CHS Integration Strategy: Facilitated and Negotiated Integration Process Directional Plans - Scarborough & Peterborough

December 18, 2013

OVERVIEW

CHS Scarborough and Peterborough Directional Plans

2

Strategic Aim for Community Health Services Integration

Design and implement a 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, and;

- make the best use of the public’s investment

3

Benefits

• Improve client access to high-quality services

– Access to consistent and integrated basket of services will improve client and caregiver experience and outcomes.

• Create readiness for future health system transformation

– Create critical mass in governance, management, delivery and IT capacity to enable future growth in community care.

• Make the best use of the public’s investment

– 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.

4

PROCESS

CHS Scarborough and Peterborough Directional Plans

5

Facilitated Integration Planning Process for both Scarborough & Peterborough

6

Facilitator Recruitment

Communications & Stakeholder Engagement

Evaluation Criteria

established

Governors Engagement

Current State initiated

LHIN Team Formation

Kick Off Meetings IPT

Governance Strategy Sessions

1 &2

July – Dec 2013 Directional

Plan

Transition Planning June 2014 – Mar 2015

Implementation

Communications & Stakeholder Engagement

Options Analysis

Options Selection Jan – March 2014

Preferred Integrated Service Delivery

Model

Communications & Stakeholder Engagement Governance Check-Ins

April – May 2014 HSP Boards Review/ Decision

LHIN Board Review/ Decision

Integration Plan

Communications & Stakeholder Engagement Governance Check-Ins

Draft: V4 Sept 24.13

Governance Check-Ins

Governance Check-Ins

HSP/LHIN Board

Approvals

Scarborough/Peterborough Process Summary

July LHIN Integration Team and Facilitator selection finalized

Aug 25 Integration Planning Team Kick Off

Sept Initiation of Current State Development

Sept 25 Governors’ Kick Off Session

Oct 28/Nov 4 Peterborough Governors’ Strategy Session (2 evenings)

Nov 2 Scarborough Governors’ Strategy Session (1 full day)

Nov 22 Directional Plan to HSP IPT for Boards

Nov 25-Dec 5 HSP Boards Directional Plan Review & Decision

Dec 18 Central East LHIN Board Directional Plan Review & Decision

7

DECISIONS BY HEALTH SERVICE PROVIDER BOARDS

CHS Scarborough and Peterborough Directional Plans

8

Scarborough IPT Organizations

• TAIBU Community Health Centre

• Scarborough Centre for Healthy Communities

• St. Paul’s L’Amoreaux Centre

• TransCare Community Support Services

• Centre for Immigrant and Community Services

9

Scarborough Directional Plan Board Motion That the Scarborough CHS Integration Planning Team be directed to explore the following FIVE options as they develop a DRAFT model for the delivery of community-based health services in Scarborough.

1. Improved Sharing of Current and Best Practices: Formation of best practices committee that includes LHIN or provincial representative, and provide information about best practices to all the organizations.

2. Client service intake/referral process consolidation: Provide more efficient and effective intake at agency and client level, and standardize eligibility of clients and awareness of breadth of services. This may have a back office impact.

3. Client services integration (meals, adult day, etc.): Select services based on client. This may have a back office impact.

4. Back Office integration (HR, IT, Finance, etc.): Opportunity for stronger system, quality, cost effectiveness, and standardization.

5. Reducing the number of LHIN-funded organizations: Structural integration of two or more LHIN-funded organizations

10

Scarborough HSP Board Decisions

11

CHS Integration Directional Plan

Health Service Provider

Date HSP Board Decision

Nature of Comments

TAIBU Community Health Centre Nov 26 Carried

Scarborough Centre for Healthy Communities

Nov 27 Carried

St Paul’s L’Amoreaux Centre Nov 26 Carried

TransCare Community Support Services

Dec 5 Carried (with

comments)

• Request for funding to support one-time costs, communication and stakeholder engagement.

• Recommend agency management and governors meet to discuss integration requirements and again to provide further input

Centre for Immigrant & Community Services

Dec 4 Not carried (with

comments)

• Willing to explore other integration options

Summary - Scarborough • Four of five HSPs approved Directional Plan

• Centre for Immigrant & Community Services didn’t approve Directional Plan, but is willing to explore other integration opportunities

• Transcare recommends enhanced board engagement of all identified HSPs to support Directional Plan

12

Peterborough City and County IPT Organizations

• Community Care Peterborough

• Community Counseling & Resource Centre

• Hospice Peterborough

• Lovesick Lake Native Women's Association

• St. John's Retirement Homes Inc.

