South West Local Health Integration Network. Clinical Services Planning Strategy

Transcription

1 South West Local Health Integration Network Clinical Services Planning Strategy Revised March 2014

2 Table of Contents Background... 4 What is Clinical Services Planning?... 5 Clinical Services Planning Implementation Framework... 8 Clinical Services Planning Core Principles... 9 Roles and Responsibilities Reporting Structures HSFR Local Partnership Effective Leadership & Executive Sponsorship Collaboration and Integration Risks of Clinical Services Planning Role of LHIN and Hospitals in Implementing Change Role of the LHIN Role of the Hospitals Stakeholder Engagement Engagement of Health Professionals Physicians Clinical Leadership Nurses and other Health Professionals Engagement of the Community Community members Ministry of Health and Long-Term Care, MPPs and Local government(s) Clinical Services Planning Approach Evaluation APPENDIX A: LHIN Priority Setting & Decision Making Framework

3 Executive Summary Clinical Services Planning (CSP) has been identified as a strategic priority for the South West Local Health Integration Network (LHIN) and is a key deliverable in our Integrated Health Service Plan This document is intended to provide stakeholders with a common understanding of Clinical Services Planning (CSP) and what is intended to be achieved through this work. Given that CSP is an iterative process, this document will be updated as more information becomes available and the planning process unfolds.. This document describes how CSP aligns to the Integrated Health Services Plan and the Health System Design Blueprint - Vision 2022 and outlines the processes, responsibilities, expectations and goals associated with successful CSP initiatives. The document also identifies the associated roles and responsibilities of health system partners and describes the supporting structures required for effective CSP in the South West LHIN. CSP Vision Health Service Providers in the South West LHIN are leaders in the Province in the effective implementation of integrated clinical streams across the system that drive performance, exceptional patient/family experiences, and and accountability 3

4 Background Created in 2005, Local Health Integration Networks (LHINs) are crown agencies of the Ministry of Health and Long Term Care (MOHLTC) that are responsible for planning, integrating, and funding health services across their geographies. LHINs work with local health providers and community members in an effort to determine health service priorities that address the needs of their local communities. In 2009, the South West LHIN brought community and health service providers (HSPs) together to create a future health care vision that resulted in the development of the Health System Design Blueprint Vision The following five system level goals were identified in the Blueprint: Blueprint System Level Goals: 1) Healthier South West LHIN Community 2) Equitable access to services 3) Quality of Care and Services 4) Sustainability of the Local Health System 5) Integration of Health Care Delivery The Blueprint identifies the following six priorities specific to the future state of the acute (hospital-based) sector: 1) The need to optimize current acute capacity in order to offset the projected increase in demand; 2) Alternative models are needed to coordinate resource capacity across the LHIN to better manage upstream and downstream flow of patients; 3) The need to strengthen the health resource base outside of London to enable care closer to home where appropriate and create capacity for London-based services to better deliver upon their local, tertiary and quaternary care mandates; 4) Enabling better use of visiting specialists requires adequate local resources to support care; 5) All geographic clusters will need to play a role in delivering acute services that meet quality standards and bring care closer to home; and 6) The need for community-based programs to address needs of growing population and to alleviate acute bed pressures. 4

5 The Blueprint provides a compelling case for change including a current state profile and a future state service delivery model for Internal Medicine, Surgical Services, Critical Care, Emergency, Women s Health, and Paediatrics. To work towards that long term vision, the South West LHIN has committed in its third Integrated Health Services Plan ( ) to: Prioritize, develop and implement LHIN-wide hospital clinical services plans in alignment with Health System Funding Reform, Wait Time Strategies & other cost, quality improvement initiatives (IHSP ) The goal of this work is to manage health system resources in the South West LHIN and balance access challenges in our rural and northern communities with required system changes. CSP will place the patient at the center of planning discussions; safe patient care, as close to home as possible, will be central in decision making. CSP recommendations will be made regarding centralizing, decentralizing and realigning services where it makes sense to ensure the delivery of high quality, safe patient care and to meet demand and population need. The LHIN is committed to working with South West LHIN hospitals and community partners to improve quality of care and achieve health outcomes that patients and families deserve. The work undertaken by CSP will build on the priorities and goals specific to the acute sector as outlined in the IHSP , the Blueprint Vision 2022, Health System Funding Reform and other related initiatives. What is Clinical Services Planning? The South West LHIN will implement a number of initiatives under the umbrella of CSP. CSP will be a multipronged approach with a number of work streams and phases that will consider implementation of best practice guidelines, capacity assessment and realignment of services. CSP will predominantly focus on the acute sector and will include sub-acute and community sector when appropriate. Improved quality and safe patient care will be accomplished by a comprehensive approach to planning and new streams of work that build on and complement the work currently underway. Clinical Services Planning involves collective action by health system partners to: Provide strategic directions to inform the future delivery of health services on a specified horizon (e.g., ); Define a clinical area and the health services/sectors that are involved in providing that patient/client care; 5

