Mississauga Halton LHIN g CSS and MH&A Sector Meeting D - - PowerPoint PPT Presentation

Mississauga Halton LHIN g CSS and MH&A Sector Meeting D b 10 2010 December 10, 2010

Agenda

Welcome Angela Jacobs 5 min Mississauga Halton CCAC Strategic Plan Caroline Brereton 15 min Shared Services West – Procurement Opportunities John Simpson 10 min Shared Services West – Procurement Opportunities John Simpson Senior Account Executive Shared Services West 10 min Mississauga Halton LHIN Updates

• Community Investments
• Excellent Care for All

Fi Monita O’Connor Monita O’Connor P l tt Z li ll 35 min

• Finance

Paulette Zulianello HRIS – Testimonial George Parselias Accountant Nucleus 10 min Break 15 min Falls Prevention Program Seniors Friendly Hospital Priti Patel 30 min MSAA Update Angela Jacobs 15 min Metamorphosis Strategic Plan Ray Applebaum Lorena Smith 10 min Lorena Smith Members of Metamorphosis Leadership Team CHA Steering Committee Presentation (CSS) (MH&A HSPs are free to leave) Lisa Gammage Ashim Rizki Judy Bowyer 30 min Closing Angela Jacobs 5 min

Charting Our Future: MH-CCAC Strategic Plan MH CCAC Strategic Plan 2 0 1 1 -2 0 1 4

Presentation to MH LHI N Com m unity Support Services ( CSS) & Mental Health and Addictions ( MH&A) Quality Sector Meeting Decem ber 1 0 , 2 0 1 0

Mississauga Halton

Today’s Presentation

• Context

P ti i

• Process, timing
• Strengths & opportunities
• Five Strategic Directions
• Definitions, goals, action plans
• Success measures

Success measures

Mississauga Halton

Strategic Planning Process g g

• Early 2010 - Environmental scan (focus groups, surveys)

S 2010 St t i di ti id tifi d

• Summer 2010 - Strategic directions identified
• Fall 2010 - Strategic directions, goals, draft measures,

role mapping action planning stakeholder engagement role mapping, action planning, stakeholder engagement

• Winter 2011 - Confirm measures, annual operating plan
• April 1, 2011 - Strategic plan 2011-2014 in place

Mississauga Halton

Strengths to be Sustained g

• Unique role in health care continuum (navigator)
• Positive relationships, collaboration, sharing data
• Quality programs

Q y p g

• Responsiveness
• Long view combined with trend awareness

Mississauga Halton

Areas to I m prove p

• Educate public – what to expect
• Educate service providers – CCAC processes
• Better information management (support decisions)

g ( pp )

• Staff should be process and content experts

Mississauga Halton

Areas to I m prove - Service p

• Fewer gaps in care, better continuity
• Address needs other than aging population
• Partner to address complex needs
• Community referrals must also be priority

(not just acute) ( j )

• Identify clients early and upfront
• Collaboration versus “owning” community care (CSS)
• Build on diversity programs
• Build on diversity programs

Mississauga Halton

Our Foundation

• CCAC sector vision:
• Outstanding care, every person, every day
• Mississauga Halton CCAC Values:
• Caring * Accountability * Respect * Excellence

g y p

Mississauga Halton

Outstanding care, every person, everyday

Quality Com m unity Care

• Design quality and safety into our services
• Set the standard for outcomes in community-based

healthcare healthcare

• Rapidly adopt evidence-based models for targeted

populations, develop new ones

Culture of quality improvement, client safety Programs of clinical excellence for major client populations Right care right time right provider

• als

Right care, right time, right provider Information management optimized

Go

Mississauga Halton

I ndicators

• Quality Homecare Indicators
• % Clients with goals met
• HSMR
• Avoidable hospitalizations

A id bl Ad t

• Avoidable Adverse events
• ALC rate
• % Clients on evidence based care pathways

p y

Client & Fam ily Focus

• Demonstrate care and compassion for clients/families
• Exceed clients/families expectations through quality

service and responsiveness p

• Collaborate with client and care network of acute and

community providers to ensure seamless transitions

Implementation of new client service model Customer service culture throughout CCAC Comprehensive diversity plan

Goals

Comprehensive diversity plan

G

Mississauga Halton

I ndicators

• Client and caregiver experience scores

Exceptional People

• Retain and attract committed people who will transform

community-based care

• Collaborate with our team and partners to create healthy
• Collaborate with our team and partners to create healthy

and productive work environments across diverse locations and teams

• Our people are recognized as experts in their field
• Our people are recognized as experts in their field,

particularly in care coordination and system navigation

Highly engaged team right skills in place

s

Highly engaged team, right skills in place Dynamic leadership model, responsive and agile Productive and engaged hospital and community-based teams are key enablers of access to acute care

Goals

are key enablers of access to acute care

Mississauga Halton

I ndicators

Employee engagement Turnover rates Leadership of quality and project initiatives locally and provincially Leadership of quality and project initiatives locally and provincially

Operational Stew ardship

• Advocate for appropriate resources to meet the health

needs of our community

• Provide effective stewardship over financial and other

p system resources

• Leverage community care investments for maximum

benefit

Strategic business model drives identification of resources, allocation of resources, ensures sustainability

als

Solid business cases/advocacy rewarded with more funding Culture of accountability makes most of resources

Goa

Mississauga Halton

I ndicators

• Efficiency measures
• Productivity

Leadership & I nnovation

• Partner strategically to enhance integration, build

community capacity to deliver care close to home

• Lead the development and adoption of innovative best

p p practices

• Foster a learning culture, support creativity, new ideas

Innovation framework for supporting a culture of critical thinking and strategic innovation

als

thinking and strategic innovation Community capacity increased to meet changing needs Effective in strategy execution

Goa

Mississauga Halton

I ndicators

• Stakeholder satisfaction
• Achievement of performance targets and quality improvement

i di t indicators

Conversation

• Feedback
• Staying engaged with you

P f

• Process, forum

Mississauga Halton

Health Service Providers Procurement Opportunities Procurement Opportunities

__________________________________________________________________________

CSS and MH&A Sector Meeting CSS and MH&A Sector Meeting December 10, 2010

22

2009 h i i l l l h d In 2009, the Mississauga Halton Local Health Integrated Network (MH LHIN) engaged the services of Shared Services West (SSW) to conduct a procurement feasibility study in

• rder to identify regional supply chain opportunities

A Procurement Steering Committee representing 7 small A Procurement Steering Committee representing 7 small and 2 large agencies was established to help facilitate the process and table recommendations

23

id if i i i

1.

