National Healthcare Leadership Conference, Winnipeg, June 7, 2010

Nancy Heinrichs BSWRenata Cook RN BNMichelle Kirkbride BADan Skwarchuk B.Comm (Hons), CGA, CHENor’West Co-op Community Health Centre andWinnipeg Regional Health Authority 103-61 Tyndall Ave Winnipeg, Manitoba R2X 2T4

Winnipeg

Session Objectives� Overview of our Interdisciplinary Team

� Winnipeg Regional Health Authority and Integration

� Nor’West Co-op Health Centre and Integration

� Results from two Formal Evaluations that support collaboration and integration

� Case Studies

� Key Messages

� Discussion Period - Panel

Nor’West Co-op

Community Health Centre

Who Are We?

� Primary Care

� Mental Health

� Community Development

� Public Health

� Early Learning and Childcare

� Nor’West Mentor

� Counselling Services

- Aboriginal Health Outreach

- Family Violence

- Immigrant Women’s Counselling

- A Woman’s Place

Nor’West Co-op CHC

Board

�Only Co-op CHC in Manitoba

�Not for profit

�Community elected Board

�Programs offered in partnerships , many funders

�Inkster Community or city-wide (population specific)

�38 years in the community

Mission – Vision 2008

MissionNor’West Co-op Community

Health Centre works in collaboration with individuals, families and communities, to promote health, and enhance safety and well-being of identified populations and the community of Inkster.

VisionWe are the Leaders in Innovative,

Collaborative, Client Focused Health Services of the Highest Quality

Strategic Directions 2010

� Develop and Embrace

Innovative Health and

Wellness Models

� Enhance Co-op Identity

and Affiliation

� Ensure Organizational

Sustainability and

Independence

� Improve Integration and

Access

� Develop Communication

Strategies

� Enrich Human Resources

Inkster Community Northwest area of the city

Diverse � Filipino, Aboriginal, East Indian and Caucasian

� Recent influx of immigrants and refugees

� professionals, blue collar workers, unemployed, less than high school diploma

� higher STIs, teen pregnancies, unemployment and poverty

� Co-op Housing, two Manitoba Housings, single family and industrial parks.

Area 18.1 sq.km

Population 31953

Winnipeg Regional Health Authority

WRHA - Who We Are

• WRHA mission is to coordinate safe and caring services to promote health and well-being.

• Comprehensive health services from all sectors including community, acute care, and long-term care.

• 2009/10 Annual Budget: +$2.1 billion / year

• Approximately 28,000 employees

WRHA - Who We Are

• Community: Three Community ACCESS Centres, many funded health agencies, home care, community mental health services, and much more.

• Acute Care: Two tertiary care hospitals, four community hospitals, and other sites delivering acute care services.

• Approximately 1,950 acute care inpatient beds.

WRHA - Who We Are

• Long-Term Care: Approximately 5,848 personal care home beds, 177 chronic care beds, 516 supportive housing units, and 15 companion care units.

• Given this broad range of services the WRHA has the potential and ability to coordinate services in a very patient-focused and integrated manner!

WRHA - Who We Are

• WRHA services are coordinated in a complex matrix management model with 24 regional program teams and multiple hospital sites and community areas.

• Creation of Clinical Services Portfolio to help foster and optimize health services integration and manage regional processes than span multiple programs and multiple sites.

New WRHA Strategic Directions

� Improve Patient Experience

� Foster Public Engagement

� Support a Positive Work Environment

� Advance Research & Education

� Create Sustainability

� Enhance Quality & Integration - Enhance access to quality and safe care through improved integration of services and the use of evidence informed practice.

WRHA Priorities Regarding Integration

• Enhance provincial and inter-provincial access.

• Improve primary care infrastructure and performance.

• Improve system integration: coordination of care and health information management.

• Improve access to health prevention and promotion activity (public & community).

WRHA Priorities Regarding Integration

• Improve system performance in the areas of ER wait times, chronic disease management, palliative care and wait time targets.

• Improve physician alignment & engagement.

• Reduce inequities in access to care (aboriginal, immigrant and refugee, seniors, disabled).

Top Key Principles for Integration� Comprehensive services

across the care continuum.

� Creating and maintaining a patient focus.

� Geographic coverage and rostering.

� Standardized care delivery through interprofessional teams.

� Performance management.

Suter, Esther et al. 2009. “Ten Key Principles for Successful Health Systems Integration.”Healthcare Quarterly. Vol. 13 : 16-23.

� Information systems crossing health sectors.