6 Consider the patient journey across the health continuum and across a range of HSPs; and Provide a platform to consider partnership arrangements within/across sectors and across LHIN boundaries. The South West LHIN and partners currently have five key initiatives underway in CSP: Key initiatives underway in Clinical Services Planning: 1) Access to Care CCC/Rehab Bed Realignment 2) Perinatal Capacity Assessment 3) Oxford Joint Services Planning (JSP) 4) South West LHIN Vision Care Project 5) Endoscopy Best Practice and Realignment Project 6) Regional Stroke Care Project CSP will also include experience-based design approaches by involving and engaging the patient and family in decision-making throughout the planning process. The focus will be on providing the right care, at the right time, in the right setting, and at the right cost to ensure patients are receiving the highest quality patient care. Hospitals acknowledge that the primary responsibility for ongoing care and support of patients rests with all providers across the health care continuum (Community Care Access Centre, Community Services Sector, Long-Term Care, Primary Care, etc.). Successful implementation of integrated clinical streams aims to achieve: reductions in surgical wait times; decreases in readmission rates; avoidance of emergency department visits and hospitalization; and reduced Alternate Level of Care. Why undertake CSP? Successful implementation of Clinical Services Planning will result in reductions in surgical wait times, decreases in readmission rates, avoidance of emergency department (ED) visits/hospitalization and reduced ALC. HSPs across the South West LHIN are committed to and invested in building a high performing health system. In order to harness that commitment, we need to first understand where services can and should be provided based on local needs and evidence. Health Quality Ontario (HQO) believes all Ontarians share the common 6

7 vision of a high-performing health system that is accessible, effective, safe, patientcentered, equitable, efficient, appropriately resourced, integrated and focused on population health. 1 Significant capacity issues within some hospitals and higher waittimes than the provincial target in a number of clinical areas show that our performance in these areas can be improved. CSP will build an understanding of the strategic decisions that are necessary and drive the necessary changes to improve service delivery and build a sustainable health system. Benefits of CSP Identifies and meets patients needs at the right time and place; Strategically manages system change, such as Health System Funding Reform in a proactive manner; and Drives regional program planning and provides a platform to explore regional Health Human Resource strategies. Why undertake CSP Now? Health System Funding Reform (HSFR) was introduced by the MOHLTC in March HSFR is an approach to funding the health care system based on quality, evidence, feasibility, infrastructure for change, and cost impact. The purpose of HSFR is to lead overall system transformation and improve fiscal responsibility in uncertain economic times. HSFR helps to ensure that Ontarians receive the right care, at the right time, and in the right place. HSFR is comprised of two main elements: Health-Based Allocation Model (HBAM) and Quality-Based Procedures (QBP). HBAM is intended to be used as a funding allocation methodology and a management tool for that will enable strategic and transparent allocation of funding to the LHINs for some health services. Currently, HBAM is being used to allocate funding for the hospital and parts of the community sector and will eventually allocate funding to all LHIN health care sectors. In the South West LHIN, nine hospital corporations (Grey Bruce Health Services, South Bruce Grey Health Centre, St. Joseph s London, London Health Sciences Centre, Strathroy Middlesex General Hospital, Stratford General Hospital, St. Thomas Elgin General Hospital and Woodstock 1 Health Quality Ontario. (2013). What is quality improvement? Retrieved from 7