To identify contract savings opportunities

2.

Provide strategic supply chain options

3.

Facilitate optimal utilization of resources related to “back‐office” functions back‐office functions

24

i i i i h h

1.

Access to procurement pricing opportunities through regional contract collaboration

2.

Access to procurement software technology

3

Outsourced procurement services

3.

Outsourced procurement services

4.

Provision of logistical services

5.

Provision of back‐office support services

25

S 1 d i f i i i i Step 1‐Introduction of procurement pricing opportunities 1) Staples Advantage 2) Cardinal Health Canada 3) HealthPRO

26

O i ti t b li t ith th f ll i Organizations must be compliant with the following:

Broader Public Sector Supply Chain Guidelines

(A il 2009) (April 2009)

Management Board of Cabinet Procurement Directives

(J l 2009) (July 2009)

Current contract obligations Organizational procurement policies and procedures

V d i i d i

Vendor minimum order requirements

27

Send Participation Notification to SSW Review Requirements and Confirm Eligibility Complete Confidentiality Document Share Details of Perform Cost Share Details of Procurement Opportunities Perform Cost Benefits Analysis HSP Engagement with Vendor

28

d ddi i l i i

1.

Extend additional common procurement pricing

• pportunities

2.

Develop a contract strategy for expiring or new product and

• r service acquisition requirements

3.

Explore other supply chain or other “back office” integration

• pportunities

29

Contact:

John Simpson Senior Account Executive Shared Services West Shared Services West 2295 Bristol Circle Suite 101 Oakville, Ontario L6H 6P8 L6H 6P8 Tel: 905‐287‐2887 Fax: 905‐287‐2873 Email: john.simpson@ssw.ca

30

MH LHIN Community Investments

Monita O’Connor Monita O Connor

Transformation of the CSS, MH and Addiction Sectors using the MH Halton LHIN Investments

Objective: Increase Capacity to Reduce Dependence on Institutions (LTC and Hospital Sector)

Support Higher Need "at Risk" Seniors

Year 1 to 3 ‐ Impact to Community Increase funding due to Investments 2010/11 ($ M) 2007 ‐ 2008 2010 ‐ 2011

Focus on reducing LTC Needs 24/7;

Supports for Daily Living (SDL) Supportive Housing Pre LHIN Description of Programs

0 9

Focus on reducing LTC Needs 24/7;

$11.7 2.7

Integrated Approach; Mobile Capacity Interaction with Hospitals and CCAC MAPLE 4, 5 Support more "at risk" Seniors; MAPLe 3+

ABI Adult Day Services ABI Adult Day Services

Most Clients MAPLe 1,2s No 24/7 support Limited integration with hospitals Most Clients MAPLe 1,2s

0.4

Home Making/Maintenance

1.2

CSS

0.9 1.0

Integrated Transportation

I t t d H M ki /M i t

(High Needs) Day‐to‐Day Caregiver Relief

Stand‐alone Transportation Services

Outreach to Hospitals and LTCHs

Enhanced Respite Care Respite Care

Residential with Community Outreach

Aging at Home Strategy &

Home Making/Maintenance

1.2 0.2 0.5

CCAC

3.2

Other CSS Programs Other CSS Programs (ie. Telephone Re‐

Assurance & Elder Abuse Support Program)

Integrated Home Making/Maintencance Integrated Palliative Care Program (CCAC)

Palliative Care/ End of Life Care

Integrated Palliative Care Program (CSS)

Palliative Care/ End of Life Care

ER Wait Time Strategy

(Service Maximums)

CCAC

7.5 MH&A 1.6

Enhanced Home Care; Intensive Case Management

Mental Health And Addictions Programs

Integrated Palliative Care Program (CCAC)

Palliative Care/ End of Life Care

LHIN Wide Concurrent Disorder Program;

Focus on ED Reduction Geriatric Mental Health Outreach Expansion ‐

Home Care Services

1.1

$32.0

Geriatric Mental Outreach LHIN Wide

Silos ‐‐‐‐‐‐‐ Integrated Approach INCREASE $

MH LHIN MH LHIN Excellent Care for All Update

MH LHIN Community Support and Mental Health and Addiction Services Quarterly Sector Meeting December 10, 2010

33

34

The pursuit of quality

• not by chance, but by design

Leadership Quality is a core business strategy Engaged workforce Alignment of aims, measures & activities Focus on patient first Innovation, design & redesign of services g g Capability for improvement Information technology & Incentives & accountability gy meaningful measurement Integration of services across levels

• f care, sites & disciplines

35

Organization vs. system competencies

Leadership Quality is a core business strategy

Organization System

Alignment of aims measures & activities Focus on patient first Engaged workforce Alignment of aims, measures & activities Innovation, design & redesign of services Capability for improvement Information technology & meaningful measurement Incentives & accountability

36

measurement Integration of services across levels of care, sites & disciplines

The Excellent Care for All Strategy

Organization: g Create an enduring

• rganizational

focus on quality focus on quality and its continuous improvement. System: Create the basic environmental conditions that

37

Create the basic environmental conditions that support, enable and compel quality improvement.

