Lessons Learned: Integration Case Studies from the Community Health - - PowerPoint PPT Presentation

Lessons Learned: Integration Case Studies from the Community Health Sector

SPEAKERS – MAY 21, 2015

Andrea Abbott-Kokosin Executive Director, Breaking Down Barriers Independent Living Resource Centre

On The North Simcoe Muskoka Community Support Services Collaborative

Don Seymour, Executive Director, CMHA Middlesex

On the merger of CMHA London, WOTCH and Search Presented by Community Health Ontario

About Community Health Ontario

The strategic partnership of Community Health Ontario believes that the sustainability of Ontario’s health care system depends on our ability to keep Ontarians healthy and avoid the need for more costly care models. We envision strong community-based services that are integrated, coordinated, efficient and better able to partner, focus on the social determinants of health and are coordinated with the long-term care and acute care systems.

Integration Resources Website

An online repository of resources designed to help community health organizations survive and thrive in the world of integration pressures and

• pportunities.

www.integrationresources.ca

The North Simcoe Muskoka Community Support Services Collaborative

Andrea Abbott-Kokosin

Executive Director, Breaking Down Barriers Independent Living Resource Centre

Lessons Learned: Integration Case Studies from the Community Health Sector May 21, 2015

The North Simcoe Muskoka Community Support Services Collaborative

Andrea Abbott-Kokosin Executive Director, Breaking Down Barriers Independent Living Resource Centre and Co-Chair, NSM CSS Collaborative

Wh What at is is th the c e col

• llabor

laborati ative? e?

The NSM CSS Collaborative is a group of agencies who provide community support services in the NSM LHIN

• region. These agencies all receive LHIN funding as well

as funding from other sources. The agencies provide a wide range of services to adults with ongoing community needs. Services include meals, transportation, disability assistance, supportive housing and more. Agencies range from small to large and some are provincial or national.

A brief history:

 2004 – the group was founded and called the NSM CSS Coalition, 23

agencies joined, some operating processes and procedures were

• developed. The coalition created networking opportunities, joint

problem solving and linkages to other health system partners

 2007 – LHINS assumed responsibility for health system planning  2008 - Recognizing the complexity and diversity of community services

and the agencies providing those services, and with a growing awareness

• f the key role community agencies play in keeping people healthy and

safe in their home and communities, the NSM LHIN provided funding to the CSS Collaborative to support the development of sector-driven solutions for back office functions and health human resources planning.

 LHIN offered 6 months of funding to support CSS sector to develop a

plan and in 2009/2010 the Coalition hired consultants to assist with a capacity building study

The Capacity Building Study:

Phase 1 Conduct an organizational review of the NSM CSS Coalition and make recommendations for enhancing and improving the structure and processes to improve effectiveness Phase 2 Develop a comprehensive strategic Human Resource Management Plan “the People Plan” to provide strategies and action plans to attract and retain an engaged workforce among the member agencies Phase 3 Provide support services to enable the coalition and its agencies to successfully implement the changes embedded in the goals in phases 1 & 2

Recommendations from the Study and Results

Recommendation Result Change the name Changed to North Simcoe Muskoka Community Support Services Collaborative Replace steering committee with “Council” Collaborative is now led by a 10 member council consisting of 5 senior staff and 5 governors, elected to represent the voice of the NSM CSS Sector Adopt a new organizational structure Changed from a coalition to a collaborative with a formal MOU, membership fees and clear expectations of members Develop terms of reference Terms for collaborative and council developed Look for funding to hire a “sector coordinator” December 2012 – June 2014 funded by LHIN then 2013 – 2016 funded by OTF, coordinator in place and admin staff in place

Successes /Achievements

 Website in development for the CSS Sector linking to each individual website and nsmhealthline.ca  Pilot project with 211 for one point of access to CSS for primary care, to be rolled out further once

effectiveness measured

 Developed an orientation handbook to the collaborative for new staff or board members  Conference for senior staff and board members in March 2014  Joint strategic planning training session with NSM LHIN March 2015  Joint training regarding AODA, MSAA Compliance for all member agencies  Difficult to serve project  Joint marketing of employment opportunities in CSS Sector in NSM  CSS represented at LHIN councils, working groups, Leadership Council and Health Links  Those reps report back to full group via written report template or in person at quarterly meetings

so that everyone is in the loop but not everyone has to participate in multiple groups to keep informed

 Developed an “elevator speech” to describe the collaborative that every member uses  Board members of member agencies sit on LHIN Governance Council  One member agency co-chairs the In Home and Community Capacity Council of the LHIN with the

CCAC

 Joint quality improvement project

Benefits

 New staff or Board members can be mentored by seasoned

member agencies

 Provides a wide health system education and orientation to the

sector

 LHIN has one point of contact with the sector rather than having

to communicate or request participation from each individual agency

 Not all members have to join every initiative or working group as

staff who do join commit to sharing information back with the full group

 CCAC, LHIN and other sectors attend meetings as guest as

they are able to reach our whole sector at one meeting

Challenges

 We are very good at meeting and sharing but when it comes

to big initiatives, individual agency capacity can impact a member agency’s ability to participate

 Readiness of individual Boards to collaborate and eliminate

silos and to allow their senior staff to take on a leadership role on the council of the collaborative

What’s next?

