Better services should result for Huron Perth residents thanks to integration

It is still early days for the amalgamation of three major community support service providers in Huron and Perth Counties, but great things are expected from the resulting organization: ONE CARE Home & Community Support Services.

Executive director Kathy Scanlon shared the ONE CARE story with attendees of a board to board engagement session held by the South West LHIN in Zurich on February 23rd. Kathy noted it was one of the new organization’s first presentations and the  story is still unfolding.

ONE CARE  is the amalgamation of Town and Country Support Services, Midwestern Adult Day Services and Stratford Meals on Wheels & Neighbourly Services – all charitable not-for profit community support service organizations with volunteer boards of directors providing support to seniors and adults with physical disabilities including individuals at risk of, or living with chronic disease.

Between the three organizations, 5,723 clients were served in 2009-10. In all 302 staff provided services, and 1,164 volunteers contributed nearly 51,000 hours of service. They types of programs include adult day services, supportive housing, transportation, meals, wellness, diner programs, in-home support, respite care, safety/reassurance and Home at Last services.

“The purpose of our ONE CARE amalgamation was to create a stronger organization in order to deliver integrated services and support the evolving health care system. We believe what we’re doing is closely aligned with the LHIN goals and we believe what we’re doing is helping community services to be able to provide the services they need to provide in this evolving healthcare system,” Kathy said.

ONE CARE is evolving as a stronger organization as efficiencies are created with the integration of three agencies. A big part of that success can be attributed to the support and foresight of the executive directors of the three organizations. “They were the ones that originally were behind the idea of coming together,” she said.

“The other part of what we’re trying to do is deliver integrated services. And this is the heart of what we do – deliver service to people.” Integrated service is about an individual experiencing service in a continuous way, Kathy explained. From her perspective, the need was highlighted when she spoke with a man who had called about concerns with their service.  “As I was chatting with this client, one of the things that became crystal clear to me is that they had all these different services – meals, home help, etc. – all these different people trying to coordinate the services. Despite the fact many of those services were delivered by one organization, it didn’t feel like a wraparound service, it felt like a series of things.”

Today, with ONE CARE the goal is to provide wraparound service that is coordinated. In addition, she says they want to create high quality consistent community services. That means similar costs and ways of delivering service so that clients and other health care professionals know what to expect.

It is also important to remember the important role of volunteers in delivering services and how they are committed to working in their local community. The services of ONE CARE must therefore retain a local feeling. “That is part of our challenge as we come together,” Kathy says.

What role do community services play in the overall system?

“I really believe that community services are the best kept secret in the health care system,” Kathy says. Unfortunately, she adds, theyare often under-utilized.

“Community services are also misunderstood in what they can provide for people. They provide that preventative support – those kinds of daily supports that enable people to be at home,” she says. “It is a whole variety of things that we can provide and they are very much integrated in people’s daily lives.”

The problem for community services, she adds, is that they are often seen as an add on to services that may be planned by a physician, nurse or a CCAC case manager. That may be because the services aren’t consistently available or partly because they are services (like cleaning or meals on wheels) that may be taken for granted.

“We know from research what it is that makes people go to long-term care – it’s the simple things. I no longer have the dexterity to turn my mailbox key, so I can no longer get my mail. I no longer can do the cleaning on a regular basis. I can’t do the yardwork, so my house is becoming overwhelming. My world is shrinking because my mobility has become restrained. In winter, I just don’t go out anymore. I have no friends, my life has become increasingly isolated. I don’t get exercise … it’s a downward spiral,” Kathy says. “We need to ensure we have a consistent base of those kinds of supports. We need to ensure we support people in their health, in their recovery from illness, and in their day to day lives.”

Hip fracture improvement project gets underway

Hip fracture wait times – the amount of time it takes for a patient to make it into surgery from the time they are admitted into an emergency department with a broken hip - have been in the sights of local health care leaders. In the first six months of 2009/10, only 78 per cent of patients in South West LHIN hospitals received their surgery within 48 hours of being admitted for a hip fracture. A lot of work still needs to be done as we know that people who have their hip repaired within 48 hours have better outcomes.

Working under the direction of the Ontario Orthopaedic Expert Panel, the Bone and Joint Health Network (BJHN) released care maps and other research-based recommendations to assist Ontario hospitals to meet the target of 90 per cent of patients receiving surgery within 48 hours of their hip fracture.

Improvements are underway across the South West LHIN as the BJHN care plans are implemented at hospitals that perform hip fracture repairs. They include: London Health Sciences Centre, St. Thomas Elgin General Hospital, Strathroy Middlesex General Hospital, Stratford General Hospital, and Grey Bruce Health Services - Owen Sound site. It is expected that Woodstock General Hospital will begin implementing the expert panel guidelines soon.