The Excellent Care for All Strategy

• 1. Organization

The Excellent Care for All Act, 2010 (Bill 46)

• ECFFA became law on June 8th, 2010
• Establishes a number of requirements for health care organizations, starting first with

hospitals

• 2. System

Foundational elements

• Expanded mandate and capacity of the Ontario Health Quality Council
• Shift to patient-based payment for hospital services

Near-term initiatives

• Evidence-based changes to select OHIP insured services
• Quality improvement initiatives targeting readmission reduction

38

Key components of ECFAA

Require health care organizations, starting first with hospitals, to: q g , g p ,

• Establish quality committees of the board
• Develop and make publicly available annual quality improvement plans

Prototyping of QIP template led by Drs. Bob Howard (CEO, St. Michael’s) and Terry Sullivan (CEO, Cancer Care Ontario)

• Ensure that executive compensation is tied to success of quality improvement plan
• Ensure that executive compensation is tied to success of quality improvement plan
• Carry out patient, client, and caregiver surveys
• Carry out employee / care provider surveys

Carry out employee / care provider surveys

• Have a patient relations process
• Have a patient declaration of values

39

Complementary changes to PHA

• Strengthened critical incident disclosure and reporting requirements
• Alignment of governance related quality: MAC, Quality Committee

and Board

• Hospital Governance Consultations in progress, involving OHA, OMA and

RNAO

40

ECFAA Timelines for Hospitals

• Jun. 8, 2010 Dec. 2010 Jan. 2011

Apr 2011 Jun 2011 Apr 2012

J 8 2010 D 2010 J 2011 A 2011 J 2011 A 2012

• Apr. 2011 Jun. 2011 Apr. 2012
• Jun. 8, 2010 Dec. 2010 Jan. 2011 Apr. 2011
• Jun. 2011 Apr. 2012

Legislation received royal Public consultation for declaration of Quality committee l ti Framework for QIP to field Patient surveying i iti t d Staff surveying assent values* (Dec. ‘10) regulation (Jan. 1 ’11)

(Jan. ’11)

initiated (Apr. 1 ’11) initiated (Apr. 1 ’12) ECFAA IWG to communicate compliance requirements and recommendations for all components of legislation Post Quality Improvement Plan for 2011/12 Make declaration

• f values available

t th bli * and recommendations for all components of legislation To be defined by ECFAA IWG Plan for 2011/12 (Apr. 1 ’11) to the public* (Jun ’11) Performance based compensation Implement patient relations process Responsibility of hospital in compliance with ECFAA LEGEND * Applies to hospitals where compensation plan in place (Apr. 1 ’11) relations process that reflects declaration of values

ECFAA IWG to communicate best practice recommendations and provide toolkits/training

* Applies to hospitals where process not currently in place

Expanded role of the Ontario Health Quality Council

• Current functions
• Monitor and publicly report on system performance
• Support quality improvement

N f ti

• New functions
• Promote evidence-based care:

Recommendations on standards of care based on clinical practice guidelines and protocols p Corresponding recommendations on funding for health care services and medical devices

• Quality improvement plans:

Province wide comparison of and reporting on quality indicators associated with QIPs Province-wide comparison of and reporting on quality indicators associated with QIPs submitted by health care organizations

• Expansion phase to begin in early 2011
• Dr. Terry Sullivan appointed to develop expansion plan

42

y

Building Quality into Payment

An emerging

Australia: 3% reduction in adverse events among complex patients

2003 England 2004 France 2005 Germany meline

g g focus on quality and evidence- based care

England: Introduction of ‘Best Practice Tariffs’ based on costs of clinical best practice treatment for a patient condition United States: Associated with decreases in mortality; non-payment policies for never events

1998 Japan Finland 2000 Denmark Adoption Tim

based care

Norway: 40% reduction in wait times over 2 years Denmark: 17% reduction in wait times one year after implementation Ontario (Wait Time Strategy): Reduced 90th percentile wait times for

Improving access and

1993 A t li 1995 Italy 1997 Norway Spain Payment A

Ontario (Wait Time Strategy): Reduced 90th percentile wait times for hip replacement from 351 to 153 days, knee replacement from 440 to 184 days

reducing wait times

1992 1993 Australia 1983 U it d St t Sweden tient-based

United States: 14.1% decrease in cost per admission, 2.4% reduction in

• verall system costs over 4 years; 6.7% decrease in average LOS)

Australia (Victoria): Up to 25% reduction in cost per admission over 5 years Sweden (Stockholm): 1% reduction in total costs

Emphasis

• n cost

containment

43

1983 United States Pat

The (Long) Journey Ahead

M th Y M Y Months Years Many Years

Excellent Care for All Act implemented by all hospitals Excellent Care for All Act expanded beyond hospitals through regulation

stones

I iti l ll t f ti t b d

Patient- Centered Care Across Continuum

Funding for patient episode across the care continuum Providers form networks to

• rganize and deliver care
• ns/Miles

Launch of provincial initiatives to improve transitions in care Initial roll-out of patient-based payment policy Expanded OHQC operational

Culture of Quality and Its Continuous Improvement

• rganize and deliver care

across continuum

S t i bl

Actio

improve transitions in care Compliance with ECFAA Measureable improvements across a range of quality/safety indicators Initial set of system enablers in l

Sustainable Healthcare System

Quality counts – strong business case for quality within

• rganizations / across
• rganizations

Results

indicators place

44

Thank You

45

MHLHIN MHLHIN Financial Update

P l Z li ll Paulette Zulianello, Senior Lead Funding and Allocation Senior Lead, Funding and Allocation

Finance Update

2009/10 CAPS forms updated Q2 CAT - finance review and performance review in progress In-Year Surplus Recovery-Dec 20

Finance Update

Q3 - MIS due January 31, 2011 Q3 - CAT – due February 7/11 (Supplementary reporting for Initiatives same due date) CAPS 2011-2013 - available on WERS Jan 4, 2011

Finance Update

SRI – SELF REPORTING INITIATIVE Replace WERS (with minimal changes) IBM –off the shelf software solution (FileNet Business Process Manager Suite) Target launch date March 31, 2011

Finance Update

Target launch date March 31, 2011

All WERS data will be migrated and stored on the Ministry All WERS data will be migrated and stored on the Ministry Infrastructure SRI advisory working group Training to begin April 2011 Future integration with existing systems

Finance Update

sri@ontario.ca George Parselius - Nucleus Housing HRIS Testimonial

HRIS T ti i l HRIS – Testimonial

George Parselias Accountant Nucleus

Break!

