville and Area Centre for Developmentally
Handicapped Persons
• Brockville General Hospital
• Canadian Mental Health Association, LeedsGrenville Branch
• Community Care Access Centre School Services
• Frontenac Community Mental Health and
Addiction Services
• Hotel Dieu Hospital – Mental Health
• Kingston Community Health Centres
• Kingston General Hospital
• Tri County Addiction Services
• Youth Habilitation, Quinte
• Lanark County Mental Health (Perth Smiths Fall
District Hospital)
• Leeds and Grenville Mental Health
• Lennox and Addington Addiction and Community
Mental Health Services
• Mental Health Services Hastings and Prince
Edward
• Mental Health Support Network South East
Ontario
• Providence Care
• Quinte Health Care
• Salvation Army Harbour Lights Centre
• Sexual Assault Centre for Quinte and District
• Sexual Assault Centre Kingston
• The Brock Cottage
Redesign Options
Redesign Options
Overview
• It was noted throughout the redesign process that experience and evidence tells us that
governance structures are not the ONLY answer, but they are a critical component of the
solution through enabling the implementation of the elements that will “bring to life” the ideal
experience.
• Seven governance options were presented to the Redesign Task Force based on leading
practices and an extensive literature review.
• These options have been narrowed to the three discussed today by the Redesign Task
Force and have also been shared with a wide group of stakeholders.
• A description is provided for each governance option. Benefits and risks as identified through
stakeholder engagement to date has been summarized and is also presented.
• At the close of the section, a few slides are included to compare how elements might look if
implemented under each of the three governance options to provide greater clarity.
• Feedback received between December 2013 and February 2014 will be presented and will
also serve to inform the Board on its governance option decision at the February Board
meeting.
64
Redesign Options
South East Region - Current State
Ministry of Health and Long Term Care
Other Ministries
South East LHIN
2 Mental Health
Peer Support
Programs
1 CCAC
2 Community
Addictions and
Mental Health
Services
4 Addictions
agencies/ services
Regional Programs
5 specialty services
(i.e. sexual assault
centre and Youth
Hab)
5 Hospitals
Municipalities
Academic Health Sciences Community
Primary Care
Psychiatrists
Providers and Specialty
Physicians
Public Health
and EMS
Justice
Housing
Social Services
Employment
Transportation
4 Mental Health
agencies/ services
65
Redesign Options
Option 1: Partnership Model
• Development of a partnership model where AMH providers work collaboratively to provide
seamless care for clients/patients across the South East region
• Objective is to build on what is working well in specific sub-regions and to replicate across
the region
• System navigators (function) may be required to connect clients/patients with other providers
and cross-sector partners (i.e. housing, etc.)
66
Redesign Options
Option 1: What might this look like?
Ministry of Health and Long Term Care
South East LHIN
Regional Programs
2 Community
Addictions and
Mental Health
Services
2 Mental Health
Peer Support
Programs
Other Ministries
5 specialty services
(i.e. sexual assault
centre and Youth
Hab)
Municipalities
Academic Health Sciences Community
Primary Care
Psychiatrists
Providers and Specialty
Physicians
Public Health
and EMS
Justice
Housing
Social Services
Transportation
5 Hospitals
1 CCAC
4 Mental Health
agencies/ services
4 Addictions
agencies/ services
67
Redesign Options
Option 1: Benefits and Risks
Benefits
Risks
• Build on work that has already been done,
build on existing system leaders
• Provides immediate ownership and
implementation
• Least intrusive and least expensive
• Can provide standardized service/quality
• Aligned with processes, leadership and
collaboration
• Allows for system planning
• LHIN could provide a year for agencies to
implement elements (prioritized) and meet
system outcomes
• This model can evolve; if it isn’t working it
can evolve to Option 2
• Lack of transformation - May be perceived
as status quo; would be hard to
demonstrate how it is different to serve
providers and clients
• Challenges with agreements in the past;
could take years to get sign-off
• Lack of consideration for conflict resolution
• Lack of incentives
68
Redesign Options
Option 2: Regional Model with Community Governance
• Development of a number of integrated AMH community centres (each has a Board and
Executive Team)
• These centres provide an agreed upon and consistent common basket of services and could
include housing, employment services (and link to Health Links)
• A regional “entity” provides specialist services (such as eating disorders), conflict resolution
and measures and monitors performance of community centers
• The regional “entity” Board includes representation from the AMH community center Boards
and hospitals, peer support etc. The community centres report to the regional “entity”
• Options for numbers:
• 7 Centres – align with 7 Health Links and/or current hospital configurations
• 3 Centres – align along LHIN geography
• Note: The population in the portion of Lanark that naturally flows into the South East LHIN
for service, will be considered for inclusion (to be discussed further with Champlain LHIN)
69
Redesign Options
Option 2: What might this look like?