In addition, the South West LHIN Hospitals and South West CCAC Leadership Forum identified the need for a project that would increase access to hip fracture care and decrease the amount of time patients spend in acute care hospital beds who do not need to be there. The South West LHIN provided nearly $225,000 in one-time funds to LHSC to lead a project that focuses on improving the percentage of hip fracture repairs that are done within 48 hours and also improving patient flow within the system and between hospitals in the LHIN.

This project is in the early stages of implementation. Its purpose is to improve hospitals’ ability to meet the provincial target of hip fracture surgery within 48 hours of emergency department admission and diagnosis. It will also assess and implement other opportunities for improvement across the system that include the consideration of shared orthopaedic on-call coverage in communities where this could improve access.  Patients with a hip fracture often arrive at an emergency department of a hospital that doesn’t do hip fracture surgery and need to be transferred to another hospital for the operation. For this reason, the South West LHIN Patient Access and Flow (one number) inter-hospital patient transfer protocols will also play a key role, enabling more timely movement of patients between hospitals.

Hip fractures represent significant risk for people, particularly for seniors.  Hip fracture rates increase with age and represent the most common type of injury requiring hospitalization among people aged 65 years or older. The average age of those hospitalized in the South West LHIN in 2008/09 for a hip fracture was 81 for women and 73 for men. Hip fractures are associated with significant rates of mortality (as high as 30 per cent) and morbidity.  In 2005-06, approximately 7 per cent of seniors admitted with a hip fracture died in hospital within 30 days of admission. The risk of death within 12 months of a hip fracture is estimated to be as high as 35 per cent.

thehealthline.ca redeveloped to serve broader needs

It sounds a little dry – the South West LHIN Program and Services Inventory. But the reality is an exciting step forward for thehealthline.ca 

thehealthline.ca Information Network is partnering with the South West LHIN to expand the existing database to include more detailed information on health services providers in the region. The resulting database will provide high-quality information for patients, health care providers, and health system planners.

 “The South West LHIN’s Integrated Health Service Plan identifies the need for a ‘tool that enables for multi-level system navigation,’” notes LHIN Senior Director of Planning, Integration and Community Engagement Kelly Gillis. “That’s what the thehealthline.ca is. It’s a proven solution that attracts more than a million people a year. This project takes it to the next level.”

Before this project, thehealthline.ca had a listing for each provider across the South West.  In the first phase of the project, all of the services offered by providers across the region were identified and added to the database. In total, more than 2,700 service listings were added, almost doubling the total number of profile/organization records. By 2012 it’s expected that there will be close to 10,000 records on thehealthline.ca.

Most of the growth came as a result of splitting up current records to provide more detail about specific services. For example, Meals on Wheels London had one service profile record on thehealthline.ca until recently. Now it is broken down into five records, one for the main organization and one each for standard meal service, the frozen meal service, the “Out for Lunch Bunch,” and transportation services.   

Things get even more interesting in the second phase of the project. That’s when thehealthline.ca will be re-designed to help both consumers and experts find the information they need. In addition to the extra listings, there will be several changes:

• A specialized interface for providers, giving them access to additional information
• A specialized interface for healthcare leaders, giving them access to additional information to support system-wide planning
• Easier importing and exporting of data, making data sharing easier
• A postal code search that allows users to search for services by location and/or by topics
• A sidebar menu for service profiles, providing links to additional information about the organization,  job listings, news and events
• Better linking among related services
• Ongoing (at least annual) updating of listings

“This project will lay the foundation for a powerful integrated health service information system, capable of adapting and scaling up to meet service provider and LHIN needs,” says Gillis. “People will have access to more information about how to find services, providers will have more information to guide their clients and make better referrals, and planning staff will have more information about the services available in the LHIN.”

The next step will be a series of webinars for health service providers, explaining progress on the PSI project, showing them how to update their service profiles, and introducing them to the new features of the site. “thehealthline.ca is there to serve the organizations it lists,” says Lisa Misurak, Manager of thehealthline.ca. “We want to involve them as we move forward and ensure that they’re benefiting from the changes.”

Sandra Coleman, CEO of the South West CCAC and Chair of the Board of Directors of thehealthline.ca Information Network says thehealthline.ca has come a long way since it was first launched in 2002. “We’re delighted that its value has been recognized and is being leveraged by the LHIN,” she says.

Coleman adds that thehealthline.ca has also been selected by the Ontario Association of Community Care Access Centres and the 14 CCACs as the provincial model for health services information. “We’re proud of the valuable service thehealthline.ca has become,” she says. “This is the culmination of a lot of hard work and creativity.”

Input sought on rural and northern health care

The Ministry of Health and Long-Term Care recently held consultations in 11 communities across the province to gather feedback on the 12 recommendations in the Rural and Northern Health Care Framework released in November 2010.  The feedback gathered at these sessions and other engagements will be used to complete the framework by the summer of 2011.