15 Minutes

Mi i H lt F ll Mississauga Halton Falls Prevention Initiative Prevention Initiative

Friday, December 10th, 2010 CSS/MH&A HSP Quarterly Meeting

Priti Patel, Senior Lead, Health System Development

H it b How it began…

• High rate of falls and fall related injuries visits to

emergency rooms and subsequent hospital admissions.

• Average length of hospital stay for a fall injury was

longer. g

• Received funding through the Emergency Department

Support Fund to develop a regional falls prevention framework / strategy framework / strategy.

• Worked together for a year to develop a framework for

falls prevention in Mississauga Halton and a companion id resource guide.

• Purpose of the framework is to guide, inform and

connect efforts across an integrated continuum of g services.

Framework for Falls Prevention in Mississauga H lt Halton

• Provides a consistent reference point
• Documents a common commitment
• Guides efforts for cross-sectoral collaboration
• Comprehensive

p

• Client-focused
• Evidence Informed (based on universal best practice

E’s of injury prevention) E s of injury prevention)

G l Goal

• Reduce falls and falls related injuries in seniors.
• Reduce the rate of emergency department visits,

hospitalizations and long term care admissions among seniors in the Mississauga Halton LHIN. g

Mississauga Halton F ll P ti I iti ti St i C itt Falls Prevention Initiative Steering Committee

• Purpose: Guide the implementation of the Mississauga

Halton Fall Prevention Framework for older adults.

• Responsibilities: Facilitate and inform the

enhancement and implementation of fall prevention p p activities and strategies across the continuum of care in the Mississauga Halton LHIN catchment area.

• Cross sectoral representation: Long Term Care Homes
• Cross-sectoral representation: Long-Term Care Homes,

Hospitals, CSS, CCAC, Supportive Housing, Public Health Units, private agencies, provincial organizations d MH LHIN and MH LHIN.

A i t H (AAH) I iti ti Aging at Home (AAH) Initiatives

• Expansion of the Outpatient Falls Prevention Clinic at

CVH (2008/09)

• Implementation of Home Support Exercise Program

(2008/09) ( )

• Older Adult Specialist Certification (2008/09)
• Mississauga Halton Falls Prevention Coordinator

(2008/09) (2008/09)

• Creation of Falls Prevention Clinics at HHS and THC

(2009/10)

Outpatient Falls Prevention Clinics “St d St d ” “Strong and Steady”

• Goals:

I t th d b l

• Improve strengthen and balance
• Learn ways to make their homes safer
• Determine risk of having a fall
• Learn ways to protect themselves
• Learn ways to protect themselves
• All three hospitals have a similar program and use the same

name/brochure.

• Includes assessment by a geriatrician and/or a nurse
• Includes assessment by a geriatrician and/or a nurse

practitioner and a physiotherapist, exercise circuit, education and physical activity plan at discharge.

• Program runs two hours twice a week for 6 weeks
• Program runs two hours twice a week for 6 weeks.
• Clients return after 3 months to check on progress.
• Referral – family doctor.

“St d St d ” O t “Strong and Steady” Outcomes

• 274 clients have participated in the program (as of

September 2010)

• In 2009/10, there was an 82% decrease in the mean

number of falls.

• 6 months before the program there were a total of 39

ER visits, after the program, 3 visits to the ER (2009/10) (2009/10).

H S t E i P Home Support Exercise Program

• 10 simple exercises for frail seniors to enhance and

maintain functional fitness, mobility, balance and independence.

• Designed to be implemented by PSWs.

g p y

• Movement to Adult Day Programs – very successful!
• 38 HSEP Facilitators Trained
• 338 Trained in HSEP (172 PSWs and 166 volunteers)
• 338 Trained in HSEP (172 PSWs and 166 volunteers)
• 724 Clients receiving HSEP

Building Capacity of Recreation Sector Old Ad lt S i li t C tifi ti Older Adult Specialist Certification

• Build the capacity of the fitness sector to contribute to falls prevention.
• 20 leaders trained across our LHIN (one-time AAH funding)
• 20 leaders trained across our LHIN (one-time AAH funding).
• Sector continues to train fitness leaders – 40 trained.
• City of Mississauga plans to develop a policy that all fitness leaders will be

required to have the certification.

• HSEP being integrated into current programming at fitness centres and

seniors centres

• Mississauga Parks and Recreation with THC developed “Stronger and

Steadier” for graduates of falls prevention clinics – one site operating; Steadier for graduates of falls prevention clinics

• ne site operating;

second site in development with CVH

• Active Halton hosted falls prevention training for fitness leaders in Milton –

20 leaders attended. $54 000 f H lth C iti F d t d l th Old Ad lt

• $54,000 from Healthy Communities Fund to develop the Older Adult

Awareness Training Support Program - a master training program that will provide activity leaders and volunteers with knowledge, skills and resources to better serve older adults in a recreational setting. g

O t Hi hli ht Outcome Highlights

• 10 Organizations currently offering the HSEP to Seniors in the community
• Parks and Recreation working to train all staff in the HSEP and Older
• Parks and Recreation working to train all staff in the HSEP, and Older

Adult Specialist Course

• Hospitals within our LHIN working together to promote and deliver Falls

Prevention Programs

• Presentations in the community and provincially
• Falls Prevention E-news
• Evaluation framework in development
• Falls Prevention community of practice (SHRTN) – application accepted!

