A Symposium on Family Medicine Recruitment and Retention

Transcription

The Leadership Connect Network: A Symposium
on Family Medicine Recruitment and Retention
Contact Person:
M. Janet Kasperski, RN, MHSc, CHE
Chief Executive Officer
THE ONTARIO COLLEGE OF FAMILY PHYSICIANS
357 Bay Street, Mezzanine
Toronto, Ontario M5H 2T7
Tel: (416) 867-9646 • Fax: (416) 867-9990
Email: [email protected] • Website: www.ocfp.on.ca
October 25, 2006
The Leadership Connect Network: A Symposium on Family Medicine Recruitment and Retention
____________________________________________________________________________________________________________________________
TABLE OF CONTENTS
1.0 Executive Summary ............................................................................................................................ 2
2.0 Introductory Remarks........................................................................................................................ 3
- Dr. David Price .................................................................................................................................. 3
3.0 Keynote Address ................................................................................................................................. 4
- HealthForceOntario by: Dr. Joshua Tepper, CCFP ........................................................................... 4
4.0 Overview of the Interactive Large Group Session ........................................................................... 5
5.0 Overview of the Small Group Discussions........................................................................................ 5
6.0 Summary of the Concluding Remarks .............................................................................................. 9
Appendix A – Agenda ............................................................................................................................... 11
Appendix B – PowerPoint Presentation (Dr. Tepper) ........................................................................... 13
Appendix C – Pre-Symposium Reading Materials ................................................................................ 38
1
____________________________________________________________________________________________________________________________
1.0
Executive Summary:
Bandaid solutions to the crisis in family medicine have tended to accelerate rather than solve
the problems facing family doctors throughout the province. In the 1990s, several public policy
decisions combined to create an outright shortage of family doctors. Other hospital-based
decisions led to the erosion of family medicine involvement in hospital-based care and the
creation of full-time hospital-based speciality areas that drew family doctors away from
comprehensive family medicine practices. As communities tried to compete with one another,
new doctors were offered supports not available to well-established physicians, creating
situations in which doctors moved from town to town and position to position as they try to
find the most financial viable opportunities in the most collegial setting. Many of our newly
graduated doctors simply did locums as they sorted through the many options available to
them.
The current crisis in emergency medicine is a good example of the problems that arise when
bandaid solutions are applied to complex problems. Until recently, family physicians providing
care in their offices were financially disadvantaged. With workload increasing rapidly due to
the increased number of complex patient problems in their practices, family doctors did two
things:
1. decreased the comprehensiveness of their practices
or
2. gave up their practices and joined more lucrative, less onerous practice environments such
as walk-in-clinics, emergency departments or hospitalist programs.
The impact on the patient care was immediate – more patients were fully or partially
“orphaned” when they sought care throughout the system. Both the 2000 and 2004-05
negotiations between OMA and the MOHLTC resulted in increases in funding available for
comprehensive family doctors. With office-based payment systems increasing, family doctors
have been rewarded for providing care in the community and more and more have withdrawn
from emergency, intrapartum and inpatient care.
To address the issue of how to recruit and retain family doctors in communities throughout
Ontario in a manner that stabilizes the system and reduces the “rob Peter to pay Paul” scenarios
that have been in place for far too long in Ontario, the OCFP hosted a meeting of the provincewide “Leadership Connect Network.”
The Ontario College of Family Physicians (OCFP), in recognition of the key roles that family
physician leaders play in communities throughout Ontario, established the Leadership Connect
Network to provide family physician leaders with an opportunity to identify and develop
strategies that require co-ordinated local, regional and provincial responses.
The Leadership Connect Network met on October 4, 2006 at the Donalda Club in Toronto to
address the following two interlocking questions:
1. How do we ensure that each person in Ontario has access to comprehensive care?
and
2. How do we recruit and retain family doctors to deliver comprehensive care?
2
____________________________________________________________________________________________________________________________
The keynote address by Dr. Joshua Tepper, CCFP, Assistant Deputy Minister, Health Human
Resource Strategy Division of Ministry of Health and Long Term Care and the Ministry of
Training, Colleges and Universities set the stage for a lively debate amongst the participants
and the small group discussions that followed the presentation. The resulting messages that the
participants wished to deliver to the Government through Dr. Tepper included the development
of the following main principles:
1. There is an ongoing need to address the family physician shortages and the erosion of
comprehensive care services. The Government needs to remain committed to further
enhancements to the family medicine/primary care system in order to achieve the best
possible health outcomes for each person in the province and as key to the sustainability of
the healthcare system.
2. To achieve the main goals of primary care renewal, each citizen needs to have a family
physician who provides and co-ordinates comprehensive care.
3. Each family physician (or groups of family physicians working in teams with other
healthcare providers) needs to be supported to provide a comprehensive basket of services.
4. Given the need for every person in the province to receive comprehensive care, supports for
family practices and practice team members should not be limited to Family Health Teams.
Three key messages were developed to support further enhancements in the delivery of
comprehensive care for patients are as follows:
1. Comprehensive care needs to be resourced and remunerated at a proper and appropriate
gradient that takes into account the full scope of the basket of services. Comprehensive care
funding models need to further emphasis through measurement and incentives prevention
of disease and chronic disease management and the care of high acuity patient populations,
as well as the role of the family physician as the “Most Responsible Practitioner” in team
based care delivery systems. The re-opener for OMA/MOHLTC and the 2008 negotiations
should provide incentives for comprehensive care with subsequent disincentives for high
volume/low acuity care.
2. Family medicine residency programs need to include a focus on practice management
skills. Preceptor programs should include an emphasis on managing a comprehensive
family medicine practice, in recognition of the emerging need to encourage new doctors to
join comprehensive care practice.
3. The Government needs to focus attention on new graduates in the post residency years of
practice by funding mentorship and management skills development programs, as well as
providing initial financial incentives for new physicians to provide comprehensive care as
they build up their practice including IT support, turn-key operations and debt relief. The
mentorship and practice support programs could be synchronized with a retention program
for senior physicians.
2.0
Introductory Remarks – Dr. David Price
Dr. Price provided an overview of the day’s agenda and noted that the topic of discussion on
recruitment and retention strategies was timely in light of the recent crisis in emergency
medicine.
Dr. David Price, Chief of Family Medicine, Hamilton Health Sciences and Chair, Department
of Family Medicine at McMaster University functioned as moderator for the event and
welcomed the participants to the event by providing an overview of the Symposium’s purpose.
3
____________________________________________________________________________________________________________________________
3.0
Keynote address: Dr. Joshua Tepper
Dr. Joshua Tepper, a practising family doctor and Assistant Deputy Minister, Health Human
Resource Strategy Division provided the keynote address. Dr. Tepper has a dual reporting
relationship to the Ministry of Health and Long Term Care and the Ministry of Training,
Colleges and Universities. Dr. Tepper described the work that his division is engaged in to
identify the factors related to the shortage of health care professionals in Ontario and to develop
strategies to address them both in the practice and the educational environments. Dr. Tepper
focussed his remarks on the issues of family medicine and the anticipated changes required to
meet future needs with an aging population and an aging workforce.
Dr. Tepper identified a series of initiatives that HealthForceOntario is undertaking to address
the shortage of health care professional in Ontario. They include the following:
1. Introduction of new roles created to deal with emerging areas of increased workload
including:
• Physician assistants
• Nurse Endoscopists
• Surgical first assistants
• Clinical Specialist Radiation Therapists
2. A one-stop shop for internationally educated health professionals to receive information
and advice about opportunities in Ontario. The principles for the program reinforce the fact
that this is not about poaching or replacing Canadians. It is about removing barriers.
3. A co-ordinated marketing and recruitment centre especially aimed at repatriating
Canadians.
4. Ensuring every new nursing graduate has a full-time position.
5. Recognition programs emphasizing the value of Ontario’s healthcare work force including
a nursing education campaign, an IMG recognition ceremony and a physician recognition
program that emphasises the leadership role that physician play in the system.
6. Supports for Interprofessional Education and Care including a provincial summit to develop
a blueprint for interprofessional education and care, a 14.4 million dollar mentorship and
coaching fund and a 5.5 million dollar IPE innovation fund.
7. Funding for allied Health Continuing Education.
8. Funding for OCFP to manage the Family Medicine Interest Group program.
9. A mentorship program led by OCFP to assist new doctors including IMGs to join in rural
and focussed practice areas such as OB.
10. Changes to the re-entry positions as a result of the 20 unfilled PGY3 positions.
11. A review of the PGY3 positions resulting in access to PGY3 positions by IMGs and the
development of strategies to encourage full uptake (currently only 50 of the 75 positions are
filled)
12. Support for the Primer in Emergency Medicine and ACLS/ATLS and other skill developing
initiatives led by the OCFP to provide lifelong learning opportunities.
Dr. Tepper noted the following outcomes that have occurred to date:
•
•
•
•
141 new permanent family medicine training positions (70% expansion in capacity)
$20,000 extra for each IMG training position
218 new IMGs licensed to practice this year
150 Family Health Teams
4
____________________________________________________________________________________________________________________________
•
o 50% of the population are now enrolled in a new primary care model and the
majority of physicians are practicing in the multiple models (CHCs, FHNs,
FHGs, FHTs)
23% increase in the number of medical students are training including, a new medical
school (Northern Ontario School of Medicine) and three new campuses in Windsor,
Kitchener-Waterloo and Mississauga.
The future activities of HealthForceOntario include:
• the establishment of a permanent health human resource planning body
• discussions at HPRAC regarding scope of practice
• improved data collection
• a health workplace initiative
• LHIN support for HR planning at the regional level
and
• Increased engagement and collaboration amongst the key providers of healthcare
organizations educational facilities and government.
(See Appendix B – Dr. Tepper’s PowerPoint Presentation)
4.0
Overview of the Interactive Large Group Session
Following the keynote address, Dr. Tepper and the participants engaged in an interactive
dialogue. The interactive session provided an opportunity for Dr. Tepper to hear first hand the
concerns of family physician leaders and to receive feedback on the initiatives being taken at
the provincial level. It was noted that strategies developed at the local level tended to be short
term and not well connected to the long-term goals being developed and addressed by the
provincial strategy. The need to identify ways to bridge the gap formed the basis for the small
group discussions that followed. The small groups focused on the identification of reasons why
new physicians are reluctant to enter comprehensive family practices and why so many
experienced family doctors are narrowing their scopes of practice.
5.0
Overview of the Interactive Small Group Discussions
The following documents the reports given by the members of each of the small groups:
Group I:
The Group I participants identified a number of problems that patients experience when there is
a shortage of comprehensive family physicians. In addition to the orphan patients who have
reduced access to most healthcare services, the loss of comprehensiveness within family
practices means that patients experience delays in accessing other services or may be required
to navigate the system on their own. To overcome some of the access issues and to ensure that
family doctors can provide and access the highest quality care in a timely manner, physician
and patient tools are needed. A key tool would be to have standards that set the acceptable
timeframe for access to certain services. In addition, since most care is delivered in family
practices and the patient’s comprehensive medical record is kept by the family doctor,
government investments are needed in electronic medical records as key to patient safety and
quality care but also for planning purposes.
It was recognized that several factors were intertwined and were resulting in a lack of
commitment to comprehensive care. Those factors are as follows:
5
____________________________________________________________________________________________________________________________
1.
2.
3.
4.
lack of financial incentives
impact on lifestyle
lack of respect for the complex role of family doctors
increased ability to develop financially rewarding “boutique” practices.
The participants provided the large group with a definition of “comprehensive care”. The group
members emphasized the fact that comprehensive care meant that the physician was available
to care for people of all age groups and with various types of illnesses in all parts of the system.
They do so through a combination of clinical knowledge and skills and knowledge of the
system. Comprehensive family medicine does not mean that each physician does everything for
each patient, it means that they develop partnerships and networks of care so that they are able
to provide care and access to care through the connections they forge with other family doctors,
specialists and interprofessional team members. Obstetrics was used as an example of
developing group practices with multiple skills amongst the providers. Individual physician
may not provide intrapartum care; however, each physician would be able to access a family
doctor in the group practice or practice’s network that would be able to provide such care. To
encourage quality care, systems need to be in place so that indicators of quality can be followed
and outliers supported to improve.
Group one discussed the strategies needed to increase the number of comprehensive family
doctors. The following issues were addressed:
1. increased production – How we adequately increase the number of medical students and
residents that we are educating?
2. ensure that the comprehensive family practice is financially viable and more rewarding than
“boutique” practices.
3. ensure that new physicians receive adequate support as they finish their residency programs
so that it is easier to enter a comprehensive practice than other areas of practice such as
locums.
4. develop role models in the community so that medical students and family medicine
residents can see the rewards of family medicine balanced with the ability to maintain a
balanced lifestyle.
5. meet the needs of our rapidly growing medical schools and teaching programs especially
the new distributed learning communities.
6. demonstrate/research the benefits of good comprehensive care as those investments are
seen as a good return on investment.
7. support mentors for new physicians so that they do not struggle alone to develop into high
performing comprehensive care physicians.
The group summarized by discussing the pathways that many doctors take in their first years of
practice. Many new doctors are unsure of where they want to practice and do locums to find a
compatible group of physicians and the ideal community. As they provide locum services, they
meet burned-out comprehensive care physicians. Through these experiences, they decide not to
practice as a comprehensive care physicians. We need to find ways to better support new
doctors, especially women in practice and place them in practices that initially offer turn-key
operations, IT, infrastructure supports and debt assistance. These could be linked to senior
physicians planning retirement in a few years.
6
____________________________________________________________________________________________________________________________
Group II:
This group identified a number of barriers to comprehensive care in the current system. As an
example, many family physicians are still working in solo or small group practices that limit
their ability to deliver comprehensive care. These practices have limited back-up system to
address lifestyle requirements. The lack of cohesiveness, collegiality and supports within the
broader community in which these physicians practice makes it difficult for them to participate
in hospital-based care such as interpartum or emergency care. Mentorship programs and
appropriate levels of coverage for backups are needed. By pairing physicians who are providing
comprehensive care and in specific areas of care with new physicians, we may be able to
increase both comfort and access to care and influence both recruitment and retention.
In addition to recognizing the impact of geography on the ability of community to provide
access to all types of services, special emphasis is needed to increase the comfort of IMGs in
communities where they practice as a result of return of service obligations. Return of service
does not necessarily mean that the IMG will remain in the assigned location. Cultural and
religious issues need to be addressed, as well as the needs of spouses to find appropriate
employment. For the single physician, socialization opportunities may be limited. If these
issues are not addressed, the physician will not stay in the underserviced area.
It was noted that recent graduates in family medicine face many challenges as they try to
establish a comprehensive family practice in terms of understanding the various funding
models, rostering patients, signing contracts etc. FHTs, in particular, are quite complex and the
time commitment in extensive. As a result, many graduates tend to do locums. While they
provide a wide variety of services, without longitudinal care of patients, they are not in actual
fact providing comprehensive care. New graduates recognize their limits and are looking for
supportive communities and approaches such as team-based care and shared care. Confusions
arises when language suggests physician substitution and non face to face contact by other
organizations such as telehealth diverts contact away from the comprehensive care physician.
The importance of comprehensive care being provided by a group of physicians that each have
a special niche but together provide their patients with a comprehensive basket of services was
emphasized. PGY3s were discussed in terms of the impact on service due to the year long delay
and the involvement of graduates of PGY3 programs in comprehensive care after graduation.
Group III:
Group III concentrated on defining who has access to comprehensive services now (i.e. rural
vs. urban) and where they receive care. In communities that are not underserviced,
comprehensive care may be even more compromised since patients are able to access so many
other service providers. The various models of care should be measured to determine how
effective they are in terms of the number of patients registered and in their abilities to provide a
comprehensive basket of services and comprehensive longitudinal care.
The group discussed the joint collaboration of hospital and community to attract and retain
physicians. As well, there is a need for a community-based accountability system to reduce
over-reliance on hospitals with family physician organizations accountable for providing the
full scope of services. Increasing the capitation component of remuneration models, increased
support for IT and patient accountability for accessing other providers need to be paired with
the measurement of new standards of practice that takes to account shared care, telephone
consultations and other non face to face patient care activities.
7
____________________________________________________________________________________________________________________________
Procedure/visit based remuneration systems need to change to recognize the new models of
patient management rather than the provision of acute episodic care. Ancillary incentives such
as CME and vacation coverage were considered important as well as support for physician
leaders.
An infrastructure to better support family physicians is needed; traditionally, those supports
have been provided by hospitals. The group discussed the need to look at new models of
support through LHINs or CCACs or stand alone FP entities such as seen in other countries.
The group discussion included a statement that as payments for comprehensive care are
increased, then more responsibility for service providers is expected and these expectations and
increased levels of care need to be well-managed.
Group IV:
Group IV discussed the need for incentives rather than force to deal with recruitment and
retention issues. Concluding that a provincial health human resource was needed with different
incentives across the province since needs were different in various local communities.
