Education Session

Time
Topic
Speaker
1:00 pm
WELCOME AND CONTEXT SETTING
Donna Segal
Board Chair, SE LHIN
Chair, Collaborative Governance
Work Group
1:10 pm
CONSIDERATIONS FOR BOARD COLLABORATION
IN INTEGRATION
 LHIN Perspective
 Provider Perspective
2:00 pm
LHIN EXPERIENCES WITH COLLABORATIVE
GOVERNANCE
 North Simcoe Muskoka LHIN Experience
Jeffrey Simser
Legal Director, LHIN Legal Services
Anne Corbett
Partner, Borden Ladner Gervais
Bob Morton
Board Chair, NSM LHIN

2:50 pm
Roundtable: What is unique or different
about the approaches you are taking in
your LHIN?
SUMMARY AND CLOSING REMARKS
3:00 pm
ADJOURN PAN-LHIN SESSION
3:00 –
3:30 pm
INDIVIDUAL LHIN MEETINGS
Each LHIN will sign off the pan-LHIN session and
have its own discussion immediately following.
Each LHIN
Donna Segal
Donna Segal
Integration: Setting the Stage
CONSIDERATIONS FOR BOARD COLLABORATION IN INTEGRATION
November 27, 2014
1
Principles
Principles underlying the Local Health System
Integration Act, 2006 (“LHSIA”):
•
•
•
•
•
•
•
Planning
Coordinating
Community engagement
Accountability
Funding
Integration
Transparency
2
Definitions
Integrate and Service
The definition of “integrate” includes (s. 2):
•
Coordinating services and interactions between different persons and
entities;
•
Partnering with others in providing services or in operating;
•
Transferring, merging or amalgamating services, operations, or entities;
•
Starting or ceasing to provide services;
•
Ceasing to operate, dissolve or winding up operations, and “integration”
has a similar meaning.
The definition of “service” includes (s. 23):
•
A service or program that is provided directly to people;
•
A service or program that supports a direct service or program; or
•
A function that supports a person or entity that provides either a direct or
a supporting service or program.
3
Developing Integration Opportunities
1) LHINs may integrate under s. 25 by:
a)
b)
c)
d)
Funding – providing it or changing it
Facilitating and negotiating the integration
Requiring an integration
Stopping a voluntary integration
2) The Minister, with advice from the LHIN, may order
an integration. (s.28)
4
Developing Integration Opportunities Funding
LHSIA s. 19 and 25(1)(a):
•
A LHIN may provide funding to a health service
provider (“HSP”) for services it provides in or for
the LHIN’s geographic area.
•
A LHIN may integrate a local health system by
providing or changing funding to an HSP that it
funds.
5
Developing Integration Opportunities Facilitating and Negotiating
LHSIA s.25 (1)(b) and 25(2)(a):
• A LHIN may facilitate or negotiate an integration.
• At least one of the organizations involved is an HSP,
or the integration of services between HSPs or
between an HSP and an organization that is not an
HSP.
• The parties need to reach an agreement.
• Once the parties reach an agreement, the LHIN
must issue an integration decision.
• The integration decision must be complied with.
(s.29)
6
Developing Integration Opportunities –
Required Integration
LHSIA s. 26 and s. 25(2)(b):
• A required integration can occur without the consent of the
HSP.
• If a LHIN considers it in the public interest, it may require a
funded HSP to provide a service, to cease providing a service,
to provide a service to a certain level, to transfer location, or
to transfer all or part of a service from one person to another.
• Notice of the LHIN’s proposed decision must be provided to
the HSP, along with copies available to the public. The public
has 30 days to make submissions to the LHIN.
• The LHIN may issue an integration decision after it considers
the submissions. (s. 25(2)(b))
• The integration decision must be complied with. (s.29)
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Developing Integration Opportunities Voluntary or Stopping an Integration
LHSIA s. 27 and s. 25(2)(c):
• A voluntary integration occurs when an HSP initiates it’s own
integration activity with another organization.
• The HSP is required to provide notice of it’s proposal to the LHIN that
it receives funding from.
• The LHIN may propose to stop the integration.
• If the LHIN proposes to stop the integration, it must give notice to the
HSP, make the proposal public and invite submissions from the
public for 30 days.
• Not more than 60 days after giving notice, and having considered the
submissions and the public interest, the LHIN may issue an
integration decision.
• The decision may stop the entire integration or part of it.
8
The LHINs Duty to Integrate
To provide for an integrated health system to improve
the health of Ontarians through better access to high
quality health services, co-ordinated health care in local
health systems and across the province and effective
and efficient management of the health system at the
local level by the LHINs. (s.1)
9
Healthy People. Excellent Care. One System.