8 General Hospital) have greater than 2,700 weighted cases and, thus, are impacted by HBAM. Quality based procedures (QBPs) are groups of specific services that require similar patient care. Using a QBP metric, funding is allocated to specific procedures based on a 'price per volume' basis, with defined outcomes for quality of care, that allows for standardized reimbursement to health care providers for the type and quantity of patients treated. QBPs are being implemented using a phased approach across all LHINs. In year one (2012), QBPs were implemented for: (1) total hip replacement; (2) total knee replacement; (3) chronic kidney disease and; (4) cataract surgery. Ten hospitals in the South West LHIN have been impacted by these QBPs. In year two, all 19 public hospital corporations/alliances in the South West LHIN will be impacted with the addition of QBPs for: (1) chemotherapy systemic treatment; (2) chronic obstructive pulmonary disease; (3) congestive heart failure; (4) gastro intestinal (GI) endoscopy; (5) stroke and; (6) non-cardiac vascular. Clinical Handbooks have been developed for each QBP in order to account for the quality and evidence components of HSFR, specifically around planning for provision of evidence-based practices. Currently, there is no provincial mandate to implement Clinical Handbooks. The role each LHIN will play in the accountability of Clinical Handbooks has yet to be determined but it is an integral part of the implementation of HSFR and will be a focus in CSP. There is an opportunity to leverage HSFR changes to accelerate CSP. The impacts of HSFR on health services in the South West LHIN vary across providers and geographies. Due to population growth lower than the provincial average and limited growth in the population base for services in the South West LHIN, there will be an overall decrease in the funded dollars to this region of the province. It is, therefore, critical to ensure we are planning sustainable service levels and service distribution across the LHIN in the acute sector. Clinical Services Planning Implementation Framework The predominant goal for CSP is to remain patient focused at all times through comprehensive capacity assessments, redesigning health services and implementing best practices that will ultimately improve outcomes. Our goal is to have an integrated system that meets patient needs, while being supported by our providers. The objectives of CSP are to: Improve quality and patient safety though ongoing system planning; 8

9 Build a robust planning process with joint partnerships for implementation; Have viable hospital sites that have a vital role in their community with a clear purpose; Reduce duplication of services and centralize/decentralize where it makes sense; and Optimize capacity and reduce variation in delivery of care. Through CSP, we will identify efficiencies in the system that can generate cost savings (clinical, administrative and back-office) and enable releasing resources to other areas of the health system in the LHIN (internal & external to the acute sector) that will have an impact on delivery of services. Clinical Services Planning Core Principles The South West LHIN Hospital CEO/CCAC (Community Care Access Centre) Leadership Forum was engaged in the spring of 2013 to outline a set of principles to guide the CSP work. Using the LHIN Priority Setting and Decision Making Framework (Appendix A) and a prioritization process, the Forum identified the following three principles to guide decision making: Quality Client Focus Efficiency Following identification of the core planning principles, a focused literature review was conducted to identify the evidence base related to each principle. Through the consultation process and literature review, it was recommended that the CEO/CCAC Leadership Forum and the South West LHIN adopt Health Quality Ontario s 9 Attributes of Quality to frame CSP discussions moving forward. The three core principles, identified through the CEO/CCAC Forum, will remain the focus, and HQO s dimensions will be added to create a comprehensive framework to lead CSP planning, implementation and evaluation. 9

10 The CSP Core Planning Principles are as follows: Quality - The extent to which the health system provides safe, effective and client focused care by applying evidence based, best practice Safe - People should not be harmed by an accident or mistakes when they recieve care Integrated - All parts of the health system should be organied, connected and work with one another to povide high-quality care Accessible - People should be able to get the right care at the right time in the right setting by the right healthcare provider Client - Focus - Health care providers should offer services in a way that is sensitive to an individual's needs and preference Equitable - People should get the same quality of care regardless of who they are and where they live Focused on Population Health - the health system should work to prevent sickness and improve health of the people of Ontario Efficiency - The health care system should continually look for way to reduce waste, including waste of supplies, equipment, time, ideas and information Effective - People should receive care that works and is based on best available scientific information Appropriately Resourced - the health system shoudl have enough quaified providers, funding, information, equipment, supplies and facitilites to look after people's ehatlh needs Roles and Responsibilities Successful system transformation through CSP requires that all leaders across the health care system see CSP as a system responsibility of which they are all a part. CSP is a large, multi-stakeholder initiative that requires clear definition and agreement on the roles and responsibilities of each participating group, as well as how the different sectors and partners will interact. Given that CSP has implications for both sustainability and quality of care and as is a top priority in the South West LHIN, effective leadership from the LHIN and HSPs is essential for the successful implementation of CSP. Reporting Structures Although CSP governance and decision-making ultimately resides with the LHIN Board of Directors (BOD), there are a number of stakeholders and decision-makers who will be responsible for reporting and oversight throughout the planning work, as identified in the figure below. 10