• On May 22, 2015 the collaborative will hold a strategic planning day and work

to align the strategic plan with the MOH and LHIN priorities and to help individual agencies to align agency strategic plans with LHIN and MOH priorities

• Hold a third regional conference based on emerging issues/needs of the sector
• Evaluate recruitment strategies and fine tune as necessary
• Evaluate and possible expand South Georgian Bay 211 pilot project
• Develop database of resources for CSS sector (facilitators, HR experts, etc)
• Investigate future on-going funding for sector coordinator/administration staff
• Launch and maintenance of NSM CSS web site
• Produce marketing resources with common look/feel that can be utilized by

agencies

Andrea Abbott-Kokosin, Co-Chair 705 445-1543 ext. *300 executivedirector@breakingdownbarriers.ca Wayne Yuristy, Sector Coordinator way23@live.ca Debbie Carey, Administration 705 445-1543 ext. *221 nsmcss@breakingdownbarriers.ca

On the merger of CMHA London, WOTCH and Search

Don Seymour Executive Director, CMHA Middlesex

Context

• Three organizations:

– Search Community Mental Health Services

• 400 persons served, Budget: 1.0 Million Dollars, 14 FTE’s

– CMHA London-Middlesex

• 600 persons served, budget: 4.1 million dollars, approximately 40 FTE’s

– WOTCH Community Mental Health Services

• Approximately 1400 persons served, budget: 13 million dollars, 200 FTE’s
• Three organizations amalgamated into a new corporation

under the CMHA banner: CMHA Middlesex

How We Got There

• South West LHIN called a meeting of three CMHA Branches

and WOTCH to discuss possible integration(s).

• LHIN articulated displeasure at the lack of concrete ideas and

cooperation at the meeting.

• WOTCH approached CMHA LM to discuss amalgamation. The

same week Search called WOTCH to discuss amalgamation.

• We informed the LHIN of our discussions and the LHIN

convened a table of all three organizations with Board reps (including LHIN) and EDs.

• Process began formally in February 2012 with official

amalgamation in February 2014.

Scope of CMHA Middlesex

Organization Operates 24/7 365 days per year.

• Persons Served*

– Total: 2,012 Urban: 1,578 Rural: 434 – My Sisters’ Place: 1,090 unique individuals on a yearly basis. Averaging between 140-160 women per day. – Coffee House: No statistics regarding unique individuals. Averaging 272 individuals daily.

• Total Number of Employees/FTE’s

– Total: 325 (approx) FTE’s – 260 (approx)

• Total Service Locations

– Owned: 36 – Leased/Rented/In Kind: 10

*Note: many clients access one or more programs in each location and may access programs in multiple locations.

Geographic Scope of CMHA Middlesex

Geographic area of 7120 square kilometers. Total population approximately 500,000.

Financial Scope

• Total Operating

– $18,748,711 (PWC Statements reflect a figure of 18,255,637)

• Addition of new positions related to Eating Disorders, Mental Health

Housing Workers

• Budget will approach $20 million dollars in 2015-2016 as Crisis Centre

comes online.

– Total Assets: $10,217,967

• Total Capital Assets as of March 31, 2013

Lessons Learned

• Research best practices at very beginning of process (no need to

reinvent the amalgamation/merger wheel).

– Create a plan based on proven methodology

• Develop a common vision, ensure everyone understands process,

create terms of reference and a decision making framework.

• Create an operating agreement between amalgamating entities to

ensure no significant changes are made during negotiations (such as restructuring or wage increases). “Continued to work through the process with the end vision in spite of challenges and bumps along the way. Continued to hold the value of more effective seamless service for clients and families at the centre of this process.” (Participant)

Lessons Learned

• Develop a communication plan and identify stakeholders at the

beginning.

– Communication was often inaccurate due to interpretations of legacy

• rganizations.

– Needed better mechanisms to engage persons served

• Develop clear timelines from very beginning and stick to them.

– Process was originally slated to take a year.

• Careful attention to the right consultant.

– National firm engaged with no connection to community. Perception was the firm was more interested in extending the engagement than completing the work

“Process was way too long, disjointed, consultants not on track, dropped the involvement of the ED’s, little direction from the LHIN” (Participant)

Lessons Learned

• Engage appropriate legal counsel from the outset.

