JUN. 13/07
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  • (ASK THE AUDIENCE): What is the one thing that will predict success in the 21 st Century? Take points… The one thing that will fundamentally predict either an organization’s or individual’s chances for success in the 21 st Century is the “Capacity and Capability to handle Change” Review favourite books (ASK THE AUDIENCE for a show of hands): who has read: Leadership by Rudolph Juliani ? 29 Leadership Secrets from Jack Welsh ? The 7 habits of Highly effective people by Stephen Covey? The 7 Principles for Making Marriage Work: John Gottman? Given all of the travelling I do since arriving at the LHIN, this one is required reading for any LHIN employee…(smile)
  • 2. Is it aligned with the IHSP – add comments that if it is not. Then why is it important.
  • What we’ve already done - HSP Service Agreements - Completed Compiled a core set of indicators from which LHINs can select measures to monitor and/or report on LHIN system and accountability and progress towards meeting the LHIN’s IHSP goals. As John mentioned, your agreements with us must align with our agreements with the Ministry and our MLAA. HAPS/HAA - Completed Defined the overall HAPS/HAA framework, process, tools and timelines required to successfully negotiate service accountability agreements to enhance hospital stability and accountability. We will monitor in-year progress towards targets. Process design includes engagement startegies to involve the HSPs to ensure an integrated approach is being used in developing and implementing Health Provider plans. Where we are now - Funding Proposals – Expected by mid June Developing a consistent approach for all LHINs to respond to unsolicited funding requests and proposals from Health Service Providers In th enew LHIN environment, enhanced accopuntability for operating in a financially responsible manner is assigned to the HSP. Develop a standard template to link HSP funding requests to local strategic priorities and initiatives. Capital/PCOP – In Progress for Process Model and Chart Defining the overall framework, processes, tools and timelines that LHINs will use in the receipt, review and approval of capital projects, Also define the role of the LHINs in this process in its interaction with MOHLTC, Ministry of Public Infrastructure and HSPs. Developing the Risk Management Framework and Communications Plans
  • Where we are going - Funding Letters - Mid to end of June Define the business processes associated with allocation letters to be issued by LHINs. The immediate focus is to define the business process associated with the allocation/assignment letters for the 2007-08 fiscal year. In-Year Pressures – Late Summer 2007 To develop a framework for LHINs to receive and review integration initiatives for handling of in-year pressures from health service provider organizations. The framework will contain criteria to prioritize the relative urgency of in-year pressures and any requirements for mitigation strategies. Ask the 5 questions mentioned earlier. Transfer Payment & Allocation Management - in progress Comprehensive business processes associated with annual appropriations thru RbP (Results-based Planning) Quarterly reports are a key element to the Reporting and Business Planning Framework to support accountability, risk management and decision support. We are in process of defining TP allocation framework, reporting processes, tools and timelines to fairly allocate funds to the HSP’s to address needs of the population in the catchment area.

Transcript

  • 1. Performance Contract and Allocation Overview
  • 2. What LHINs Do Community Engagement Funding & Allocation Patient Centred Integration & Service Coordination Local Health System Planning IHSP: Setting the Course Accountability & Performance Monitoring Accountability Agreements: Executing the Course
  • 3. What does this look like?
    • What has changed as of April 01, 2007?
    • Accountability
    • Tool kit
    Performance Monitoring Accountability Agreements: Executing the Course Accountability & Allocation
  • 4. Video clip Video Clip
  • 5. What changed as of April 1?
    • World on April 2 was much the same as it was on March 31, 2007
    • Transformation will be evolutionary not revolutionary
    • Health Service providers will want to prepare for:
      • An increased emphasis on accountability
      • A focus on integration & improved service coordination
      • new approaches to everything from funding to health system planning
  • 6. 5 main areas where changes will be felt…
    • Increased integration and improved service coordination
    • Increased local decision-making about funding and allocation
    • Greater emphasis on local health system planning
    • Increased community engagement
    • Enhanced Accountability
  • 7. 1. Increased integration & improved service coordination
    • After April 01, health service providers will:
    • Be responsible for aligning their service planning within the CE LHIN IHSP
    • Implement the directions for integration laid out in the accountability agreements with CE LHIN
    • Demonstrate continuous improvement in service integration & coordination (LHIN will help facilitate shared best practices through our Comm Engagement structures)
    • Take part in agreements and initiatives designed to further provincial objectives in areas such as access, quality, safety and efficiency
  • 8. 2. Increased local decision-making about funding & allocation
    • CE LHIN will…
    • Assess priorities at local level
    • Determine service configuration based on priorities
    • Allocate funds accordingly
    • Monitor fiscal performance & contribution of providers to ensure integration & system sustainability
    • Health Service Providers will…
    • Submit business and service plans as required by their accountability agreements (same tools for now)
    • Be responsible to CE LHIN for delivering programs and services on budget
  • 9.
    • Was it vetted by your Planning Partners?
    • Is it aligned with the IHSP?
    • Is it evidence-based and can it be measured & monitored? (ie., Decision Support & Performance Monitoring)
    • Who shares accountability for its accomplishment? (ie., agreements & funding)
    • How will it be resourced?