Falls Prevention community of practice (SHRTN) application accepted!

• Actively pursuing funding for a communication plan & website
• Many organizations recruited to work on falls prevention
• Seniors for Seniors trains all staff in the HSEP.

Ad lt D P ti l f f ll

• Adult Day Programs routinely screen for falls.
• CVH and THC working on internal falls prevention strategies.

Mississauga Halton Falls Prevention C di t Coordinator

• Monica Marquis BScHE CHES
• 647-290-0235
• mmarquis@cvh.on.ca

Senior Friendly Care

In Mississauga Halton Local Health Integration Network (LHIN)

Friday, December 10th, 2010 CSS/MH&A HSP Quarterly Meeting CSS/MH&A HSP Quarterly Meeting

Vision Vision

The Challenge The Challenge

• Seniors are three times more likely to be hospitalised and

their length of stay is significantly longer than younger g y g y g y g patients

• 1/3 of frail seniors lose independent function while in hospital

(and 1/2 of these seniors are unable to ever recover what (and 1/2 of these seniors are unable to ever recover what function they lost)

• Loss of functional ability as a result of hospitalization can

easily result in unintended complications, delay transition out

• f hospital, or even prevent a successful return to the

community that might otherwise have been achieved. y g

• Hospital environments were not designed to meet the current

needs and expectations of our growing and diverse aging population population.

Goals of a Senior Friendly Hospital Goals of a Senior Friendly Hospital

• Patient / family
• Minimize risk improve safety

Minimize risk, improve safety

• Maximize functional ability, improve outcomes
• Improve care experience & satisfaction
• Staff

Staff

• Enabled to deliver best practice
• Improve satisfaction
• Hospital Strategic Alignment
• Improve quality
• Reduce adverse events & iatrogenic complications

Reduce adverse events & iatrogenic complications

• Improve capacity for independent living
• Reduce LOS and readmissions
• Align with ECFAA

g

What is a Senior Friendly Hospital? y

Regional Geriatric Program (RGP) Senior Friendly Hospital Framework Senior Friendly Hospital Framework

Processes of Care Emotional & Behavioural Environment Ethics in Clinical Care & Research Organizational Support Physical Environment

What we do How Who Why Where

Framework: Organizational Support Framework: Organizational Support

• Leadership at the highest levels of the organization

demonstrate commitment to the change process for demonstrate commitment to the change process for senior friendly care

Framework: Processes of Care Framework: Processes of Care

• Processes of care become enablers

for providers to deliver the most up- for providers to deliver the most up to-date care to seniors possible

• Evidence-based or best-practice

guidelines adapted to the needs of specific organizations C i il d t d d

• Concise, easily understood and

conveniently accessible

Framework: Emotional and Behavioural Environment Framework: Emotional and Behavioural Environment

• Promote a more respectful and engaging

level of involvement of older persons and level of involvement of older persons and their families in health care decision- making through program planning and communication strategies communication strategies

• Mitigate negative effects of ageism and

the combination of unfamiliarity of hospital the combination of unfamiliarity of hospital environment and traditional communication structure with health care providers providers

Framework: Ethics in Clinical Care & Research Framework: Ethics in Clinical Care & Research

• A thoughtful and consistent approach to the ethical

dimensions of health care delivery for older patients at dimensions of health care delivery for older patients at all levels, from systems planning to the bedside

• Policies to address ethical dilemmas that arise daily in

clinical decision-making due to the complexity of competency and end-of-life issues related to care of the elderly elderly

Framework: Physical Environment Framework: Physical Environment

• Consider the capacities of elderly

patients and visitors in the physical patients and visitors in the physical environment of the hospital

• Environmental audits designed based on

a comprehensive literature review of senior friendly design guidelines to inform capital construction and inform capital construction and accessibility planning

Contacts Contacts

• Priti Patel, Senior Lead, Health System Development,

Mississauga Halton LHIN

MSAA Update MSAA Update

Angela Jacobs

MSAA Steering Committee

MSAA Steering Committee

MSAA

• 3-year agreement 2011-14
• CAPS Guidelines, CAPS Forms and CAPS User Guide

have been prepared and just approved have been prepared and just approved

• Indicator Working Group has just received approval for

the MSAA Indicators CAPS T i i S i f i l d LHIN t ff ill t k

• CAPS Training Session for involved LHIN staff will take

place on Dec 9th with training for HSPs to happen in early January (if required). y y ( q )

• More information coming early next week

Metamorphosis Strategic Plan

Ray Applebaum & Lorena Smith Ray Applebaum & Lorena Smith Members of Metamorphosis Leadership Team Members of Metamorphosis Leadership Team

Metamorphosis B ildi C it H lth t k Building your Community Health network, Neighbourhood by Neighbourhood

Strategic Plan

Prepared by Metamorphosis Leadership Team August 2010 August 2010

Metamorphosis Strategic Plan June 2010 June 2010 Facilitated by The Desk Consulting Group Inc. Solutions for Strategic Questions Metamorphosis is a collaborative forum of community based health service providers working together to achieve knowledge transfer, system integration and shared planning with other sectors of the health system. For additional details on the network, contact: Angela Brewer, RN MBA Chair Metamorphosis Network Email: abrewer@acclaimhealth.ca Phone: 905-827-3390

Table of Contents

• Introduction
• Leadership Team
• Community and Services Factors
• Funding and Policy Factors
• About the Strategic Planning Process
• Purpose of the Network

O Mi i

• Our Strategic Directions
• Milestones - Three Year Outlook

I l ti th St t i Pl

• Our Mission
• Our Vision
• Our Values
• Implementing the Strategic Plan
• Summary
• Appendix 1: Milestone Chart
• Our Values
• Value Proposition
• Understanding The Current Situation
• Appendix 1: Milestone Chart

Understanding The Current Situation

Introduction

Metamorphosis is an independent network of community support service providers and health system partners The network strategic plan guides the organization for the time period April 1 2010 to March

• partners. The network strategic plan guides the organization for the time period April 1, 2010 to March

31, 2014. Leadership Team The Metamorphosis Leadership consists of the following individuals.

