Erie St. Clair Community Care Access Centre Response to Patient First: A Proposal to Strengthen Patient-Centred Health Care in Ontario

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1 Erie St. Clair Community Care Access Centre Response to Patient First: A Proposal to Strengthen Patient-Centred Health Care in Ontario BACKGROUND AND INTRODUCTION The Erie St. Clair CCAC, comprised of the Chatham-Kent, Sarnia-Lambton and Windsor-Essex geographies is pleased to respond to the Ministry of Health and Long Term Care s Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. The Ministry s proposal dated December 2015 includes four areas of focus to reduce gaps and create a more consistent, integrated care experience for patients: 1. Strengthen the role of Local Health Integration Networks (LHINs) to drive more effective integration services and greater equity; 2. Timely access to primary care, and seamless links between primary care and other services; 3. More consistent and accessible home and community care; and 4. Stronger links between population and public health and other health services. The Erie St. Clair CCAC defines itself as a Partner of Choice. To that end, the CCAC envisions being an engaged stakeholder in the creation of a more integrated system for patients and families. Therefore, the Erie St. Clair CCAC response focuses on opportunities presented with the proposed changes to the governance and delivery of home and community care within an integrated health system. True transformation is required to successfully implement this vision. The transition should result in a balance in health care across Ontario... an Ontario where the patient interests are the top priority, where the health system universally has access to patient records and where efficiency is achieved in health care services. Erie St. Clair Board Member Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 1 of 6

2 PATIENT AND FAMILY CENTRED CARE Recommendation 1: Embrace and Expand Patient & Family Centred Care It is recommended that the Ministry ensure the adoption of Patient & Family Centred Care as a provincial framework and that consideration be given to leveraging current relationships with Patient Advisors of existing organizations. The Erie St. Clair CCAC has established itself as a leader in Patient & Family Centred Care within the home and community sector. As the first CCAC or home care organization in Canada to join and take the pledge of the Institute for Patient & Family Centred Care, this organization has transformed the way it does business. The Erie St. Clair CCAC involves patients and caregivers in every facet of the organization from hiring new staff through setting policy to educating Personal Support Worker students in the College system. This CCAC s exceptional performance in patient satisfaction and wait times may be in part attributed to this approach. The over 40 Patient Advisors associated with the Erie St. Clair CCAC have expressed a desire to contribute their knowledge and wisdom to the broader sector. We want to be involved. Let us help. Erie St. Clair CCAC Patient Advisor Ensure patients and their families are at the centre of the decisions being made. Erie St. Clair CCAC Staff Member To ensure the most effective patient engagement and to ensure that individuals are not being approached by multiple organizations within a LHIN or sub-lhin geography, it is recommended that the Ministry give consideration to a provincial framework and approach to Patient & Family Centred Care. Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 2 of 6

3 EQUITABLE CARE AND SERVICE ACROSS THE PROVINCE Recommendation 2: Identify Critical Path & Success Factors to Create Equity in Access It is recommended that the Ministry consider a work-plan that sequences and links critical elements that will contribute to establishing equitable home and community care for Ontarians: 1. Identify a Levels of Care Framework for Home and Community Care, which may in fact be very different from those levels that are currently funded; 2. Conduct a comprehensive Community Capacity Assessment in each geographic area leveraging the 2014 Windsor Essex Community Capacity Plan to better understand how well existing services match those identified in the Levels of Care Framework; and 3. Determine how best to fill the gaps, if any, between the commitment to Ontarians and the level of service currently available. This should include addressing any funding inequities that exist across the Province. Equitable access to home and community care across the Province is an important principle of the proposed transformation. In the past year, the residents of Erie St. Clair have expressed the need to better understand how decisions are made in resource allocation and service planning. While the Patients First: A Roadmap to Strengthen Home and Community Care lays out a number of inter-related strategies designed to improve the system and demonstrate transparency, a careful sequencing of the components is essential to achieve this equity. It should be noted that the Erie St. Clair LHIN completed a Community Capacity Plan for Windsor Essex in The work of this document may serve as a guide for the other sub-geographies. It is important that the Community Capacity Plan(s) should be prepared through the transition period to inform any integration. This broader view of the various initiatives becomes even more important within the context of presumed disruption and distraction as the structure of the system itself is transformed. During this transformation, services need to be consistent as possible, as too many changes at once may confuse and overwhelm the patient. Communication and collaboration across the health care sector. With the lack of team work, patients are being told different things from the hospital, to primary care to the CCAC. The challenge will be to educate, empower and bring these partners together to meet the health care needs of our patients. It is important to note that funding equity, or more specifically the lack of it, is the primary factor that creates variability in access to home and community care from one LHIN area to the next. In the absence of funding equity, patients experience varying thresholds for immediate access to care, varying wait times, as well as widely variable levels of service. Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 3 of 6