South East LHIN
Specialist services
(e.g. eating disorders)
Academic Health
Sciences Community
AMH Centre
Seniors
Adult
Children &
Youth
• Common basket
of AMH Services
• Formal links to
housing, social
services
• Mobile Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
Performance
Management and
Measurement
AMH Regional Entity
Conflict Resolution
AMH Centre
AMH Centre
• Common basket
of AMH Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
• Common basket
of AMH Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
Peer Support
AMH Centre
• Common basket
of AMH Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
70
Redesign Options
Option 2: Benefits and Risks
71
Redesign Options
Option 3: Regional Entity with Local Satellites
• One South East Region AMH Agency with satellite offices throughout the region (# to be
determined) – single service, single provider – one Board, one Executive Team
• The Agency prescribes the levels of services and staffing requirements at each satellite
office
• Satellite offices provide a common basket of services
• Local community committees (i.e. consumer groups) are developed to ensure that local
needs are reflected in the satellite offices
• The Agency works collaboratively across sectors (i.e. with housing, etc.)
72
Redesign Options
Option 3: What might this look like?
South East LHIN
Specialist services
(e.g. eating disorders)
SE Region AMH Agency
Academic Health
Sciences Community
Satellite Office A
Seniors
Adult
Children &
Youth
• Common basket
of AMH
Services
• Formal links to
housing, social
services
• Mobile Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
Performance
Management and
Measurement
Conflict Resolution
Satellite Office B
Satellite Office C
• Common basket
of AMH
Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
• Common basket
of AMH
Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
Peer Support
Satellite Office D
• Common basket
of AMH
Services
• Formal links to
housing, social
services
• Mobile
Outreach
• Health Links
• Service
Collaborative
• Psychiatry
• Hospital
Peer Support
73
Redesign Options
Option 3: Benefits and Risks
74
Redesign Options
The Fundamentals to System Transformation
The more we transform the system, the more we must rely on people to collaborate within the
system. We recognize that structures and processes are critical to achieving high performing
mental health and addiction systems; however, a deliberate focus on enabling leadership and
promoting a culture of collaboration is fundamental to system transformation.
Through-puts
Inputs
Vision, Mission,
Values
Provincial Strategy
SE LHIN Mental
Health & Addiction
Services System
Redesign
Legislation Accountability
Outputs &
Outcomes
Community Capacity
Needs-based
Population Health
Governance
Common Language
Relevant Ministries
Improved client
experience
South East
LHIN
Mental
Health &
Addiction
HSPs
Regional
Programs
Other
providers
(e.g. Health,
Education)
Access to equitable
consistent and
quality care
The health of
population is
improved
Sustainability of the
system
Mental Health & Addiction
Professionals
75
Redesign Options
Comparing the Options
2 Mental
Health Peer
Support
Programs
1 CCAC
2 Community
Addictions &
Mental Health
Services
OPTION 1
4 Mental
Health
agencies or
services
5 Specialty
services
(e.g. youth rehab,
sexual assault)
5 Hospitals
4 Addictions
agencies or
services
OPTION 2
AMH
Centre
AMH
Centre
AMH
Centre
OPTION 3
Satellite
Office
Satellite
Office
Satellite
Office
76
Redesign Options
Comparing Elements of AMH Redesign
Processes: Common Service Access
Common service access (CSA) is an effective and efficient way to link families and individuals to appropriate services and
supports. CSA clinicians determine the most appropriate services and supports for clients and their families, redirect
referrals, divert use of the emergency department, estimate risk, establish priorities, triage clients and their families to
specialized services and recommend interim alternatives for client and families facing a long wait for services and
supports. CSA system for a geographic area must match community needs and priorities.
