Integrated Health Service Plan

2013-2016

Appendix: A

Planning Framework

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The LHIN’s Framework for Planning

The development of the 2013-2016 Integrated Health Service Plans (IHSPs) was informed by a number of planning frameworks, guidelines and tools:

Institute for Healthcare Improvement’s Triple Aim Approach1

LHIN 2012/2013 System Imperative Framework2

LHIN Priority Setting and Decision Making Framework Toolkit3

LHIN Health System Performance Indicator Framework4

LHIN Community Engagement Guidelines and Toolkit5

These resources and tools will also assist us as we move forward with the implementation of the directions and activities identified in our 2013-2016 IHSP and will help us to:

Embed quality improvement and learning strategies into our activities

Advance strategies related to the collective system-wide imperatives

Implement a consistent and transparent approach to planning, priority setting and decision making

Continue to identify and measure performance indicators that support the achievement of provincial and LHIN-level goals and priorities

Apply a variety of communication and engagement strategies and tactics

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IHI Triple Aim Approach

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. The “Triple Aim” strives to improve three things for a population simultaneously:

People’s health care experiences

The health of populations

Per capita cost of health care

It does so by:

Focusing on individuals and families

Redesigning primary care services and structures

Managing the health of a particular population(s)

Establishing a cost-control platform

Reinforcing system integration and execution

Building coalitions with other sectors

The LHINs have committed to the Triple Aim approach as a framework for system quality improvement that will assist us in advancing our priorities and goals.

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LHIN 2012/2013 System Imperative Framework

Through a strategic planning process that took place from November 2011 to June 2012, the 14 LHIN CEOs identified and confirmed the four system-wide imperatives to be pursued and supported collectively. These include:

1. Implementing Evidence-Based Practice to Drive Quality & Safety will focus on high priority safety issues that require consistent, coordinated responses to ensure that patents are safe and that adverse events are minimized/eliminated;

2. Enhancing Access to Primary Care by advancing strategies to ensure people have timely access to a primary care provider and creating enabling structures and processes to align primary care more effectively within the overall continuum;

3. Enhancing Coordination & Transitions of Care for Targeted Populations will ensure key populations of patients have individualized plans of care that allow them to receive the care they need, when and where they need it; and the transitions post-acute are smooth and coordinated; and

4. Holding the Gains is a fourth imperative to ensure that new initiatives will not cause previous gains to be eroded (e.g., ER/ALC, ER Wait Times, and access to care, coordination amongst providers, enhanced focus on accountability).

Recommendations to Build a Successful Plan

To deliver on the system-wide imperatives, LHINs acknowledged potential opportunities, barriers and risks that may impact the workplan. The result is a list of key recommendations necessary to build a successful plan in order to move forward.

In order to confirm where we are going, LHINs will focus on four areas:

Ensuring accountability and action on patient-centred care

Assessing the impact of evolving funding models

Establishing an effective communication strategy

Leveraging scientific evidence

Enhancing Access to Primary Care

Enhancing Coordination & Transitions of Care for

Targeted Populations

Implementing Evidence Based Practice to Drive Safety

Holding the Gains

System Imperatives

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To build partnerships and enhance alignment of activities, LHINs will focus on four areas:

Aligning with the ministry

Aligning with provincial strategies

Building partnerships

Engaging with our providers

To ensure the ability to deliver on the plan, LHINs will support four areas:

Effective project management

Leverage technology

Ensure capacity to deliver

Measuring impact of the efforts

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LHIN Priority Setting and Decision Making Framework Toolkit

The LHIN Priority Setting and Decision Making Framework Toolkit was released in November 2010 to provide all LHINs with a common tool and consistent criteria to facilitate transparency and accountability in LHIN priority setting and decision making processes. The Priority Setting and Decision Making Process includes the following four steps:

Step 1: Compliance Screen – This screen allows for the immediate removal of courses of action from further consideration that do not meet fundamental criteria for acceptable LHIN actions.

Step 2: Using the LHIN Priority Setting and Decision Making Tool – This step involves the application of the tool (see table below). A score is determined for each potential course of action based on the relevant criteria, criteria weights and ratings.