• About the Strategic Planning Process
• The network strategic planning process consists of three steps. The first step involves creating a shard purpose for the

network by clarify the mission, vision and supporting values. The second step is a common understanding of events y y , pp g p g that impact the network and are of importance to the members. The third and final steps in the development of shared actions the network can take collectively. Figure 1 illustrates the three major phases of the Strategic Planning Process

Figure 1 - Four Phases of Network Strategic Planning Process

Purpose of the Network

• The purpose consists of four statements that define the mission, vision,

values and the value proposition of the network. They outline why the network exists, its desired future and principles by which it operates on a y daily basis.

• Figure 2 illustrates the four keys to the purpose of Metamorphosis

Our Mission

• A collaborative forum of community based health service providers working

A collaborative forum of community based health service providers working together to achieve knowledge transfer, system integration and shared planning with other sectors of the health system.

Our Vision Our Vision

• A network of health service providers sharing their expertise and knowledge

to support the health and well-being of individuals in the community to support the health and well-being of individuals in the community.

Our Values

• The values of the network represent the basic ground rules used by the

network to support meetings, design projects and resolve emerging issues of interest.

The values of the network are as follows:

• Objective – We remain open to look at the objective data to support dialogue, learning and opportunities for

change change.

• Neutral – We are a neutral network designed to support open and honest dialogue with all of the partners.
• Proactive – We seek and anticipate emerging opportunities to enable members to serve their clients.
• Collaborative Planning – We support and foster planning that encourages active participation by the people

involved both in receiving service and providing service.

• Engaging – We support and encourage all members to engage and participate in the work of the network.
• Inclusive – We support and encourage the participation of Health System Partners in the work of the network

Inclusive We support and encourage the participation of Health System Partners in the work of the network related to the health and well being of the community.

• Evidence Based Planning – We support the use of an evidence based approach to planning at all times in the

work of the network.

Value Proposition

• The value proposition outlines the unique value that

Metamorphosis brings to the network participants. As a network member, you can use the information and tools you obtain through our events, newsletters and various activities to build relationships and improve your ability to service clients. Being part of the network puts you directly in touch with key decision makers (volunteers and y y ( staff) of other organizations, funders and decision makers in the community.

Understanding The Current Situation

• In crafting strategic directions for the network, a series of key documents were used as key reference points. This section

highlights the type of documents and activities that continue to play an important role in developing long term strategy for the highlights the type of documents and activities that continue to play an important role in developing long term strategy for the network. Figure 2 illustrate the two sources of information that impact the ongoing of the network. The requirements of the community and the factors of how to provide services is constantly being balanced with the emerging requirements and policy directions of funders.

Figure 2 - Balancing Funding, Policy Community and Service Factors

The following is summary of the key documents that continue to impact and play a role in the ongoing work of the network.

Community and Service Factors

1. Shifting Demographics of the Community 1. Shifting Demographics of the Community

• The communities of the two LHINs are very diverse. There is a wealth of information on the demographics and health needs of the communities. The

sources include, but are not limited to:

• LHIN Demographic Profile of the Communities
• Regional Municipalities
• Public Health Departments

Public Health Departments

• Social Planning Councils
• Alternative Level of Care and Emergency Room Priorities as set out the government
• Seniors seen as persons non grates in the health care system
• The documents can be found through a website search of the above mentioned organizations or upon request of the sponsoring agency.

2. Emerging Research on the Work of Community Support Services

• Research is an important element in the work of the network. Working in partnership with Universities, research continues to provide the necessary

evidence to support the ongoing changes and improvement in services provided in the community. Research data and research activities are found in any number of the following sources:

• Partnership projects with the Universities, such as the Balance of Care Project with the University of Toronto.
• Supportive Housing with Ryerson University
• Ontario Health Quality Council 2006 1st Year Report Presentation

y p

• SHRTN
• Other Sector Research – Ontario Federation of MHA, Ontario CHC
• Emerging research reports on seniors such as epidemiological data from Peel Public Health
• The support documents on current research and projects can be found through the supporting partner’s websites and public documents.

Funding and Policy Factors

• The Local Health Integration Network and the work of the Ontario Quality Council provide two solid sources of information that impact the

vision and ongoing work of the Metamorphosis Network vision and ongoing work of the Metamorphosis Network.

• 3. Local Health Integration Network (LHIN)
• The Mississauga Halton LHIN and the Central LHIN provide local health planning and funding for members of the Metamorphosis Network.

Both organizations have a comprehensive multi-year planning document and they have formal relationships with members through a Mutli- Sector Acco ntabilit Agreement Sector Accountability Agreement.

• The LHIN ISHP plans are current and provide overall direction for the respective links for the next two year.
• The current Mutli-sector Accountability Agreements are due to expire on March 31, 2010. The LHIN IHSP and supporting Accountability

Agreement materials can be found on the LHIN website.

• Reference information on the LHINs can be found online at http://www lhins on ca
• Reference information on the LHINs can be found online at http://www.lhins.on.ca
• 4. Ontario Health Quality Council
• The Ontario Health Quality Council is responsible under the Commitment to the Future of Medicare Act care out a variety of tasks related to

monitoring and reporting on the quality of health care in Ontario. An important aspect of their work is the annual report provided to the Minister of Health on the state of health care system in Ontario Minister of Health on the state of health care system in Ontario.