Government needed to continue to explore and encourage various primary care models
emphasizing the need to make family doctors feel valued rather than undermined. The group
also explored the effect of personal vs. group incentives and the supports available for
sustainable local models of comprehensive care.
Family physicians need an organization that represents family physicians in the province. In
turn, family physicians need support to develop leadership skills to manage the more complex
organizational structures that are developing in the province. OCFP was suggested as the
organization most likely to provide the structure and educational process needed to better
support family physician leaders.
Group V:
Group V identified the fact that financial incentives were needed to encourage physicians to
practice comprehensive family medicine, noting that obligations need to be tied to rewards.
Monetary rewards need to acknowledge complex, comprehensive care and should not provide
the same level of remuneration for physicians who provide high volume, low acuity care. In
addition, infrastructure support is needed to decrease the administration time and paper work
that is currently distracting physicians from clinical care delivery.
Medical students and residents need to be educated regarding the various funding models and
clinicians should be encouraged to take learners into their practices by providing rewards for
their educational efforts.
In order to make comprehensive care the most attractive choice amongst physicians, the
following was recommended by the group:
•
increase incentives for services provided by rostered practices that reflect
comprehensive care including:
o the roster payment
o payments for chronic disease prevention and management
o infrastructure support
o incentives for family physicians functioning in the inpatient MRP role.
o increasing educational opportunities
8
____________________________________________________________________________________________________________________________
•
•
•
decrease incentives for behaviour not consistent with comprehensive care (i.e. high
volume, low acuity transient services).
provide recognition for the roles that family doctors play in our communities and the
value of primary care/ family medicine in the health care system (community service
awards/ family physician of the year awards etc.).
demonstrate that morbidity and mortality are reduced through comprehensive care and
are the result of the family physician role in preventative medicine especially their role
in addressing the needs of populations at risk.
The group identified the fact that the evidence demonstrates that populations have improved
outcomes when the number of family physicians is relatively high and the same or worse
outcomes when the number of specialists is high.
• Emphasize the role of family doctors as “case manager” throughout the system rather
than “gate keeper” which results in medical legal/liability concerns.
The group discussion included a review of Dr. Starfield’s work that demonstrated that all
services should be provided in the community by primary care physicians within the bounds of
competency; however, the co-ordinating role of family doctor throughout the rest of the system
becomes even more important in the delivery of chronic diseases, especially with patients who
have multiple co-morbidity.
6.0
Summary of the Concluding Remarks
Dr. David Price led the groups through a final exercise to determine the key messages that the
participants wished to deliver to Dr. Tepper and to government. The key principles for the
development of any strategy designed to enhance the recruitment and retention of family
doctors are as follow:
1. There is an ongoing need to address the family physician shortages and the erosion of
comprehensive care services. The Government needs to remain committed to further
enhancements to the family medicine/primary care system in order to achieve the best
possible health outcomes for each person in the province and as key to the sustainability of
the healthcare system.
2. To achieve the main goals of primary care renewal, each citizen needs to have a family
physician who provides and co-ordinates comprehensive care.
3. Each family physician or groups of family physicians working in teams with other
healthcare providers needs to be supported to provide a comprehensive basket of services.
4. Given the need for every person in the province to receive comprehensive care, supports for
family practices and practice team members should not be limited to Family Health Teams.
Three key messages were developed to support further enhancements in the delivery of
comprehensive care for patients are as follows:
1. Comprehensive care needs to be resourced and remunerated at a proper and appropriate
gradient that takes into account the full scope of the basket of services. Comprehensive care
funding models need to further emphasis through measurement and incentives prevention
of disease and chronic disease management and the car of high acuity patient populations as
well as the role of the family physician as the “Most Responsible Practitioner” in team
based care delivery systems. The re-opener for OMA/MOHLTC and the 2008 negotiations
9
____________________________________________________________________________________________________________________________
should provide incentives for comprehensive with subsequent disincentives for high
volume/low acuity care.
2. Family medicine residency programs need to include a focus on practice management
skills. Preceptor programs should include an emphasis on managing a comprehensive
family medicine practice, in recognition of the emerging need to encourage new doctors to
join comprehensive care practice.
3. The Government needs to focus attention on new graduates in the post residency years of
practice by funding mentorship programs and management skills development programs, as
well as providing initial financial incentives for new physicians to provide comprehensive
care as they build up their practice including IT support, turn-key operations and debt relief.
The mentorship and practice support programs could be synchronized with a retention
program for senior physicians.
Dr. Price adjourned the meeting and wished everyone a safe trip home.
10
____________________________________________________________________________________________________________________________
Appendix A
AGENDA
11
____________________________________________________________________________________________________________________________
Chiefs of Family Medicine Network
Symposium on Family Medicine Recruitment & Retention
Strategies
Date:
October 4th, 2006
Time:
Location:
0800-1500
Donalda Club (Dining Room)
12 Bushbury Drive
Don Mills ON M3A 2Z7
Ph: 416-447-5575
Agenda
0800-0830
Registration and Continental Breakfast
0830-0845
Welcoming Remarks
David Price, MD, CCFP
Chief of Family Medicine, Hamilton Health Sciences Centre
Chair, Department of Family Medicine, McMaster University
0845-0915
Keynote Address
HealthForceOntario: Addressing the Shortages in Family Medicine
Dr. Joshua Tepper, CCFP
Assistant Deputy Minister
Health Human Resources Strategy Division
Ministry of Health and Long Term Care
0915-1000
Small Group Discussion #1
Will the government strategy solve problems in family medicine locally?
1000-1015
Nutrition Break
1015-1045
Feedback to the Panel (Dr. Tepper, Dr. Levitt & Dr. Buchman)
Moderator: Dr. Price
1045-1130
Small Group Discussion #2
What are the local solutions that need to be shared and/or support by government?
1130-1200
Feedback to Panel (Dr. Tepper, Dr. Levitt & Dr. Buchman)
1200-1330
Working Lunch:
What strategies need to be developed regionally (i.e. within LHINs) to address the
major issues in family medicine?
1330-1400
Feedback to Panel (Dr. Tepper, Dr. Levitt & Dr. Buchman)
1400-1500
Networking opportunity
12
____________________________________________________________________________________________________________________________
Appendix B
Dr. Joshua Tepper’s
PowerPoint Presentation
13
____________________________________________________________________________________________________________________________
Priorities and Innovations
in Health Human Resources
Chairs Family Medicine
Toronto, Ontario
September, 2006
2
6 Questions – 30 minutes
•
•
•
•
•
•
Who is part of an HHR strategy?
How does an HHR strategy fit with this government’s
priorities?
What is the status quo?
What will the future of HHR look like and why?
What are the key principles & pillars of an HHR strategy?
What have we done and where are we going?
14
____________________________________________________________________________________________________________________________
3
Who is part of an HHR strategy?
4
You Are
15
____________________________________________________________________________________________________________________________
5
How does an HHR strategy fit with this
government’s priorities?
6
HealthForceOntario In Context
Improved Structure &
Process
(LHINs)
Healthier Ontarians
Increased Access
(Health Results Team)
Health Provider
(HHR Strategy)
16
____________________________________________________________________________________________________________________________
7
What is the Status Quo?
8
Northern Ontario
17
____________________________________________________________________________________________________________________________
9
Distribution of the physician workforce in
Ontario
1%
7%
2%
2%
Rural FP
Rural Specialist
N. Referral FP
49%
N. Referral Specialists
Urban FP
39%
Urban Specialists
10
Selection of FM as 1 st career choice
40%
35%
30%
Percent of
Med. students
selecting FM as
1st career choice
34.7%
31.5% 32.2%
29.3% 28.2% 29.6%
24.8%
25%
20%
15%
10%
5%
0%
1997
1998
1999
2000
Source: CaRMS PGY-1 Match Report 2003
18
2001
2002
2003
____________________________________________________________________________________________________________________________
11
National CaRMS Family Medicine Positions:
Quota Offered and Quota Vacant
23.3%
550
500
2.3%
19.1%
450
400
350
300
250
200
1997
2001
Quota
Filled
2004
Quota
Vacant
FP/GP count
12
8000
7000
6000
5000
4000
3000
2000
1000
0
1992
1993
Female
1994
1995
1996
1997
1998
1999
Male
2000
2001
Total
Note: Includes fee-for-service FP/GPs only. From 1992-2001 approximately 1% of FP/GPs
w ere of unknow n age. Source: National Physician Database, CIHI
FP/GP Counts in Age Group <35 by Gender
19
____________________________________________________________________________________________________________________________
13
Focused Interest Family Medicine
30%
31% plan on
specializing their
Practice
‘04 NPS R2
25%
20%
15%
10%
5%
Considering R3
0%
1997
1999
2001
2004
14
14
Not
Not establishing
establishing aa practice
practice
•• 60%
60% will
will be
be locum
locum tenens
tenens after
after residency
residency training
training –– NPS
NPS
2004
2004
•• Those
Those leaving
leaving after
after 1985
1985 much
much less
less likely
likely to
to establish
establish
practice
immediately
after
or
even
2
years
after.
practice immediately after or even 2 years after. –Pong
–Pong et
et
al
al
•• Anecdotal
Anecdotal tales
tales
20
____________________________________________________________________________________________________________________________
15
Aging workforce
FP/GP count
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
1992
1993
1994
1995
Female
1996
1997
1998
1999
Male
2000
2001
Total
Note: Includes fee-for-service FP/GPs only. From 1992-2001 approximately 1% of FP/GPs
w ere of unknow n age. Source: National Physician Database, CIHI
FP/GP Counts in Age Group 45-54 by Gender
16
16
Aging
Aging workforce
workforce
FP/GP
FP/GPcount
count
5000
5000
4500
4500
4000
4000
3500
3500
3000
3000
2500
2500
2000
2000
1500
1500
1000
1000
500
500
00
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
Female
Female
1997
1997
1998
1998
Male
Male
1999
1999
2000
2000
2001
2001
Total
Total
Note:
Note:Includes
Includesfee-for-service
fee-for-serviceFP/GPs
FP/GPsonly.
only.From
From1992-2001
1992-2001approximately
approximately1%
1%of
of FP/GPs
FP/GPs
wwere
ereof
of unknow
unknownnage.
age. Source:
Source:National
NationalPhysician
PhysicianDatabase,
Database,CIHI
CIHI
FP/GP
FP/GP Age
Age 55-64
55-64
21
____________________________________________________________________________________________________________________________
17
Percent Change, 2001 Compared to 1992
Loss of comprehensive care
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
-10.0%
-20.0%
-30.0%
-40.0%
-50.0%
18
87.9%
57.4%
35.0%
32.9%
19.4%
-7.6%
-30.9%
-32.4%
-28.5%
-42.8%
Surgical
Assistance
Advanced
Procedures
Obstetrics
Participation Rate
Surgery
Anaesthesia
Average number of services provided
11.96% drop in in-patient care
22
____________________________________________________________________________________________________________________________
19
Other key findings in changing scope of practice
• Men more likely to participate and do a lot more
• Older physicians more likely to maintain or even increase their
participation levels while younger are decreasing
• Average workloads increasing steadily where participation is falling
• Rural doctors more likely to participate across the board
• Large provincial variation
20
We might define comprehensive care as the provision of the following 10
activities/services
•
•
•
•
•
• Chronic disease
management
• Women’s healthcare
• Psychotherapy
• Geriatric medicine
• Palliative care
Gynecology
Obstetrics
Pediatrics
Preventive medicine
Adolescent medicine
Source: NPS, 2004
23
____________________________________________________________________________________________________________________________
21
Proportion of FPs who do 1 or more of the 10 comprehensive care
activities
All 10 activities
6.3% of FPs in Canada
7-9 of 10
21.7%
4-6 of 10
18.0%
1-3 of 10
30.0%
0 of 10
20.4%
No response
3.6% of FPs in Canada
Based on N=11,041 Family Physicians (FPs)
Data Source: NPS, 2004
22
Low Morale
•
•
•
•
•
•
4/5 feel status has diminished
50% expectations for their career not met
52% change specialty or get out of medicine
2/3 under paid
Disconnect with patients views of them
80% feel condition worse in last few years
• “The doctor is in pain”, Macleans dec.2003
• 1,000 phone; 3500 mail
24
____________________________________________________________________________________________________________________________
23
Low Morale
• "Never have so many physicians worked so much for so little income
and so little gratitude."
• "Why do young people still want to go to medical school? I try to
discourage them every chance I get."
• 55% say their family and personal life has suffered because they chose
medicine as a profession.
-CMA 1998 Physician Resources Questionnaire
24
Team Based Care Strategies
• Primary Care Nurse Practitioner Program introduced for
collaborative practice arrangements with family physicians in diverse
settings and supported through a monthly fee for collaboration and
consultation.
• Office Practice Nurse Pilot Project introduced for harmonized
models and shortly to be implemented in predominantly fee for service
practice settings.
• Family Health Teams with approximately 1400 family physicians
participating in 150 teams with funding for a variety of
interdisciplinary team providers based on the population health needs
and the business case submitted by the team.
• Shared Care Pilots introduced to provide for 6 small pilots to
evaluate the success of interdisciplinary team practice in a
predominantly FFS compensation model.
25
____________________________________________________________________________________________________________________________
25
Figure 1: Access to a Regular Doctor in
Ontario over Time (2001-2006)
Percent Ontarians with Regular Doctor (18+)
100
90
91.4
90.7
90.9
92.5
90.4
80
70
60
50
40
30
20
10
0
2001 (CCHS)
2003 (CCHS)
2005 (CCHS) *
2006 (PCAS-I)
2006 (PCAS-II)
The percentage of Ontarians having a regular doctor has been similar for the past 5 years…
•Canadian Community Health Survey data 2001, 2003, and 2005 were provided by Statistics Canada
• Note that 2005 CCHS was based on population 20+.
26
Access to a Regular Doctor in Ontario
over Time (2001-2006)
Ontarians with a Regular Doctor (18+)
9,500,000
9,000,000
8,500,000
8,000,000
7,500,000
7,000,000
2001 (CCHS)
2003 (CCHS)
2005 (CCHS) *
2006 (PCAS-I)
2006 (PCAS-II)
…but the population has grown, so about 750,000 more Ontarians now have a regular doctor.
* 2005 CCHS based on population 20+.
26
____________________________________________________________________________________________________________________________
27
Access to a Regular Doctor - National
Comparison
(% Canadians age 12+ with Regular Doctor )
P
N
N
P
R O V IN C E
S
B
E I
2003
9 4 .6
9 3 .0
9 1 .9
O N T
9 0 .9
B C
8
8
8
8
8
7
N FLD & LA B
S A S K
M A N
A LB
Q U E B
8
7
7
5
5
6
.9
.8
.6
.8
.3
.6
9 3 .1
9 6 .1
2005
9 4 .6
9 3 .3
9 5 .3
9 4 .2
P R O V IN C E
N S
N B
9 3 .8
9 1 .8
9 2 .4
9 4 .2
8 9 .7
9 4 .1
O N T
9 1 .1
9 0 .8
9 1 .5
8 9 .8
9 2 .1
9 1 .3
9 0 .3
8 8 .4
8 9 .6
8 5 .7
8 9 .8
N FLD & LA B
8 5 .8
8 8 .6
8 6 .1
8 9 .1
8 3 .2
8 5 .5
8 4 .1
8 7 .5
8 2 .7
8 5 .1
8 3 .3
8 7 .4
8 1 .4
8 3 .4
7 4 .6
7 8 .6
S A S K
M A N
A LB
Q U E B
8
8
8
8
8
8
7
8 8 .1
8 7 .4
P E I
B C
7 4 .1
7 5 .6
95% C I
9
9
7
4
3
2
4
.7
.0
.2
.3
.9
.4
.9
95% C I
Note: The table is based on the 2003 & 2005 cycles of the Statistics Canada Canadian Community Health Survey
Note: 95% CI means “95% confidence interval”, representing the possible range of the observed percentage
28
What will the future of HHR look like and why?
27
____________________________________________________________________________________________________________________________
29
Tomorrow in Ontario…
People will:
Health services will:
Health service providers will:
•
be more numerous and
older
•
be increasingly based in
the community setting
•be
•
be more culturally
diverse
•
be delivered by
interprofessional teams
•continue
•
have more chronic than
acute diseases
•
•want
•
be increasingly involved,
informed consumers
focus on health
promotion and disease
prevention
•
make greater use of new
technology including
tele-medicine, robotics
and genetics/proteomics
•
seek complementary and
alternative care
•
focus on wellness and
disease prevention
older and seeking career
transition and retirement
to come from a range of
other nations
more balance and flexibility
in their careers
•work
in a mobile, international
and opportunity-laden market
•demand
healthy and stimulating
workplaces
•need
new educational models to
deal with a rapidly evolving base
of knowledge and technology
…. New expectations, capacities and roles are demanded of our workforce
We must act now!
More of the same…
the same practice models,
the same educational systems,
the same planning approaches…
will not prepare us
High demand and system pressures
creates motivation and opportunity
for innovation
28
____________________________________________________________________________________________________________________________
31
32
29
____________________________________________________________________________________________________________________________
33
What are the key principles & pillars of an HHR
strategy?