• Victorian Order of Nurses of Canada, Ontario Branch

13

Peterborough Directional Plan Board Motion • Based on the understanding that the governors of the six

organizations involved in the Peterborough CHS Facilitated Integration process wish to continue to build on the momentum that has been created through the Governance Strategy Sessions in achieving the stated outcomes of the Central East LHIN’s Community Health Service Integration Strategy;

• And recognizing that learning about previous Central East LHIN integrations and related best practices will support the governors to make strategic decisions to support the delivery of community-based health services in Peterborough City and County;

• Therefore, the Peterborough CHS Integration Planning Team is directed to explore the following SIX options as they develop a DRAFT model for the delivery of community-based health services in Peterborough City and County.

14

Peterborough Board Motion cont’d 1. Advisory Committee: Creation of an Advisory Committee to reflect the interests of all

organizations and funders. Advisory Committee would be a strategic and operational planning partnership and strategic alliance between community-based providers.

2. Back Office Integration – Identification of Centres of Excellence/Lead Agencies to deliver Back office functions (BOF) for two or more of the six agencies or a Consolidated Single Back Office Function (BOF)

3. Overarching Anchor/Umbrella organization: A new single organization (Anchor Agency) to be accountable to the LHIN for the delivery of all LHIN-funded community based health services that would continue to be delivered by six separate organizations in Peterborough City and County

4. Integration Front-line Services (I.e. transfers of service): Identification of logical re-alignment of front line services between six entities

5. Two or more integrated service delivery entities: Explore logical options for voluntary merger/amalgamation of governance, leadership , service delivery and back office functions amongst the individual agencies.

6. One integrated service delivery entity: Creation of a new single CSS entity for Peterborough City-County that would assume accountability for the delivery of all services currently delivered by the six organizations with a new Board of Governors.

15

Peterborough Board Motion cont’d • This should include an analysis based on the questions noted above,

along with a review of the enabler options of investing in capacity development for each of the organizations and information on population needs to determine what services need to be provided now and in the future.

• Further, that the Peterborough CHS IPT members continue to keep their stakeholders – board members, clients/caregivers, volunteers, donors, funders and local residents - updated on their progress and identify opportunities where these stakeholders can be engaged in the development of these models.

16

Peterborough HSP Comments

17

CHS Integration Directional Plan Health Service Provider

Date HSP Board Decision

Nature of Comments

Community Care Peterborough Nov 27/13 Carried (with comments)

Removed 6th option – No readiness to examine #6 at this time.

Community Counseling & Resource Centre

Nov 28/13 Carried (with comments)

Removed 6th option – emphasized need to check in with Governors on risks and benefits.

Hospice Peterborough Nov 28/13 Carried (with comments)

Included all six - after discussion on removal of 6th option

Lovesick Lake Native Women's Association

Nov 30/13 Carried (with comments)

Included all six - caution that due diligence difficult in a compressed timeframe

St. John's Retirement Homes Inc. Dec 5/13 Carried (with comments)

Removed 6th option – No readiness to examine #6 at this time.

Victorian Order of Nurses for Canada, Ontario – Peterborough

Dec 11/13 Carried No particular comments on the proposed options with the understanding that due diligence still to take place

Summary – Peterborough • All six HSPs approved moving forward with some cautions

– Three of six requested removal of option 6 (one entity).

• All HSPs remain committed to moving forward collaboratively through the PIPT.

• Additional feedback included: – ongoing involvement of HSP boards;

– integration should be measured against meeting the evolving needs of our community and must meet the goals set out by the CHS Integration Strategy;

– concern about the ability to meet the timelines;

– risk of integration given different funders and funding formulas, volunteer bases, unique internal and external restrictions – cultural, religious, major fundraising projects.

18

PROPOSED MOTIONS

CHS Scarborough and Peterborough Directional Plans

19

Scarborough CHS Motion The Central East LHIN Board acknowledges receipt of the Scarborough Directional Plan which was developed through facilitated consensus, and endorsed by 4 of 5 of the participating health service providers. The Central East LHIN Board further acknowledges that the Scarborough Community Health Services integration plan will be informed by an analysis of the following five options:

1. Improved Sharing of Current and Best Practices 2. Client service intake/referral process consolidation

3. Client services integration 4. Back Office integration 5. Reducing the number of LHIN-funded organizations

Further, the Central East LHIN Board directs staff explore alternative integration options with the Centre for Immigrant and Community Services aligned to the integration process as set out in the Directional Plan.

20

Peterborough CHS Motion The Central East LHIN Board acknowledges receipt of the Peterborough Directional Statement report, which was developed through facilitated consensus among the participating health service providers. The Central East LHIN Board further acknowledges that the Peterborough City-County Community Health Service Integration Plan will be informed by an analysis of the following five options:

1. Advisory Committee 2. Back Office Integration

3. Overarching Anchor/Umbrella organization 4. Integration Front-line Services 5. Two or more integrated service delivery entities

Further, the Board instructs staff to amend the Directional Statement Report (November 15, 2013) to include an Addendum stating this motion and to inform the Peterborough Integration Planning Team and HSP Governors of same.

21