1. Giving Shape to the Vision: Putting together the puzzle of planning and integration in the Central East LHIN Planning Partners Symposium, June 5-7, 2007 James Meloche Sr. Director, Planning, Integration and Community Engagement

2. Pause and reflect… Framework for Engagement and Planning Extensive community engagement across the region Detailed feedback and data collection to validate directions Establishment of 9 collaboratives, 3 networks, 5 task groups Integrated Health Service Plan and community consultations IHSP work plan and feedback New investments and projects launched LHIN Board and organizational developmental start-up

3. A year ago we told you…. …that the path of change would be challenging and that there would be bumps along the way

4. Today… The Path travelled is clear. The Path ahead remains unknown. The journey of change continues….

5. Objectives of this Presentation For Planning Partners –Need: Planning partners (Networks, Collaboratives, Task Groups) are maturing as planned. As the LHIN develops, these teams are in need of a overview of how “the pieces fit together.” –Objective: Give an overview of the planning flow that will ultimately lead to the provision of advice to the CE LHIN Board For Health Service Providers (HSPs) & Other Stakeholders –Need: Enhanced capacity to work across organizational boundaries to identify and implement health system improvements and integration. –Objective: Outline CE LHIN planning & engagement framework and expectations regarding integration decisions; and provide HSPs an opportunity to leverage LHIN planning structures.

6. Objectives of this Presentation (2) For the CE LHIN Board –Establish clear expectations on the processes used to gather local advice such that there is increased confidence that the community has been involved in creating solutions for Board decisions.

7. Context Local Health Integration Act Central East LHIN Framework for Community Engagement and Local Health Planning Central East Integrated Health Service Plan & Work Plan Presupposes future additional context of: LHIN Decision Making Framework Supporting tools and documentation that will provide direction/assistance in planning and proposal development.

8. Commitment to Change and Engagement The Central East LHIN is committed to on-going engagement. Engagement provides an opportunity to unlock and leverage system planning expertise from within the CE LHIN and overcome artificial barriers between providers On-going engagement allows for emerging trends to be identified in support of existing or future LHIN priorities and/or integration decisions. The focus on engagement is on improved access and performance through integration/realignment/establishment of health services. –It is not focussed on internal health service provider matters (i.e., operations) that are the prime responsibility of a health service provider and its board. Accountability for system performance lies ultimately with the CE LHIN board and the local health provider boards. Engagement of planning partnerships does not displace this accountability – only strengthens it.

9. Other LHIN Interests Create Opportunities by through capacity building and/or removing traditional barriers Eliminate gaps in awareness and knowledge (i.e., surprises) and the friction that it creates. Redesign local health system based on cooperation and mutual interests (negotiation) rather than the failed approaches of command and control (provocation).

10. Caveats In addition to CE LHIN priorities, the Minister/Ministry of Health and Long Term Care set provincial priorities through its strategic plan and/or Ministry-LHIN accountability agreements (MLAA). Ministry direction may require the LHIN to implement without a fulsome engagement of local planning partnerships The CE LHIN may be required to exercise its authority at anytime and without consultation in the name of public interest. The CE LHIN Board and health service provider boards will work collaboratively in identifying and negotiating integration opportunities. This is learning process. Adaptations may be necessary.

11. Planning Partnerships 9 Collaboratives 3 Priority Networks Task Groups (5 current) Health Professionals Advisory Committee (TBD) All are guided by a terms of reference outlining purpose and function. All the scenarios presented here are consistent with existing policy, terms of reference, and the requirements of LHIN legislation

12. Planning Partnerships: Functions Example: Collaborative as defined by the Terms of Reference Provide advice on the needs of the population of the Planning and Engagement Zone; Considering the Central East LHIN strategic priorities and objectives, work with healthcare providers, local and regional networks and consumers to identify local service gaps and opportunities for improved coordination and integration of health care services; Review LHIN-wide priorities and objectives against local strengths and gaps in capacity; Identify emerging local health needs and future health care priorities; Advise on opportunities for improved health care efficiencies and cost effectiveness; If requested, assist Central East LHIN staff and local providers in the implementation and monitoring of the Integrated Health Service Plan including assessing progress against action plans, identifying barriers to progress and advising on strategies to overcome barriers; When requested by the Central East LHIN and agreed to by the Collaborative as a whole, serve as a resource to local service providers/agencies in their planning and engagement needs.

13. Health System Planning & Integration The Integrated Health Service Plan (IHSP) sets the priorities and context for the local health system. Development and implementation of the IHSP, as well as addressing emerging system challenges and opportunities will require coordinated efforts of the LHIN, planning partners, and health service providers. –Scenario 1: Development of IHSP and strategic plans –Scenario 2: Identifying emerging local needs and opportunities –Scenario 3: Supporting health service providers and new planning expectations The IHSP and other local priorities will also generate opportunities for integration –Scenario 4: Facilitated or Negotiated Integration Decisions –Scenario 5: Required Integration Decisions –Scenario 6: Stopping Voluntary Integration

14. Supporting Planning

15. Scenario 1: IHSP Action for LHIN-wide implementation LHIN LHIN Priority Network Or Task Group LHIN Collaborative LHIN Health Service Provider LHIN Board Approves IHSP and Work Plan Network/Task Group creates and/or advises on strategy that supports IHSP implementation Collaboratives and/or agencies provide local direction to strategy and advice on implementation back to Network. CE LHIN considers strategy and negotiates implementation through Service Accountability Agreements (SAA) or facilitated integration decision with health service providers (Scenario 4) Health Service Providers implement strategy Denotes potential referral back to LHIN Health Service Provider

