A Message from the Minister

We thank you for your response to our introductory Bulletin on Local Health Integration Networks. Your feedback is integral to the process of transforming healthcare into a true system working for each and every Ontarian. For example, you asked about the boundaries. The Ministry is currently working on finalizing the boundaries based on postal code assignments to each LHIN. This will result in some refinement of the boundaries, but it will not change the geography or groupings of health care providers in any significant way. As well, there were multi-site organizations that were split over two LHINs, and, of course, boundaries will be altered to address this.

You also asked why only certain hospitals were placed on LHIN maps. These were highlighted because they are the high-volume hospitals used by ICES (Institute for Clinical Evaluative Sciences) in determining the boundaries for LHINs.

In a future bulletin, you will find a complete analysis of your responses to the questions we posed in Bulletin No. 1.

The MOHLTC recognizes that, by their very nature, networks are complex, diverse, organic and self-organizing. This is why the engagement of our health care partners from the outset is fundamental to the long-term strength and sustainability of LHINs. We need communities to build on their current structures and relationships and focus their collective strengths on the creation of an integrated, patient focused system that improves population health and the experience of Ontario citizens.

The Ministry hears from you, our health care partners, through various forums and mechanisms about the need to better integrate service delivery in the province.

Following the government's announcement of LHINs, a multi-sectoral group representing a cross section of health care and social service providers met to consider principles the participants believed should guide the successful evolution of LHINs. (See www.oha.com/integrationtaskforce)

On the group's advice, the Ministry has endorsed the following principles :

Patient Focus - LHIN's overriding mandate is to improve population health and the citizen's experience; represent and engage patients' interests; and achieve better health outcomes while measurably improving quality of life and value in health.

Clarity of Roles - Success depends on clear understanding of the intersecting roles and responsibilities of citizens, the Ministry, LHINs, and health and community service providers in delivery of care. The mapping of roles should also include the cross-jurisdictional responsibilities of specialty and academic programs.

Strategic Partnership Role - LHINs will assume a strategic leadership role with a particular focus on a long-term view of the community, as opposed to a delivery one. The LHIN will focus on community-based system planning and integration, implementation of provincial priorities, performance standards and accountability, and funding and allocation.

Stakeholder Engagement - Improvement to health outcomes requires coordinated community engagement. Engagement of stakeholders from the outset of the LHIN building process is fundamental to the long-term strength and sustainability of LHINs. The same broad-based approach must also inform LHIN activities.

Evidence-Based Balanced Approach - LHINs will progressively evolve through a balanced use of evidence-based practice, continuous re-evaluation, together with flexibility for innovation and responsiveness to community, regional and provincial concerns.

Transparency - open communication, transparent and non-partisan decision-making by LHINS and health and community service providers will maximize stakeholder acceptance and commitment to common goals, respective responsibilities, and mutual accountability.

Fostering Changes Through an Incentive-Based Approach - An incentive-based approach will encourage integrative and creative solution to achieve LHIN objectives.

Voluntary Boards - In the best interests of the populations their organizations serve, community-based volunteer boards will continue to govern.

Partnership of Equals - The contribution of all health and community service providers must be valued equally within LHIN initiatives and collaborations.

The LHINs will facilitate the transformation of health care in Ontario To enable this, LHINs will integrate health care at a local level and consolidate the following functions: planning, system integration and service coordination, funding allocation, and evaluation of performance through accountability agreements. The first of these functions that the LHINs will be expected to take on will be integrated health system planning, to help inform and shape the design and execution of the other functions.

• The LHINs bring the management of health care delivery to the local level and enable the Ministry of Health and Long-Term Care to focus on providing stewardship to the system.
• The Ministry of Health and Long-Term Care will continue to be responsible for the provision of high quality, accessible health care services that meet the needs of Ontarians.
• Within this framework, the Ministry will :
• Establish overall strategic directions and provincial priorities for the health system;
• Develop legislation, regulations, standards, policies and directives to support strategic directions within the context of its overall stewardship role; and
• Monitor and report at a provincial level on the performance of the health system and the health of Ontarians.

The following outlines the key milestones in the work leading to the start up and implementation of LHINs in Ontario :

In partnership with the Ministry's LHIN team, we're asking the full spectrum of health care providers in your community to come together. Community support service providers, mental health service providers, community health centers, community care access centers, long-term care providers and hospitals should collectively prepare the "ground" for the transition to LHINs in your community.

Many of you are currently involved in integration initiatives within their community. The MOHLTC recognizes the strong foundation these initiatives provide for the LHIN building process. Therefore, one of our first steps will be to work with you on an environmental scan of your community. This scan will identify current integration activities and enhance our understanding of how LHINs can help create new opportunities.

To help kick-start this process, the Ministry will hold one-day workshops in 14 locations in each LHIN geographic area across the province, starting in November. Specific details about dates, locations, and how to participate in these workshops will be posted in our next Web update on November 1.

In preparation for these workshops, here are some questions to initiate your thought process :

• What are the inherent strengths of your community that the LHIN-building process will be able to leverage in order to improve integration/coordination of services?
• What does your community identify as the barriers to achieving improved high-impact, system-level integration/coordination?
• What can we learn from partnership/integration initiatives that are currently underway or have been successfully implemented within your community?
• What unrealized integration opportunities exist within your community? How can LHINs help realize these opportunities?
• What are the must-have readiness conditions to successfully build an integrated system across health care providers within your community?

Thank you for participating in the building of a true health care system in Ontario. We look forward to working with you on this important initiative.

Please look for the LHIN Bulletin on the 15th day of every month. Also, as more information becomes available, LHIN-related updates and reports will be posted on this site on the 1st day of every month on an as-needed basis.

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