34
HealthForceOntario -- Principles
• Must include broad range of
providers in the system
• Recognize educators, leaders,
patients, family and community as
key members of the strategy
• Align with government priorities
• Must engage government,
providers, employers, planners, and
the people who use the system
• Ensure safety and competency for
patients and providers
• Encourage patient/client focused
collaborative care
• Must recognize and treat health
care providers as core assets, ‘value
centres’, in the health care system
• Must be a ‘package’ for all sectors
and players- short, medium and
long term
30
____________________________________________________________________________________________________________________________
35
STRATEGIC FRAMEWORK
Information & Planning
Capacity
Right number and mix;
in right place at right time;
with the right skills
Assessment &
Education
Practice
Environment
36
Where are we going and what have we already done?
31
____________________________________________________________________________________________________________________________
37
Introducing HealthForceOntario
What is HealthForceOntario?
• HealthForceOntario is Ontario’s innovative, multi-year, plan to
ensure that the right number and mix of appropriately educated
professionals are available now and in the future to meet the
needs of Ontarians
• Created in partnership with MTCU and MCI
38
HealthForceOntario -- Goals
• Make Ontario more competitive
• Maintain and develop a competitive work force
• Establish new roles in areas of high need
Make Ontario the employer-of-choice in health care
32
____________________________________________________________________________________________________________________________
39
HealthForceOntario – Steps to Date
1. Four new roles:
Guiding Principles
•
•
•
•
Proof of principle exists
Local champions for demonstration
Area of need
Safety
40
1. Four new roles:
¾ Physician Assistant
¾ Nurse Endoscopist
¾ Surgical First Assist
¾ Clinical Specialist Radiation Therapist
33
____________________________________________________________________________________________________________________________
41
HealthForceOntario – Steps to date
2. One-stop shop for internationally educated health
professionals
•
•
•
•
•
A single point of access for comprehensive information and
counseling to assist health professionals to work in Ontario faster
Not about poaching
Not about replacing
Not about putting more barriers in place
Work with Ministry of Citizenship and Immigration
42
3. Establishment of a coordinated marketing and recruitment
centre with a comprehensive job portal www.hfojobs.ca
•
•
•
•
•
•
Reaching out to repatriate
Create a common brand and message
Avoid poaching
Part of www.healthforceontario.ca
LHIN resource
Target November for launch
34
____________________________________________________________________________________________________________________________
43
4. Every new nursing graduate (RN and RPN) will have a full
time job opportunity
•
•
•
•
Taskforce to develop recommendations led by Mr. Tom Closson
Promise to come into effect Spring/Summer 2007
Province wide approach – all regions and sectors
Link to ww.HFOjobs.ca portal
44
5. Recognize and Value Ontario’s health force
•
•
•
Nursing Education Campaign – “part or your health care team”
IMG recognition ceremony
Future phases underway
35
____________________________________________________________________________________________________________________________
45
6. Interprofessional Education and Care
•
•
•
Provincial Summit – ‘developing a blueprint for interprofessional
education and care’
Mentorship and Coaching fund
Innovation fund for interprofessional education
7. Allied Health Continuing Education Fund
46
8. Family Medicine Interest Group
9. Mentorship program for Family Medicine
1. Rural
2. IMG
3. Focused Practice Areas e.g. OB
36
____________________________________________________________________________________________________________________________
47
10. Changes to Re-Entry position
1. Already have 20 position in PGY3 for FM (not filled)
11. PGY3
1. Allow IMG access to PGY3
2. Need to encourage full uptake (fill about 50 of 70/75)
3. Review by Mike Green
12. ED primer and other skilling initiatives – life long learning
48
Success to Date
• 70% expansion
• 23% increase in medical school
• 141 new permanent FM
training positions (CMG and
IMG)
• $20K premium for each IMG
training position
• 218 new IMG this year
• 150 FHT
• 50% of province and >50%
of FP now participating in
new primary care models
37
• NOSM
• 3 new campuses
• HPRAC report under review –
Bill 50 in house
• Multiple approaches to primary
care CHC, FHG, FHN,FHT
• Changes to CaRMS process for
IMG
____________________________________________________________________________________________________________________________
49
Future Steps
¾
¾
¾
¾
¾
¾
HHR Planning Body
HPRAC and advance discussion of scope of practice
Improved data collection
Healthy workplace initiative
LHIN Support
Engagement and collaboration
Thank You
38
____________________________________________________________________________________________________________________________
Appendix C
Pre-Symposium Reading
Materials
39
____________________________________________________________________________________________________________________________
Chiefs of Family Medicine Network Meeting
Participants List
Date:
Time:
Location:
Wednesday, October 4, 2006
0800-1500 hours
12 Bushbury Drive
Phone: 416-447-5575
TABLE 1
TABLE 2
Facilitator: Dr. Cheryl Levitt
Recorder: Dr. Frank Martino
Facilitator: Dr. Sandy Buchman
Recorder: Dr. Rahim Hirji
Dr. Robert Doherty
Dr. Eligio Palermo
Dr. Elizabeth Johnston
Dr. Kenneth Burgess
Dr. Rosalie Jackson
Dr. Mel Cescon
Dr. Christopher Cressey
Ms. Eilyn Rodriguez
TABLE 3
TABLE 4
Facilitator: Dr. Philip Ellison
Recorder: Dr. David Kaplan
Facilitator: Dr. Peter Selby
Recorder: Dr. Risa Bordman
Dr. Howard Petroff
Ms. Margaret Kahng
Dr. Christopher Jyu
Dr. Joshua Tepper
Dr. William Newton
Dr. Geordie Fallis
Dr. Darren Larsen
Dr. David Price
40
____________________________________________________________________________________________________________________________
Chiefs of Family Medicine Network Meeting
Participants List
Date:
Time:
Location:
Wednesday, October 4, 2006
0800-1500 hours
12 Bushbury Drive
Phone: 416-447-5575
TABLE 5
Facilitator: Dr. Fionnella Crombie
Recorder: Dr. Joseph Lee
Dr. Harvey Blankenstein
Dr. Adam Winterton
Dr. Adrian Sohn
Dr. Wendy Graham
Dr. George Southey
41
____________________________________________________________________________________________________________________________
Chiefs of Family Medicine Network
October 4, 2006
Discussion Overview: Facilitator Questions and Answers
Small Group # 1
1. What are the key recruitment issues that need to be addressed locally?
2. What are the key retention issues that need to be addressed locally?
3. Will Health Force Ontario address local recruitment and retention issues?
Small Group # 2
1. Are there innovative local solutions that have addressed recruitment and
retention?
2. Are they sustainable locally?
3. Do they require MOHLTC support and what kind of support is needed?
Small Group # 3
1. LHINs are developing their Health Service Plans.
What are the key issues that should be addressed to support patient care in
primary care/family practices?
42
To the Economic Club of Toronto
Speaking Notes Presented by the Honourable George Smitherman
Minister of Health and Long-Term Care
September 11, 2006
Good afternoon. It's a real pleasure to be here.
Although as I say that, I have to admit that I have mixed feelings about talking to you on this particular day, after the
events of five years ago.
There are very few things that I care about more than what I am here today to talk about, but even so September 11th
has a way of making even the most important things seem inconsequential. I suppose it'll be that way for a good many
years to come.
The fact is, though, health care is not inconsequential, even on this day, so I am very glad to be here talking about it,
and I am pleased that so many of you are here to listen.
Now…this might seem to be an odd way to kick off a health care speech, but I'd like to start by talking about elephants.
One in particular.
We have an elephant in the room in health care.
Nobody really wants to talk about it, but it's a big elephant, and a small room, and it is posing a grave threat to our
values and our economic competitiveness.
That elephant is represented by one Dr. Brian Day, the recently elected president of the Canadian Medical Association.
For years we have been shadow-boxing with often obscure voices agitating for two-tier health care. Now, Canada's
doctors have selected one of the country's most prominent private providers to lead them.
The CMA is an organization whose mission statement declares it to be "the national advocate, in partnership with the
people of Canada, for the highest standards of health and health care."
This is an organization that was created just three months after Canada was born and for most of its history its values
have evolved in lockstep with the country's. Since the early 1960s, it has been a staunch supporter of the public health
care system that helps define this country.
But they have just elected a guy who runs a private surgery clinic, is an advocate for private care, and is one of those
who believes in a system where well-off Canadians can pay to get faster treatment.
Ladies and gentlemen, the first thing I'm here today to tell you is that I believe the public health care system that most
people in this country cherish is under threat.
Under threat from those who pretend that you and I will somehow have enhanced access to care as soon as more
doctors leave the public system to treat people who are better off.
So it is time to take sides.
Our government leads the side that champions innovation in the context of universal access.
Innovation that is producing tangible results for Ontarians.
We need more doctors to start fighting for that side. Doctors like Robert Bell at UHN, who wrote such an eloquent piece
in the Star a few weeks ago about the difference between Canadian and American health care…
…differences that underscore the current competitive advantage we enjoy. He pointed out that in the US, General
Motors is forced to spend more money on health care than it does on steel.
That's the same General Motors that just announced they're going to be building the much anticipated Camaros in
Oshawa – just one site where Ontario's impressive investment pattern in automobile manufacturing is producing tangible
results.
We need more nurses to fight for our health care system and we especially need their unions to balance their criticisms
with honest acknowledgment that thousands more nurses have been hired since we took office and many more of them
are working full time.
We need public sector unions to help fight for our health care system by honestly acknowledging that there are more of
their workers providing care and support to Ontarians and that their wages are secure and rising.
So I have to say to them, by all means hold me and my government to account for what we're doing in health care, but
do so in context.
That elephant I identified requires that those of us who profess the greatest love for our health care system step up and
be heard.
Because really, who exactly do you think is going to defend public health care if it's not us?
British Columbia? Quebec? Alberta?
The Conservatives in Ottawa, and Tony Clement?
I don't think so.
Is John Tory going to defend public health care?
I don't think so.
Last time I checked, he was promising to take $2.4 billion out of the system.
So, at a time when Medicare is under the kind of threat that it is today, from people who think nothing of giving priority
access to people on the strength and thickness of their wallet, with whom will you stand?
Our government stands alongside great Canadians like Roy Romanow, whose commitment to this country is
unsurpassed.
Many of you will have read Mr. Romanow's recent article in the Walrus magazine. It was also excerpted in the Globe and
Mail. This is part of what he said :
"In health care, the provinces need to do the heavy lifting involved in properly re-engineering the universal system: using
new money to buy real change…and telling their electorates that it will take seven years to achieve these goals, not
seven months."
I call that continuous quality improvement. He went on to say :
"Playing around with private-delivery health-care options is the default position of those governments that have not had
the courage to innovate within the public model."
Couldn't have said it better myself, which is why I didn't try.
When my Premier honoured me with this job three years ago, I took it believing that it could be done. That it must be
done.
I took it believing that if we were more honest with our patients – the shareholders who own this public health care
system – we could gain their confidence through an unabashed dedication to renewal within the context of our
established values.
And thankfully, each and every one of the 1000 days since I took the job, there have been leaders – many of them
heretofore unknown except to those who have benefited from their loving care – who have stepped up to the plate and
said count me in.
Doctors, nurses, administrators…all over the province, have stepped up.
So to those who haven't yet…what's that expression? "You're either wid us, or agin us"
People are going to have to choose. Where do you stand?
My task today is clear – to expand the number of believers.
Ontario's option is about better access.
And that's what I want to talk about today.
I want to demonstrate to you that we are on the right track, measured for once on the quality of our results, not simply on
the quality of our rhetoric.
And the results I am going to show you today demonstrate very clearly that we are improving access to health care in
Ontario, by innovating on the foundations laid by Tommy Douglas and Lester Pearson nearly 50 years ago.
And so to the numbers. You might imagine that a $35 billion operation produces a lot of them. Today I'm going to use
about 15. They are noted on the handy scorecard that I trust has been placed at your table.
Let's start with nursing.
From the compassion epitomized by Florence Nightingale to the skill on evidence every day in hospitals and long-term
care homes across this province, nurses have long earned the loving esteem in which they are held.
And from this government, they are also getting the respect they deserve.
The fact is, Ontario's nurses enjoy some of the most advanced practice opportunities anywhere.
And yes, there are more of them.
To date, our initiatives have created and funded 4,299 new nursing jobs in Ontario, and further program growth over the
next 12 months will add 2,500 more.
That's new nurses working in communities, hospitals, long-term-care homes and public health units throughout this
province.
We have worked hard to increase the number of nurses working fulltime by nine percent and we've invested millions to
install more than 15,000 bedlifts to literally lighten their load.
Amongst a wide range of other initiatives, our fulltime job guarantee for 2007 nursing graduates holds much promise.
And as of this month, we have more than doubled the number of nurse practitioners we can educate, fulfilling that
commitment a full year ahead of schedule.
This entire array of nursing initiatives forms just part of our new leadership role in health human resources. The newly
created HealthForceOntario is evolving new health care roles as we strive to make Ontario the jurisdiction of choice for
health care professionals.
We created HealthForceOntario to increase the number of nurses, and doctors, and other health professionals in this
province, and examples of this innovation and leadership can be found as we establish a one-stop shop for
internationally educated health professionals and a marketing and recruitment centre that arms us to compete.
And nowhere is the competition more great than in the game of "physician beat the clock" made necessary by the
decisions of our predecessors.
I spent this summer traveling to smaller communities in our vast province, relying as little as possible on 400-series
highways.
What I found was community after community bearing the DNA of the two political parties who oppose us - political
parties that bear responsibility, yet duck accountability for the patients orphaned by their action and inaction respectively.
Two parties that stood by and did essentially nothing while the number of Ontarians without a doctor grew at a simply
disgraceful rate.
Now…as your Health Minister and as an accomplished former pizza driver I'd like to offer two thoughts :
First off, as I have often said, you can't make a doctor as fast as you can make a pizza.
And second, the continuous portrayal of all our foreign-trained doctors as sadly languishing in the service industry,
driving cabs and delivering pizza, is inaccurate, harmful, and it robs us all.
But if we are honest we will acknowledge that not all medical schools in the world, some 5,000 across the globe,
automatically produce an equal graduate - no matter how impressive-looking a certificate they can produce.
Our citizens demand that all doctors meet our very high standards - a principle that has served us well.
So while that may serve as context, it's the results that should speak loudest. When our government took office three
years ago, Ontario offered 90 training and assessment positions to foreign trained doctors.
This year we surpassed our own targets of 200 by providing 218 of these positions.
And so since 2003, 750 new IMGs have begun practicing in Ontario communities, and another 470, give or take, are
currently enrolled in training and assessment programs.
That's a lot of doctors.
One day soon I hope to see an above-the-fold headline in the Toronto Star :
"Taxi and pizza industries threatened by labour shortage."
But the needs of Ontarians can not be met by doctors produced on foreign soil alone. A badly-needed expansion of our
own medical schools is underway, much of it into areas of the province new to the honour and responsibility of physician
education.
Sudbury and Thunder Bay emerged one year ago as medical educators, as the Northern Ontario School of Medicine
opened its doors to the first 56 medical students to be trained in the North.
Later this week I will have the privilege of addressing this year's crop of 56.
Windsor, Niagara, Kitchener-Waterloo and Mississauga are joining the ranks of medical education communities, while
Queen's and Ottawa are expanding as well.
56 new positions in the North. 104 new positions in the South. That's a 23 percent result on what was a 15 percent
campaign promise. Take that out to 2008 and you have 852 first year medical school spots.
That's a lot of new doctors coming on board, and we're awfully glad to have them.
And just when you thought you couldn't take any more good results, the renewal of primary care in Ontario has made it
possible for us to increase the proportion of those doctors who will work as family medicine residency positions by a
whopping 70 percent.
Health care systems the world over are striving to meet similar challenges, perhaps none more important than improving
the way care is delivered at the community level.
Better managing care for the elderly and those with chronic disease stands as both a challenge and a huge opportunity
to situate our resources close to people's homes and closer to our hearts - and our deep-seated inherent belief in
prevention.
There should be no doubt that the single greatest contribution that we must all make to sustain our public health care
system is to stay healthy in the first place.
And that's why we have been proud to put your money where that sentiment lies.
You can see that in Premier McGuinty's decision to form the Ministry of Health Promotion, and you can see it in three
distinct initiatives now reaping rewards for Ontarians.
In 49 communities that are experiencing challenges with equitable access to primary health care we are creating
Community Health Centres. That's a doubling of the number of CHCs in this province.
And all of the new CHCs in Toronto are in communities identified as high-risk in the City of Toronto and the United Way
of Greater Toronto's Strong Neighbourhoods Report.
We are also innovating in primary care with the creation of inter-disciplinary teams of health professionals to provide
comprehensive care to hundreds and hundreds of thousands of Ontarians.
We promised 150 family Health teams and we have delivered.
And our landmark agreement with Ontario's doctors has led to monumental gains in the number of Ontarians enrolled in
group practice and enjoying better primary care as a result.
