1. Developing Rural Health Hubs
in the
Central East LHIN
Varouj Eskedjian
November 2014

2. Agenda
Central East Community Health Services Integration Strategy
Integration Planning: Northumberland County
Kawartha Lakes/Haliburton County
Haliburton County Integration Transition
HHH Becoming Leaders as a Rural Health Hub

3. Design and implement a cluster-based service delivery model for
Community Support Service, Community Health Centre agencies by
2015 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 and,
make the best use of the public’s investment.
Hospitals were included in the Northumberland and Haliburton County –
City of Kawartha Lakes Processes
Central East LHIN Strategic Aim: Community
Health Services Integration Strategy

4. Our Challenge, Our Opportunity
Coherent, Coordinated,
Sustained Integration Strategy
Health
Links
Small Rural
Hospital
Initiative
Community
Health
Services
Integration

5. • Improve collaboration between small and rural hospitals and
community care to create integrated networks that will:
 Ensure patient access to core acute care services
 Ensure collaboration with community services
 Respond to community needs for post acute care and palliative
services, as appropriate; and
 Improve the quality and safety of services for patients and ensure
good value for money
• Central East $989,900 (2012/13) $709,100 (2013/14)
 Pro-rated by combining global budgets of RMH-HHHS & CMH-NHH
• Kawartha Lakes-Haliburton $ 965,400
• Northumberland-Campbellford $ 733,600
SRNHTF Objectives & Allocation

6. 1. Improve client access to high-quality services
o Access to consistent and integrated basket of services will
improve client and caregiver experience and outcomes
2. Create readiness for future health system transformation
o Create critical mass in governance, management, delivery and IT
capacity to enable future growth in community care
3. Make the best use of the public’s investment
o Create opportunities through efficiencies to re-invest in direct
client services and reduce latent risk within the sector that
jeopardizes quality and access to client services
CHS Integration Strategy -
Summary of Benefits

7. • Facilitated Integration Process
 Recruitment of dedicated integration facilitators
 Literature Review
 Operational review of back office integration opportunities
 Legal Advice on integration
• Hospital and Community HSP Investments
 Information Technology and Communication
 Process review and redesign (e.g. Procurement)
 Shared Mental Health and IT Leadership
 Pharmacy Upgrades
 Diagnostic Imaging
 QI and Education
Development of Rural Health Hubs!
SRNHTF Enabled

8. A CHS Toolkit guided the work of the Integration Planning Teams:
• Part 1: Identification of potential integration options
• Part 2: Identification of pros and cons for each option
based upon a range of criteria
• Part 3: Risk identification, assessment and mitigation
strategies
• Part 4: Identification of high-level estimates of savings
for reinvestment and any associated one-time
transition costs
• Part 5: Approvals & Transition Planning
Full transition/implementation up to 12 months post approval
CHS Facilitated Integration Toolkit

9. • Community Care Northumberland
• Campbellford Memorial Hospital
• Campbellford Memorial Multicare Lodge
• Branch 133, Legion Village
• Northumberland Hills Hospital
• Port Hope Community Health Centre
• VON – Ontario Branch
County of Northumberland:
Integration Planning Team Organizations

10. Northumberland County
Current State Future State

11. Scope and Results:
 Integrate acute, community, primary care, mental health and
long term care services in Trent Hills area
– Continue development of Rural Health Hub in Trent Hills
– Supportive Housing/ Assisted Living for High Risk Seniors alignment
– Develop integrated strategy for Hospice/ Palliative Care and Diabetes
– Formalize relationship between Northumberland Hills Hospital and
Port Hope CHC
– Create System Transformation Council
 Current Status:
– Campbellford Memorial Hospital and Campbellford Memorial Multi-
care Lodge have fully integrated back office services (i.e. finance
administration, payroll, HR, procurement, IT and Facilities Mgmt)
– Back office integration between Community Care Northumberland and
Campbellford Memorial Hospital
Northumberland County CHS Integration Plan

12. Kawartha Lakes/Haliburton County
Integration Planning
• Haliburton Highlands Health Services
• VON Canada
• Ross Memorial Hospital
• Community Care City of Kawartha
Lakes
• SIRCH Community Services

13. Current State – Future State

14. 1
4
• January 2014 -Integration Transition Team formed Integration
transition project plan developed to address:
• Governance,
• Communication,
• Human Resources
• Volunteers
• Clients
• Finances/Budget and Fundraising
• Facilities
• April 2014 - Directional Plan and Transition Team Terms of
Reference Approved by all boards
• May 2014 – Sept 30 as Transition Date approved
• June 2014 – Central East LHIN Board approved Transition
Plan
Haliburton County Integration
Transition Planning

15. Recommendations for
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 entities, with their
own boards, programs and services but would no longer have an
Accountability Agreement with the CELHIN
• SIRCH would investigate piloting a new centralized volunteer bureau
model (Volunteer Match) that could be used by the One Entity in Haliburton
County to recruit, screen, orient and train volunteers

16. Governance Plan
 Integration Plan identified formation of a new Health Services Entity for
Haliburton County BUT discussions initiated only with Community Care
and HHHS as governance of only these organizations’ governance
would be impacted
 Two Boards agreed “new entity” would be HHHS and Community Care
Haliburton County would wind-down as a corporation following the
transfer of the community services on September 30, 2014
 To facilitate the Governance Plan, vacancies on the HHHS Board would
be held for Community Care Board members wishing to move to the
HHHS Board confirmed as of June 26th, 2014 HHHS Annual General
Meeting
 Formation of Community Advisory Committee to give a “Voice” to
providers and recipients of community support services

