Working Together to Dramatically Improve the Patient Experience

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Working Together to Dramatically Improve the
Patient Experience
Presentation to the Canadian Assistive Devices
Association Susan Gibson, Advisor, Access to
Care Hamilton Niagara Haldimand Brant Local
Health Integration Network September 18, 2014
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Vision A health care system that helps keep
people healthy, gets them good care when they
are sick, and will be there for our children
and grandchildren."
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What is a LHIN?

• Local Health Integration Network
• Created by the Ontario government in March 2006
• 14 not-for-profit corporations that work with
  local health providers and community members to
  determine the health service priorities for their
  regions
• Local Health Integration Networks (LHINs) plan,
  integrate, and fund local health services,
  improving access and the patient experience

HNHB LHIN
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LHINs

• Erie St. Clair
• SouthWest
• Waterloo Wellington
• Hamilton Niagara Haldimand Brant
• Central West
• Mississuaga Halton
• Toronto Central

• Central
• Central East
• South East
• Champlain
• North Simcoe Muskoka
• North East
• North West

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Snapshot of HNHB LHIN

• 6,500 km2
• 1.4 million people
• Brant, Burlington, Haldimand, Hamilton, Niagara,
  most of Norfolk
• Most seniors of any LHIN (230,000)
• Compared to Ontario, HNHB LHIN has higher rates
  of
• Smoking, drinking, obesity
• Premature death hospitalization

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Environmental Scan

• HNHB LHIN has lower population growth but the
  largest number of seniors
• HNHB residents are not as healthy as other
  Ontarians on many measures - most disturbing of
  these is the higher mortality rate and higher
  number of potential life years lost
• Age standardized data shows some utilization
  rates (cardiac bypass, hip and knee replacements,
  hysterectomy) above the provincial average.
• There is a higher prevalence of poor life style
  choices as shown by higher daily or occasional
  smoking, heavy drinking, and obesity (in adults)
  in the HNHB LHIN
• Higher rates of chronic conditions including
  arthritis, high blood pressure and asthma
  compared to Ontario rates

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Health Service Providers in HNHB LHIN

• HNHB LHIN allocates 2.8 billion to the 234
  health service providers
• HNHB LHIN operational budget is 5 million
• This means that the LHIN allocates 99.8 of all
  funding received to our health service providers

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Accountability
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Strategic Health System Plan

• Strategic Aim
• Dramatically improving the patient experience
  through Quality, Integration and Value.
• Strategic Directions

Quality Integration Value
Dramatically improving the patient experience by embedding a culture of quality throughout the system Dramatically improving the patient experience by integrating service delivery Dramatically improving the patient experience by evolving the role of the LHIN to become a health system commissioner
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Strategic Direction 1Dramatically improving
the patient experience by embedding a Culture of
Quality
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Creating a Quality System
Everything is Quality and Quality is Everything

• Common LHIN-wide philosophy and approach to
  quality
• Reduce variation, increase standardization
• Drive quality, drive outcomes, drive value for
  money
• LHIN to provide leadership to
• Achieve better outcomes for their communities
  lives saved, quality of life improved and
  disability decreased
• Ensure a better experience for the people it
  serves.
• Reduce disparities in quality measures across
  different groups in HNHBs communities
• LHIN will work with provincial partners both at
  the Ministry of Health and Long -Term Care and at
  Health Quality Ontario to achieve these goals

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Strategic Direction 2Dramatically improving
the patient experience by Integrating Service
Delivery
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Integration Health Links

• A new practice of care where ALL providers in a
  community, including primary care, hospital,
  long-term and community care come together to
  create a plan for future care at the patient
  level
• Each Health Link will
• Be led by those that live in the Health Links
  area
• Base programs on the needs and preferences of
  local residents
• Focus on the patient and their family through
  coordinated planning specific to each persons
  needs and preferences
• Build services and programs around patients the
  right care, at the right time, in the right place

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The Relatively Few People with Complex Health
Problems Account for the Majority of our Health
Expenditures
5 of the population accounts for 66 of
health care spending
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The Top One Per Cent

• Heart failure
• Chronic obstructive pulmonary disease (emphysema)
  
• Myocardial infarction
• Pneumonia and urinary tract infections
• Stroke
• Hip fracture
• Cancer
• End of life care

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Strategic Direction 2Dramatically improving
the patient experience by Integrating Service
Delivery
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LHIN-wide Integrated Programs
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LHIN-wide Integrated ProgramsWhat are we Trying
to Fix?