• The Council provides a comprehensive report on the status of the work undertaken by LHINs on annual basis.
• To learn more about the LHIN Analysis Report, visit the Ontario Health Quality Council website.

Our Strategic Direction

• The power of the Network is its ability to continually meet the needs of the members and be a creative group

in support meaningful change in the design and delivery of health care services in the community. The network identified four strategic directions to guide its ongoing work for the membership Figure The following is a summary of the four strategic directions and measureable results to be achieved.

Figure 3 - Strategic Directions

1. Governance Leadership Model

• It is important that the network is a model that supports ongoing engagement of community partners in the
• verall health care process. Our governance leadership model is responsive to the needs of the network

partners. Measureable results will include:

• Written roles and responsibilities clearly defined and shared with the network
• Formal Communication process
• Strong Governance Team
• Viewed by those outside the group as a creditable group

e ed by t ose outs de t e g oup as a c ed tab e g oup

• Financial accountability
• Strategic Plan in place and list of accomplishments
• Plan to bring people and organizations on board
• 2. System Engagement
• Metamorphosis provides a forum to discuss, identify, and brainstorm solutions to issues and topics of

common interest to members that impact an organization’s ability to provide services in the community. Measureable results will include:

• Community Support Services is an integral part of the health care system
• Th

t k i

• The network is:
• consulted prior to decision making
• an integral part of the IHSP implementation process
• a valued partner with provincial associations
• The accountability process is clearly defined
• Well defined formal linkages with other networks/ collectives within the LHINs.

g

• 3. Communication and Knowledge Transfer
• It is important that the network is the neutral round table that supports dialogue, learning and sharing of

information related to health care and community support services in the community. Measureable results will include:

• Small agencies will feel involved and valued
• Linkage between organizations e.g., SHRTN, LHINs, OHQC Strong peer to peer network
• 4. Quality Organizations
• The network is the repository of excellent and documented information on the effective benefits of working together as

a network to provide services in the community Our work will include Front Line Service delivery Back Office a network to provide services in the community. Our work will include Front Line Service delivery, Back Office Efficiency and Performance Improvement results to ensure services to clients remain the centre of network projects and activities. Measureable results will include: CSS Portal CSS Portal

• Methods to best utilized the CSS Portal

Performance Improvement

• Shared Strategies to support agencies completing their first Accreditation
• Sharing best practices

Milestones - Three Year Outlook

• Metamorphosis established the following measureable results for each of the areas of focus for
• Metamorphosis established the following measureable results for each of the areas of focus for

the next three to five year period. Figure 4 contains the direction on the left and measureable results in the arrow.

Implementing the Strategic Plan

• The implementation process for the strategic plan will consist of

p p g p the following steps: Creating a work plan in support of the Directions and the identified Measureable Results Identification of working groups to address each area of focus. Each group will identify a work plan for the current year. g p y p y Sharing of the work plan with the network prior to implementation. Implementation of the work plan with updates to the network. Annual report on the identified results to the network.

Summary

• The strategic plan for Metamorphosis is a living document.

Each year, at the bi-annual conference, the plan will be reviewed and updated by the network to ensure the plan is reviewed and updated by the network to ensure the plan is current at all times. The plan will serve as guide to ensure the work of the network continues to meet the needs of the network participants on an ongoing basis.

Angela Brewer Sandy Milakovic Sandy Milakovic Co – Chairs, Metamorphosis Leadership Committee Facilitated by The Desk Consulting Group Inc. Solutions for Strategic Questions

Appendix 1: Milestone Chart

The Milestone Chart contains the following information.

• Strategic Directions outline the key areas of focus for Metamorphosis for the next three year period.
• Time Frame outlines the results that should be accomplished in the identified year.
• Measurable Results contains a list of the results that should be completed by March 31, 2014.

Strategic Direction i Time Frame Measurable Results should include: 04/2011 04/2012 04/2013 01/2014 is: 04/2011 04/2012 04/2013 01/2014 Governance Leadership Model

• Central West LHIN is engaged in the work of

Metamorphosis System Engagement

• A documented and working relationship exists between

Hospitals and members of Metamorphosis Communication and Knowledge Transfer

• SHRTN provides leadership reports on research

Quality Organizations

• Agencies have access to Quality Management Resources
• All Mississauga Halton members have completed the

MHLIN Accreditation requirements MHLIN Accreditation requirements Network Operations

• Bi Annual Conference
• Network Breakfast Meetings
• Network Website is current and operating
• {other core operating results}

CSS Common Assessment Project j

An Update from the MH LHIN Steering Committee An Update from the MH LHIN Steering Committee December 10, 2010

Provincial CSS Challenges

• Over 900 CSS health service providers (HSPs) across Ontario
• No common language or consistency of assessment approaches
• No formal collection of data across the Ontario CSS sector
• Lack of standardized quality data gathering for aggregate reporting,

benchmarking and comparisons

CSS Sector under new scrutiny

• Recognition of value of CSS sector
• Recognition of value of CSS sector
• Evidence – based decision making climate
• New accountability measures required to bring CSS Sector into

alignment with other healthcare sectors (i.e. Hospitals, CCAC etc.) g ( p )

Provincial CSS CAP Steering Committee

• High demand among HSPs for a common assessment in Ontario
• Steering Committee formed in 2009/2010 to evaluate tools

Steering Committee formed in 2009/2010 to evaluate tools

• Provincial CSS CAP Steering Committee has representation from

different types of CSS providers, Provincial associations and LHIN and MOHLTC and MOHLTC

• interRAI = a suite of assessment instruments

What exactly is the interRAI-CHA?