407 may be the designation of a highway, but it's also the percentage increase in the number of Ontarians now receiving
care in a group practice since our party came to government.
Put another way…nearly seven million Ontarians can count on nurses and doctors to be there for them 24/7. For them,
the emergency room is just that – for emergencies.
Now I know you've been waiting for me to talk about wait times.
The outgoing President of the CMA has described our efforts in Ontario as moving from "a laggard to a leader".
Our Premier took us there, just as he has helped take Canada there.
From our 2003 election campaign which influenced the subsequent federal election, through his role as Chair of the
Council of the Federation which culminated in the 2004 First Minister's Meeting in Ottawa, Dalton McGuinty's imprint is
unmistakable.
That is a result we should all take pride in for it well represents just how much we can do when we work together.
Here's a result :
If you were to take the number of procedures performed since we launched our wait times website and multiply that
number by the average number of days that we have reduced wait times for each procedure, you'd get 6.4 million days.
That's 6.4 million days that somebody somewhere in Ontario has not had to spend waiting for a joint replacement, or
cataract surgery, or an MRI/CT scan, or a cancer or cardiac procedure.
One example : We have increased the number of MRIs performed by 61%, and we have reduced wait times for this
procedure by 28 days.
All told, that's 3,064,609 fewer days of anxiety, and undoubtedly for some a better shot at winning what might be the
fight of their lives.
Expressed as a percentage, MRI waits are down 24 percent. Cataracts are down 10 percent. Angiography a whopping
44 percent.
In fact, wait times are down in all five key areas of focus including hips and knees, which to put it bluntly are wearing out
under Ontarians at a rapid rate.
All cancer and cardiac wait times are lower than the national benchmarks and also meet our more aggressive access
targets.
I mentioned the wait times web site – more than one million hits have been logged on that site since it was launched last
summer.
Ontarians are coming to understand that they can take part in, and take charge of, their health care, and that website is
helping them do it.
And perhaps the best news yet is that some of the most powerful lessons learned by our health care system are being
enthusiastically applied by leaders who have stepped up to the plate and said we can and we will produce improved
results for Ontarians.
While wait times tend to focus on the health care services we are providing, I hold my greatest enthusiasm for the health
we are preserving in our kids.
Newborn screening, three new vaccinations and reduced rates of teen smoking all add up to healthier kids.
Surely these are exactly the kinds of initiatives Tommy Douglas had in mind when he said :
"Let's not forget that the ultimate goal of Medicare must be to keep people well, rather than just patching them up when
they get sick."
What I set out to do in this speech today is to make the case that the solutions to the problems facing public health care
aren't to be found in private health care.
It really ought to be a no-brainer. If you have something great and a problem develops, you don't toss the whole thing
away. You fix the damn problem.
And you stay committed to the thing that was great in the first place.
Well here in Ontario, we have stayed committed to Medicare. We believe it to be the best expression of Canadian
values.
The first thing we did in health care three years ago was introduce Bill 8, the Commitment to the Future of Medicare Act.
That legislation reflects our belief that the health system must be patient-centred, accountable, and respond to assessed
need, not a person's ability to pay. It closed legislative loopholes that allowed queue-jumping and extra billing, and made
two-tier health care illegal in Ontario.
When the American company Life Line wanted to bring mobile ultrasound diagnostic clinics into Ontario, to charge
people for their services of course, Bill 8 let us stop them at the border.
When Copeman Healthcare tried to open its private clinics here in Ontario, charging people thousands of dollars in
enrollment and yearly fees, Bill 8 let us stop them too.
Queue jumping is not a Canadian value.
What people who support clinics like Copeman either don't know or don't want to know is that it not only flies in the face
of some pretty fundamental values to give wealthier people better access to health care, it also damages the public
system - the system we collectively own.
Defenders of these clinics – and now we're back to Dr. Day at the CMA - insist they will relieve the strain on the public
system.
That's untrue and the Copeman math proves it as well as I ever could. Every nine-doctor clinic proposed by Copeman
would leave 3,500 more people orphaned without doctors in the public system.
Somebody want to explain to me how exacerbating the doctor shortage and creating more orphan patients is going to
relieve the strain on the public system?
So no. Thanks very much. We are on a different path.
Remain true to our values, commit to excellence, act with courage and innovate as if the life of our publicly-funded,
universally accessible health care system depends on it.
Because it does.
And so this call to arms come complete with a battlefield opportunity, where values and passion and ideas are the
weapons of engagement.
By our own law, our government is obligated to develop a 10-year, forward-looking strategic plan. And what that is, is a
roadmap to spend around 400 billion dollars.
We're going to need help with this. Help from the people whose system this is. Help from the shareholders – the people
of Ontario. And that help will be sought in a hand-on process that we will be initiating shortly.
And I'm serious when I say we need help. This is about the democratization of a public asset. And it gets back to what I
said at the outset :
A system we believe in and value and cherish is under threat. We need to fight for it.
We need to fight for the right of all citizens to get the health care they need, when and where they need it, regardless of
how much money they have in their pocket.
Because that is our birthright, and we care about it.
The battle has been joined. And we will win.
Because we have results on our side.
Thank you.
McGuinty Government Launches New Health Human Resources Strategy HealthForceOntario Strategy Aims To Fill Shortage of Health Care Professionals
May 3, 2006
TORONTO - The McGuinty government is improving health care for Ontario families by investing $45 million
this year in an innovative strategy designed to ensure the right supply and mix of health care professionals,
Health and Long-Term Care Minister George Smitherman announced today.
"We are committed to Ontario families, who need and deserve the best health care. That's why we're
working to meet the need for more health care providers over the next five to 10 years," Smitherman said.
"Through our HealthForceOntario Strategy we will create new and innovative health care roles. We will
aggressively recruit the best and brightest health care workers to Ontario where we will educate them, train
them, and provide them with the best possible working environment."
The HealthForceOntario Strategy has three components:
1.
Creating four new roles in areas of high need :

2.
3.
Physician Assistant
Nurse Endoscopist
Surgical First Assist
Clinical Specialist Radiation Therapist.
Developing Ontario's workforce by setting up a one-stop centre for internationally educated health
professionals to obtain the information they need to work in Ontario.
Better equipping Ontario to compete for scarce health care professionals, in the rest of Canada and
throughout the world, by establishing a marketing and recruitment centre including a
comprehensive job portal.
"Establishing new and expanded roles is a creative way to meet human resource needs in our health care
system," said Chris Bentley, Minister of Training, Colleges and Universities. "We will be developing new
training programs so that current health care providers can expand their knowledge and responsibilities
while meeting the growing and changing needs of patients."
Today's announcement builds on initiatives already underway in Ontario to improve access to health care
professionals, including:

A 23 per cent increase in medical school enrolment

Developing a comprehensive nursing strategy
The creation of 150 Family Health Teams
More than doubling the number of training and assessment positions for international medical
graduates
Opening a new school of pharmacy in Waterloo
Reinforcing the new fully inter-professional curriculum at the Michener Institute, funded by the
Ministry of Health and Long-Term Care.
"Our government believes that internationally educated health professionals have a lot to offer to our
province's health care system," said Mike Colle, Minister of Citizenship and Immigration. "We look forward to
extending new opportunities for these health professionals to provide health care services in Ontario."
"We want health care professionals to make Ontario their employer-of-choice," Smitherman said. "Through
HealthForceOntario, we will be establishing the programs and an environment that make Ontario the
obvious choice for a fully realized health career."
Additional HealthForceOntario initiatives are under development in consultation with stakeholders and will
be announced in the coming weeks and months.
Today's initiative is part of the McGuinty government's plan for innovation in public health care, building a
system that delivers on three priorities - keeping Ontarians healthy, reducing wait times and providing better
access to doctors and nurses.
Backgrounder/
Document d’information
Ministry of Health and Long-Term Care Ministère de la Santé et des Soins de longue durée
May 3, 2006
HealthForceOntario STRATEGY
The McGuinty government is launching a new health human resources strategy, HealthForceOntario, to
ensure that Ontario has the right supply and mix of health care professionals. As part of this strategy the
government will:
• Establish new roles in high-need areas
• Develop Ontario’s health care workforce
• Better equip Ontario to compete for health care professionals.
Establishing New Roles
In order to address the shortage of health care professionals in key areas, the government is adopting
innovative new approaches to delivering these services. As part of this initiative, the government is helping
to develop four new professional roles:
o Physician Assistant
o Nurse Endoscopist
o Surgical First Assist
o Clinical Specialist Radiation Therapist.
Developing Ontario’s Health Care Workforce
Ontario has well-educated health care professionals that are among the best in the world. The government
is working to ensure that Ontario has competitive job opportunities, professionals working in interprofessional teams, better education programs, and improved compensation and incentives. As part of this
initiative, the government is:
• Setting up a one-stop centre for internationally educated health professionals to obtain the
information they need to work in Ontario
• Developing new public education campaigns honouring the roles and contributions of Ontario’s
health care professionals and their commitment to team-based health care
• Holding a summit in June to bring industry leaders together to advance the agenda of interprofessional education and care delivery
• Funding a new fully inter-professional curriculum at the Michener Institute
• Funding MRI and CT teaching simulators at the Michener Institute
• Collecting and developing the data and expertise to better plan population health needs and
changes in health care delivery – including fellowships and a health human resources expert
advisory body
Better Equipping Ontario To Compete For Health Care Professionals
Ontario is in competition with other jurisdictions for health care providers. The government will be branding
HealthForceOntario to develop a presence that goes beyond the province’s border to convince health
providers there that Ontario is the “employer of choice.” As part of this initiative, the government is:
• Making Ontario more competitive through the establishment of a marketing and recruitment centre,
including a comprehensive job portal. This portal will build on the expertise of the Professional
Association of Internes and Residents of Ontario (PAIRO) and the New Health Professionals Network.
PAIRO will be expanding its current physician job registry to create a new Ontario employment portal
that includes province-wide job listings for needed health care professionals.
• Setting up a global phone number which health care professionals can use to reach the recruitment
and marketing centre
Backgrounder/
Document d’information
Ministry of Health and Long-Term Care Ministère de la Santé et des Soins de longue durée
May 3, 2006
NEW HEALTH CARE PROFESSIONAL ROLES
The McGuinty government is launching HealthForceOntario, a new health human resources strategy aimed
at ensuring Ontario has enough health care professionals to meet the needs of Ontarians.
One of the key components of the strategy involves establishing innovative new health care professional
roles in areas of high need. These new roles are:
Physician Assistant Assists supervising physicians to deliver medical services, such as conducting patient
interviews, histories, physical examinations; performing selected diagnostic and therapeutic interventions;
ordering and interpreting patient laboratory and radiological results; and counselling patients on preventive
health care.
Nurse Endoscopist A registered nurse with extended specialized education (in anatomy, physiology and
pathophysiology) who works with a physician to perform flexible sigmoidoscopies (diagnostic procedure
used to screen for abnormalities in the lower third of the colon).
Surgical First Assist
Works with the surgeon and the rest of the operating room team to ensure the safe outcome for a surgical
patient before, during and after surgery. A registered nurse can perform this role with an additional
certification in surgical assistance.
Clinical Specialist Radiation Therapist
Medical radiation technologists (radiation therapists) with additional training to provide more specialized
care. They will work with the radiation oncologists, nurses and medical physicists to ensure safe and optimal
patient outcomes.
Issue 1 ~ Spring 2006
Family Health Team
e-News
Produced quarterly for Family Health Teams, government, health care sector and stakeholders.
The Future of
Primary Care in
Ontario: Family
Health Teams
By: Dr. Jim MacLean,
Lead Primary Care Reform
Team-based
care is integral
to many parts
of our health
system, and
evidence from
around the
world strongly
supports the
Dr. Jim MacLean
development
of interdisciplinary primary care
teams. It’s no surprise then that our
model, the Family Health Team,
has generated tremendous interest
from communities and providers
throughout Ontario.
Significant progress has been achieved to
date in implementing Family Health Teams.
The ministry has announced 150 Family
Health Teams promised by the government.
As a result of the flexible model we developed,
Family Health Teams vary in size, scope and
structure/governance. But common to all is the
delivery of primary care by a mix of professional
disciplines within a context of team-based
decision-making and mutual respect.
While we acknowledge that the application and
approval processes as well as the development
of governance and business plans require
significant effort by communities and providers,
the end results are truly worth it.
Teams have reported positively about the
enhanced comprehensiveness and quality of
care being provided to their patients. They
are also very excited about the programs
they are developing to keep their populations
healthier, including reducing the need for
crisis intervention and hospitalization for
those patients living with chronic disease.
Team members’ feedback demonstrates
strong commitment to education and disease
prevention, which are important aspects
of team-based care.
I am very pleased to be part of this exciting
development in primary care in Ontario.
Perhaps I am dating myself with this reference,
but my future plans remind me of the famous
commercial in which Victor Kiam says,
“I liked the product so much I bought the
company.” In my case, when I return to
practice, it will be as a proud member of a
Family Health Team.
Family Health Teams
The Family Health Team is an approach to
primary health care that brings together different
health care providers to co-ordinate the highest
possible quality of care. Designed to give doctors
support from other complementary professionals,
most Family Health Teams will consist of family
physicians working with nurse practitioners,
nurses, and other health care professionals,
such as dietitians, pharmacists, mental health
workers, and physician specialists, among others.
Each Family Health Team is unique, as the
composition of the team is determined by the
health needs of the community it serves.
From Solo Practice
to Teamwork: One
Physician’s Experience
By: Dr. Garnet Maley,
Lead PhysicianPrime Care Family Health Team, Milton, ON
What is the most important decision we face in
developing a successful Family Health Team?
The recruiting and selection of our colleagues.
We must reflect on the ethical, legal, and
logistical considerations of working closely
with other health professionals. Those of us who
have been solo practitioners may also need to
surmount misgivings about working in a team.
One of the most critical decisions we make
is whether or not to incorporate a Nurse
Practitioner into our team. Having worked as an
independent physician, I was unconvinced about
the benefits of incorporating a nurse practitioner,
and had reservations about allowing free access
to my carefully cultivated patient roster. In fact,
hiring a nurse practitioner was far down on my
“to do” list. However, with some urging, I set
about looking for a suitable nurse practitioner.
My previous misconceptions melted away as
I found so many highly qualified and suitable
candidates that it was almost heart-breaking to
make the final decision. Now having worked
The team of health care professionals works
collaboratively to provide a variety of health
services – primary health care, chronic disease
management, mental health services, and
health promotion.
The key benefit of a Family Health Team is
improved access to care for patients. Family
Health Teams provide the entry point into
the health care system and make service
more accessible. Extended hours will be available
to patients enrolled with a Family Health Team,
as well as access to a registered nurse after
regular business hours through the Telephone
Health Advisory Service.
with our nurse practitioner for six months,
I am delighted to report that she has surpassed
my wildest expectations. Our nurse practitioner
routinely sees all varieties of clinical problems,
and capably deals with them all. In any given
week she sees approximately 15 per cent
of my patient load, and her abilities allow me
to spend more time with other patients who
require my services. My patients are universally
satisfied with her compassion and high level
of professionalism.
I’m happy to report that the best decision
I made in establishing our team was to hire a
nurse practitioner. I have gone from agnostic
to unqualified supporter and my patients are
the happy beneficiaries.
Garnet Maley
–2–
Unique and Flexible: One
Family Health Team Serves
its Population Health Needs
Family Health Teams provide for flexibility,
rather than a “one size fits all” approach, that
will allow interdisciplinary teams to meet the
needs of their population by offering programs
tailored to those needs. Perhaps nowhere is this
more evident than in the Seaton House Family
Health Team.
Seaton House is the largest shelter in Toronto,
with a population of 700 men. As Boris
Rosalak, manager of the shelter, says, “We only
house three types of men: somebody’s father,
somebody’s brother and somebody’s son. These
men, for a variety of circumstances, need
support in the shelter system.”
Dr. Tomislav Svoboda
becoming available to bring help to where it
is needed. Some of the 700 people here have a
burden of illness that is profound. It will blow
you away if you look down on an individual level
to see what is going on in that human being.
Say to a guy, ‘Well, just go to a hospital or go
to a walk-in clinic,’ it doesn’t work; he’ll never
make it. He doesn’t see himself in the future. He
doesn’t realize what he’s going to do today is
going to help him tomorrow. He needs help and
guidance and support. The ministry has really
offered us a great opportunity to help people get
into society and stay there.”
Seaton House has a partnership with St. Michael’s
Hospital and provides medical services with a
team of physicians. Dr. Tomislav Svoboda is the
medical director and has worked eight years in
the infirmary at Seaton House. He is the lead
in developing the Family Health Team. We met
with Boris and Tomislav at Seaton House in
December, 2005.
Tomislav: “The clients that we work with
here are some of the most vulnerable people
in society. Most people with severe mental
illness, severe physical illness, severe behavior
difficulties, have a hard time negotiating the
system. Rather than requiring them to fit in the
system, we’re trying to have the system fit them.
