1. New Expectations, New Possibilities: Creating an Integrated Health System June 5 th, 2007

2. Overview alignmentvisionreviewintegrationaccountability leadership for change

3. alignmentvision reviewintegrationaccountability leadership for change

4. What we Have Done Extensive community engagement across the region Establishment of planning partnerships Detailed feedback and data collection to validate directions Integrated Health Service Plan IHSP work plan New investments and projects launched LHIN Board and organizational developmental start-up April 1 transition to LHINs alignmentvisionreview integrationaccountability leadership for change

5. LHINs New Expectations Health Service Providers 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 Participate in LHIN planning exercises and provide the input and necessary information for the development of LHIN plans Identify integration opportunities and demonstrate continuous improvement in service integration, coordination and quality Implement the directions for integration laid out in the accountability agreements with LHINs alignmentvisionreview integrationaccountability leadership for change

6. 5 main areas where the public can expect change: 1.Increased integration and improved service coordination 2.Increased local decision-making about funding and allocation 3.Greater emphasis on local health system planning 4.Increased community engagement 5.Enhanced Accountability alignmentvisionreview integrationaccountability leadership for change

7. Alignment to the Integrated Health Service Planalignment visionreviewintegrationaccountability leadership for change

8. Central East LHIN New Investmentsalignment visionreviewintegrationaccountability leadership for change $1.35M for Geriatric Emergency Management $1.5M for ICU in Rouge Valley Ajax-Pickering $.9M for Musculoskeletal Assessment Centre $.6M to increase home care & community supports

9. Criteria for Integration Innovations and Proposals 1.Was it vetted by LHIN Planning Partners? 2.Is it aligned with the IHSP? 3.Is it evidence-based and can it be measured & monitored? 4.Who shares accountability for its accomplishment? 5.How will it be resourced?alignment visionreviewintegrationaccountability leadership for change

10. Our Commitment to Leading Change Through Engagement We will promote and reward a culture of cooperation and mutual interests (negotiation) rather than the failed approaches of command and control (provocation). Engagement will happen at all levels from governance to front lines to community residents Because…. Engagement unlocks and leverages system planning expertise to create real solutions Provides a means for emerging trends to be identified Involvement stimulates ownership and responsibility for results! alignmentvisionreviewintegrationaccountability leadership for change

11. alignmentvisionreviewintegrationaccountability leadership for change LHIN Strategic LHIN Tactical LHIN Community Networks Mental health and addictions / Seamless Care for Seniors / Chronic Disease Prevention and Management Alternative Levels of Care Emergency Department Wait Times Task Groups Rehabilitation Services / E-Health Primary Care Working Group 9 Planning and Engagement CollaborativesCollaboratives Central East LHIN Planning Partnerships Local residents, seniors, family members, physicians, nurses, pharmacists, physiotherapists, administrators, and other health professionals are working together!

12. Governance for System Change The Central East LHIN Board has identified the engagement of local health care governance as a top priority. “Board to Board” engagement will focus on bringing together governance leaders within health service providers and the LHIN to for information sharing and strategic planning It is expected that health service providers will engage each other in the efforts to meet local need A governance steering committee will be established in the Fall of 2007 that will examine ways to equitably and effectively engage local governance alignmentvisionreviewintegrationaccountability leadership for change

13. “Integration” as defined through Legislation 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. alignmentvisionreviewintegration accountability leadership for change

14. In simple language… Health system experienced as a coordinated system: People will get the right treatment at the right time by the right provider Seamless flow of information that supports patient care A system that begins with primary care providers with an equal focus on prevention and health maintenance Create timely access to quality services by aligning people, processes and resources Elimination of wasteful and time consuming duplication Involvement of patients, residents, family and informal caregivers alignmentvisionreviewintegration accountability leadership for change

15. Making Integration Happen Requires coordinated efforts of the LHIN and health service providers. LHIN Planning Partnerships are a resource to the LHIN and its health service providers alignmentvisionreviewintegration accountability leadership for change

16. Example: Supporting Health Service Provider Planning LHIN Collaborative Central East 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 LHIN planning partners for expert advice and information in support of meeting local needs, advancing new ideas, or in the preparation of business plans May also involved governance to governance engagement Health service provider(s) submit business plans or ideas (with demonstrated engagement of LHIN planning partners) to the LHIN for further consideration. Health Service Provider (s) Task Group/Networks Denotes potential referral back to LHIN alignmentvisionreviewintegration accountability leadership for change Governance Advisory Bodies (TBD) LHIN may implement through service accountability agreements (SAA) with service providers or integration decisions.

17. Opportunities for Integration & Integration Decisions Facilitated or Negotiated Integration Decisions Required Integration Decisions Stopping Voluntary Integration alignmentvisionreviewintegration accountability leadership for change

18. Example: Facilitated or Negotiated Integration Decisions under 25(2)(a) LHIN facilitates or negotiates integration involving HSP(s) Health Service Provider(s) implement LHIN issues integration decision Presupposes prior negotiation with Ministry of Health and/or engagement of health service providers, other entities and LHIN planning partners. Ministry-LHIN Accountability Agreement Use of Planning Partnerships Board-to-Board Engagement alignmentvisionreviewintegration accountability leadership for change

19. Example: Required Integration Decisions 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; 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 alignmentvisionreviewintegration accountability leadership for change

20. 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 alignmentvisionreviewintegration accountability leadership for change

21. Example: Integration Decisions that Stop Voluntary Integrations 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; 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. alignmentvisionreviewintegration accountability leadership for change

22. Example: Integration Decisions that Stop Voluntary Integrations 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 alignmentvisionreviewintegration accountability leadership for change

23. A Focus on Accountability People have the right to expect accountability from their governments –To that end, Central East LHIN has entered into an accountability agreement with MoHLTC That sets out the mutual understandings and performance obligations of both parties in the period from April 1, 2007 to March 31, 2010 The public also have the right to expect that their health service providers will be accountable for the quality of services they provide –To that end, part of CE LHIN mandate is to negotiate Service Accountability Agreements (SAAs) with health service providers alignmentvisionreviewintegrationaccountability leadership for change

24. The Purpose of the Planning to Action Symposium June 6-7, 2006 Network and celebrate champions for change: Networks, Collaboratives and Task Groups Create capacity of system to plan, coordinate and innovate across organizations Align planning partnerships to specific tasks outlined in the Integrated Health Service Plan alignmentvisionreviewintegrationaccountability leadership for change

25. 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 New challenges and opportunities for health system governance alignmentvisionreviewintegrationaccountability leadership for change

26. Confidence Abounds! alignmentvisionreviewintegrationaccountability leadership for change Thank You!