On January 3, a session was held in Hanover with about 25 members of the public in attendance.  Guelph MPP Liz Sandals, Parliamentary Assistant to the Minister of Health and Long-Term Care, hosted the event. 

Linda Stevenson, of the South West LHIN’s Board of Directors, was on hand to introduce MPP Sandals and welcome the participants to the event on behalf of the LHIN, which includes the area around Hanover.   “The South West LHIN covers a huge swath of largely rural Ontario and we work hard to stay engaged with the needs and concerns of the residents and our health care partners in these areas,” Stevenson added.

After a brief overview of the report, the 12 recommendations contained in the framework were the subject of discussion roundtables. Topics for discussion included transportation, community engagement, integration and more.  By creating a focused conversation, each table could delve deeper into an issue, but the format also allowed everyone the opportunity to provide additional comments as the other tables reported back to the whole group.

 “We’re looking for input from Ontarians on the best way to make sure that those living in rural and northern communities get the care they need, when they need it, as close to home as possible,” commented MPP Sandals.

More information on the Rural and Northern Health Care Framework is available at www.ontario.ca/ruralandnorthernhealth.
You can see a video of the opening presentation at the Hanover session by visiting the South West LHIN’s YouTube Channel.

Physicians focus on quality

Quality was the word of the day March 8 in Kemble, ON where almost 50 health care professionals packed a joint South West LHIN and Ontario Medical Association physician session to hear Dr. Anne DuVall speak.

DuVall, president of the Ontario College of Family Physicians, talked about the Excellent Care for All Act and how it affects health service providers. She discussed specific quality initiatives like the Quality Improvement and Innovation Partnership, and then explained what kind of impact all of these things will have on family doctors.

“I’m encouraged by the level of participation I’ve seen here and the work that’s going on in the LHIN,” DuVall said in reference to initiatives like the FLO Collaborative, Partnerships for Health and Residents First taking place in the South West. “The quality agenda is really being embraced here and it’s not going away.”

It’s just in time, she said. In a recent Commonwealth Fund study, Canada ranked sixth out of seven countries in quality of care.

“On an international level, we don’t look very good,” she continued, explaining improvements in health care quality are not only necessary, they’re coming - regardless of whether or not family physicians are ready for them.

“Nobody likes being told what to do in their own practice, but there are conversations going on right now with the Ontario College of Family Physicians and the Ministry about what should be done at the primary care level.”

“We need to look at process indicators ... how satisfied are patients with the services they get. Access will be an important indicator. It may be a year or two or three until it gets rolled out in earnest, but this is all coming down the pipe.”

Technology will play a role in helping physicians cope, but DuVall cautioned against reading too much into things like Electronic Medical Records (EMRs).

“An EMR by itself isn’t a quality improvement – but it certainly helps,” she said.

DuVall’s comments were followed by three break-out sessions. Brad Holman, Vice Chair of the Hanover and District Hospital, Maureen Solecki, CEO of Grey Bruce Health Services and Dr. Robert Servers, Chief of Staff at Grey Bruce, talked about the role physicians can play in influencing their hospital’s quality agenda and heard concerns from doctors about who will be setting the standards and determining the right indictors to measure.

Centralized access was discussed by Dr. Rob Annis, Chair of the Regional Primary Care and Cancer Network, and Susan Warner of the South West LHIN, and the LHIN’s Chief Information Officer and eHealth Lead, Glenn Lanteigne, was joined by SPIRE Project Manager Jason Langdon to talk about eHealth as an enabler.

Quality discussion front-and-centre at forum

More than 400 people have already registered to take part in the first annual South West LHIN Quality Symposium: Building a healthier system through quality and innovation. Considerable interest is being expressed over both the main and governance sessions of the event, which will feature keynote speakers Jim Easton of the UK National Health Service, health policy analyst Steven Lewis and The Hon. Deb Matthews, Minister of Health and Long-Term Care (invited).

The quality theme for the event blends in well with the LHIN’s overall focus on quality improvement as an enabler in achieving goals laid out in the health system design blueprint and the integrated health service plan. It also aligns well with the province’s Excellent Care for All Act, 2010.

As health service providers work through their own quality improvement planning, the symposium will provide an opportunity to learn, share and foster new ideas. Evelyn Harris Williams, Chair of the South West Community Care Access Centre, notes the timing and content for the symposium couldn’t have come at a better time: The CCAC Board was planning a retreat to focus on the Board’s role regarding quality.  “We were in the process of considering speakers and approach when we saw the outline for the LHIN Symposium on Quality on April 28th.  Our Board’s opinion was that the symposium agenda contains the content our Board needs so instead of organizing our own separate retreat, our Board members will be attending the LHIN Symposium on Quality. We can then discuss as a Board later this spring how to move forward our quality agenda reflecting on what we learn April 28th.”