• Unequal access to/availability of services (gaps)
• Long wait times for some surgery and diagnostic
  procedures
• Inefficient use of resources (duplication)
• Variation in the care delivery model
• Variation in quality and outcomes
• Unnecessary ED visits and admissions/readmissions
  

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LHIN-wide Integrated ProgramsWhat are we Trying
to Achieve?

• Key concept one clinical program multiple
  sites
• Goal improved clinical processes and outcome
  consistency
• All residents across the LHIN should have access
  to a coordinated program, with
• same approach to care delivery
• same quality standards
• System management of system level indicators
  Ministry-LHIN Performance Agreement (MLPA)

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Hospital Emergency Departments (EDs)

• Hospital EDs are the door to urgent/emergent
  hospital and ED services
• The number of admissions to the hospital through
  the ED is increasing
• LHIN considers metrics to evaluate hospital ED
  performance two key metrics in LHIN
  Accountability Agreement with hospital
• The number of people waiting in a hospital bed
  for an alternate level of care (ALC rate)
• Time people wait in the ED for admission to an
  inpatient bed
• The volume of ED visits and the number of people
  waiting in the ED for admission to an inpatient
  bed is a pressure for ED staff which can impact
  timely acceptance of admissions by ambulance

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Were Reducing ER Demand

• Community Referrals by EMS --Paramedics observe
  clients in their home environment, and where
  appropriate, refer the client to CCAC.
• Early Intervention Screening Tool pilot in
  community (family physicians) and two emergency
  departments to screen seniors aged 75 to prevent
  functional decline by referring them to CCAC for
  follow-up.
• Nurse Lead Outreach Team visit Long-Term Care
  homes to provide primary care assessments and
  treatments to residents and avoid transfer to the
  ER.
• Rapid Response Transition Team Nurses who
  facilitate hospital discharges, prevent
  readmission and prevent or delay admission to
  long-term care homes.

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Strategic Direction 3Dramatically improving
the Patient Experience by evolving the role of
the LHIN to become Health System Commissioners
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Commissioning in the HNHB LHIN

• A complex process with responsibilities ranging
  from
• Assessing population needs
• Prioritizing health outcomes
• Procuring products and services and
• Holding health service providers accountable 

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Measuring our Health System Improvements
Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators Key Performance Indicators
Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System Embedding a Culture of Quality Throughout the System
Patients state I receive the care I need when I need it. Patients state I receive the care I need when I need it. Reduction in variation Reduction in variation Improved care transitions Improved care transitions Staff ability to impact system Staff ability to impact system Culture of quality
Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery Integrating Service Delivery
Common Vision Philosophy of Care Increased use and access to community services Increased use and access to community services Increased use and access to community services Increased use and access to community services Reduced costs/wait times Reduced costs/wait times Improved percentage of funding directed to direct care activities Improved percentage of funding directed to direct care activities
Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners Becoming Health System Commissioners
Governance management capacity developed Governance management capacity developed Governance management capacity developed Mechanisms measures for meaningful provider and community engagement Mechanisms measures for meaningful provider and community engagement Mechanisms measures for meaningful provider and community engagement Mechanisms measures for meaningful provider and community engagement Residents state We have confidence in our health care system. Residents state We have confidence in our health care system.
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Thank you! Hamilton Niagara Haldimand Brant
Local Health Integration Network 264 Main Street
East Grimsby, ON L3M 1P8 [phone]
[phone] www.hnhblhin.on.ca
Email hamiltonniagarahaldimandbrant_at_lhins.on.ca
www.hnhblhin.on.ca