Excellent Care for All. Camille Orridge Chief Executive Officer

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1 Planning for Diversity A Key Pillar in the Quest for Excellent Care for All Camille Orridge Chief Executive Officer Toronto Central CCAC 1

2 Excellent Care for All Act The Excellent Care for All Act puts patients first by improving the quality and value of the patient experience through h the application of evidence-based d health care. It will improve health care while ensuring that the system we rely on today is there for future generations - Ministry of Health and Long-Term Care 2

3 Government Commitment to Quality and Accountability of the Health Care System Excellent Care for All Act requires health care providers to Report critical incidents id in a timely manner Create quality committees to report to Boards on quality related issues Develop and post annual quality improvement plans Link executive compensation to achievement of quality plan performance improvement targets Implement client and employee satisfaction surveys and patient complaints process

4 Diversity and Equity are Pillars of Excellent Care for All Age Gender Place of origin Sexual Orientation Religion Income 4

5 Equality Equity Excellent Care means that when both people enter the hospital, one can take the stairs and the other can take the ramp to get care 5

6 Toronto Central LHIN Diversity Toronto is recognized as one of the world s most ethno-racially diverse cities 42% of population comprised of immigrants and visible minorities from 169 countries Higher proportion of immigrants and visible minorities relative to the rest of the Province 51.5% do not speak English or French as first language g 170 languages spoken in Toronto 12% of population are new immigrants 6

7 Toronto Central LHIN Diversity Torontonians belong to over 40 religious denominations, sects and groups Highest rates of low income and single parent families 20% of children live below poverty line 36% of Toronto households have low incomes 40% of homeless in Ontario live in Toronto Largest gay population in Canada TB rate is triple (3.1 times) the provincial average HIV/AIDS rate 11.3 times higher than Ontario average Highest rates of completed post-secondary education and some of the wealthiest Canadians live in Toronto 7

8 North West LHIN Diversity The North Western Ontario has a much higher percentage of Aboriginal population % compared to the provincial average of 1.7% The area has a lower percentage of immigrants and visible minorities than the province The Francophone population 4.1% - similar to the province at 4.7% Unemployment rates are higher in the North West, coupled with lower percentages of post secondary education in the population Health status, life expectancy at birth in the North West is the lowest in the province A higher prevalence of many poor health practices e.g. smoking, drinking, overweight/obesity Has a lower proportion of the population self-rating their health as excellent or good. 8

9 Laying the Foundation For Diversity Toronto Central CCAC Experience Then.1986 Now % female 60% female 40% male 99% nursing experience Small range of languages social work, physiotherapy, occupational therapy 39 languages 9

10 Laying the Foundation for Diversity it Toronto Central CCAC Experience We have an overarching statement/ value proposition: Valuing Diversity in the Workplace Definition and objective of equity Develop Cultural Competence We hire to reflect the community we serve Lay the foundation for future hiring through partnerships Engage other partners to serve populations we are not equipped to serve Build capacity in the community through employment and education 10

11 Toronto Central CCAC Experience Building Cultural Competence Mandatory Training A one-day workshop for all employees Added specific leadership training Managing a Diverse Workforce Incorporated into orientation with refresher series every 2 years Hold Lunch n Learns focused on persons with disabilities, LGBT Community Highlight ht cultural/religious l/ li i holidays in our weekly newsletter Care Coordinators have access to tools to support them in working with diverse populations (e.g. TTY, translation services) 11

12 Excellent care for all means everyone gets care 12

13 The Case for a Model of Care Focused on Diverse Populations A growing disconnect between how we were organized and our goals for clients and caregivers Understanding our value and role in the system Value for money are we making a difference? Difficult to support the care needs of diverse populations with a generic model Difficult to develop effective partnerships with a generic model Sustaining quality improvement initiatives Organization and culture Involving our clients in service design 13

14 How We Approach Care With an Urban Health Population 14

15 Delivering Excellent Care to an Urban Population Barriers to Care No primary care practitioner or routine health maintenance checks Issues with treatment compliance: Don t always take medications or follow prescribed treatment plans Do not always return to follow-up visits or appointments Many seniors experiencing homelessness have been denied admission to long-term care because of difficult behaviours (i.e., smoking, substance use, aggression, etc) 15

16 Integrated Approach to Care No single agency can serve complex health/social needs of homeless population Integrated team approach to health/social services helps address complex needs The Inner City Access Program pilot project demonstrating new multi-partner service delivery model Inter-professional care teams bring health care and supportive housing services to marginalized seniors living in three shelter and alternative housing sites 16

17 The Partners Toronto Central CCAC Shelters and alternative housing sites: Fred Victor Centre Women s Residence Homes First Society Inner City Health Associates (ICHA) St. Elizabeth Health Care City of Toronto Shelter, Support and Housing Administration 17

18 The Interdisciplinary Team Integrated team meets regularly to support assessment, care planning and monitoring: Family Physician and Psychiatrist Shelter/Alternative Housing Staff Dedicated CCAC Care Coordinator Dedicated Nursing and Personal Support Staff Provides consistent care for those who have difficulty establishing trusting relationships 18

19 What our Partners Say: Case Management by tick-box does not work with our clients. Traditionally we have trouble treating them because they will not show up for their appointments. The ICAP program provides a consistency and familiarity for our clients that makes them feel supported. We have seen a huge improvement in the follow-through. Susan Harris from Women s Residence Susan from the City of Toronto (Women s Residence ICAP Site) 19

20 What Our Partners Say: There is good communication between all the team members: the PSW, the nurse and the psychiatrist from our hospital program. Our clients can make a connection to the entire healthcare system now. Getting the right people in the right roles has improved the lives of many of our clients. Because there is dedicated staff, we are not under the same pressures as the regular CCAC services. Our Care Coordinator advocates for the needs of the clients, regardless of who funds them. The staff at the Shelter are happier because the entire burden does not fall on them. We work as a team to treat the whole person. 20

21 Outcomes Increased access to health and support services Linkages to other community health and social supports Improved client satisfaction Avoid hospitalization and reduced ER visits Delayed need for LTC application/admission 21

22 Toronto Central CCAC Populations and Annual Clients Served Information & Referral Services Helping callers find their way & supporting CCR hits for information Community Independence Connecting seniors to care & supporting them to remain independent in the community Hospital Transitions Supporting patients to safely transition from hospital Adult Supportive Care Supporting 1100 adults & their caregivers to manage their long term conditions Child and Family Helping 5000 kids get the right support in schools; 382 children who have complex medical needs & 1000 children with post acute & rehab needs Urban Health Helping1200 marginalized clients with mental health issues, or homeless to access services & be supported dto live in their community Seniors Enhanced Care Intensive support to 6400 seniors & their caregivers so that they can remain at home with dignityit Palliative Care Supporting 1600 clients to die at home with dignity Acute & Rehab Care Providing 13,000 clients with post acute & rehab care 22

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