11 HSFR Local Partnership The MOHLTC introduced the concept of local partnerships (LPs) to help inform implementation planning, change management and future reform components. Rather than looking at moving volumes between hospitals, the LP is determining how best to plan and deliver the level of quality identified in the clinical handbooks. LPs will act as an advisory group and will facilitate clinical, financial and decision support advice to and from the LHINs and Ministry. There are 14 LPs in the province representing each LHIN. Representatives include members from the LHINs and HSPs (hospitals, CCACs and Long-Term Care Homes initially) that are impacted by HSFR, with the intent to give local issues and challenges a voice at the provincial level. The South West LHIN HSFR LP table was launched in May CSP will leverage the work of the South West LHIN LP through advocacy, support and consultation of the membership regarding the impact of CSP and HSFR. 11

12 Effective Leadership & Executive Sponsorship Visible and continuous executive leadership is critical to the success of planning, implementing and sustaining CSP. For the South West LHIN, this means involving and engaging executive support from providers and engagement of hospital administration, medical administration, clinicians and clinical support services. At times, organizational change can have a top down approach, where organizational transformation begins at the executive leadership level. The South West LHIN s goal is to work with senior leadership sponsors in the respective organizations to bring together staff from all levels and backgrounds, fostering collaboration and leading change across the entire organization. The LHIN aims to create a regional culture of change where CSP is valued and recognized as key to successful and sustainable service delivery and high quality care. The LHIN will engage and encourage formal and informal leaders to sponsor and support planning, implementation, and evaluation in an effort to signal the importance and priority of CSP across the region. Collaboration and Integration CSP requires successful implementation of service delivery changes identified by partners and leaders across a number of sectors. To do this, extensive collaboration between the LHIN and acute care hospitals across the South West region is required. Stakeholders from CCAC, Long-Term Care Homes, community services, mental health, 12

13 and primary care sectors will also be part of the CSP process. Every party involved in CSP must take responsibility for implementing and sustaining the changes to their programs and services. Working together effectively will facilitate the process changes, service delivery and human resource shifts required to successfully implement the recommendations outlined by the CSP process. By leveraging existing knowledge, skills, and resources in the health system, the LHIN is able to achieve the sustainability required to complete regional transformation. To achieve and maintain a strong partnership, each partner should clearly understand the elements of CSP as well as the role that they play during implementation. It is especially important for hospital administration and front line clinicians have a strong relationship since they are vital in on-the-ground changes to services. Risks of Clinical Services Planning CSP is not without risks. Some foreseeable risks are identified below and do not include predictable risks that may arise at any stage of the process. The LHIN is committed to working with partners to ensure awareness of and response to such risks. Strategic risks, as they relate to CSP, may arise as a result of shifts in patient/family preferences, emerging technologies and MOHLTC direction. The CSP process will use the information and data available and regularly solicit feedback from our stakeholders in an effort to detect, and mitigate, potential changes early. Keeping the lines of communication open and having access to data at the regional level will help the LHIN to predict changes such as population demographics. Financial risks have the potential to be affect CSP. Some, such as HSFR implementation, may not be under the LHIN s control. However, throughout the CSP process, the LHIN will be conscious of mitigating financial risks currently present in our health system (e.g., service duplication, lack of coordination, and compromised quality of services). The LHIN and HSPs will work collaboratively to understand and mitigate financial risks as part of CSP. The LHIN will seek input from partners to ensure any potential changes will include a robust financial methodology and analysis. Relationship risks among the LHIN and HSPs can affect the success of CSP. The South West LHIN embraces a patient-centered and community oriented approach. Part of our CSP approach is to constantly involve and update stakeholders to ensure an accountable and transparent process, ultimately to create a regional, sustainable acute care service delivery model. As outlined above, all LHIN-staff and partnering HSPs need to work collaboratively in order for CSP to be successful. Having a unified CSP approach means changes in service delivery and HSP operations will be implemented 13