Option 1
Option 2
Option 3
■ CSA system is established based on
service level agreement between 22
AMH organizations/agencies and at
least 76 programs
■ CSA system is established within
new governance structure: AMH
Regional Entity and 3-4 AMH
Centres (entities)
■ CSA system is established within
new governance structure: SE
Region AMH Agency and 3-4
satellite offices
■ Lead organization(s) (centralized or
sub-regional) identified to establish
CSA programs with oversight TBD
■ Each AMH Centre will establish CSA
program and there will be
centralized oversight by AMH
Regional Entity
■ The SE Region AMH Agency will
provide oversight and support to 3-4
satellite offices
■ Funding for CSA will be shared
amongst participating AMH
organizations/agencies and
evaluated by LHIN
■ Funding for CSA will be managed by
each AMH Centre with oversight by
AMH Regional Entity
■ Funding for CSA will be centrally
managed by SE Region AMH
Agency
77
Redesign Options
Comparing Elements of AMH Redesign
Structures: Common basket of services along continuum
The five tiers describe the continuum of
addiction and mental health
services and supports in order of increasing
complexity/intensity. Promotion and
prevention is threaded throughout the other
four tiers.
Four of five tiers will be available within all
local communities and specialized treatment
will be available at the sub-regional or regional
levels.
Screening
and brief
intervention,
support
and relapse
management
Short-term
clinical
intervention,
support
and relapse
management
Longer-term
treatment,
support and
rehabilitation
Specialized
treatment,
rehabilitation
and
associated
supports, and
relapse
management
Promotion/Prevention
Option 1
Option 2
Option 3
■ 22 organizations/agencies use
partnership to collaboratively plan
and coordinate AMH services and
supports;
■ Continuum of services and supports
is designed within new governance
structure: AMH Regional Entity and
3-4 AMH Centres (entities)
■ Continuum of services and supports
is designed within new governance
structure: SE Region AMH Agency
and 3-4 satellite offices
■ The AMH partnership will complete
inventory of services and supports
and will work together to realign
services and supports across the
continuum; note that not all agencies
will have the capability to deliver the
entire basket of services
■ Each AMH Centre will provide the
full continuum of services and
supports and there will be
centralized oversight by AMH
Regional Entity
■ The SE Region AMH Agency will
provide oversight and support to 3-4
satellite offices
78
Redesign Options
Comparing Elements of AMH Redesign
Leadership & Culture of Collaboration
System leadership drives accountability and focuses on: quality and continuous improvement, integration and coordination,
resource optimization, risk management and performance management. Transformational leaders shift from organizational
ownership to system ownership of improving the client experience.
Formalized collaboration across the AMH continuum and with other sectors to support clients, families and communities.
Collaborative relationships build upon existing relationships, trust, respect, communication and willingness to collaborate.
Option 1
Option 2
Option 3
■ Operational and clinical leaders
from 22 organizations/agencies work
together to collaboratively plan and
coordinate AMH services and
supports
■ Operational and clinical leadership
will be established within the new
governance structure: AMH
Regional Entity and 3-4 AMH
Centres (entities)
■ Operational and clinical leadership will
be established within the governance
structure: SE Region AMH Agency
and 3-4 satellite offices
■ The AMH partnership will be used to
shift from organizational to system
ownership. This means that system
priorities would potentially take
precedence over organizational
priorities
■ Each AMH Centre will work
together to shift from
organizational to system
ownership.
■ The SE Region AMH Agency will work
across the SE LHIN to promote system
ownership.