• CHA = Community Health Assessment

Purpose

• Helps identify adults needing

supports to prevent or stabilize early functional or health decline

Target Population

• Adults living in the community

and a variety of residential care settings

Modular Instrument

g

• Core + 4 Supplements
• Minimum Data Set

Instrument

Benefits of the interRAI-CHA

Client Level Client Level

Reduce need to “re-tell” personal story Assists in accessing the most appropriate services Facilitates more comprehensive discussions & care plans

HSP Level HSP Level

A common shared language among providers Increases transferability Standard outcomes inform care planning Informs service/program planning

Funder Level

Informs decision-making and system planning based on standardized aggregate data

MH LHIN CSS CAP Steering Committee Membership

Name Agency Service Area

Tara Monks-Canfield Canadian Red Cross Meals on Wheels Debra Martini Canadian Red Cross Transportation Theresa Greer Heart House Hospice Hospice Allison Price LInks2Care Various (Home Help Home Allison Price LInks2Care Various (Home Help, Home Maintenance, SH, Respite etc.) Lorena Smith Seniors Life Enhancement Centre Adult Day Program Allyson Mitchell Sheridan Villa Adult Day Program L i M t i h R i f H lt Ad lt D P & SDL Laurie Martovich Region of Halton Adult Day Program & SDL Joanne Hawkins Acclaim Health Various (Friendly Visiting, Reassurance Service, ADP etc.) Victoria Baby Canadian Hearing Society Specialized Support Chris Rawn Kane Alzheimer Society of Peel Specialized Support Caroline Countryman VON Various (SDL, ADP, Congregate Dining, Reassurance Service etc.) Steve Kavanagh Peel Senior Link SDL Lisa Gammage SDL Lead / Nucleus Independent Living SDL & Attendant Outreach Judy Bowyer MH LHIN N/a Ashim Rizki CCIM N/a

MH LHIN CSS CAP Steering Committee Terms

• f Reference
• Members must make recommendations on behalf of the “common good”

Responsibilities Include:

• Providing direction for project implementation resolving arising issues
• Providing direction for project implementation, resolving arising issues,

ensuring project deliverables

• Represent interests of all stakeholders
• Represent interests of all stakeholders
• Decision-making of critical project issues

4 M ti

Work Carried Out To Date

4 Meetings Discussions included: Early Adopters in MH LHIN CCIM’s project scope CCIM’s education resources CCIM s education resources Agency groupings Implementation timelines Potential barriers Available resources Vendor options Vendor options

1. Training

Current Agenda Items

g 2. Coordination with Provincial Steering Committee 3. Implementation Phases and Timelines 4. Technology Inventory / Vendor Selection 5. Implementation Funding p g 6. Communications

• 1. CHA Training
• Learnings:

Skilled Lead Assessor Skilled Lead Assessor Competency of assessors following project implementation and

• ngoing

Need for options and flexibility

• Decisions:

Decisions: Fully utilize CCIM’s training resources Hybrid Training Model

• 2. Coordination with Provincial Steering Committee

Activity

• Learnings:

Screener Privacy Group Shared Assessment Working Group Shared Assessment Working Group

• Decisions:

Participation on Shared Assessment Working Group Coordinate with Provincial level Coordinate with Provincial level

• Learnings:
• 3. Implementation Phases and Timelines

g Original phases Accreditation timelines Accreditation timelines Program-specific Early Adopters Implementation timeline p

• Decisions:

Early Adopters Modification of original phases and timelines

• 4. Technology Inventory / Vendor Selection
• Learnings:

Vendor issues out of scope p Vendor solutions affect on implementation Existing CHA Software Vendor specifications

• In Process:

Technology questionnaire Software decision making guide Software decision-making guide

• 5. Implementation Funding
• Context:

Available one time funds from CCIM Available one-time funds from CCIM MH LHIN Steering Committee role

• Learnings:

S i C i i Steering Committee requires additional information information

• 6. Communications

Learnings:

Confusion about CAP project Confusion about CAP project Need for strong Communication Plan HSPs at different stages

Decisions:

Regular project updates Regular project updates Opportunities for HSPs to provide input/feedback Establish Subcommittee

Change as THREAT OR OR Change as OPPORTUNITY Change is Happening - We have the power to choose how we perceive the change p g

Stages of Change

• Denial Ignoring Minimizing
• Denial, Ignoring, Minimizing
• “It won’t happen”, “Just wait, this will blow
• ver”

Denial

• Avoiding, Doubting, Blaming, Complaining
• “It won’t work”, “It will cost too much”, “It will

be too difficult”

Resistance

• Questioning, Seeking clarification
• “How would that work”, “What would we have

Exploration

to do exactly?”

p

• Innovation, Creativity, Passion

Commitment

• “Hey, maybe we could do this... Or what if

we....”

Commitment

The Advantages of Embracing Change Now

Later Now Later Now

Questions Questions

MH LHIN CSS CAP Steering Committee

Name Agency Service Area

Tara Monks-Canfield Canadian Red Cross Meals on Wheels Debra Martini Canadian Red Cross Transportation Theresa Greer Heart House Hospice Hospice Allison Price LInks2Care Various (Home Help, Home Maintenance, SH, Respite etc.) Lorena Smith Seniors Life Enhancement Centre Adult Day Program Allyson Mitchell Sheridan Villa Adult Day Program Laurie Martovich Region of Halton Adult Day Program & SDL Joanne Hawkins Acclaim Health Home Care Support Services Victoria Baby Canadian Hearing Society Specialized Support Chris Rawn Kane Alzheimer Society of Peel Specialized Support Caroline Countryman VON Home Care Support Services & SDL Steve Kavanagh Peel Senior Link SDL Lisa Gammage SDL Lead / Nucleus Independent SDL & Attendant Outreach Lisa Gammage SDL Lead / Nucleus Independent Living SDL & Attendant Outreach Judy Bowyer MH LHIN N/a Ashim Rizki CCIM N/a

Closing

Angela Jacobs