14 successfully. Without the right people on board, it is possible to be faced with more challenges and barriers. Role of LHIN and Hospitals in Implementing Change CSP may impact the roles that hospitals currently hold within the acute sector in the South West LHIN and will require robust change management strategies to be implemented by providers. Changes in roles and processes can be very difficult and require a great deal of focus and effective planning. The LHIN will build on the work currently underway and identify where changes need to occur and where a hospital s role may be impacted. Any changes to clinical services will largely depend on the current state of where services are provided and what CSP analysis and consultation determines is the ideal alignment for them in the future. Role of the LHIN LHINs have a mandate to plan and integrate the health system. To date, the majority of integrations within the South West LHIN have been done on a voluntary basis. We applaud the work of our HSPs in making these integrations successful. Through CSP, we are embarking on a partnership between the LHIN and our HSPs to lead and identify integration opportunities. We acknowledge this is a tremendous undertaking with many challenges and plan to take guidance from our HSPs in CSP work already underway in the LHIN, such as CCC/Rehab bed realignment and Oxford Joint Services Planning, as well as learning from our LHIN counterparts across the province where similar work is underway or has been completed. The South West LHIN s role in CSP is to oversee the CSP strategy, provide overall leadership, set goals, and garner support from relevant stakeholders. This includes ensuring that CSP is a top priority for HSPs and that all HSPs are committed to improving the safety and quality of clinical services and reducing overall health system costs. As the regional health system steward, the LHIN will provide contextual information around how CSP will fit with existing related provincial strategies (e.g., Integrated Orthopedic Plan, Access to Care, etc.), as well as local strategies specific to Provide overall leadership and ensure this is a priority for all system partners Oversee strategy and communicate system objectives and expectations Conduct capacity assessment and promote the alignment of services to match population demand and capacity of large and small hospitals as appropriate Set performance expectations and ensure proper monitoring and evaluation mechanisms are in place Promote consistent application of best /leading practice and evidence based decision making Allocate and align resources where able to maximize system effectiveness 14

15 the LHIN (Perinatal Capacity Planning, Oxford Joint Services Planning, IHSP, etc.). The LHIN will work with HSPs to realign resources as required to ensure the right care is provided in the right place, at the right time, and at the right cost. This includes working to ensure there is capacity to reduce wait times for patients through realignment of resources and priorities where appropriate and, where possible, the infusion of additional funds. As part of the potential spread of CSP, the LHIN will support an analysis of existing CSP clinical areas that have been identified as high risk from sustainability, quality, and safety perspectives. The LHIN will look for opportunities to promote service integrations between hospital corporations where it makes sense based on recommendations that come out of the CSP process. The South West LHIN will ensure continuous monitoring and evaluation of CSP through performance reporting and monitoring of provincial and local data. The LHIN will also play a role in creating public awareness about CSP and ensure consistent messaging is being provided through hospitals, the CCAC, and the community. In summary, the LHIN s role is focused on providing leadership, along with initiation and monitoring of CSP. Role of the Hospitals As the primary system partner providing acute services to patients, hospitals will play an integral part in the implementation of CSP. In order to achieve success, hospitals need to gain a commitment from staff to move forward. Hospitals are key facilitators of CSP and are able to facilitate the provision of high quality acute services for patients to receive the right level of care when and where they need it. To identify and implement service delivery enhancements and best practice in clinical areas, the hospitals and the LHIN will work through the process of realigning existing resources to increase capacity and quality care in the acute services, where it makes sense to do so. This will be an intensive and iterative process of planning, implementing and evaluating CSP recommendations. 15