– Much discussion regarding difference between amalgamation and merger. Significant issues related to assets and letters patent in all three legacy

• rganizations.
• Create opportunities to build trust and have a conflict resolution

process in place.

– Lack of trust between EDs and organizations hampered process.

• Do specific training around confidentiality and highlight possible

legal ramifications of not maintaining strict confidentiality.

– Proposed leadership structure was shared outside of deal development team with person whose position was not part of new org structure.

“I believe more involvement from those involved operationally with the

• rganization would have been of great benefit, overall, to the process

and avoided many pitfalls.”

Lessons Learned

• Clearly define Governance and Operations from the outset.

– What is the role of Board Members vs. Role of Staff

• Define the role of the Funder vs. the legacy organizations

– Funder started off very directive, eventually legacy orgs took control of process

• Board members need to be aware of the time commitment

involved in this process.

– A mostly governance driven process. Board members initially caught

• ff guard by the time commitments. Many needed to use holiday time

from work to make meetings.

“Volunteer Board members were committed and invested much energy and time into the process; milestones were reached as identified.” (Participant)

Lessons Learned

• Pay attention to issues related to culture and change management. Spend

time doing cultural analysis

– Create a script for all to follow. Make no assumptions everyone is on the same page. – All three legacy organizations were in various stages of readiness on the day of amalgamation.

• Create a transition team early in the process.

– Transition team created in September of 2013, with amalgamation date scheduled for February of 2014. – Include transition plan for governance

• Acknowledge the legacy of organizations – remember to grieve and also to

celebrate.

– Express gratitude to volunteers (Board Members).

“When we finally got to this point, everyone was so relieved we were just there! Everyone just wanted to get it done and begin the integration process.”

Lessons Learned – Post Amalgamation

• Stick to the transition plan and timelines.

– One year transition plan created with clearly defined goals and

• milestones. All were achieved.
• Ensure new CEO has a clear playing field to lead the
• rganization.

– Legacy EDs were still on the ground post amalgamation. This hampered cultural integration.

• Be transparent in all appropriate areas, ensure constant
• ngoing communication internally and externally.

– First position created/hired was Communications Manager.

Lessons Learned – Post Amalgamation

• Be overly sensitive to different organizational cultures.

– WOTCH was a very large organization (three times the size of CMHA LM and Search combined). Many people voiced that it felt more like a takeover than an amalgamation.

• Don’t reinvent the wheel to appease sensitivities.

– Used the best or most robust process.

• Recognize the difference between doing what is right as
• pposed to what seems fair.

– Ensure timely decision making and ground decision making in what is best for individuals served and the organization.

• Recognize the first year is very transactional.

– Transformation comes once new strategic plan is in place and new mission vision and values are created.

Lessons Learned – Post Amalgamation

• Be prepared for an enormous amount of work.

– Internal and external visibility give stakeholder a sense of comfort and stability. – The real work still exists in addition to creating a new organization.

• Keep the new Board updated in all areas. Operational

information in early stages is important.

– Ensure appropriate Board training takes place.

• Learn to recognize when internal stress or dissention is rooted

in cultural differences.

– We learned early that one legacy organization had a culture of yelling when frustrated. – Another difference was the varying levels of autonomy at the direct service level of the three orgs.

Lessons Learned – Post Amalgamation

• Regularly engage persons served to gauge their thoughts on

the process.

– 88% of persons served felt services had not changed or improved

• Regularly engage staff to gauge their thoughts on the process.

– Staff gave the amalgamation process a 7/10

• CELEBRATE MILESTONES

– Recognize individual and team effort – Share success publicly about organizational milestones – Launch new Strategic Plan (Mission Vision Values) in a public forum. CMHA Middlesex hosted over 250 community partners and stakeholders to launch new plan.

Recognition & Question

• Note that much of the material for this presentation was

taken from a Lessons Learned document commissioned by the South West LHIN post amalgamation. Maria Sanchez Keane of Centre for Organizational Effectiveness was the consultant who undertook this work. The full document can be accessed at:

– http://www.southwestlhin.on.ca/~/media/sites/sw/uploadedfiles/BO ARD/Board%20of%20Directors%20FINAL%20REVISED%20Agenda%20P ackage%20%202014%20Oct%2021.pdf?la=en

Case Studies from the Community Health Sector

Q & A Session

Presented by Community Health Ontario

What’s Next?

Case Studies from the Community Health Sector

Webinar #3: Thursday, June 25th, 12 noon to 1 pm

Presented by Community Health Ontario

www.integrationresources.ca/submit-a-resource

Presented by Community Health Ontario

www.integrationresources.ca

Presented by Community Health Ontario