    Integration Initiatives/Ideas/Proposals
  • 10. 3. Greater emphasis on local health system planning
    • CE LHIN will…
    • Identify and determine local health care priorities
    • IHSP to reflect local priorities & link with provincial strategic directions
    • Health Service Providers will…
    • Continue to participate in CE LHIN Planning exercises
    • Align strategic plans with those of CE LHIN
    • Provide input and info necessary for CE LHIN Plans
  • 11. 5. Greater Accountability
    • People have the right to expect accountability from their governments
      • To that end, CE LHIN has entered into an accountability agreement with MoHLTC
    • Patients have the right to expect that their health service providers will be accountable for the quality of services they provide
      • To that end, part of CE LHIN mandate is to negotiate Service Accountability Agreements (SAAs) with health service providers
  • 12. Accountability Framework
    • STEWARD MANAGER PROVIDER
    . . . . MOHLTC LHIN 1 LHIN 2 LHIN 14 Hospitals CCAC LTC Homes CSS MH&A CHC OTHER Strategies and Directions - Tools and processes are being developed
    • Operationalizing Policy/Direction
    • Tools/processes NEED
    • to be developed
    ∙ ∙ ∙ ∙ ∙ ∙ ∙ ∙ ∙ ∙ ∙ ∙
  • 13. Ministry of Health & Long-Term Care & the Central East LHIN Accountability Agreement 2007-2010
  • 14. Primary Agreement
    • Purpose
      • Supports the collaborative relationship between the MOHLTC and LHIN to carry out the made in Ontario solution to improve the health of Ontarians
      • To set out the mutual understandings between the MOHLTC and the LHIN of their respective performance obligations in the period from April 1, 2007 to March 31, 2010
    • The Primary Agreement was previously reviewed and approved in principal in November 2006
  • 15. Agreement Components
    • Primary Agreement
    • Schedule 1 General
    • Schedule 2 Community Engagement, Planning and Integration
    • Schedule 3 Local Health System Management
    • Schedule 4 Information Management Supports
    • Schedule 5 Financial Management
    • Schedule 6 Financial Processing Protocols
    • Schedule 7 Local Health System Compliance Protocols
    • Schedule 8 Integrated Reporting
    • Schedule 9 Allocations
    • Schedule 10 Local Health System Performance
  • 16. Where are we at? Building Blocks for YEAR 1
  • 17. Times have changed: Environmental Scanning is secondary to community engagement, it quantifies what we heard. Our mantra: “Heard, Found, Do” What We Heard (Engagement) What we Found (Environment Scan) What We Will Do (Our Plan)
    • Number of seniors in CE LHIN and its Planning Zones
    • Population Growth of Seniors
    • Estimate of dementia cases in seniors
    • Priority 1:
    • Seamless care for Seniors
    1.1 Improve access to LTC home services 1.2 Enhance coordination of services 1.3 Reviewing and building specialized geriatric services Seniors Seniors
  • 18. We Own This Now! DATA Raw counts of units of service, or total expenditures. Databases. INFORMATION Profile of agency, type of service, location, number of clients KNOWLEDGE How agency provides service, other similar services, total units of service in an area related to population. Very limited use of data to inform operations and planning. WISDOM How to make programs work together to improve health outcomes for a given population
  • 19.
    • Environmental Scan Overview—Our Population:
    • The CE LHIN geography stretches from the culturally diverse and densely populated Scarborough planning zones to the rural and less populated areas of Haliburton Highlands, and northern sections of the City of Kawartha Lakes and Peterborough Counties.
    • The population is mainly concentrated in the South West area of the LHIN, with almost 50% of the population in Scarborough.
    • The area is characterized by rapid population growth for certain age groups and the second highest percent of those over 65 in the province. The 85+ age group will increase by over 91% between 2001 and 2016, and the 14-17 age group will decrease by 0.5% for the same period.
    Central East LHIN Planning Zones Haliburton Highlands Kawartha Lakes Peterborough City & County
  • 20. Example: Historical Wait-time Trending Diagnostic Imaging - CT Scan
  • 21. How we Approach Performance March 2008 Estimated WT for MRI = 115 It takes people to bend this curve
  • 22. Example of Health System Goal Managed by LHINs Improve patient-centredness, integration and quality of health services
    • Performance measure Score
    • Total number of days percentage alternative level of care (ALC) 9.3%
    LHIN ( 1) Scorecard
    • Performance measure
    • Total number of days ALC
    • Target
    Score 7.72% 7.72% LHIN (2) Scorecard
    • Performance measure
    • Total number of days ALC
    • Target
    Score 10.30% 8% LHIN (3) Scorecard
    • Performance measure
    • Total number of days ALC
    • Target
    Score 11.04% 9% Hospital (A) Report MLAA -negotiation MLAA -negotiation MLAA -negotiation Health System Scorecard
    • Performance measure
    • Total number of da y s ALC
    Score 10.55% LHIN (2) negotiates service agreements with its hospitals on an individual basis regarding strategies for managing alternative level of care patients: e.g. conducting a daily utilization review to determine appropriateness of admission and readiness of discharge; developing closer relationships with community agencies, etc. LHIN 1 LHIN 2 LHIN 3 5.27% 10.30% 11.04% Hosp A 10.55% 3.85% 12.09% Hospital (B) Report
    • Performance measure
    • Total number of days ALC
    Score 3.85% Hospital (C) Report
    • Performance measure
    • Total number of days ALC
    Score 12.09% Hosp B Hosp C 2003-0 4 2002-0 3 2001-0 2 2000-0 1 1999- 00 9.10% 1998- 99 10.1 0 % 9.75% 9.62% 8.79% 9.20% Average across Ontario Average across LHIN (2) Strategy Map
  • 23. The “Toolkit”: Accountability Agreements
    • HSP Service Agreements
    • HAPS/HAA
    • Funding Proposals
    • Capital/PCOP
    • Risk Management
  • 24. The “Toolkit”: Population-based Funding
    • Funding Letters
      • - Summer 2007
    • In-Year Pressures
      • - Late Summer 2007
    • Transfer Payment & Allocation Management
  • 25. A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty. - Sir Winston Churchill
  • 26. Discussion And Questions