16 Stakeholder Engagement To effectively realize the large system changes required to build a sustainable health care system, full system engagement is recommended. Engagement across a variety of stakeholders, including health care professionals, the community and local and provincial government representatives, will be important. The LHIN s engagement framework will ensure active participation of necessary stakeholders in the CSP journey. The South West LHIN believes in shared vision, mutual respect, accountability, transparency and commitment and is committed that the outcomes of CSP will be achieved through upholding these values. Engagement of Health Professionals Physicians Physicians in the hospital and the community will be engaged extensively given that physician support is critical to the adoption of CSP. In many hospital processes, the physician is viewed as a leader amongst the interdisciplinary team and any regional change in process should be adopted by the physician in order to be accepted by the rest of the team. We are aware that many of the South West LHIN s current integrations have been led by physicians who have been champions and leaders in the planning and implementation. We hope the same for the CSP, where physicians will be on board as leaders and champions for this process. Community physicians refer patients into the acute system and play a key role in monitoring discharged patients, ensuring their continued recovery. Given their role as trusted health care experts in the community, the engagement and support of community physicians is important. Clinical Leadership The support of clinical leadership in the implementation of CSP is essential to help engage physicians and other health professionals hospital-wide. Clinical leaders (e.g., medical administration/chief of staff) can provide advice on how to best reach clinical audiences and can also be at the forefront of organization-wide communication and education. Nurses and other Health Professionals Support from nurses is also critical. As health care providers who spend a significant amount of time with patients, it is important that nursing teams are fully aware and supportive of CSP. Nurses are a key point of contact for patients and families and can provide significant insights into patient experience, as well as areas for improvements in care. Working with patients, nurses can identify barriers and challenges to 16

17 implementation of best practice and work with colleagues to identify potential solutions. Nurses often serve as a link between physicians, allied health professionals, the CCAC, and community service providers. They are a conduit for knowledge transfer, and their ability to provide information and to provide support should be leveraged. Other health professionals and clinical support services will also be engaged to ensure that all areas of the hospitals administration are part of the CSP process. Engagement of the Community Community members The South West LHIN is committed to building and maintaining a useful dialogue with the community. This is demonstrated though our four goals of community engagement: 1) Focus on the people who use health care 2) Enhance local accountability 3) Balance priorities 4) Develop system capacity and sustainability Ministry of Health and Long-Term Care, MPPs and Local government(s) It is important that we inform stakeholders early in the journey. This is especially true of our local and provincial government officials to ensure that, if shifting of resources occurs, they are fully informed. It is vital that our government partners are aware of the planning process in place around CSP and how conclusions are reached. We will keep our partners informed at every step of the way through our established modes of communication, such as regular meetings with CEOs, communiques, and notifications. We are well aware of the important role MPPs and local government representatives play in their local communities. By engaging government officials, we can help them understand how we made our decisions and considered the impact they will have on the different interests of each community. Lastly, it is important to keep the MOHLTC informed of our work so they can ensure the Minister and key parts of the Ministry are informed and supportive of what we are trying to achieve. Clinical Services Planning Approach The key to successful CSP is engagement of stakeholders from the onset of the process. Whether holding administrative or clinical roles, leaders need to be involved early in the CSP process. Clinical services were identified through the development of the LHIN s IHSP Strategically, a number of different clinical areas will enable 17

18 the LHIN and its hospital partners to be responsive to the clinical planning needs as they arise. A standard approach to CSP (see figure below) will be used to allow for a common language to discuss, plan, implement and evaluate; however, the approach will be tailored for each specific clinical area, as necessary. Evaluation It is critical to continuously monitor and evaluate CSP to assess its impact on the goals of clinical streams and show the benefits of CSP to stakeholders in the health system. The South West LHIN and its HSP partners will play a significant role in conducting consistent and effective evaluation. The evaluation plan will be part of the larger process, and will be embedded throughout each step of CSP. The LHIN will regularly monitor and report on CSP process and outcome. Part of our planning phase is also implementing an evaluation of current and on-going CSP. For example, we will look at the work being done in the Oxford Joint Services Planning and evaluate it against our CSP framework. By doing this, we will get an onthe-ground sense of what is working and how this approach is transferable to other areas. 18

19 APPENDIX A: LHIN Priority Setting & Decision Making Framework In March 2009, the LHIN Collaborative (LHINC) identified the need to establish a common priority setting and decision making approach that would provide clear, understandable and objective criteria by which proposals or opportunities can be evaluated. Through a consistent approach, the LHIN priority and decision making framework provides transparency and supports accountability for health care dollars by engaging key stakeholders in the priority setting and decision making process. The criteria in the framework will provide the basis for the decision making process to identify priority clinical areas for Clinical Services Planning across the next 3 years of the IHSP. The following Framework forms the basis for the decision making process. There are 4 Domains and 15 criteria in total. 19

20 The description of each domain and the criteria within that domain are outlined below 20

21 21