The document summarizes Haliburton Highlands Health Services' integration journey in Haliburton County, Ontario. It discusses three phases: 1) initial planning which resulted in a recommendation for a "one entity" model in Haliburton County, 2) transition and implementation which involved transferring programs and governance to HHHS on October 1, 2014, and 3) future plans. Key accomplishments included establishing a strategic alliance between HHHS and the local hospital and developing a new strategic plan to guide the integrated organization. Governance lessons highlighted the importance of local autonomy for Haliburton County.

1. HaliburtonHighlands HealthServices–
IntegrationJourney
Presentationto TemiskamingHospital
September 2015

2. Agenda
1. Haliburton County
2. Integration Journey – Phase 1 (Planning)
3. Integration Journey – Phase 2 (Transition /
Implementation)
4. Integration Journey – Phase 3 (Longer Term /
Future) 2

3. Haliburton County Geography
 Most northerly region of CE LHIN
 Large rural geography (4000 sq. km.)
with dispersed small population
(17,000)
 The Haliburton Minden sub-cluster is
made up of four Census Subdivisions
defined by Statistics Canada:
 Algonquin Highlands
 Dysart et al
 Minden Hills
 Highlands East

4. Haliburton County Population
• Smallest population sub-LHIN region but highest population
growth (as % of total population) within the North East Cluster
of CE LHIN (including Peterborough, Kawartha Lakes and
Northumberland County).
• Highest % of seniors, and the lowest proportion of individuals
0-24 in Central East LHIN; 28% proportion of seniors 65+
(above 15% LHIN and Ontario averages)
• Expected growth - residents aged 65+ are 36% by 2025 and
41% by 2035.
• 12% proportion of persons aged 75+ is also highest compared
to other Sub-LHIN Regions of North East Cluster and Central
East LHIN (10%) and Ontario Average (6%).

5. Haliburton County Population
Health Status
• Higher rate of arthritis, asthma, diabetes, high blood pressure, cancer,
and COPD than both CE LHIN and Ontario averages.
• The CE LHIN average is also higher than the Ontario average for all of
these chronic conditions with the exception of cancer.
• Deaths per 100,000 are higher in Haliburton County and the North East
Cluster for all conditions for which data is available on the CE LHIN, and
Ontario.
• This includes from cancers, circulatory diseases, ischaemic heart
diseases and respiratory diseases.
• Furthermore, while residents of the region have a self-perceived feeling
of good health that is in line with the CE LHIN average, the average life
expectancy is below both the CE LHIN and Ontario averages at birth and
age 65.

6. 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 6

7. 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
7

8. 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
8

9. Current State – Future State
9

10. 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
10

11. Phase 1: StrategicAlliance betweenRoss
MemorialHospitaland Haliburton
Highlands HealthServices
 Criteria for pursuing shared service opportunities included, quality
improvement, service enhancement and/or cost savings
 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
• Exploring more back-office integration
11

12. 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 and transitions 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
12

13. Phase2:TransitionPlanningforHaliburtonCounty
 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
13

14. 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
14

15. 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, EMS
Note: 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
15

16. New STRATEGIC PLAN 2014-2017
Integration Opportunities
Improve Care Coordination
IT Integration
Community Engagement
& Communication Plan
Community Advisory
Committee (CAC)
Recruitment & Retention
Enhance Communication
Seasonal Residents Plan
Long Term Plan
Annual Operating Plan
Improve the quality of
services and access across
the continuum
Phase 2: Governance Progress

17. 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
17

18. 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
18

19. 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
 CCAC Services?
 FHT?
 EMS?
 HHHS will leverage its integrated organizational structure and continue
to improve quality, transitions of care and enhance the range of services
to meet the needs of full-time and seasonal residents and visitors of
Haliburton County
 Palliative / End-of-Life Care is first integrated program which includes:
 Single Manager for Palliative / Hospice Care
 Inpatient Palliative Care Suite (planned expansion to 2 palliative rooms and
family areas)
 Palliative Care Community Team
 Community Hospice Program
 Palliative Steering Committee which includes HHHS, HHFHT, CE CCAC,
contracted CCAC providers, regional Palliative Pain and Symptom Control
Coordinator
19

20. Phase 3: Long Term/ Future Planning
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 20

21. Minden Hospital / Hyland Crest
Long-Term Care Home
Haliburton Hospital / Highland Wood
Long-Term Care Home
Community Support
Services
Supportive
Housing Offices:
Haliburton, Minden,
Wilberforce
What we have become…
Mental Health Services

22. LeadersinInnovativeRuralHealthCare
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23. Questions
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