“We’ve stretched our resources to the maximum
here. We’ve basically rearranged every single
service that we can think of to try to make things
work. I would say that we’ve done a fairly good
job addressing acute care. But when it comes
to giving people comprehensive primary care
and ultimately reintegrating them back into the
community, I feel that’s where we could use a lot
more help.”
Boris: “Putting resources into shelter programs
like ours – it’s not an option – it’s a necessity. I
couldn’t be happier in partnering with places like
St. Michael’s Hospital with the Ministry of Health
and Long-Term Care. The opportunities are now
Tomislav: “The traditional system that we have
in place for the clients that we care for here is
this: when they get into trouble, that’s when they
get care. They get picked up by the ambulance;
they get taken to the emergency department;
they’re cared for there, and then they’re released
back into the community. When another crisis
erupts, they get picked up by an ambulance,
taken to the ER and the cycle starts all over
again. This can costs thousands of dollars.
Something as simple as a seizure disorder can
result in that sort of revolving door care. Simply
prescribing somebody medications that will
prevent seizures has tremendous savings for the
system and it’s a lot more far-sighted to provide
up-front care rather than wait for acute crisis,
acute emergencies that require hospitalizations
that can be tens of thousands of dollars.”
Boris: “We’ve developed a needs analysis, we
tested it out, and we put in an application for
a Family Health Team. We need internists.
–3–
We need mental health professionals. We need
psychiatry. We need psychology. We need rehab
therapists. A much under-appreciated malady
that our people deal with is foot care. We need
chiropody. You wouldn’t believe the condition
of people’s feet when they spend three-quarters
of their lives walking nowhere. They become
unbelievably bad. Another key malady is dentistry.
There’s such a lack of dentistry. Oral hygiene is a
critical gap in the service delivery to the people
that we care for in the shelter system.”
Tomislav: “Expanding the team is really
important and the Family Health Team is
something that can really take us to the next level.
Right now we’re able to address acute issues.
But when it comes to rehabilitation – taking
somebody from a state of psychosis if they have
schizophrenia, for instance, is one thing but then
to get them rehabilitated so that they can actually
return back into society – that is a whole other
level. And that’s something that we can do with a
Family Health Team. Also with addictions, getting
clinical psychologists, addictions counselors,
all of those people working together so we can
rehabilitate people and get them back into the
community, that’s something that we haven’t been
able to do until now.”
Boris: “It’s tough to put a price on human
suffering but I’m sure there are formulas that can
show the emergency room visit way of interacting
with the health system is totally unsustainable.
It’s totally inefficient. The vast majority of our
guys when they do use the health care system on
their own do it through emergency departments.
So creating a Family Health Team opportunity
provides a diversion from the emergency system,
which in turn saves money.”
Mind and Body: Mental
Health Services as Part of
Primary Health Care
A mental health specialist is an individual with
mental health expertise, be it related to health
promotion, prevention, treatment, self-help or
peer support. A range of mental health services
and supports may be provided within Family
Health Teams by a variety of providers, or
through arrangements with community agencies.
There can be considerable crossover in terms of
the services and supports available from various
mental health and addictions specialists.
Leah Robichaud, MSW, RSW, is a geriatric mood
clinician who provides cognitive assessments,
diagnosis and treatment for depression and
memory problems. She is a psychotherapist
who has worked for 30 years in the Providence
Continuing Care Centre in Kingston. She is a
member of the Sharbot Lake Family Health Team
which serves a population of approximately 3,000.
“I find that there is a lot of stigma with older people
as many see mental health problems as a weakness.
Many older people live with depression and other
illnesses for an average of ten years before they, or
one of their family members, ask for help.
Leah Robichard
Having them come to their family doctor’s office
is not as frightening for them as they know the
people and the office. It’s also more accessible as
they can stay in Sharbot Lake instead of driving
an hour to Kingston.”
“In our team, we work with Dr. Peter Bell, family
physician, Mary Woodman, a nurse practitioner,
Dr. Joe Burley, psychiatrist, and Sue Powell,
community social worker. It is incredibly efficient.
I have waited a long time for this job. We’re in the
early days but it’s working terrifically. It’s really
nice to be part of this service. We see people
getting better.”
(Editors Note: Mary Woodman is no longer with
Shabot Lake FHT.)
–4–
Expanding the Role
of Registered Nurses
in Health Care:
The Marathon Experience
As communities across the globe face a shortage
of health care professionals – and this includes
many communities right here in Ontario - they
are looking for new ways to meet health care
needs. The consensus here and elsewhere is
that team-based health care is the wave of the
future. While medium- to long-term efforts are
under way to increase the supply of physicians,
one thing is clear: we need to make the most
of our existing resources now to fill the unmet
demands of patients across the province. This
has led to much discussion and innovation
around the role of different health care providers.
Does a physician have time to spend educating
patients? Can someone else handle some of
the load? Who should do what? The answer to
the last question, usually, is that services that
do not require a physician, should be delivered
by another qualified professional. This way, the
physician has more time to see those patients
whose needs can only be met by a doctor. This is
why health professionals such as registered nurses
are teaming up with physicians and playing an
ever-expanding role in caring for patients.
One community that has benefited from the
team-based approach to health care is Marathon.
The town’s motto - Built on paper, laced with
gold - suggests a rich history that mirrors that of
many small northern Ontario communities where
economic development was fueled by the pulp
and paper and mining booms. Another similarity
with other northern communities is that the town
is located far from any large city – the nearest,
Thunder Bay, is about 300 km away. This relative
isolation adds to the challenges faced by so many
communities – like attracting health professionals
to the community and keeping them there. But
it also promotes resourcefulness: the people of
Marathon are used to finding creative solutions to
overcome obstacles. This is especially true when
it comes to health care.
The health care needs in Marathon and
surrounding communities range from basic,
comprehensive health care – more commonly
referred to as family medicine – to more
specialized services such as services for
“at-risk” patient populations and supporting
health clinics located in the two neighbouring
First Nations communities. To meet these needs,
a group of local physicians is in the process of
forming the Marathon Family Health Team.
The nine physicians in the group are excited
about expanding the roles of the registered
nurses who currently work in the clinic and
with other health care providers.
“Thanks to the new social worker and
registered nurses, I expect that we will
see wait-times reduced for some types
of visits, better access to physicians in
general and an overall improvement in
the level of services we provide in and
around Marathon.”
- Dr. Sarah Newbery
What makes Family Health Teams different from
other group practice models is that registered
nurses, nurse practitioners and other allied
health providers are seamlessly integrated
into the team. There is continuity of care as
different team members contribute to meeting
the patient’s needs in a coordinated fashion
while keeping each other informed so that the
patient’s regular doctor is never out of the loop.
Another important feature of the Family Health
Team model is the emphasis on education and
prevention. Why just treat people when they are
sick when we can do more to keep them healthy
in the first place?
And that’s exactly what they are doing in
Marathon. So far, the physicians have added a
social worker and two registered nurses to the
team. The two newly hired registered nurses
are participating in education and prevention on
a scale never before seen in this community to
help patients help themselves. They are stepping
beyond the traditional role of the registered
nurse and taking on an expanded portfolio of
services to meet local needs. Their focus is on
those segments of the population that are most
vulnerable to health problems such as: women,
–5–
members of the First Nations communities,
adolescents, diabetic patients, mental health
patients and obese patients.
 Assist
the Family Health Team social
worker to develop a home visit program
for patients with mental health needs
that are in crisis or in a destabilized
state. The registered nurses will ensure
patient direct contact, monitor the
administration of medications and arrange
for appropriate interventions by other
health professionals when necessary.
The Marathon Family Health Team registered
nurse program has already taken on some
responsibilities such as:
Woman clinics that provide breast
exams and pap testing.
 Well
 Preventive
health education and
interventions, such as pap testing, at the
existing high school medical clinic.
 Establish
a collaborative relationship with
the family physicians and eventually with
a registered dietitian to formulate a multidisciplinary approach intended to assist
obese patients. The registered nurses
will play an important role in developing
preventive strategies and promoting
health education in an effort to educate
patients so that they are able to make the
right lifestyle choices.
And they intend to expand their service in
Phase two to address other issues such as:
 Collaborating
with clinics in two
neighbouring First Nations communities
to promote health education and assist
patients to navigate through the system
to access diabetes programs and drug/
alcohol abuse clinics.
 Collaborate
with local diabetic counseling
services to provide comprehensive
diabetic care, in collaboration with
physicians and other health professionals,
in Marathon and in the nearby First
Nations communities.
Family Health Team e-News is produced and e-mailed quarterly.
Primary Care
Ministry of Health and Long-Term Care
1075 Bay Street, 9th Floor
Toronto, ON M5S 2B1
Tel: 416-325-3575
Fax: 416-327-1968
Are you starting to form or working in a Family Health Team?
Do you have a question or experience to share?
Please send it to your ministry Family Health Team coordinator.
–6–
May/2006 © Queen’s Printer for Ontario
These are just some of the ways that registered
nurses are taking on additional responsibilities
in Marathon, with the intent to free up the
physicians’ time so that they are able to deal
with cases that require their specific expertise.
This benefits the community by making it
possible for a greater number of patients to
access health services and also by providing a
higher level of care since the registered nurses
can spend more time educating patients and
helping them stay healthy.
Family Health Teams
Progress on Family Health Teams
The Government of Ontario is in the process of transforming its health care system. A key priority of their
agenda is to deliver the very best access to primary care through the establishment of Family Health Teams.
Below is a list of Family Health Teams that have been announced to date, organized by Local Health
Integration Network.
Family Health Team
Location
LHIN : Erie-St.Clair
Amherstburg Community FHT
Amherstburg
Chatham-Kent FHT
Chatham
Harrow Health Centre
Harrow
Lambton County FHT
Point Edward
Leamington and Area FHT
Leamington
Tilbury and District FHT Action Group
Tilbury
Windsor FHT (Dennison)
Windsor
LHIN : South West
Bluewater Area FHT
Hensall, Zurich,
Dashwood
Brockton and Area FHT
Walkerton, Mildmay,
Paisley
Bruce Peninsula FHT
Lion’s Head,
Tobermory
East Elgin FHT
Straffordville
Huron County FHT
Seaforth
Listowel FHT
Listowel
London/Middlesex FHT
London
Maitland Valley FHT
Goderich
Owen Sound FHT
Owen Sound
Perth County FHT
Stratford
St. Mary’s FHT
St. Marys
Stratford FHT
Stratford
VON Salvation Army
London
VON Sauble Beach
Sauble Beach
Wingham FHT
Wingham
LHIN : Waterloo Wellington
Centre for Family Medicine
Kitchener
Erin FHT
Erin
Grandview FHT
Cambridge
Guelph FHT
Guelph
Minto-Mapleton FHT
Palmerston
Mount Forest-North Wellington FHT
Mount Forest
New Vision
Kitchener
Two Rivers FHT
Cambridge
Upper Grand FHT
Fergus
LHIN : Hamilton Niagara Haldimand Brant
Beamsville Medical Centre
Beamsville
Caroline Medical Group FHT
Burlington
Core Care FHT
Hamilton
Delhi Community Health Centre
Simcoe
Escarpment Family Health Team
Hamilton
Garden City FHT
St. Catharines
Haldimand FHT
Hagersville
HCHC FHT
Hamilton
Hamilton Downtown Medical Centre FHT
Hamilton
Innovations Family Medicine FHT
Hamilton
Intramed FHT
Hamilton
McMaster FHT
Hamilton
Niagara Medical Group FHT
Niagara Falls
Niagara-on-the-Lake FHT
Niagara-on-the-Lake,
Virgil
Ottawa-Sherman Medical Associates FHT
Hamilton
Portage Medical Group
Niagara Falls
Prima Care Community FHT
Paris
Rosedale Medical Group Family Health Team
Hamilton
Six Nations Health Services
Ohsweken
Smithville Family Medical Centre
Smithville
Stoney Creek and Hamilton Mountain Family Health
Team
Stoney Creek
LHIN : Central West
CANES FHT – Rexdale-Malton
Etobicoke
Dufferin Area FHT
Orangeville, Grand
Valley
Mel Lloyd Family Health Centre
Shelburne
Queen Lynch FHT
Brampton
LHIN : Mississauga Halton
Credit Valley FHT
Mississauga
Etobicoke Medical Centre FHT
Etobicoke
Halton Hills Family Physicians
Georgetown
Prime Care
Milton
Dorval Medical Associates FHT
Oakville
South Mississauga & South West Etobicoke FHT
Mississauga/Etobicoke
LHIN : Toronto Central
Bridgepoint FHT
Toronto
Family Health Team for South East Toronto
Toronto
St. Joseph's Health Centre Family Medicine Urban
Health Clinic
Toronto
Meridia Medical Group FHT
Toronto
Mount Sinai FHT
Toronto
Sherbourne FHT
Toronto
St. Michael's Urban Angels FHT/Seaton House FHT
Toronto
Sunnybrook and Women's College (Grenville St.)
Toronto
Taddle Creek FHT
Toronto
Toronto Western Hospital Family Health Centre
Toronto
LHIN : Central
Aurora Wellington FHT
Aurora
Carefirst FHT
Scarborough,
Richmond Hill
Markham FHT
Markham
New Tecumseth FHT
Alliston
North York FHT
Toronto (North York)
Southlake FHT
Newmarket
LHIN : Central East
Durham West FHT
Pickering, Ajax
East Northumberland FHT
Campbellford
Fenelon Health Team
Fenelon Falls
Haliburton Highlands FHT
Haliburton
Brighton Health Services Centre
Brighton
Greater Peterborough Family Health Team
(Chemong)
Peterborough
Peterborough Medical Centre (Greater Peterborough
Health Care Alliance) FHT
Peterborough
Peterborough Clinic Family Health Team (Greater
Peterborough Health Care Alliance)
Peterborough
Peterborough Palliative Plus Family Health Team
Peterborough
Urban Outreach Health Centre Partnership
Toronto (Scarborough)
VON Havelock-Belmont-Methuen Family Health
Team
Peterborough
LHIN : South East
Athens & District FHT
Athens
Belleville FHT
Belleville
Brockville FHT
Brockville
Cataraqui FHT
Kingston
Central Hastings FHT
Madoc, Marmora
Bancroft FHT
Bancroft
Kingston FHT
Kingston
North Hastings Family Health Team
Bancroft
PFMMA FHT
Prescott, Brockville
Prince Edward FHT
Picton
Queen's FHT
Kingston
Sharbot Lake FHT
Sharbot Lake
VON Gananoque Community FHT
Gananoque
VON Brockville Community FHT
Brockville
LHIN : Champlain
Bruyere Academic FHT
Ottawa
Clarence-Rockland FHT
Rockland
Eastern Ottawa FHT
Cumberland
North Renfew FHT
Deep River
Ottawa Hospital Academic FHT
Ottawa
Petawawa Centennial FHT
Petawawa
Pikwakanagan FHT
Golden Lake
Riverside FHT
Ottawa
University of Ottawa FHT
Ottawa
West Carlton FHT
Carp
The Westend Family Care Clinic FHT
Ottawa
LHIN : North Simcoe Muskoka
Algonquin FHT
Huntsville
Central Simcoe Family Health Team (3 Teams) **
Barrie
The Cottage Country FHT
Gravenhurst,
Bracebridge
Couchiching FHT
Orillia
Georgian Bay FHT
Wasaga Beach,
Stayner, Creemore,
Collingwood
Penetanguishene FHT
Penetanguishene
LHIN : North East
Anson General Hospital
Iroquois Falls
Blue Sky FHT
North Bay
Burk’s Falls and District FHT
Burk’s Falls
City of Lakes FHT
Sudbury
East End FHT
Timmins
Elliot Lake FHT
Elliot Lake
Englehart and District FHT
Englehart
Espanola and Area FHT
Espanola
Haileybury Rural and Northern Physician Group
Haileybury
Kirkland Lake FHT
Kirkland Lake
Municipality of Assiginack
Manitowaning
Northeastern Manitoulin FHT
Little Current
Parry Sound FHT
Parry Sound
Temagami Medical Central FHT
Temagami
Township of South Algonquin FHT
Whitney
Wawa FHT
Wawa
White Pines Family Health Network
Timmins
LHIN : North West
Atikokan and District FHT
Atikokan
Dilico FHT
Fort William Reserve
Dryden Area FHT
Dryden
Fort Frances FHT
Fort Frances
Fort William FHT
Thunder Bay
Greenstone FHT
Geraldton
Machin Medical Health Group
Vermilion Bay
Marathon FHT
Marathon
North Shore FHT
Schreiber
Red Lake - Ears Falls FHT/Ear Falls Community
Health Centre
Red Lake/Ear Falls
Sunset Country FHT
Kenora, Keewatin
How LHINs Are Good For Your Health
Building A True System – Delivering Better Care
On November 24, 2005, the Ontario government introduced historic
health care legislation. The Local Health System Integration Act
2005 will, if passed, change forever the way our health care system
is managed by placing patients squarely at the centre. The vehicle
for doing that is Local Health Integration Networks, or LHINs.