16. Scenario 2: Identifying Emerging Local Needs/Opportunities Task Group/Networks Networks / Task Groups LHIN Health Service Provider Collaborative, Network or Task Group identifies system need, service realignment and/or integration opportunity. Notifies and seeks direction from LHIN staff. Reciprocal engagement of relevant CE LHIN planning partners Appropriate engagement of relevant providers Networks/Task Groups/Collaboratives provide advice and findings to the CE LHIN CE LHIN considers advice. May decide to Approve, and negotiate with health service providers through the SAA or negotiated integrated decision (Scenario 4) Consider further engagement and planning or issue a required integration order (Scenarios 1 and 5, respectively) Defer decision Health service providers implement local strategy as outlined in SAA or integration decision. LHIN Collaborative Health Service Provider Denotes potential referral back to LHIN

17. The Transition to LHINs: Supporting HSPs and New Planning Expectations As of April 1, 2007 Health Service Providers are now expected to Align their strategic and service planning within the overall LHIN framework, with specific reference to the priorities identified in the 2006-2010 Integrated Health Service Plan Implement the directions for integration laid out in the accountability agreements with LHINs Demonstrate continuous improvement in service integration, coordination and quality Play a role in informing the community and general public about opportunities for participate in LHIN initiatives Provide the input and necessary information for the development of LHIN plans Participate in LHIN planning exercises (e.g., utilize LHIN community engagement/planning partnerships)

18. Scenario 3: Supporting HSPs and New Planning Expectations LHIN Collaborative LHIN Local health service provider (s) identify to the LHIN Integration opportunity New program / services Local barriers for improved performance Health service provider(s) engage local and LHIN planning partners for expert advice, information and/or support in the development of a business plan Health service providers may plan for voluntary integration (see Scenario 6). Health service provider submits business (with demonstrated engagement of LHIN planning partners) to the LHIN for further consideration. LHIN may implement plan through service accountability agreements (SAA) with service providers, or integration decisions (see below) Health Service Provider (s) Task Group/Networks Denotes potential referral back to LHIN

19. Informing Integration Decisions

20. Facilitated or Negotiated Integration Decisions under 25(2)(a) 25 (2) A local health integration network shall issue an integration decision when the network, (a)facilitates or negotiates the integration of persons or entities where at least one of the persons or entities is a health service provider or the integration of services between health service providers or between a health service provider and a person or entity that is not a health service provider and the parties reach an agreement with respect to that integration; 2(1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity.

21. Scenario 4: Facilitated or Negotiated Integration Decisions under 25(2)(a) LHIN facilitates or negotiates integration involving HSP(s) Health Service Provider(s) (or other) LHIN issues integration decision Presupposes prior negotiation with Ministry of Health and/or engagement of health service provider, other entities and LHIN planning partners. Ministry-LHIN Accountability Agreement Scenarios 1, 2, 3 and/or Board-to-Board Engagement

22. Required Integration Decisions under 25(2)(b) 25 (2)(b) A local health integration network shall issue an integration decision when the network requires a health service provider to proceed with an integration under s. 26; 2 (1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity. Such instances may be a result of government action or policy, or public interest requiring expedited outcomes In all other instances, use of such authority signals a shortcoming by the LHIN in meeting its standards of collaborative planning

23. Scenario 5: Required Integration Decisions under 25(2)(b) LHIN considers any submissions; may change or confirm original integration decision LHIN requires integration by funded HSPs Health Service Provider LHIN issues proposed integration decision LHIN issues final integration decision Within 30 Days No timeframe specified Anyone may make submissions regarding proposed decision, including Task Group/Networks LHIN Collaborative Health Service Provider

24. Integration Decisions that Stop Voluntary Integrations under 25(2)(c) 25 (2)(c) A local health integration network shall issue an integration decision when the network orders a health service provider not to proceed with an integration under s. 27; 2(1) “integration” includes (a) to co-ordinate services and interactions between different persons and entities; (b) to partner with another person or entity in providing services or in operating; (c) to transfer, merge or amalgamate services, operations, persons or entities; (d) to start or cease providing services; (e) to cease to operate or to dissolve or wind up the operations of a person or entity. Use of such authority by the LHIN signals a shortcoming by the health service provider(s) in providing early awareness of the issues and/or health service providers lack of participation in LHIN collaborative planning.

25. Scenario 6: Integration Decisions that Stop Voluntary Integrations under 25(2)(c) HSP gives notice to LHIN that it wishes to integrated funded services LHIN considers HSP notice LHIN does not issue a proposed decision stopping integration LHIN issues proposed decision stopping integration LHIN Considers any submissions; may change or confirm proposed integration decision LHIN does not issue a final decision stopping integration LHIN issues a final decision stopping integration Integration may proceed Integration may NOT proceed Within 60 Days Within 30 days, anyone may make submissions regarding proposed decision, including Task Group/Networks LHIN Collaborative Health Service Provider Within 30 Days See Scenario 3 for generation of such opportunities

26. Together, we will deliver change! The costs of competition are greater than…. …the costs of cooperation!

27. N = Network!! Identifying and implementing change is our collective responsibility Your LHIN is committed to removing the barriers that keep all of us from working and achieving together (that is, acting as a Network). To do so requires a plan and a commitment to building capacity for integration and cooperation across the system.

28. Look Around You – Feel Empowered! You are members of new teams with new mandates! Collectively, your talent and motivation is unparalleled! Replace self-doubt and permission-seeking with confidence and courage! Forget perfection – you are it!

29. Together, we are unstoppable!