January 27, 2017
We are pleased to share this update on the work supported by the Patients First Act, 2016. You will also find this update archived at this link. You may also be interested in the answers to some Frequently Asked Questions at this link.
You can count on regular emails like this as your source of ongoing information and updates, which can also be shared with staff members, local stakeholders and other stakeholders and colleagues.
Writing in the January 16th edition of the New Yorker magazine, Dr. Atul Gawande describes the Heroism of Incremental Care and advocates for a change in emphasis from hospital-based medicine to community-based primary care in Western health systems.
Using examples from his career as an eminent cancer surgeon, Gawande describes how we have built and outfitted high technology hospitals that excel in “find it and fix it” urgent treatment for trauma, heart attacks, cancer and other acute problems. However, Dr. Gawande argues, the next generation of medical advances will depend on longer term observation, tweaking medications and treatments, counseling to change behaviour in people with chronic disease, and providing social and medical services that allow frail, elderly people to live in dignity.
Dr. Gawande is describing the necessary changes in health systems that many jurisdictions around the world are pursuing, including those the Patients First Action Plan will deliver in Ontario. The Patients First Act and the work it supports are important steps forward in this plan. Ontario excels at delivering high-quality care in a cost-effective hospital system. However, as Gawande emphasizes, the real challenge in improving our system lies outside hospital walls.
The system that Gawande describes and that the Patients First Act enables is based on a solid foundation of primary care. This approach has long been advocated for by Ontario primary care stakeholders. Each Ontarian should be able to develop a relationship with a primary care provider for long-term health advice and counseling as well as ready access (within a group accountability model) when the patient is sick. Not only is this primary care provider available during illness, she also recognizes and coaches the behaviours necessary to prevent and treat chronic diseases.
Effective primary care requires integration of services outside hospital: for mental health and addictions, for homecare supports for frail or cognitively impaired seniors and for rehab services that prevent chronic pain with its risk of opioid addiction. Currently, Ontario community services tend to be siloed and can be difficult for patients to navigate. The Patients First Act recognizes the complexity of organizing these community services and the importance of ensuring good linkage to primary care. Effective integration of services requires a consistent single point of accountability and the Patients First Act reconfirms the Local Health Integration Network (LHIN) as responsible for that organizing role.
LHINs will be responsible for organizing and managing home and community services, mental health services in the community and planning primary care. To create logical and thoughtful communities of practice for primary care and home and community care, the LHINs have divided their geography into 4 to 7 sub-regions as a planning lens. In the lens of each sub-region, all providers will understand how to access all of their local community services. The LHIN will plan care using this regional lens and clinical leaders in the LHIN will ensure that citizens get easier access to primary and community services. This will mean patients will no longer have to try to find a family doctor or nurse practitioner by themselves. Family doctors and nurse practitioners will have the support they need to effectively guide their patients to the right care where it is convenient for them - whether it’s a specialist, a personal support worker or a diabetes education program.
We are also creating a closer link between public health experts and LHINs. This stronger relationship will help ensure equitable services to address population health needs. Finally, the new LHINs will be responsible for improving primary and community care for Indigenous Ontarians and working to offer services to Francophone Ontarians in French. All planning will be informed by the advice of Patient and Family Advisory Committees to ensure the patient voice is front and centre.
To foster the incremental care that Gawande refers to, the Patients First Act is making changes that will affect many health care providers. None more than those working in the CCACs, however, they have been highly involved in planning. The professionalism and commitment of CCAC staff and home care providers in the community has been admirable throughout this process.
Change is difficult. But if our goal is to truly put patients first then failing to adapt to a changing environment is not an option. Critics have argued that the cost of administration will increase. In fact the merging of CCACs into LHINs will reduce management costs by 8%. We’ve also heard concerns about maintaining the privacy of patient information despite the fact that the Information Privacy Commissioner and his office worked with government to ensure that the Act protects patient confidentiality.
What about concerns that physicians will lose their freedom of professional practice and will face increased administrative burden? Implementation of the Act would simply require that physicians report major changes (such as prolonged leave or retirement) to their patients and the LHINs, so plans can be made as necessary to ensure no interruption to patient care.
Ontarians should be proud that our hospitals provide excellent and cost effective care. However as Dr. Gawande advocates, the rest of our system urgently needs our attention. Home and community care needs to be more accessible, standardized and understandable to Ontarians. Mental health services need to be more accessible and community rehabilitation services need to be strengthened. We need to better understand population health challenges in local regions and need to improve equity of health service distribution, especially for Indigenous and Francophone Ontarians. Finally we need to enhance access to comprehensive primary care. Gawande has described these changes in health systems necessary to prepare for the future in his eloquent essay. Ontario is preparing to deliver these changes for our patients today.
Partners across the health care system are working together on the work supported by the Patients First Act.
To oversee implementation planning, a joint Steering Committee has been set up with Ministry of Health and Long-Term Care (ministry) and LHIN executive leadership. The ministry is also regularly meeting with LHIN Board Chairs, CCAC CEOs, CCAC Board Chairs and external advisors to obtain their valued input. The ministry, LHINs and CCACs are communicating regularly and collaborating with all local health care partners.
Implementation is focused on ensuring a smooth transition of home and community care service delivery and management from CCACs to the LHINs through collaborative project planning, focus on continuity of care, and increasing partnership.
Some particular areas of focus are:
LHINs will be supported to build their capacity to successfully undertake their enhanced role in the health care system. This includes embedding clinical leads in the LHINs to support better planning and integration of patient care locally and working to successfully transition home and community care services and staff from CCACs to the LHINs.
One key priority underway is collaboration between the ministry, LHINs, CCACs and health care partners on capacity and readiness planning and activities to prepare for a smooth and seamless transition. Readiness assessments and capacity building are underway in all LHINs to inform a staged transition to the new LHIN in Spring/Summer 2017.
The ministry is also working with Patient and Family Advisory Councils across Ontario to seek advice and benefit from existing best practices in order to expand patient engagement activities and support the creation of Patient and Family Advisory Councils in all LHINs. Some meetings are already scheduled, however please feel free to reach out to us through this email address if you feel there is a particular group we should be engaging with.
You can expect regular updates like this as we move forward together.
And you’ll hear from us soon about our next Webinar, which is planned for February. That will provide another opportunity to share updates and ask questions.
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