■ The SE Region AMH Agency will
collaborate with other sectors
■ 3-4 AMH Centres will collaborate
with other sectors
■ 22 organizations/agencies will
collaborate with other sectors
79
Redesign Options
Comparing Elements of AMH Redesign
Hospital governance
Within option 2 and 3, hospital AMH services are provided through the AMH centre or satellite offices respectively (service and
supports will still be provided at the hospital site). As many clients and staff have shared concern about the transition between
hospital and community, the RTF members provided the collective wisdom that if hospital AMH supports and services were
“housed” with other AMH services and supports, that the transitions between acute and community could be seamless and the
experience would be the same as an internal transfer.
Option 1
■
Current state – no change for hospital
governance in Option 1
■
Partnership agreements between a
hospital and 15 agencies will be
required to delineate transition
protocols, priorities and accountabilities
Option 2
■
■
■
Local AMH Centres are responsible
for setting strategy, setting
performance expectations , defining
tools and processes, managing
admissions, budgeting and
evaluation of performance of hospital
AMH services
Hospital governors will retain
responsibility for ensuring appropriate
delivery of AMH hospital services in
accordance with Public Hospital Act
obligations (similar to CCO)
Option 3
■
AMH services and supports provided by
hospital are provided through the local
satellite offices.
■
Local AMH Centres are responsible for
setting strategy, setting performance
expectations , defining tools and
processes, managing admissions,
budgeting and evaluation of performance
of hospital AMH services
■
Hospital governors will retain
responsibility for ensuring appropriate
delivery of AMH hospital services in
accordance with Public Hospital Act
obligations (similar to CCO)
■
Hospital governors will be representatives
on the AMH Board
80
AMH Centre Board may include
hospital governors
Redesign Options
Comparing Elements of AMH Redesign
Leadership Provides Oversight: Performance Management
Performance management includes activities which ensure that goals are consistently being met in an effective and efficient
manner. Managing employee, organizational and system performance and aligning to shared objectives facilitates the effective
delivery of strategic and operational goals.
System leadership will be required to drive performance management and improve overall AMH system performance. The
establishment of an AMH system-wide culture of continuous quality/process improvement and a rigorous approach to
performance management will be required.
Option 1
■ 22 organizations/agencies develop,
implement and evaluate standard
approach to performance
management
■ Organizational strategies and goals
continue to be key driver
■ System performance goals and
metrics established and are
translated to organizational level
■ 22 organizations/agencies share
their approaches to quality/process
improvement and ‘spread’ plan
established
Option 2
Option 3
■ AMH Regional Entity and 3-4
AMH Centres (entities) develop,
implement and evaluate standard
approach to performance
management
■ SE Region AMH Agency develops,
implements and evaluates one
approach to performance management
■ System performance goals and
metrics established and are
translated to AMH Centre level
■ AMH Regional Entity and 3-4
AMH Centres share their
approaches to quality/ process
improvement and ‘spread’ plan
established
■ System performance goals and
metrics established and distributed to
satellites
■ The SE Region AMH Agency
establishes a comprehensive approach
to quality/process improvement and
internal ‘spread’ plan established
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Redesign Options
Comparing Elements of AMH Redesign
Culture of Collaboration: Health Links
Health Links will bring local health care providers together and ensure that people are at the centre of their care. Health Links
will give family doctors the ability to connect patients with specialists, home care services and other community supports,
including AMH services and supports. For patients being discharged from hospital, it allows for faster follow-up and helps
reduce the likelihood of readmission to hospital. This will result in better patient care and strengthen partnerships in the
community. Coordinating care is an important step in improving the services available to clients with addictions and mental
health issues.
Option 1
Option 2
Option 3
■ 22 organizations/agencies establish
a consistent approach for
collaborating with the respective 7
Health Links
■ AMH Regional Entity establishes a
consistent approach for collaborating
with the respective 7 Health Links
■ SE Region AMH Agency establishes
a consistent approach for
collaborating with the respective 7
Health Links
■ 22 organizations/agencies align with
their respective Health Links while
regional programs establish working
relationship with all 7 Health Links
■ Clients/families have better
transitions between providers
■ 3-7 AMH Centres align with their
respective Health Links while
regional programs establish working
relationship with all 7 Health Links
■ Clients/families have fewer providers
and better transitions
■ 3-7 satellite offices align with their
respective Health Links while
regional programs establish working
relationship with all 7 Health Links
■ Clients/families have fewer providers
and better transitions
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Redesign Options
Discussion
What questions do you have about the Redesign options?