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Step 3: Cost-benefit Analysis – This step involves undertaking a cost-benefit analysis for each of the remaining potential courses of action. This analysis is completed to determine their net impact. Top ranked courses of action (lowest cost-benefit ratio to highest) would then move forward to Step 4.

Step 4: System Readiness Screen – The final step in the priority setting and decision making process involves an in-depth review of the potential courses of action within the context of the broader healthcare system, while considering the questions below. Courses of action satisfying the system readiness screens are eligible for LHIN support as per the rank order identified through the priority setting and decision making process.

Guiding Principles

Guiding Principles have been identified to assist LHINs in the application of the priority setting and decision making framework:

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LHIN Health System Performance Indicator Framework

The LHIN Health System Performance Indicator Framework was developed as a tool for LHINs to identify indicators to monitor the performance of their health service providers (HSPs). As a tactical and operational tool, the goal of the framework is to allow LHINs and HSPs to work together to identify and monitor indicators that support the achievement of provincial priorities, by focusing on the components of and enablers to the delivery of quality health care services (across the continuum of care) to the people of Ontario. The framework is designed to support organizational and system performance measurement, guided by the strategic areas of focus for the LHIN, encouraging health care providers to work together in support of improved outcomes and experiences.

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LHIN Community Engagement Guidelines and Toolkit

A key component of the LHIN mandate is to work in concert with our community partners (the public, LHIN-funded and non-LHIN funded health service providers, primary care, etc.) to make the health care system more person-centred and responsive to local needs. Community engagement refers to the methods that LHINs and health service providers undertake as they interact, share and gather information from and with their stakeholders.

Community engagement is a LHIN requirement under the Local Health Systems Integration Act, 2006 (LHSIA). Section 16.2 of LHSIA defines “Community” as patients and other individuals in the geographic area of the network, health service providers and any other person or entity that provides services in or for the local health system, as well as employees involved in the local health system.

The purpose of community engagement is to inform, educate, consult, involve, and empower stakeholders in health care or health service planning and decision-making processes to improve the health care system.

The LHIN Community Engagement Guidelines and Toolkit was released in February 2011 with the objectives of:

Achieving and sustaining high quality community engagement across all LHINs by establishing a set of minimum specifications for community engagement

Improving public accountability and transparency of community engagement practices and products

The Toolkit includes the following documents:

Annual Community Engagement Strategy Worksheet to help LHINs develop their annual Community Engagement strategy

Community / Stakeholder Assessment Worksheet, designed to enable community engagement planners to identify all relevant stakeholders and how they relate to a specific plan or project

Community Engagement Planning Worksheet for both small and large community engagement undertakings

LHIN Community Engagement Performance Indicators that each LHIN will report on annually through their annual report and on both ministry and LHIN websites

1 Institute for Healthcare Improvement. (no date.) The Triple Aim. Retrieved September 24, 2012, from

http://www.ihi.org/offerings/initiatives/tripleaim/pages/default.aspx.

2 Corpus Sanchez International Consultancy. (August 2012.) Continuing the Conversation: Moving from a Framework

to an Action Plan to Deliver on System-Wide Leadership Imperatives for the Health Care System: LHIN CEO Strategic Planning Session Proceedings.

3 LHINCollaborative. (November 2010.) LHIN Priority Setting and Decision Making Framework Toolkit. Retrieved

September 24, 2012, from http://www.champlainlhin.on.ca/uploadedFiles/Public_Community/Health_Service_Providers/H-SIP/8%201%20-%20LHIN%20Priority%20Setting%20%20Decision%20Making%20Final%20Toolkit%2011_2010.pdf.

4 LHINCollaborative. (January 2011.) LHIN Health System Performance Indicator Framework. Retrieved September

24, 2012, from

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http://www.lhincollaborative.ca/uploadedFiles/LHIN_Collaborative/LHIN%20Performance%20Indicator%20Framework%20Guide%20FINAL%20JAN%202011.pdf.

5 LHINCollaborative. (February 2011.) LHIN Community Engagement Guidelines and Toolkit. Retrieved September

24, 2012, from http://www.lhincollaborative.ca/uploadedFiles/LHIN_Collaborative/LHIN%20Community%20Engagement%20Guidelines%20and%20Toolkit%20-%20February%202011%20-%20FINAL.pdf.