Haliburton Highlands Health Services – Update on HHHS Integration Journey

May 2015

Agenda

1. Integration Journey – Phase 1 (Planning)

2. Integration Journey – Phase 2 (Transition / Implementation)

3. Integration Journey – Phase 3 (Longer Term / Future)

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Phase 1: CE LHIN Community Health Services Integration Strategy (2012)

Cluster-based service delivery model through integration of front-line services, back office functions, leadership and/or governance to:

improve client access to high-quality services, create readiness for future health system transformation make the best use of the public’s investment

Hospitals were included in the Northumberland County and Haliburton County/City of Kawartha Lakes planning processes 4

Phase 1: Haliburton / Kawartha Lakes Integration Planning Organizations

• Community Care City of Kawartha Lakes

• SIRCH Community Services• Community Care Haliburton

County

• Victorian Order of Nurses, Ontario Branch

• Ross Memorial Hospital • Haliburton Highlands

Health Services

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Phase 1: Integration Planning – Haliburton County /Kawartha Lakes January 2013: Integration Planning Team (IPT) formed to include Executive

Directors of CE LHIN-funded health services organizations in Haliburton County and City of Kawartha Lakes• Mandate to develop an integration plan

January – May 2013: Weekly meetings of IPT• Commissioned literature review of rural health models• Determined decision-making criteria to evaluate models• Evaluated models from status quo to single organization across the two communities• Recommended model to include two health services providers in Kawartha Lakes and

“one entity” in Haliburton County June – July 2013: Community consultations with other health services agencies

(EMS, CMHA, Ontario Shores, CCAC, FHTs) and general public/clients September 2013: Finalized draft Integration Plan October – November 2013: All Boards approve Integration Plan December 2013: Haliburton County / Kawartha Lakes Health Services

Integration Plan was presented and approved by the CE LHIN Board 6

Current State – Future State

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Phase 1: Integration Recommendations

Haliburton County Voluntary merger between Community Care Haliburton County

and Haliburton Highlands Health Services “One Entity” to deliver hospice/palliative services provided by

SIRCH and Adult Day Program services provided by VON. Accountability for coordinating Foot Care services would also be

transferred from VON to the “One Entity”. SIRCH and VON would continue to exist as ongoing agencies,

with their own boards, programs and services, but would no longer have an Accountability Agreement with the CE LHIN

Volunteer Co-ordination – SIRCH would investigate piloting a new model (Volunteer Match) that could be used by the “One Entity” in Haliburton County to recruit, screen, orient and train volunteers 8

Phase 1: Strategic Alliance between Ross Memorial Hospital and Haliburton Highlands Health Services

Established to facilitate existing and future shared services opportunities, including:• Laboratory Services • Medical Device Reprocessing• Medical Records Transcription • Shared Information Technology Department • Inventory Management System and Procurement • Pharmacy Services • Mental Health Leadership • Cardiac Rehabilitation • Diagnostic Imaging Management• Document Management System for Policies and Procedures

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Phase 1: Benefits of “One Entity” in Haliburton County Local autonomy and local management over Haliburton

County health services Potential cost savings for reinvestment Local residents would not have to go through as many

“doors” and would have access to a broad range of services Improved continuum of care Streamlined volunteer opportunities for local residents

who want to support their local health care organization More opportunities for staff in a larger organization “One voice” with an understanding of the health needs of

the residents of Haliburton County to advocate for/apply for new funding 10

Phase 2: Transition Planning for Haliburton County January 2014: Discussions began between Community Care Haliburton County and

HHHS related to their amalgamation and more specifically about the governance structure for the amalgamated organization with decision to have HHHS be the “one entity organization

February 2014: Transition Team, with executive representation from HHHS, CCHC, SIRCH and VON, was formed to begin planning for the implementation of the Integration Plan in Haliburton County (weekly meetings) Integration transition project plan developed by Transition Team to address:

• Governance, • Communication• Human Resources• Volunteers• Clients• Finances/Budget and Fundraising • Facilities

April 2014: Directional Plan approved by all Boards May 2014: Transition Plan complete with October 1, 2014 set and approved as

Transition Date June 2014: Central East LHIN Board approved Transition Plan July – September 2014: Continued focus on project tasks leading to Transition Date October 1, 2014: Staff, volunteers, clients, programs, funding and accountability

agreements transferred to HHHS

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Minden Hospital / Hyland Crest Long-Term Care Home

Haliburton Hospital / Highland Wood Long-Term Care Home

Community Support Services

SupportiveHousing Offices:

Haliburton, Minden, Wilberforce

What we have become…

Mental Health Services

Phase 2: Governance Plan Although the Integration Plan called for the formation of a new

Health Services Entity for Haliburton County, discussions were initiated with Community Care and HHHS since the governance of only these organizations were to be impacted