The goal of LHINs is to restore equity to Ontario’s health care
system, ensuring quality care for every patient, in every community,
in the province.
Health Care Choices By The Community, For The Community
Under LHINs, community health care priorities would be identified
at the local level, by people closer to what is really going on.
The health care system belongs to the people of this province;
they’re the ones who depend on it and who pay for it. LHINs
would, along with the new Ontario Health Quality Council,
involve Ontarians in the health care conversation, giving them
a chance to participate in decisions about the health care system
in their communities.
Transparency, Accountability And Responsibility
LHINs would ensure that health care dollars are spent in the
most efficient and effective way possible, yielding the best results
possible. Accountability agreements between health care providers
and LHINs, and between LHINs and the government, would ensure
the responsible use of precious health care resources, and the
sustainability of the health care system for generations to come.
A System With Patients At The Centre
The health care system has not always been an easy one to
navigate. LHINs would change that, breaking down the
barriers that patients face, and ensuring that decisions are
made in the interests of patient care.
For more information about LHINs, visit the Ministry of Health and Long-Term
Care website at www.health.gov.on.ca or the LHIN website at www.lhins.on.ca.
Catalogue No. 7610-2544056 Revised 7M Jan/06 © Queen’s Printer for Ontario
We’re All In This Together
Local Health System Integration Act, 2006
Frequently Asked Questions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
LHIN chairs and CEOs are already announced and organizations are getting up and running. What is
the purpose of the Local Health System Integration Act?
What are Local Health Integration Networks (LHINs)? What will they do?
What programs/services will LHINs be responsible for?
What programs/services will the Ministry be responsible for?
Why does the government need to organize the health system by LHINs?
Are LHINs expected to reduce health service costs?
What does a LHIN-organized health system means to patients and what are the benefits for patients?
How will LHINs make health care better in communities across Ontario?
What authority will LHINs have to integrate services in their local areas? How will they improve service
delivery?
Why are the LHINs being given this authority?
The Ministry is handing over nearly two-thirds of the Ministry's $33 billion budget to LHINs. What
checks and balances are in the legislation to ensure that LHINs do not overstep the wishes of
government, or take the health system in a direction counter to the government’s strategic direction?
How can communities be sure that LHINs will include them in local decision making?
Will meetings of LHIN boards be open to the public?
Will LHINs be able to make decisions to close hospitals?
Does this mean that services will move from hospitals in smaller communities to hospitals in major
centres?
Do I have to get health services from the LHIN in which I live?
How independent will LHINs really be? Do they have to report back to the Ministry?
Are LHINs an expensive and additional level of bureaucracy? Shouldn't we spend more energy on
increasing the numbers of doctors and nurses?
Does the legislation give LHINs the power to override collective agreements?
Are LHINs a move to expand privatization in health care?
How much will it cost to run LHINs?
What is the status of LHIN operations and when will all their offices be functioning?
What impact will this legislation have on French language services in the province?
Will residents of Ontario continue to have access to insured health services outside of the province
following the full implementation of Local Health Integration Networks?
1. LHIN chairs and CEOs are already announced and organizations are getting up and
running. What is the purpose of the Local Health System Integration Act?
The legislation gives the LHINs the legislative power and authority they will need to effectively plan, coordinate, and fund
their local health systems to make it easier for patients to access the care they need.
2. What are Local Health Integration Networks (LHINs)? What will they do?
LHINs are not-for-profit corporations that will be responsible for planning, integrating and funding local health services in
14 different geographic areas of the province. LHINs are intended to be the managers for health services that are
delivered in hospitals, long-term care facilities, community health centres, community support services and mental health
agencies.
LHINs are based on a principle that community-based care is best planned, coordinated and funded in an integrated
manner within the local community because local people are best able to determine their health service needs and
priorities.
LHINs will determine the health service priorities required in their local community. Starting with community engagement,
LHINs will work with local health providers and community members to develop an integrated health service plan for
their local area. They will eventually be responsible for funding and ensuring accountability of local health services
providers.
3. What programs/services will LHINs be responsible for?
LHINs will have responsibility for :

Public and private hospitals (including divested Provincial Psychiatric Hospitals)
Community Care Access Centres
Community Support Service Organizations
Mental Health and Addiction Agencies
Community Health Centres
Long-Term Services Homes
4. What programs/services will the Ministry be responsible for?
The government will retain control for :

Individual practitioners and Family Health Teams
Ambulance Services
Laboratories
Provincial drug programs
Provincial programs
Independent Health Facilities
Public Health
5. Why does the government need to organize the health system by LHINs?
LHINs are a key component of the government's plan for transforming the health system to ensure people receive the
care they need now and in the future. Through improved integration and the coordination of services, it is expected
LHINs will create a more efficient and accountable health care system that will help ensure its sustainability.
6. Are LHINs expected to reduce health service costs?
LHINs will improve the way health services are planned and delivered at the local level across the province so that
patients get the services they need. LHINs will also lead to a more efficient and accountable health system and provide
better value for investments in health services.
7. What does a LHIN-organized health system means to patients and what are the benefits
for patients?
Patients will benefit from having health service decisions affecting them made by people in their community, who
understand the needs of the community and the people who live there.
LHINs are specifically mandated to engage people and providers in their communities about their needs and priorities.
They will develop ways to improve access to health services, respond to concerns people have about those services
and look for ways for service providers to improve the quality of care.
LHINs will play an important role by ensuing that patients have better access to coordinated and integrated services
through proper planning, and by building on the strength of local health organizations to improve communication among
providers.
8. How will LHINs make health care better in communities across Ontario?
LHINs will be responsible for managing the local health system to ensure that services are integrated and coordinated.
LHINs are expected to ease the flow of patients across the health care continuum and improve their access to services
in their community. They are also expected to plan and allocate resources better to ensure better access to health care
and make good health care available into the future.
LHINs will allow for more community input into local health care decisions, improving health care experiences for
patients in every part of the province.
9. What authority will LHINs have to integrate services in their local areas? How will they
improve service delivery?
LHINs have the authority to integrate local health services and programs. LHINs will not make integration decisions in
isolation, but will work with local health service providers to identify ways to reduce duplication in the health system and
to improve health services in Ontario.
10. Why are the LHINs being given this authority?
By devolving responsibility for health services to LHINs, the ministry will play a more strategic role in the health system
by concentrating on setting overall strategic directions and provincial priorities for the health care system.
However, the Minister is also ultimately accountable for the health care system and will ensure that there are appropriate
checks and balances in place to hold LHINs accountable for the performance of the local health system and the services
Ontarians receive.
11. The Ministry is handing over nearly two-thirds of the Ministry's $33 billion budget to
LHINs. What checks and balances are in the legislation to ensure that LHINs do not
overstep the wishes of government, or take the health system in a direction counter to the
government’s strategic direction?
The legislation ensures that there is an appropriate balance between granting LHINs the authority they need to
effectively and efficiently manage the local health system while retaining the ability to hold LHINs accountable for their
performance.
The relationship between LHINs and the Ministry will be governed by a Memorandum of Understanding (MOU) between
each LHIN and the Ministry, and an accountability agreement between each LHIN and the Ministry. The accountability
agreements will include performance goals and objectives for the LHINs, performance standards, targets and measures,
and a plan for spending the money the LHINs receive.
The legislation requires LHINs to provide the Minister with annual reports, including audited financial statements. The
Auditor General will also have the authority to audit any aspect of the operations of a LHIN.
12. How can communities be sure that LHINs will include them in local decision making?
Community engagement is a core function of LHINs aimed at reaching out to communities for a variety of reasons,
including assessing local needs and planning for local health services. The legislation requires LHINs to engage their
communities. Each LHIN will determine the process, format, and frequency of community engagement activities based
on the unique characteristics and needs of the local community.
The Ministry will provide guidelines and direction to the LHINs and could make a regulation setting out additional
requirements.
13. Will meetings of LHIN boards be open to the public?
Most board meetings will be open to the public. However, the legislation allows the board to go in camera to discuss
matters in certain circumstances such as human resources advice and information from legal counsel.
14. Will LHINs be able to make decisions to close hospitals?
The legislation stipulates that LHINs will not have the authority to direct amalgamations, to direct changes to provider
Boards or to direct service providers to close or cease their corporate operations. LHINs can not order the closure of a
hospital.
15. Does this mean that services will move from hospitals in smaller communities to
hospitals in major centres?
Services provided in each LHIN will depend on the local characteristics and needs of the community. LHINs will have the
flexibility to address unique local population health needs and priorities, without compromising the quality, access, or the
efficiency of health services.
16. Do I have to get health services from the LHIN in which I live?
No. LHIN boundaries are for management and administrative purposes only. People will not be restricted to only
receiving services within their LHIN. They will continue to be able to choose their health services provider as they do
today.
17. How independent will LHINs really be? Do they have to report back to the Ministry?
The government will always be ultimately responsible for providing Ontarians with high quality, accessible health care
services. LHINs will work in partnership with the ministry to ensure that unique local health care needs and priorities are
addressed.
The ministry will continue to set the principles, goals, and baseline requirements for all LHINs to ensure that all
Ontarians have access to a consistent set of health care services when they need them, regardless of what LHIN they
reside in. At the same time, it is intended that LHINs will have the flexibility to address unique local population health
needs and priorities.
As Crown agencies, the LHINs are subject to Ministry of Government Service accountability policies and directives. The
LHIN/Ministry relationship is subject to the new legislation, the Memorandum of Understanding, accountability as well as
regular, ongoing dialogue between the Ministry, LHIN CEOs and Chairs of the LHIN Boards.
18. Are LHINs an expensive and additional level of bureaucracy? Shouldn't we spend more
energy on increasing the numbers of doctors and nurses?
LHINs are an important vehicle that will be responsible for creating a true health care system at the local level . One that
can assess the health needs of the community and resource these needs better – including providing advice about the
numbers of doctors and nurses. LHINs are intended to change the silo and fragmented approach to health service
delivery and create an integrated and coordinated local health care system. LHINs are expected to reduce duplication,
not increase it.
19. Does the legislation give LHINs the power to override collective agreements?
The legislation provides for the application of a special labour law to deal with labour relations issues that arise following
any integration. This will give employees and their representatives rights at the new employer and it will establish
processes for resolving any issues.
20. Are LHINs a move to expand privatization in health care?
This initiative is not about privatizing health care, it is about providing better health care to the people of Ontario by doing
some things differently than in the past – like involving communities in important health care decision. LHINs will play an
important role to ensure that patients have better access to coordinated and integrated services through proper
planning, and by building on the strength of local health organizations to improve communication among providers. In
fact, the legislation prohibits private payments for services that result from an integration decision, unless the payments
is permitted by law. Moreover, the Commitment to the future of Medicare Act preserves the public health care system in
Ontario.
21. How much will it cost to run LHINs?
The 2005/06 allocation is almost $40 million.
22. What is the status of LHIN operations and when will all their offices be functioning?
All of the LHIN offices are ready and open for business. The LHINs are in the process of hiring the four initial staff
positions (including two senior directors). As these positions are filled, the LHIN’s functionality will increase. Please see
updates on LHIN implementation posted mid-month.
23. What impact will this legislation have on French language services in the province?
Under the French Language Services Act, (FLSA) any head or central office of a government agency must provide
services in French. The FLSA also indicates that members of the public have the right to receive services in French from
the Government of Ontario in 24 designated areas. Each LHIN will provide services to the public in French in
accordance with the FLSA. Although 2 of the 14 LHINs are not within designated areas, there will be no difference in
French-language services provided to the public by these LHIN offices.
Although LHINs will not be providers of clinical services, LHINs will plan services, fund and integrate the delivery of
health care services. In these roles, LHINs will need to assess and plan for French-language services in their areas, and
provide the appropriate funding and allocation of resources. In doing so, the LHINs will be required to engage a French
language health planning entity for their geographic area.
24. Will residents of Ontario continue to have access to insured health services outside of
the province following the full implementation of Local Health Integration Networks?
There is no change to access to insured health services outside of Ontario under the Local Health System Integration
Act, 2006. If you are an insured resident of Ontario and you are outside the province temporarily (for example, in
neighbouring Manitoba) you can use your Ontario health card to obtain insured health services. Because of
arrangements that Ontario has with most other provinces and territories, the publicly-funded hospital or physician that
you visit while outside Ontario will not bill you directly.
In some cases, you may have to pay for health care that you receive in another part of Canada, such as doctors'
services (for example, in Quebec). In those cases, you are eligible for reimbursement from the ministry, and the OHIP
rate for the service will apply.
Local Health Integration Networks
Myths and Facts
Common myths about LHINs
1.
LHINs mean less access to health services and services further away from your community
LHINs are not sensitive and responsive to local health care needs
LHINs will open the door to privatization
LHINs mean lost jobs and lower wages
The LHIN plan lacks a comprehensive plan to deal with employees in a way that protects
jobs and improves patient care
6. LHINs reduce accountability by placing decision-making at arm's length from the
government
7. LHINs ignore the role of doctors
8. LHINs take away local control and there is no input from front-line staff
9. LHINs have the potential to extend the 'competitive bidding' model to the entire health care
system
10. LHINs are driven by the bottom line
11. There has not been consultation on LHINs
2.
3.
4.
5.
MYTH #1: LHINs mean less access to health services and services further away from your
community
FACT: By ensuring that community priorities and patient needs are determined at the local level, by people
within the community, LHINs will ensure that patients in those communities receive the best and most
efficient health care services.
MYTH #2: LHINs are not sensitive and responsive to local health care needs
FACT: It does not make sense to micromanage a $33 Billion operation from Head Office. People and
communities at the local level best understand the needs of their communities. LHINs are based on the
understanding that community based care is best planned, coordinated and funded in a locally integrated
manner.
MYTH #3: LHINs will open the door to privatization
FACT: We are committed to the principle of a publicly funded health system. We confirmed this in Bill 8, the
Commitment to the Future of Medicare Act. The Local Health System Integration Act contains a provision
restating this commitment to publicly funded Medicare. This initiative is not about privatizing health care, it is
about providing better health care to the people of Ontario by doing some things differently than in the past –
like involving communities in important health care decisions. Furthermore, the legislation very specifically
prohibits any integration that would result in an individual being required to pay for a health service, unless
the payments is permitted by law.
MYTH #4: LHINs mean lost jobs and lower wages
FACT: LHINs are not about closing programs or hospitals, cutting jobs, or slashing wages. They are about
improving the quality and accessibility of health care for Ontarians. They are also about doing things
differently and more efficiently, so that there is money in the future to continue to invest in health care. The
status quo is not good enough and we are making the necessary changes to make it better.
MYTH #5: The LHIN plan lacks a comprehensive plan to deal with employees in a way that protects
jobs and improves patient care
FACT: The legislation provides a specific and known process for dealing with employees and labour
relations issues. The legislation makes the Public Sector Labour Relations Transition Act available to ensure
a fair, balanced and stable transition for employees.
MYTH #6: LHINs reduce accountability by placing decision-making at arm's length from the
government
FACT: :LHINs need independence to respond to local needs and priorities. The government retains the
ultimate responsibility to ensure high quality and accessible health services. As a Crown agency, LHINs are
subject to the government's accountability policies and directives. And the relationship between LHINs and
the Ministry is subject to a Memorandum Of Understanding, and an accountability agreements. The
accountability agreements will include performance goals and objectives for the LHINs, performance
standards, targets and measures, and a plan for spending the money the LHINs receive.
MYTH #7: LHINs ignore the role of doctors
FACT: LHINs will work in partnership with doctors, Family Health Teams, and other health care
professionals to make sure that patients continue to receive high quality care. The legislation requires LHINs
to engage their community, including physicians and other health care practitioners, on an ongoing basis for
planning and priority setting.
MYTH #8: LHINs take away local control and there is no input from front-line staff
FACT: LHINs are about putting decision making and spending power back into the hands of local people
and communities. LHINs have an obligation to engage communities in discussion about where money is
spent, which certain services should be strengthened or consolidated, and how to improve patient care.
MYTH #9: LHINs have the potential to extend the 'competitive bidding' model to the entire health
care system
FACT: The goal of the Local Health System Integration Act is to promote better access to health services,
coordinated health care and effective and efficient management of the health systems through LHINs. There
is no intent to expand the home care competitive bidding process.
MYTH #10: LHINs are driven by the bottom line
FACT: LHINs are about improving patient centered care. LHINs will devolve power to the local community
to give them a voice to allocate scarce health resources.
MYTH #11: There has not been consultation on LHINs
FACT: Many public meetings and working sessions about LHINs and the health system were held in each
LHIN across the province. More than 6,000 people attended those sessions, including representatives of
patient advocacy and community groups, unions, the public, health care providers and health related
associations, to help shape the development of LHINs. We've also met with many organizations on
proposals for the legislation.
THE WAIT TIME STRATEGY
REVIEW OF ACTIVITIES
APRIL-SEPTEMBER 2006
UPDATE #6 – September 19, 2006
INTRODUCTION
Reducing wait times for key health services is one of the Ontario government’s top
priorities and an important part of its strategy to transform the province’s health system.