Objectives of the symposium include better understanding and commitment to key quality strategies and initiatives, to celebrate our successes and to build momentum for change. In addition to the keynote speakers, there will be a panel discussion on Partnerships for Health, a three-year quality improvement initiative that resulted in enhanced diabetes care for more than 6,500 people in the South West living with diabetes as well as other care improvements that will have far reaching benefits for health care in the South West LHIN.

Participants will also hear from quality improvement experts from other areas on the Home First initiative, local successes with programs that help improve access to care and much more.

Check the LHIN website for the latest symposium news and information. 

South West LHIN hospitals developing standards for non-urgent patient transportation

When hospital patients need to be moved between hospitals and an ambulance is not needed, non-urgent transportation services are often used. These services may include anything from a private car to something that may look like an ambulance, but without the lights and sirens. These forms of service are provided by many hospitals in the South West LHIN.

Non-urgent patient transportation may be used to move medically stable patients between hospital facilities. In the past, many of these patients may have travelled by ambulance, but as demand for ambulance services has increased and the ability for Emergency Medical Services (EMS) to respond to calls for non-urgent transportation decreased, private businesses providing non-urgent transportation have become more available and visible.

Unlike ambulance services, there are no regulations to govern the quality of services provided by non-urgent patient transportation providers in Ontario. This puts hospitals in a challenging situation in determining who can best meet their service needs.

In the fall of 2010, there was considerable discussion among the hospitals in the South West LHIN about potential patient safety concerns and the liability and risk that hospitals assume when they enter into a contract with non-urgent medical transportation providers. In early January 2011, the South West LHIN announced $123,000 in funding for the project that will result in the creation of high quality non-urgent transportation service standards that will be applied consistently across the South West.

In addition, a standard decision guide will be created for hospital staff to use in weighing their options about what form of vehicle or service to request when transferring a patient. Given the demand on ambulances and the importance of making the best use of health care dollars, it is essential the most appropriate form of transportation be used.

Watch future editions of Exchange for updates on the non-urgent patient transportation project in the South West LHIN.

Nicole Robinson joins the South West LHIN team

Nicole Robinson joined the South West LHIN as the Performance Improvement Lead on March 7, 2011. In her new role, Nicole will be providing leadership and guidance to LHIN-wide access improvement initiatives, wait time strategies and performance related activities including further development  and implementation of a Performance Improvement Framework.  Prior to joining the LHIN, Nicole worked in the health sector for the Erie St. Clair Regional Cancer Program of Windsor Regional Hospital as the Coordinator of Cancer Prevention and Patient Education. During her time there she provided leadership of several leading practices and high-level strategic projects, and regional collaborations. Prior to this, Nicole worked in the private sector for Chrysler Canada as a Black belt working on various launch projects and LEAN initiatives.  Nicole is currently on the Advisory Board of the Leadership Windsor-Essex Program, and is also a member of the Steering Committee for the Canadian Cancer Patient Education Network.  Nicole has a Bachelor of Science from the University of Western Ontario and Master of Applied Science from the University of Windsor.  She is also a certified Black belt in Problem Solving Strategies from Shainin LLC.

ENITS helps trauma patients, saves millions

Trauma patients across the South West LHIN now have access to a neurosurgeon 24 hours a day, 7 days a week as the province connected its 100th and final acute care centre to the Emergency Neuro Image Transfer System (ENITS).

“This is a significant milestone for improving patient care in Ontario through eHealth,” Deb Matthews, Minister of Health and Long-Term Care Deb Matthews said of the centralized online system that makes remote neuro-consultations easier, faster and more accurate than ever before.

“It means that people right across the province will benefit from neurological specialists regardless of geography. It also means that unnecessary transfers will be avoided, sparing families needless travel, expense and worry.”

Through ENITS, 70 neurosurgeons at 13 neurosurgical centres provide online consultations to acute care sites throughout the system, including those in the South West. In the past, head trauma cases were sent either to the USA (38 per cent) or to a neurosurgical centre within the province (62 per cent). According to the MOHLTC, the average cost of each out-of-country neurosurgery transfer is between $75,000 and $100,000.

ENITS significantly reduces the need for patients to travel for treatment. Since January 2009, 2,404 head trauma neurosurgical cases have been referred to ENITS and 1,558 patient transfers have been avoided, saving the system more than $50 million.

“ENITS provides the critical infrastructure physicians require to eliminate unnecessary transfers by connecting them to specialized neurosurgeons across the province in real time,” said Greg Reed, President and CEO of eHealth Ontario. This is a perfect example of how collaboration within the health care system is changing the way patients receive care.”

For more information on ENITS and the Picture Archiving and Communications System (PACS) that makes it possible, click here.