� Organizational culture and leadership.

� Physician engagement and integration

� Diverse governance structure promoting coordination.

� Financial management and aligning resources to services

Nor’West and WRHA

Integration

WRHA Inkster Team

� 1998-99 – co-location of WRHA Inkster team

- Public Health Nursing Team

- Families First Home visitors

� 2000 - Community Mental Health Worker

� Co-location enhanced focus on client and community needs between both agencies.

� Opportunities for partnering, integration and collaboration.

Strengths – Integrated Processes

� Leadership

� Co-location

� Integrated Processes

� Joint Triage and Committees

� Many Points of Access

Strengths Committees / Culture

� Expectation that staff join teams

� Integrated Project Teams

� Integrated Orientation Process

� Joint Social Wellness Committee

� Joint Quality and R&E

Joint Quality, Safety and Commitment

to Excellence

� Three partner QI Team

� Three Priorities identified:

- Job Shadowing

- Ethics Team

- Professional Development Team

� Workplace Safety and Health

� Staff Retreats

Monthly All Staff MeetingNor’West, WRHA, FSH and Parent Child Coalition

Formal Team Evaluation

Nor’West and WRHA

Formal Team Evaluation

� Formal Evaluation between Nor’West and WRHA Inkster Public Health and Mental HealthTeam –2008 and 2009

� Purpose: To identify factors affecting primary care and public health integration and collaboration, and factors affecting staff’s attainment, maintenance and utilization of Public Health Core Competencies in Partnerships, Collaboration and Advocacy, and Diversity and Inclusiveness.

Team Evaluation

� WRHA Research and Evaluation unit and financial support from Public Health Agency of Canada

� Methodology:

- Phase 1 - Formative Evaluation using Appreciative Inquiry process with our interdisciplinary team and focus groups and partner interviews;

- Phase 2 - client interviews and focus group

� Positive findings and clear examples of collaborative factors.

Evaluation Plan – Methods

� Appreciative inquiry workshop with staff (n=25)

� Questions– developed around each Competencies

� Staff consultation

� Interviews with external partners (n=7)

� Interviews with clients (n=13)

� Client focus group (n= 5)

Findings: Staff and Partners

Reported findings:

� Enhanced understanding of clients/community

� More inclusive and holistic health services to support clients and the community

� Increased ability to respond to urgent situations.

� Increased support for employees and opportunities for skill development

� Enhanced accessibility - for diverse and underserved populations

Case Scenario

Local School Incident

� 2005 serious blood exposure incident in a local school

� Many students involved

� Initial PHN and CD

� 48 Hr local joint response – Nor’West and WRHA:

- opening Saturday PC clinic – PC nurses and PHNs

- parent notification and contact tracing and follow-up

- counselling, blood testing and vaccination

- 3 and 6 months follow-up

Findings: Staff and Partners� Key factors identified for supporting collaboration:

� Design of space, co-location, absence of cubicles

� Integrated structures and processes – joint reception, charts, case meetings, co-visiting

� Staff diversity being valued– having different skill sets, perspectives and cultural backgrounds

� An organizational culture and leadership that promote trust, flexibility and staff knowledge of available resources.

- staff being open to collaboration and flexible,

- staff knowing each other’s roles and trusting each other

- leadership playing active role in promotion of collaboration

Findings: Client Perspectives

� Clients expressed being happy and satisfied with services received;

� stated that Staff understand their diversities, respect their values and beliefs, and provide care with dignity;

� Clients stated positive impact on improving their health and ability to manage health conditions and cope with their life situations

� Clients expressed increased accessibility and increased coordination and continuity of care; co-location

� Increased well-being and quality of life; and trust building

Client Story

Mrs. C.

Mrs. C.

“The work that she (mental health worker) did for me in the

beginning impacted my health, life, and whole society.

What she has done for me, it is a growth. If that wasn’t

done, I would be cut off … That state put me to the

hospital for 3-6 weeks in the past. With this work, I

haven’t been in the hospital for that long; just overnight..

It helped me be an outpatient instead of being at the

hospital… They support my handicap. They make it a

more even playing field. They help me to be part of

society. It’s not my only benefit; society is benefited from

me.”

Findings: Client Perspectives

� “It works fairly good. They listen so they can connect you. I saw nurse, doctor, mental health worker, pharmacist, dietitian. Mental health because after I had a heart attack, I had anxiety, post-traumatic stress. 3 doctors, 8 trips to ER. Nobody would listen. Then it took one doctor here to listen. The doctor listens and says, okay, I would like you to see this person and this person.”