Wait times are a symptom of a broader problem: managing how patients get access to
care. On November 17, 2004, the Minister of Health and Long-Term Care, George
Smitherman, officially announced Ontario’s Wait Time Strategy. The Strategy is
designed to reduce wait times by improving access to healthcare services for adult
Ontarians in five areas by December 2006: cancer surgery, selected cardiac procedures,
cataract surgery, hip and knee total joint replacements, and MRI and CT scans.
This is the sixth in a series of updates on the Wait Time Strategy. 1 It presents the
highlights and major accomplishments from April to September 2006.
HIGHLIGHTS AND MAJOR ACCOMPLISHMENTS
1.
Reduced Wait Times
Ontario is meeting its commitment to reduce wait times in the five major areas.
As reported in the Wait Times Update #5, the Minister of Health and Long-Term Care,
George Smitherman, announced Ontario’s wait time targets for each of the five service
areas. The Strategy now has twelve months of data on how long Ontarians waited for
procedures in each of the five areas (August 2005 to July 2006). An analysis of this data
indicates that:
•
Wait times for all key services have decreased as measured by the 90th percentile
(i.e., the point at which 90% of patients received their treatment).
•
Ontario is meeting its wait time targets for cancer surgery and cardiac bypass surgery
when the 90th percentile is viewed in relation to the Priority IV access targets (i.e., the
least urgent cases). Our goal for cancer and cardiac surgery is to ensure that wait
times stay within these targets.
•
The provincial 90th percentile wait time for cataract surgery has decreased 19.6% or
61 days. Although Ontario is not yet meeting its access target for cataract surgery
when the 90th percentile is viewed in relation to the Priority IV access target (182
days), 82% of people who need cataract surgery are now within this range. Working
1
See www.ontariowaittimes.com for the first five updates.
1
in partnership with hospitals and Local Health Integration Networks (LHINs), our
goal is to meet the cataract targets by April 2007. We are confident given the
available capacity to do more of these surgeries and the innovative approaches that
are being used to perform this procedure.
Cancer
Surgery
Wait Times Data: 90% Completed Within Target
Days
Completed
Current vs. Baseline
Within Target
Baseline
Current
Access
Net
% Change
Jun/July 06
Aug/Sept
Target
Change
(in days)
05
(days)
(days)
81
78
84
91%
-3
-3.7%
Angiography
Angioplasty
Bypass
Surgery
56
28
49
28
21
53
182
100%
-28
-7
4
-50.0%
-25.0%
8.2%
Cataract
Surgery
311
250
182
82%
-61
-19.6%
Hip
Replacement
Knee
Replacement
351
288
182
77%
-63
-17.9%
440
388
182
65%
-52
-11.8%
MRI
CT
120
81
92
70
28
28
42%
68%
-28
-11
-23.3%
-13.6%
•
The provincial 90th percentile wait times have decreased 17.9% or 63 days for hip
replacements and 11.8% or 52 days for knee replacements. Although Ontario is not
yet meeting its access targets for hip and knee joint replacement surgery when the
90th percentile is viewed in relation to the Priority IV access targets (182 days), 77%
of hip replacements and 65% of knee replacements are now within this range.
Physicians and hospital staff have worked very hard to perform 37% more joint
replacements from November 2004 to March 31, 2006. Working in partnership with
hospitals and LHINs, our goal is to meet the targets for hip replacements by April
2007. Very good progress is being made with knee replacements.
•
The provincial 90th percentile wait times have decreased 23.3% or 28 days for an
MRI scan and 13.6% or 11 days for a CT scan. Although Ontario is not yet meeting
its access targets for MRI and CT when the 90th percentile is viewed in relation to the
Priority IV access targets (28 days), 42% of MRIs and 68% of CTs are now within
this range. Ontario hospitals have worked very hard to perform 8% more CT scans
and 42% more MRI scans from November 2004 to March 31, 2006. Scanners are
also being used more efficiently. Very good progress is being made with increasing
access to MRI and CT scans.
2
2.
Increased System Capacity Through More Funded Volumes
On September 12, 2006, Ontario’s Premier, Dalton McGuinty, announced $108 million
to support the Wait Time Strategy. Specifically, $50 million was dedicated to fund an
additional 127,200 medical procedures in Ontario hospitals by March 31, 2007. This
includes:
• 6,100 more cataract surgeries;
• 71,858 CT scans;
• 3,008 more hip and knee joint replacements; and
• 46,300 more MRI scans.
This mid-year increase was over and above additional wait time volumes that were
allocated to hospitals on April 1, 2006 for 2006/07. In total, hospitals will have received
$275.4 million in 2006/07 through the Wait Time Strategy to perform 281,423 additional
procedures:
• 4,761 additional cancer surgeries;
• 31,950 additional cataract surgeries;
• 9,388 additional cardiac surgeries;
• 11,990 additional hip and knee replacements;
• 151,495 additional MRI scans; and
• 71,858 additional CT scans.
3.
Increased System Capacity Through Greater Efficiencies
In addition to funding additional volumes, the Wait Time Strategy has focused on
increasing system capacity through greater efficiencies.
The Strategy has linked additional funding of cases to conditions that promote system
and process improvements.
Peri-operative Improvement Expert Coaching Teams – made up of clinical and
administrative leaders with experience in effective management of peri-operative
resources – have been working with hospitals to identify areas and develop strategies to
improve peri-operative efficiencies. Hospital CEOs were informed of the coaching team
initiative in late September 2005. As of August 2006, 23 peri-operative coaches have
been trained, 13 hospitals have received peri-operative coaching and 18 additional
hospitals have expressed interest.
Progress is being made on implementing the Surgical Efficiencies Program to assess
surgical processes in hospitals and target areas for improvement. The Ministry has
selected a vendor (McKesson) to develop and implement the program. All hospitals
receiving wait time funding will be required to participate in the program. To date, eight
hospitals are running the program with more than half of hospitals scheduled to
participate by October 2006. The program will develop standard provincial performance
targets to assess all surgical programs in Ontario, and generate site specific, peer group,
3
LHIN and provincial reports on surgical activity and performance. The program will also
support hospitals as they work to reach performance targets.
Critical Care Improvement Coaching Teams have been developed in the areas of: i)
critical care service appraisal; ii) end-of-life decision making; iii) intensivist-led ICU
management model; iv) critical care surge capacity planning; v) patient flow and interunit coordination; and vi) leadership and team building. Team leads have been identified,
and the teams selected and trained. A total of 41 hospitals applied to have a critical care
coaching team work with them to improve their critical care services. All 41 hospitals
have been scheduled for team visits. To date, coaches have visited 16 hospitals, with 24
additional hospitals scheduled for visits though September and October. 2
4.
Wait Time Expert Panels
Expert Panels are making a significant contribution to the success of Ontario’s Wait Time
Strategy by shaping the Strategy, creating momentum for widespread change, and
impacting on the policies and decisions related to this initiative. Expert panels have
continued to meet and provide ongoing advice on allocations and system improvements.
A number of these panels have taken on expanded mandates as noted below. The panels
include:
•
•
•
•
•
•
•
•
•
•
Access to Care eHealth Expert Panel (formerly the Wait Time Information
Management Expert Panel): Sarah Kramer, Chair.
Cancer Expert Panel (formerly the Cancer Surgery Expert Panel): Cancer Care
Ontario, lead organisation.
Cardiac Care: Cardiac Care Network, lead organisation.
Critical Care Expert Panel: Dr. Tom Stewart, Chair.
MRI and CT Expert Panel: Dr. Anne Keller, Chair.
Ophthalmology Expert Panel (formerly the Cataract Surgery Expert Panel): Dr. Philip
Hooper, Chair.
Orthopaedic Expert Panel (formerly the Hip and Knee Joint Replacement Expert
Panel): Dr. Allan Gross, Chair.
Primary Care/Family Practice Wait Times Expert Panel: Dr. Philip Ellison, Chair.
Surgical Process Analysis and Improvement Expert Panel: Valerie Zellermeyer RN,
Chair.
Trauma Expert Panel: Dr. Murray Girotti, Chair.
In addition to these panels, the Ministry established the Diabetes Management Expert
Panel in June 2006 to recommend how to implement a comprehensive provincial diabetes
management plan for Ontario. Chaired by Dr. Catherine Zahn, the Panel’s work will be
completed by the end of 2006.
The Ministry is also in the process of establishing two other expert panels:
2
For additional information, please see: www.health.gov.on.ca/criticalcare.
4
•
•
5.
The Quality and Safety Expert Panel – chaired by Dr. Michael Baker, University
Health Network – will provide advice on quality and safety for all the wait time
initiatives.
The General Surgery Expert Panel – chaired by Dr. Ori Rotstein, St. Michael’s
Hospital – will provide advice on wait times and access to general surgery.
Information Management to Support the Wait Time Strategy
Phase 1 of the Wait Time Information System (WTIS) and the Enterprise Master Patient
Index (EMPI) was successfully implemented as scheduled by March 31, 2006 at five
hospitals: Grand River Hospital, Hamilton Health Sciences Centre, St. Joseph’s
Hamilton, Southlake Regional Health Care, and University Health Network. In addition,
Grey Bruce Health Services implemented the EMPI. In Phase 1, over 300 surgical
offices started using the WTIS and patient priority ranking scales developed by the
clinical expert panels. This Phase captured about 18% of the incremental wait time cases
in Ontario.
Phase 2 of the WTIS and EMPI implementation is well under way (April-December
2006). In this phase, 50 more hospitals are implementing the provincial system. By the
end of December 2006, about 80% of all wait time funded cases will be in the provincial
wait time system. By the end of Phase 2, the WTIS and provincial priority ranking scales
will be used in over 1,400 surgical offices.
In Phase 3, about 25 additional hospitals will implement the provincial system
(December 2006-June 2007) accounting for 100% of all wait time funded cases, and the
participation of over 1,700 surgeons’ offices.
As part of the Wait Time Strategy’s information management and technology efforts,
additional progress has been made in the following areas:
•
•
•
A vendor has been selected to develop the Provincial Critical Care Performance
Measurement System which will be piloted in seven hospitals between January and
March 2007. The provincial roll-out will occur in 2007 in all hospitals that receive
funding for critical care services.
The Provincial Surgical Information System will track hospital peri-operative flow
and productivity, help identify bottlenecks that lead to longer wait times, and focus
efforts on areas that need to be improved. As noted above, a vendor has been selected
to develop the Provincial Surgical Efficiencies Program which will be piloted in a
small group of hospitals with a provincial roll-out in 2007. The Surgical Information
System will support the Surgical Efficiencies Program.
The Toronto Central LHIN Joint Health and Disease Management Information
System is being developed to support a virtual LHIN joint program. This new model
focuses on improving access across the continuum of care from primary care to postoperative rehabilitation. The information systems to support this model of care will
be developed as a prototype to be used in other areas of the province and for other
clinical programs.
5
6.
Wait Times Web Site: www.ontariowaittimes.com
On October 24, 2005, for the first time in Ontario, the public was given access to wait
time information for the five service areas in hospitals that received additional wait time
cases. These waits reflect the length of time patients had to wait from the decision to
have the procedure to actually receiving the procedure. Data is refreshed every two
months. The website now has wait time information for June and July 2006.
Increasingly, the wait time information is being used by the province and LHINs to
inform funding decisions, and by hospitals to help manage their patients. Since hospitalspecific wait time data was first posted to June 2006, the website has had more than
1,200,000 hits. The site receives an average of 6,000 to 7,000 hits a day. The advertising
campaign launched in March 2006 – It’s Worth Knowing – has had a significant impact
on website activity. As well, funding announcements in late April and September 2006
resulted in significant increases in the number of website hits.
7.
Celebrating Innovations in Health Care 2007
On April 19-20, 2006, the Ministry and the LHINs co-sponsored the Celebrating
Innovations in Health Care Expo, an event showcasing the wide range of innovative
activities occurring in Ontario’s healthcare system. Over 600 applications were received.
The two-day event featured over 100 poster presentations, more than 80 display booths,
over 35 interactive workshops and panel discussions, and five award-winning
“showcase” innovations. Over 2,000 people attended this two-day conference.
This successful event will be held again in the Spring of 2007. Formal notices inviting
organisations to submit their innovations will be sent out early in 2007.
8.
Communications and Information
The Wait Time Strategy has made – and will continue to make – every effort to obtain
input and communicate progress to the field through updates, the Ministry website,
presentations at LHIN- and hospital-sponsored meetings, and the media. In particular,
the Wait Time Information System (WTIS) has developed a vast array of communication
tools, presentations and publications to support the education of surgeons and managers,
and the implementation and adoption of the WTIS.
Significant efforts have also been made to communicate the Strategy broadly throughout
Ontario, Canada and internationally in a series of articles published by Longwoods
Publishing Corporation. We encourage healthcare providers, managers and others to
review these articles:
•
3
“Waiting Lists and Nursing” Canadian Journal of Nursing Leadership 18(4) 2005:
36-40. 3
See www.nursingleadership.net.
6
•
•
•
•
“Ontario’s Wait Time Strategy: Part 1” Healthcare Quarterly 9(2) 2006: 44-51. 4
“Expert Panels and Ontario’s Wait Time Strategy: Part 2” Healthcare Quarterly 9(3)
2006: 43-49.4
“The Pivotal Role of Critical Care and Surgical Efficiencies in Supporting Ontario’s
Wait Time Strategy: Part 3” Healthcare Quarterly 9(4) 2006: forthcoming.4
“Developing a Culture to Sustain Ontario’s Wait Time Strategy (Invited Essay)”
Healthcare Papers 7(1) 2006. 5
ONGOING ISSUES
Communications and Information
In spite of significant communication efforts, there are healthcare providers and managers
in Ontario who have little or no awareness of the Strategy and the major changes that are
taking place in this province’s healthcare system. For example, our consultations have
indicated that many physicians and managers have not even visited the wait times web
site. We strongly encourage LHINs, hospitals, health care providers and managers to use
the wait time information to discuss and address issues of access.
Increasing Attention on Equity of Access
Although average wait times have decreased in Ontario, wait times by LHIN and hospital
have decreased at varying rates. Realistically, individual patients who wait an
extraordinary long time for a procedure are not comforted to know that average waiting
times have decreased. Given the significant amount of funding that government has
provided for additional wait time cases, it is difficult to understand why some patients
continue to wait well beyond target time frames in certain hospitals especially when more
recently diagnosed, non-urgent patients are receiving their procedures.
Equity of access within a LHIN and across LHINs is a pressing issue for the Wait Time
Strategy. We will be examining more closely why inequities exist and what hospital
boards are actively doing to manage their wait lists. In addition, we will be encouraging
LHINs to take a more active role reviewing local wait time imbalances between their
hospitals, and managing them in partnership with their hospitals and adjoining LHINs.
Increasing Attention on Quality and Safety
Consistent with past practice, additional conditions will be associated with wait time
funding in 2007/08. Quality and safety conditions will be identified by the newly created
Quality and Safety Expert Panel noted in #4 above (Dr. Michael Baker, Chair). The
panel will consider indicators such as hospital standardized mortality rates which are
available from the Canadian Institute for Health Information for all Canadian hospitals,
and the six initiatives of Safer Healthcare Now (suggested by the Canadian Patient Safety
Institute and the Institute for Healthcare Improvement to improve hospital mortality
4
5
See www.healthcarequarterly.com.
See www.healthcarepapers.com.
7
rates). All hospitals should be reviewing their hospital standardized mortality rates, and
their compliance with the six Safer Healthcare Now initiatives.
Using the Hospital Board Wait Times Checklist
As noted in the Wait Times Update #5, hospital Boards are accountable for governing
their organisation’s access management strategy and assessing their hospital’s
performance compared to other hospitals in the LHIN and province. Hospital CEOs
should be reporting at each regular Board meeting their hospital’s wait time data and
compliance with funding conditions. (Although it is recognised that the Wait Time
Information System and the Enterprise Master Patient Index will make tracking this
information easier, it is expected that hospitals should be documenting and tracking this
information already.).
Below is the Hospital Board Wait Time Checklist that was included in the previous wait
times update. It is recommended that the Board Chair ask the following questions of the
CEO at each Board meeting.
1.
2.
3.
4.
5.
6.
HOSPITAL BOARD WAIT TIME CHECKLIST
For each wait time procedure, what is our hospital’s wait time data compared
to every other hospital in our LHIN? What are you doing to manage our
wait lists? What are you doing to make access more equitable between
facilities?
Show me the information that we are maintaining our base volumes in
addition to performing the incremental cases. Show me the evidence that we
are maintaining high quality care for all cases.
How many patients in our hospital are waiting longer than the target for each
wait time procedure? If this number is increasing, what are you doing to
address the issue?
How many patients have been waiting for surgery or a scan longer than 10
months? Have they been reassessed? Why are they still waiting? If this
number is increasing, what are you doing to address the issue?
Does the length of specialists’ waiting lists vary significantly in our hospital?
What are we doing to promote equitable access to specialists?