4 CONSISTENCY AND CONTINUITY ACROSS THE PROVINCE Recommendation 3: Adopt a Consistent Approach to the Transformation It is recommended that the Ministry create and resource a centralized process to plan and oversee the implementation of the transformation with the appropriate skills, knowledge and experience at both the provincial and local levels to ensure success. In the various documents published by the Ministry regarding home and community care over the past year, the theme of consistency figures prominently. It is important that the proposed transformation unfold in a consistent manner across the Province. With each component of the new organization (LHINs, CCACs, Public Health and Primary Care) the complexity for the governors, leaders and staff has the probability of compounding exponentially. Every community currently has a different basket of services available through a variety of providers. It is to be expected that there will continue to be some local variability in the delivery of care and service. This does not negate the need for a consistent planning framework across the Province. It is essential that those who know the system well be involved in the creation of that plan: existing system governors, leaders and providers from across the sectors. Only in this way can the Ministry make commitments to Ontarians regarding what they may expect at the local level regardless of where they live. Create a model to ensure there is consistency of services across the community and an opportunity to enhance communication across system partners. Understand the specific needs of our patients within each region CONTRACT MANAGEMENT Recommendation 4: Modernize contract model for home care services It is recommended that the Ministry give priority to streamlining the current contracting model to allow the new organization to be successful in its mandate as the single point of accountability for home and community care. Ontario s publicly-funded home and community care system is made up of many agencies with complex purchasing models. These complexities contribute to provincial variability in how care is delivered, in the cost to administer care and in the quality of care received. The Erie St. Clair CCAC supports the OACCAC s recommendation that priority must be given to streamlining and modernizing the current contracting model for home care services. Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 4 of 6

5 RECOGNIZE THE STRENGTHS OF THE CURRENT SYSTEM Recommendation 5: Retain and leverage strong components of the existing system It is recommended that in the transformation process, an assessment of current programs and services be conducted to identify that programs and approaches to care that contribute to the quality of patient care be retained. The Erie St. Clair CCAC understands the need for change and will embrace an aspirational vision for a new system. One staff member said it best in that they are Hopeful this proposal will produce action and build transparency and trust between the patients and health care providers. It is important to recognize that there are many strengths in the current system that should be both celebrated and maintained. These include: CCACs are the only health service providers that have a fully operational electronic patient record. The Client Health Related Information System (CHRIS) is a provincial ehealth asset that is used to support clinical assessment, care planning, service delivery and payment management for all CCAC patients and service providers. CCACs have led the adoption of innovative service models and technology enablers such as eshift or telehomecare which allow more patients to be cost effectively served. Primary care strategies such as the innovative Clinical Care Coordinator in Erie St. Clair provide an opportunity to bring together the skills of the Rapid Response Nurse with the Care Coordinator to respond to the health links population in a very different way. CCAC Clinics offer a cost effective approach to delivering care to ambulatory patients Information and Referral functions already offer the one number to call for the community supported by thehealthline.ca website Direct care providers in the areas of mental health, telemedicine, rapid response, geriatric response and palliative care make a difference in patients lives. It is important to preserve the expertise, knowledge and resources that are currently working in the community. There is a lack of knowledge of what services are provided by the Erie St. Clair CCAC and other services available in the community. There needs to be a better understanding of what each other s roles are in providing seamless care to the patient. Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 5 of 6

6 STABILITY AND STAFF RETENTION Recommendation 6: Recognize the skills and abilities of all CCAC staff and governors It is recommended that specific assurance is needed as soon as possible, and to the extent possible, CCACs should be transitioned to LHINs intact. Once LHINs have a full understanding of their ongoing needs after transition, consideration can be given to opportunities for alignment and streamlining of functions and leadership. The Erie St. Clair CCAC is extremely proud of all its staff who contribute with such commitment and professionalism every day. The Ministry s proposal suggests that the CCAC staff responsible for patient care will be transitioned to and employed by LHINs. To ensure successful transition, it is important to recognize the complexity of CCAC operations. The delivery of high-quality care to the populations of Chatham-Kent, Sarnia-Lambton and Windsor-Essex each year involves care coordinators & team assistants; direct patient care providers; contract & facilities management staff; quality improvement specialists; finance, human resource & communications specialists; planning & decision support analysts; and health information systems and technology specialists. Everyone makes critical contributions to patient care. It is essential that CCACs are able to retain and recruit skilled staff to ensure stable service delivery and operations while consultation and transformation take place. Strong, skilled leadership will also continue to be needed to maintain collaborative relationships with hospitals, primary care, community services and others and support ongoing improvements to integrated care delivery. CONCLUSION This paper highlights the advice of the Erie St. Clair CCAC in response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. The advice is offered to support the successful implementation of the Minister s vision. Focus on the patient. Provide equitable access to health care and ensuring their health care needs are being met. By streamlining the resources available it will provide more money for direct patient care. Erie St. Clair CCAC s response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario Page 6 of 6

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