17. Integration Planning: Lessons Learned
 Leadership critical to success - need positivity, commitment and focus on what
is best for community
 Project Management Resources should include dedicated support rather than
adding stress to operational responsibilities of CEOs and Management Team
 Communication/Community Engagement should be done regularly and
consistently (never enough) with all stakeholders who would be directly impacted,
using a detailed Communication Plan
 Post Integration must include:
– Maintain Stability through the change but maintain change momentum
– Evaluation with all stakeholders (clients, volunteers, staff)
– Supporting Staff during Transition and retain and leverage staff skills, support equity
in staff compensation and offer training and development
– Involve Local Decision Making and minimize impact on volunteers and local fundraising
 LHIN Direction and Support is needed from the LHIN to initiate integration
planning, support and ensure success but not to dictate outcome

18. Current State:
 Integration work well underway with CHS Integration process as catalyst for
change – setting the stage further discussion and integration
 Transitions between home, hospital, and community improving – a collective
multi-year investment strategy for SRNHTF developed and re-investment priorities
identified
 Established Regional Priority Program Focus; chronic disease (diabetes),
hospice/palliative care, supported living environments
 Progress made on addressing community need within available resources
 Final Plans as a strong foundation for continued integration between Hospitals
and the Community Sector

19. Minden Hospital / Hyland Crest
Long-Term Care Home
Haliburton Hospital / Highland Wood
Long-Term Care Home
Haliburton
Highlands
Health Services
Community Support
Services

20. Haliburton County Geography
 Most northerly region of CE LHIN
 Large rural geography with dispersed
small population
 The Haliburton Minden sub-cluster is
made up of four Census Subdivisions
defined by Statistics Canada:
 Algonquin Highlands
 Dysart and Others
 Minden Hills
 Highlands East

21. Haliburton County Population
 Smallest population sub-LHIN region but highest population growth
(as % of total population) within the North East Cluster.
 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%).

22. 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.

23. HHHS Strategic Plan 2014 - 2017

24. HHHS Mission
Haliburton Highlands Health Services, working with partners
and accountable to our community, promotes wellness and
provides access to essential, high quality health services,
including:
 Primary Care
 Hospital (Acute Inpatient and Emergency Care)
 Long-Term Care
 End-of-Life Care
 Mental Health and Addictions Services
 Community Support Services.

25. HHHS Vision
Our Vision is to be:
Leaders in innovative
rural health care.

26. HHHS Values
Compassion
Accountability
Integrity
Respect

27. Rural Health Hub - Model

28. Defining a Rural Health Hub
 OHA working definition of a Local Health Hub
“ a local integrated health service delivery model where most, if not all
sectors of the health system are formally linked in order to improve patient
sectors of the health system are formally linked in order to improve patient
access, and a single funding envelope is provided to a fund-holder
organization to manage the health of the local population”
 Core services requirements to be provided by Local Health Hub include:
– Emergency and Inpatient Care
– Comprehensive Primary Care
– Home and Community Long-Term Care
– Mental Health and Addictions
 Would also need to partner with local municipalities with Ambulance Services
and with Public Health
 Expectation to pursue partnerships with local health and human service providers
to ensure that local residents have access to a comprehensive range of treatment
support and prevention services

29. HHHS Becoming a Leader as
a Rural Health Hub
 Structural Integration
– Vertically-integrated; Continuum of hospital, community and LTC Services
– Horizontally integrated: strategic relationship with Ross Memorial Hospital
– Not an end but means to further enhance quality and access and save $$
 Enhance Quality and Access: Leverage integrated delivery structure as a platform
– Across HHHS
 End of Life Care
 Physiotherapy & Falls Prevention, Health Promotion and Illness Prevention
 Integrated QIP for Hospital / LTC / Community Support Services
 Diagnostics
– With local provider partners: FHT, CCAC, EMS,
 Health Links
 Rural Gain
 Community Paramedicine
 Central East CCAC – office within HHHS

30. HHHS Becoming a Leader as
a Rural Health Hub
 Strategic Alliance with Ross Memorial Hospital
– Explore further clinical opportunities
 Mental Health and Addictions
 Ambulatory Chronic Disease Management (Health First)
– Explore further back-office opportunities
 Finance/HR
 eHealth as enabler to integrated service delivery
– Common HIS: LHIN-wide/ GTA / Province
– Network Infrastructure/ Shared IT: Regional with RMH
– Local connectivity: with FHT, EMS, CECCAC
– mHealth Strategy: for personalized care in community

31. HHHS Becoming a Leader as
a Rural Health Hub
 Other Partnerships
– Partnerships with CE LHIN and with Larger Tertiary Centres
 Common HIS
 Pilot Projects (e.g. UHN/OTN remote patient monitoring)
– Partnerships with Local Agencies and Municipalities
 Haliburton County Service Providers Network
 Seniors housing and retirement homes
 Transportation infrastructure
 Partners with Haliburton County residents
– Community Advisory Committee
– Community Engagement and Communication Plan

32. HHHS Becoming a Leader as
a Rural Health Hub
 Long Term Vision (5-10-15 year timeframe)
 Guided by Master Program / Master Plan to be developed in broad
consultation with internal and external stakeholders
 Determine demographics of population in longer term timeframe and
determine Service Needs, particularly growing numbers of seniors and
frail elderly
 Assess capability of facilities in Minden and Haliburton to delivery longer
term Master Plan
 Reconfigure Minden and Haliburton Sites?
– Seniors Site with expanded Aging in Place options and services and
enhanced Primary / Urgent Care
– Acute Hospital Site with consolidated ED and expanded diagnostics
– Transportation infrastructure across communities

33. Leaders in
innovative rural
health care.