Are we using surgical best practices? For example: Is the length of stay for
our surgeries best practice? Is our use of day surgery best practice?
√
√
B
O
A
R
D
√
√
T
O
O
L
√
√
IN CONCLUSION
We will continue to seek input and advice from local consultations and our expert panels
on improving the system. To ensure that this advice is integrated and doable, we have
established a Wait Time Executive Committee – comprised primarily of providers who
are leading the expert panels – to advise the government on broad strategic approaches
and how best to manage and sequence the wait time projects that are underway. This
Committee is chaired by Alan Hudson and reports to Hugh MacLeod.
8
Rachel Solomon, Project Manager of the Ministry’s Access to Services and Wait Times
Office, is leaving the Ministry for a position at the University Health Network. I would
like to thank Rachel for her invaluable contributions supporting the Wait Time Strategy
since it began, and wish her well in her new position. I am pleased to welcome Melissa
Farrell who is taking over as Project Manager of the Access to Services and Wait Times
Office.
Finally, I would like to extend my congratulations to the thousands of individuals who
have contributed to making the Wait Time Strategy a success, thus far. You have all
helped to improve access, reduce wait times and implement new approaches to health
care that will benefit of the citizens of Ontario. I thank you most sincerely and look
forward to continuing to work with you.
I ask that everyone reading this update take responsibility for communicating the
Strategy to others by circulating this communiqué as broadly as possible.
Alan R. Hudson, OC
Lead of Access to Services and Wait Times
Acknowledgement: Thanks are extended to Joann Trypuc for producing this update.
9
Update
Health Results Team (HRT)
Information Management
Ministry of Health and Long-Term Care
Produced for our partners and information management stakeholders across the health care sector.
August 31, 2006
Health Care Professionals Making an Impact on
the Quality and Availability of Health Information
by Adalsteinn Brown,
Information Management Lead,
Health Results Team
I am pleased to once again
update you on a number of
developments related to
Ontario’s Information
Management Strategy.
The strategy has a steadfast goal of producing better data.
To that end, we continue to launch and expand initiatives
focused on making tangible advancements to the quality
of data produced in the health system – the basis for
evidence-based decisions.
In striving towards this goal, we are fortunate to benefit
from the knowledge and expertise of many dedicated health
care professionals across the system, our partners in this
effort. In this update, I would like to highlight and recognize
how nurses are significantly contributing to improving
health information, in a way that will not only benefit
the patients that they serve, but also their profession.
You will also find out how the Ontario Case Costing
Initiative is expanding across the province. This
initiative gives us the ability to identify and assess the
true cost of medical procedures and services received by
individual patients in hospitals.
Milestones
• Start of data collection on nursing-sensitive health
outcomes across two Local Health Integration
Networks
• 41 health care facilities now part of the Ontario
Case Costing Initiative
The HOBIC Initiative:
Better Information, Better
Care, Better Outcomes
Many Ontario patients view nurses as being at the centre
of good health care. Yet, we are currently limited in our
ability to measure the impact of that care. The same is
true of other disciplines, such as occupational therapy,
pharmacy and physiotherapy.
From the perspective of these health care professionals,
information about health outcomes is integral to improving
the quality of care that they provide to patients, clients
and residents, on a daily basis.
Starting this fall, through the Health Outcomes for
Better Information and Care (HOBIC) initiative,
Ontario nurses in two areas of the province, Hamilton
Niagara Haldimand Brant and North Simcoe Muskoka,
will begin to close this critical information gap by
collecting and recording health outcomes in a
standardized way.
Initially, HOBIC will focus on the nursing profession. In
later years, it will target other disciplines, including
occupational therapists, pharmacists and
physiotherapists, in a variety of health care settings.
The implementation of this initiative across the province
in the coming years will be significant on a number of
fronts. First and foremost, it will empower clinicians to
get the best results for their patients, clients or residents.
...continued on page 2
The HOBIC Initiative
continued...
The more they know about how people are reacting to
different interventions, the better they can manage their
care. As a result, the condition of individual patients,
clients and residents will improve. Over time, the overall
quality of care provided will also improve.
The implementation of this initiative across
the province in the coming years will be
significant on a number of fronts. First and
foremost, it will empower clinicians to get
the best results for their patients, clients or
residents.
Second, historically Ontario has collected administrative,
financial and clinical-type data, but this is the first time
that we are collecting patient-centered information. Once
it is abstracted onto databases, this new information will
be invaluable, at both a unit and organizational level, not
only for evaluating the effectiveness of care provided, but
also for health care planning activities.
Third, at a health system level, HOBIC will be vital to
setting benchmarks for performance, planning, resource
allocation, and research.
At the end of the day, it will make the contribution of
trusted health care professionals visible, because we will
be able to accurately assess the impact that they have
collectively on patient/client/resident health outcomes.
In their own words – What an
early adopter site had to say
about HOBIC
Implementation of
HOBIC will occur in
stages over three
years. The provincewide collection of
information on
nursing-sensitive
health outcomes will
begin this fall in 26
early adopter sites in
selected facilities in
the acute care,
complex continuing
care, long-term care
and home care
sectors.
“In the fast-paced world of health care,
we as registered nursing staff often do
not have the opportunity to reflect on the
outcomes that patients derive from our
care. We are missing an integral step in
our practice: the actual evaluation of
how effective our plan of care has been.
With the help of the HOBIC initiative, we
will be able to evaluate and compare our
resident health outcomes to derive the
best possible patient-centered, evidencebased, and outcome-focused plan of care
possible. This new ability to analyze our
resident outcomes and benchmark our
data will also allow for sharing across
the entire continuum of care to support
nursing decision-making and
demonstrate nursing effectiveness.
In 2008/09, collection will be expanded to pharmacy,
occupational therapy and physiotherapy, for the same
sectors, as well as for the primary care, mental health,
public health and rehabilitation sectors.
HOBIC recently won the Amethyst Award for
excellence in the Ontario Public Service.
Congratulations to the entire HOBIC team within the
Ministry of Health and Long-Term Care for their hard
work and dedication. The recognition is very much
deserved.
We are looking forward to being one of
the HOBIC early adopters and playing a
role in filling this important
information gap.”
For more information about HOBIC, go to:
http://www.health.gov.on.ca/english/providers/project/nur
sing/nursing_mn.html.
Tricia Swartz RN BScN CRN(c)
Acting Director of Care
Woods Park Care Centre (early adopter site)
2
The Ontario Case Costing Initiative: Accurate Patient
Level Costs, Better Decisions
The Ontario Case Costing Initiative (OCCI) aims to
improve the availability of case costing data, which
attaches an actual dollar value to patients for medical
procedures and services received within a range of
hospital settings.
available. The OCCI will support the facilities throughout
this process to ensure that they are equipped to provide
high-quality information that complies with the needs of
the case costing system.
Additionally, a software solution provided by the ministry
will open the door for more hospitals, particularly smaller
ones, to participate in the OCCI by removing significant
upfront expenses required to establish and maintain a
case costing system. The standardized software solution
will also allow for patient costs to be allocated more
consistently across the system.
Having this kind of information on hand can help health
care administrators to better identify and manage cost
structures within their organizations. Without case
costing data, these organizations cannot accurately
pinpoint specific cost drivers related to most patientbased procedures and services.
Within the ministry, it provides us with the ability to
calculate, through multiple funding formulas, which
facilities are providing which procedures or services to
patients and at what cost. Through various health care
planning activities, we then use this evidence to identify
resources and determine where these critical resources
should best be directed.
Having this kind of information on hand
can help health care administrators to better
identify and manage cost structures within
their organizations. Without case costing
data, these organizations cannot accurately
pinpoint specific cost drivers related to most
patient-based procedures and services.
Initially, only 12 Ontario hospitals were providing annual
case costing data to the ministry. In May 2005, we invited
hospitals across the province to join the OCCI. The goal
was to add a representative mix of hospitals, including
large and small community hospitals, children’s hospitals,
mental health facilities, chronic rehabilitation centres and
institutions located in Northern Ontario.
The ministry will be issuing a Request for Proposal (RFP)
for a software vendor for the OCCI this fall. It is
anticipated that the software system will be built and
implemented within eight months’ time. The new
software system is expected to be fully functional in 2007.
The greater the diversity of hospitals – in terms of size,
geographic coverage, patient mix, specialties, range of
procedures – who participate in the OCCI, the more
robust will be the available case costing data on which
important funding, planning and organizational decisions
are based at the provincial, local and individual
organizational levels.
The OCCI also aims to expand case costing to other
health sectors to accurately track patient costs across the
continuum of care. The inclusion of CCACs are a step in
this direction. They will serve as a pilot to develop a case
costing methodology specific to CCACs.
In the future, long-term care homes and community
mental health centres are among other sectors that could
be targeted for the OCCI.
The response we received from hospitals and other health
care facilities was overwhelming. In all, thirty-seven
hospitals as well as four Community Care Access Centres
(CCACs) submitted applications to become case costing
facilities. The breakdown included 21 large teaching
hospitals, nine chronic rehabilitation centres, six small
hospitals and one children’s hospital.
The ultimate goal of the OCCI is to create an optimum
environment for evidence-based decisions that support
the delivery of high-quality patient care.
All 41 facilities were selected. This brings the new total of
institutions participating in the OCCI to 53. The new
organizations are currently being assessed for their
readiness using the initiative’s four milestones, which
include examining the format and quality of information
3
Coming Soon…
Emergency Department Utilization Reports by LHIN geographic area.
The reports, produced by the Health System Intelligence Project (HSIP),
provide an analysis of patterns of emergency department utilization.
A variety of factors can impact on patterns of utilization, including age
structure, socio-economic status, geographic distribution, and disease
patterns of the population, as well as the capacity of the health care
system (e.g., availability of inpatient beds, outpatient services, family
physicians, and walk-in clinics). This kind of information is needed for
local health care planning activities.
For more information
Write to [email protected], or call 416-212-4263. Visit the Ministry of Health and Long-Term Care’s web site,
Information Management section (for Health Care Providers) at: www.health.gov.on.ca.
4
© 2006, Queen’s Printer for Ontario
The development of these and other reports is part of the province’s
Information Management Strategy.
The Pandemic Planner
A Monthly Newsletter for Health Care Professionals
Emergency Management Unit, Ministry of Health and Long-Term Care
September 2006
There is a lot to celebrate since the first issue of the newsletter. In four short weeks since the launch of the Pandemic Planner, the provincial pandemic
plan has been released, local pandemic plans are being approved and the health care sector and academia are filling our calendars with important and
exciting conferences and seminars. September’s issue of the Pandemic Planner will highlight the good news stories and will profile community initiatives
that are key to our on-going efforts for dialogue, discussion and effective pandemic planning.
I would like to take this opportunity to thank all of those who provided feedback and shared ideas and suggestions for the newsletter. We received many
positive comments and many of the ideas and information shared are included in this issue. Please continue to share your feedback and keep us informed of
the exciting activities taking place in your organization and community!
~ Allison J. Stuart, Director, Emergency Management Unit
What’s New?
The Emergency Management Unit (EMU) is growing!
The release of the 2006 Ontario Health Plan for an
Influenza Pandemic (OHPIP)
As many of you know, the Ontario Health Plan for an Influenza
Pandemic (OHPIP) was released on Thursday September 21, 2006. The
plan is available on the ministry’s web site at:
www.health.gov.on.ca/pandemic.
We encourage you to share with your colleagues, members and
stakeholders that the plan is now available online. We hope that the
options provided for downloading will make it easier for you to access
and use.
The EMU now has an Office of Public Health Emergency Preparedness.
This office will focus its attention on furthering business continuity
planning as well as emergency readiness within the ministry’s Public
Health Division and the broader public health community. The
office will work on ensuring integrated planning at the local and
provincial levels to maximize health response efforts to any
emergency – including an influenza pandemic.
Stay tuned for updates on the work and activities of this team!
Great Lakes Border Health Initiative (GLBHI) Update
Avian Influenza Update
The provincial government has a new website on avian influenza which
can be reached directly at www.government.gov.on.ca/birdflu; or
through our web site at:
www.health.gov.on.ca/english/providers/program/emu/avian/links.html.
A federal/provincial/territorial workshop on human and animal aspects
of avian influenza was also held this month. We have been working on a
document to support the human health aspects of an avian influenza
outbreak. We hope to have the document posted on the ministry’s
website in the next month.
The 3rd Annual Great Lakes Border Health Initiative was held on
August 24 & 25, 2006 in Dearborn Michigan. Federal, provincial, state
(five states) and local public health representatives participated in this
two-day conference, where the primary focus was on the importance of
cross-border surveillance. Representatives discussed opportunities to
further their work together, explore options and improve infectious
disease surveillance in all participating jurisdictions.
The GLBHI Steering Committee is completing its work on a plan which
will outline roles and responsibilities, protocols and decision-making
guidelines for notification of infectious disease outbreaks in
participating jurisdictions, including an influenza pandemic.
The document will be presented to members for comment and further
discussion in the near future. For more information, please visit the
GLBHI web site at: www.michigan.gov/mdch/0,1607,7-132-
2945_5104_5279_40279---,00.html
Useful Web Resources
www.osach.ca/ - The Ontario Safety Association for Community &
Healthcare web site provides important information about
occupational health and safety.
www.publichealthgrandrounds.unc.edu/ - The Public Health Grand
Rounds web site offers satellite broadcasts and webcasts which
present real-world case studies on a range of public health issues
(from infectious diseases to an influenza pandemic). Registration is
free and past programs are available to download on the “Archives”
section of the site.
You Asked…..?
Personal Protective Equipment:
The ministry will be participating in a federal consensus meeting on the
mode of transmission of the influenza virus in a pandemic. This meeting
will help inform a provincial position and decision on personal
protective equipment. The meeting is scheduled to take place on
October 26 & 27, 2006.
Prophylaxis:
The ministry will participate in the federal government’s public
consultation on prophylaxis. The consultation will help inform a
decision on prophylaxis priority groups. The public consultation is
expected to begin later this fall.
Decision Tree:
Work is underway to develop an interactive web-based decision tree.
This decision tree will allow for the public to enter influenza symptoms
on-line. Based on the information provided, the decision tree would
inform the individual on what to do, such as go to a hospital, a local
community treatment centre, or family physician for treatment.
As the project develops, further updates will be provided.
Influenza Pandemic Antibiotics:
A number of antibiotics have been identified for use in secondary
infections during an influenza pandemic. The list includes the following
antibiotics (in oral liquid and tablet and intravenous form):
Amoxicillin/ Clavulinic Acid
Azithromycin
Levofloxacin
Vanocomycin
Cefuroxime
The ministry will be stocking antibiotics as with other supplies and
equipment in preparation for an influenza pandemic.
Local Planning Initiatives
On September 20, 2006, the Simcoe Muskoka District Health Unit
released its pandemic plan. The plan can be found at:
www.simcoemuskokahealth.org/pdfs/SMDHU_PandemicPlan.pdf
The health unit’s plan was used as a framework for the development of
the interagency pandemic plan for the health care and emergency
response sectors. This interagency plan can be found at:
www.county.simcoe.on.ca/media/emergencyplanningfiles/Pandemic%5
FPlan2.pdf
The interagency pandemic plan was a result of a successful partnership
with over 40 health care and emergency response agencies in Simcoe
County. Congratulations to everyone for a job well done!
Important Dates: September – December
2006
•
October 11, 2006 - Industry Canada is hosting the 2006
Regional Emergency Telecommunications Conference in
Toronto. For more information, please call: 905-428-8637.
•
October 19, 2006 - The Centre for the Study of Democracy,
Queen’s University is facilitating the symposium: “Ethics and
Emergencies - Who lives, who dies, who decides and why?” For
more information or to register, please visit the web site at:
http://www.queensu.ca/csd/.
•
November 28, 2006 – An Aboriginal Health Summit will be held
by the Government of British Columbia. Details to follow.
•
November 30 & December 1, 2006 - A Pandemic
Communications Forum will be held in Toronto. For a complete
copy of the agenda please visit:
http://www.summersdirect.com/pdf/Pandemic_Communications_Fo
rum.pdf; or call 1-866-869-7969 for further details.
•
December 12, 2006 - The Health Care Network of Southeastern
Ontario, Incident Management Committee presents the Second
Annual Southeastern Ontario Emergency Preparedness
Symposium. The theme for this one day event is “Managing the
Next Moment!” For more information, or to register, please visit
the web site at: http://seohealthnet.com/.
Guides & Books
Avian Influenza
The CDC has released new guidelines around avian influenza. To
view these guidelines, please visit
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/guideli
nes/.
“The Flu Pandemic and You: A Canadian Guide”
Authors Dr. Vincent Lam and Dr. Colin Lee are celebration the
release of their latest book: “The Flu Pandemic and You: A Canadian
Guide.” Dr. Lee is a member of the Provincial Infectious Diseases
Advisory Committee (PIDAC) and is the chair of PIDAC’s
Communicable Diseases sub-committee. Dr. Lam is an emergency
physician, who has contributed to The Globe and Mail, National Post
and Toronto Life Magazine.