What concerns do you have about the Redesign options?
What do you like about the Redesign options?
What other information would you like to know to make a decision in February?
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Next Steps
Next Steps
Stakeholder Engagement Tactics
Newsletters/Communiques - continue
Website and Social Media - continue
Roundtable Sessions – to be completed
• Targeted stakeholder sessions and one-to-one meetings:
• Aboriginal and Indigenous – 2014
• Housing – November 29 and December 6
• Children & Youth – November 25
• Primary Care – January 2014
• Police and Correctional Service – January/February 2014
• Francophone – January/February 2014
• Full day Validation Session with multiple stakeholders – December 2
• Additional Addictions and Mental Health engagement session (Executive Director’s)– December 10
Additional AMH Governance engagement opportunity – early February 2014
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Next Steps
Overview
Presentation of the AMH
Redesign Options to LHIN Board
December 16, 2013
Additional Engagement Sessions
– EDs and unique populations
January 2014
Additional AMH Board
Engagements
Early February 2014
LHIN Board Decision on Preferred
Governance Structure for the
Future
February 2014
Development of Implementation
Plan Components
March – May 2014
Provider/ Administrative/Clinical Support Teams
LHIN Board Decision to Launch
Implementation Plan
June 2014
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Next Steps
Overview of South East LHIN Decisions
• Decision to launch the Redesign
March 2013
• The question of “why” are we doing this has been answered in the ‘case for
change’ and the decision by the SE LHIN Board to launch In March 2013.
• Decision on governance model
February 2014
• The question of “what” are we going to do to make this ‘live’ is being informed by
the work of the Redesign Task Force, Expert Panel, stakeholder feedback, and
application of the SE LHIN Board Governance Option Evaluation Criteria.
• Decision on timing and nature of implementation (e.g. phasing)
June 2014
• Answering the “how” and “when” questions will be made after the development of
a detailed implementation plan with all necessary components delineated to
enable a considered and successful implementation within the resources we have
available.
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Next Steps
Implementation Considerations
• The Implementation Phase will continue to involve on-going and extensive stakeholder
engagement
• As a first step, we need to develop an Implementation Plan. This will include:
• Development of an implementation plan outline (describing necessary components)
and process
• Creation of implementation planning teams to develop key components. Examples
may include (to be confirmed):
• Clinical Advisory Team: common basket of services, tools, protocols and
processes, competency framework.
• Administrative Advisory Team: agreements, privacy tools, enabling
technology plan, other back office services, transportation
• Financial Advisory Team: location of services, HR plan, costing
• Transition Planning Team: overall management and leadership, ongoing
engagement, client and clinician/staff support in transition, evaluation
• Creation and launch of an ongoing communications and stakeholder engagement
plan
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Next Steps
Implementation Considerations – Addressing Unspoken Fears
• Unspoken Fears
• Where am I in these models?
• By changing something I’ve created, does this mean I have failed?
• How do I prepare myself for change (system, organizational and personal)?
• Considerations
• Need to pay close attention to these fears during the implementation/transition
phase
• Need for early transition planning considerations – it is never too early
• Need to remain focused on a collaborative process
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Next Steps
Our Commitment that we have made to stakeholders and partners
• A decision has not been made
• This is not the only opportunity to share perspectives
• We are committed to creating a system that is focused on the client
• We are committed to a collaborative approach
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Thank You
Contact
Jennifer Payton
South East Local Health Integration Network
(613) 967-0196 ext. 2249
jennifer.payton@lhins.on.ca
Amanda Pieris
KPMG
(416) 777-8771
akpieris@kpmg.ca
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