The two Boards agreed that the new “One Entity” would be HHHS and Community Care Haliburton County would wind-down as a corporation following the transfer of the community services on October 1, 2014

To facilitate implementation of the Governance Plan, vacancies on the HHHS Board were held for Community Care Board members who wanted to move to the HHHS Board and would do so as of the HHHS Annual General Meeting on June 26th, 2014

Recommended development of Community Advisory Committee to give a “Voice” to community support services providers and clients

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Phase 2: Governance Progress June 2014: HHHS Board (including nominated Directors from the Community

Care Board) held a Strategic Planning session, as part of the process to develop a new Plan, to determine HHHS priorities for 2014/17

August 2014: Full-day Board orientation session held for all HHHS Board, including the new Directors from the Community Care Board, with an agenda to educate all about HHHS services and the new transferred services:• HHHS Governance – Model, Committee Structure, Policies• CE LHIN / Ministry of Health and Long-Term Care – Mandates, Priorities,

Relationship to HHHS, Capital Process, Governing Legislation• Financial Management – Budgeting, Reporting, Financial Statements, Capital

Budgets• Overview of Hospital Services – ED, Acute and Palliative Care, Physiotherapy, OTN• Overview of Long-Term Care Services – Hyland Crest, Highland Wood• Overview of Community Services – Supportive Housing, Diabetes Education,

Community Support Services, Hospice, Adult Day Programs, Mental Health Services• HHHS Partners – Ross Memorial Hospital, Family Health Team, CCAC, EMSNote: The afternoon of the Board Orientation day was a follow-up session for Strategic Planning to present the draft Strategic Plan (and then a social at a Board member’s cottage since we are located in cottage country)

September 2014: Strategic Plan 2014-2017 was approved

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Phase 2: Governance ProgressStrategic Plan 2014-2017

15Compassion • Accountability • Integrity •

Respect

Health SystemIntegration

Leaders in Innovative

Rural Health Care

CommunityEngagement

Sustainability

EffectivePeople and

Teams

Quality and Service

Excellence

Phase 2: Governance Lessons Learned Local autonomy and local management over Haliburton County Health services

(versus governance and management from Kawartha Lakes) was important for the all Haliburton County Boards, so it became a common rallying point• Development of a Strategic Alliance and operational integration initiatives between Ross

Memorial Hospital and HHHS was supported by the HHHS Board because it did not impact on local autonomy

Recognition that HHHS was perceived as the large hospital with a medical culture that would swallow up the small community agencies in Haliburton County, so bent over backwards to be respectful of the differences of approach to governance and accommodating to the input of the smaller community agencies throughout integration

Bringing on members from the Community Care Board to the HHHS Board facilitated the transition of services

Full Board orientation was important to educate HHHS Board members about the community services being transferred into the organization, as well as for the new members from Community Care about HHHS services

The creation of the Community Advisory Committee as a sub-committee of the Board was perceived favorably by community agencies and the public

Ongoing support to CEO and leadership team regarding integration

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Phase 2: Integration Lessons Learned Leadership: critical to success; need positivity, commitment, persistence and focus

on what is best for community from the Board(s) and executives

Project Management Resources: should include dedicated project management support, if possible, rather than adding stress to operational responsibilities of CEO and Management Team

Communication/Community Engagement: should be done regularly and consistently (never enough) with all internal and external stakeholders who would be directly impacted as well as general public, using a detailed Communication Plan

Change Management: integration is not easy and one must not underestimate organizational anxiety and upheavals that may result, including staff/management departures; so need to have a comprehensive change management plan that includes significant communication, education

LHIN Direction and Support: strong and ongoing support is needed from the LHIN to initiate and facilitate integration planning, including providing additional resources if required

Integration Has Benefits: alignment to LHIN / Provincial strategies yields organizational benefits; for example, Community Services Enhancements and funding

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Phase 3: Long Term / Future Planning The 2014/2017 Strategic Plan highlights Health System Integration as one of five

strategic directions for HHHS over the next several years to build on the community services integration

HHHS will strive to further develop as a comprehensive Rural Health Hub over the next several years to become the model for the Province

HHHS will leverage its integrated organizational structure and continue to improve quality and enhance the range of services to meet the needs of full-time and seasonal residents and visitors of Haliburton County

HHHS has set an objective to develop a Master Program and Master Plan for the next 5-10-15 year timeframe to meet the needs of a proportionately large and growing seniors population that has higher than average complex health issues• Master Program will define what programs and services will be required to meet the

future health needs• Master Plan will determine what facilities, including alterations, additions and

rationalization across sites, may be required to carry out the Master Program Discussions have been initiated with the Board and local municipal leaders about

Master Programming and Master Planning The CE LHIN has been approached to support Phase 3 of our integration journey

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Leaders in Innovative Rural Health Care

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Questions

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