Collaborative Governance
November 27, 2014
Implementation Structure, 2013-2016
Lead Organizations for each ‘Areas of Focus’:
Health Service Provider Boards and LHIN Board
NSM LHIN Leadership Council
GBG
H
CCAC/IL
S
OSMH
Waypoint
RVH
CGM
H
1. Complex &
Chronic Health
Needs
2. In Home &
Community
Capacity
3. Maternal Child
Health
4. Mental Health
& Addictions
5. Medicine
6. Surgery
Complex Continuing
Care
Alternate Level of
Care
Maternal and Child
Health Community of
Practice
Waypoint
Schedule1Beds to
community hospitals
LHIN-wide Critical
Care System
Chronic Disease
Prevention and
Management
Home First
Building Child &
Adolescent Capacity
LHIN-wide Integrated
Vascular Care
System
LHIN-wide
Musculoskeletal
Program
(Bone and Joint)
Community Crisis
Management
LHIN-wide
Emergency Care
System
Behavioral Support
System
LHIN
7. Communications
and Community
Engagement
Seniors Health
Strategy
LHIN
8. Governance
LHIN
9. Information
Communication
Technology/eHealth
LHIN
10. Integrated
Health Human
Resources
CCAC
11. System
Navigation
County of
Simcoe
12. Transportation
Standardization of
Process and Policy
Information &
Referral
Inter-facility
Organizational
Development
Transitions of Care
Community
Workforce Planning
and Education
Recruitment and
Retention
Coordinating Councils for 12 ‘Areas of Focus’
Project Steering Committees for > 40 Projects
Boards, Councils & Project Steering Committees supported by:
• NSM LHIN Leadership Council - CEOs & Executive Directors (the Care Connections (CC) Steering Committee)
• CC Operations Committee ( the Chairs of 12 Coordinating Councils)
• CC Implementation Team (LHIN Staff as Liaisons for Councils and Project Steering Committees)
2
Care Connections Governance Coordinating Council:
Governance Vision
Purpose
Challenges
and issues
• Sustainable Governance model to support future design
• Minimal education, information-sharing, and relationships across the HSP community
• Lack of shared vision for the future
• Tension between existing organizational fiduciary responsibilities and future systemwide governance and oversight
Hospital Boards
Key
stakeholders
Long-term Care Boards
Community Boards
“A Network”
LHIN Board
• Facilitated networking of Boards to support the transformation and delivery of the
future health system
• Delivered through:
Strategies
• Clear and consistent communication and information-sharing protocols
• Effective governor engagement strategies
• Platform for Board to Board sharing and relationship building to create a foundation
for change
North Simcoe Muskoka LHIN’s Governance Journey
June 2012
Care Connections Update
Governance Coordinating
Council Role
Collaboration Continuum
June 2013
Governance 101
Generative Governance
October 2013
“Made in Ontario Solution”
Unique role for governing bodies
Governance Leadership in
System Transformation
Chairs only session –
focused on sub-geography
January 2013
April/May 2014
Health Links
Implications for governing
bodies
Local improvement plans
Regional Sessions
November 2012
May 2014
Governance Education
Session
Sept/Oct 2014
Second Curve Transformation
Patient Experience
November 2014
2nd Governance Education
Session
“Put back on the table of the boards not just a request, but an absolute sense of obligation, that learning who
does better and then doing at least that well is central to proper stewardship of health care. The buck stops in
the board room.” D. Berwick
Continuum of Collaboration
Formal and Whole
Agency
Collaboration
Informal and Local
Collaboration
Communication
Cooperation
• Individuals from
different
disciplines
talking together
• Providers
working jointly
on lower
priorities on a
case by case
basis
Coordination
Coalition
Integration
• Formalized joint
working group
• No sanctions for
non-compliance
• Joint structures
created with
willingness to
sacrifice some
autonomy
• Integration of
services, staffing
or initiatives
between health
system partners
locally or
system-wide
and across
sectors.
Collaboration – T, T, T.
The impact of Trust Building
http://www.actforyouth.net/youth_development/communities/collaboration.cfm
6
Accountability
- Organizational Level
ORGANIZATIONAL
BALANCED
SCORECARD
• describes strategy,
measures & targets
• guides execution
• information on
performance
Financial
Customer
Value Creating
Processes
Learning &
Growth Enablers
Dialogue &
Continuous Dynamic
Evaluation &
Learning
Accountability
Agreement for
CEO
Managerial
Accountability
Agreements
ACCOUNTABILITY
AGREEMENTS
• sets out what parts of the
scorecard each individual is
accountable for achieving &
the supports they need to be
successful.
7
Accountability
- System Level
ORGANIZATIONAL
BALANCED
SCORECARD
• describes strategy,
measures & targets
• guides execution
• information on
performance
Financial
Customer
Value Creating
Processes
Learning &
Growth Enablers
SYSTEM BALANCED
SCORECARD
Financial
Customer
Value Creating
Processes
Learning &
Growth Enablers
Dialogue &
Continuous Dynamic
Evaluation &
Learning
• states the financial & customer
outcomes
• defines the strategic contribution of
the board
• helps manage the performance of
board / committees
• clarifies the strategic information the
board needs
Accountability
Agreement for
CEO
Managerial
Accountability
Agreements
ACCOUNTABILITY
AGREEMENTS
• sets out what parts of the scorecard
each individual is accountable for
achieving & the supports they need
to be successful.
8
A Governance Model
Generative
Strategic
Fiduciary
Source: Jim Nininger, Conference Board of Canada
Trust
9
System Governance: Finding the Balance
Board members
need to govern
on a broader
health system
level
Board members
need to focus on
their own
organization
10
Questions for Consideration
•
How much time do you or should you spend on systems
versus organizational priorities?
•
What about your CEO? How much time and effort is
reasonable for your CEO to spend on system
issues/priorities?
•
What does this mean for your Board?
•
Does your Board need to do anything differently?
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