Findings: Recommendations � Continue to build on strong collaborations and

integration, and develop new ones;

� Leadership - more work processes that support collaboration and opportunities for increased understanding of each other’s roles and programs

� Space conducive to collaboration

� Continue to focus on relationships between staff, clients and partners

� Include clients in the planning of programs

� develop communication / promotion strategy

Integrated Initiatives

Integrated Initiatives - Scenarios

� Inkster Teen Clinics

� Integrated H1N1 Inkster Clinic

� Inkster in Action – project and results

� Work Readiness Project

� HANS

� Resource Centres

� Gilbert Park Going Places - project and case

� Community Trauma Response

Inkster Teen Health Clinics

� Joint Proposal and Initiative – Nor’West, WRHA and Community

� Focus – to improve teens’ access to health care

� 4 Teen Health Clinics in Inkster Community

� Core Team - public health nurses, primary care nurses, physician and or nurse practitioner, community development worker, social worker –all internal partners

� Offer reproductive health, primary care, one-on-one support, health promotion, relationship counseling, group education, smoking cessation, and nutrition counselling etc.

Inkster H1N1 Clinics

� H1N1 and Flu Clinics – 2 months intense initiative

� Central location, group homes and Resource Centre

� PHNs, integrated admin team, management team, all Nor’West staff

� Integration – planning and delivery level – scanning for sites, promotion, supplies, staffing, cross - training

� Opportunity to further develop trust, respect, teamwork

Inkster in Action

� 3 Partner Strategic Priority – 3 year research

� Goal – To enhance nutrition and promote physical activity to residents of Inkster Community

� Included: programs, support groups, individual lifestyle counselling, questionnaires, client interviews and focus groups

� Kids in the Kitchen, Catering, Fun with Food and Fitness, Diabetes Groups, etc

Inkster in Action: Client Outcomes

� The following were reported during individual interviews:

- Increased self esteem and support systems

- Enhanced social skills

- Achieved healthier diet and active lifestyle

- Less isolation

- Reduced hospitalization

Inkster in Action: Findings Staff

� Some of the findings reported – staff questionnaires and focus groups:

� Improved collaboration , understanding of each other’s roles and trust among 3 partners

� Staff engaged in more physical activity and healthier eating

� Team able to offer timely services

Work Readiness Project

� GOAL – to help enable residents to development the necessary and appropriate skills and tools needed to search for employment with confidence, seek employment and become gainfully employed.

� Partnerships - Family Services, Employment and Income Assistance (EIA), Manitoba Housing, The Centre for Aboriginal Human Resource Development (CAHRD) and Nor’West.

� Offered out of Resource Centres – Inkster residents

� Catering Project

Future – HANS

� Health promotion peer led self-help groups based on Japanese Model – Inkster and Seven Oaks Areas.

� Participants will be empowered to monitor their own physical, social, emotional and mental health and well-being .

� Monitor indicators such as BP, BS, Stress, Sleep patterns, Nutrition and physical activity logs etc

� Ongoing self – management and ownership of own health.

Resource Centres� 3 Resource Centres

� Partnerships

� Increased access to health and social services

- support, counselling

- Programs and resources

- Free phone, computer

- advocacy and referral

- community advisories

- Events – Health Fairs, concerts, BBQs

Gilbert Park Going Places Project

� Goal of Going Places: Healthy and resilient youth in Gilbert Park

� Supported by multi agency steering committee and Integrated Team

� Programming - general recreation program (including art and cooking), counselling, skill development and peer mentoring

� Evaluation

Community Story - Trauma

Key Messages

� Leadership

� Champions

� Integrated Processes

� Culture of Teamwork, diversity and respect

� Co-location and space

� Technology

Our Thanks to

The Staff at Nor' West and WRHA

Family Services and Consumer Affairs

and Employment and Income

WRHA Research and Evaluation Unit

Gerry Kaplan and Associates

The Public Health Agency of Canada

Contact InformationNor’West Co-op Community Health Centre and WRHA Inkster Team

103-61 Tyndall Ave Winnipeg, Manitoba R2X 2T4

www.norwesthealth.ca

• Nancy Heinrichs

Executive Director

PH: 204-940-2020

Email: nheinrichs@wrha.mb.ca

• Dan Skwarchuk

Executive Director , Health Services Integration

Winnipeg Regional Health Authority's

PH: 204-926-7099

Email: dskwarchuk@wrha.mb.ca

Question- Discussion

Period