Notes from a Roundtable on Building Capacity for Governance Collaboration to Advance Integration. April 28, 2014

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1 Notes from a Roundtable on Building Capacity for Governance Collaboration to Advance Integration April 28, 2014

2 Acknowledgements The Governance Centre of Excellence (GCE) would like to acknowledge the contributions of Maureen Quigley & Associates in the development of this report. Disclaimer Themes and perceptions within this report are those of participants and do not necessarily reflect the view of the GCE, or indicate its commitment to a particular course of action. 2 NOTES FROM A ROUNDTABLE ON

3 Background The Governance Centre of Excellence (GCE) held a oneday course and roundtable in Toronto on April 28, Approximately 45 participants convened to learn from recent and current experiences of integration in Ontario s health care sector, including practical approaches, opportunities and challenges, and lessons learned. The interactive course was designed to enable boards to validate critical elements for effective governance and to build accountability among Board members with respect to providing leadership for integration initiatives, ranging from informal alliances or partnerships to formal mergers. The presentations included examples of LHIN-wide and voluntary health sector integration initiatives in Ontario and information on the legal considerations for board collaboration in integration initiatives. Following the course, a roundtable was convened with approximately 20 participants who attended the course. The objectives of the roundtable were to: Enable the workshop faculty and participants to engage in a discussion of lessons learned from the workshop presentations and identify other leading examples of governance collaboration; and, DEFINITION OF COLLABORATION AND COLLABORATIVE GOVERNANCE For the purposes of the roundtable, the following definition of collaboration and collaborative governance was used. Collaborate and Collaboration - A mutually beneficial, well-defined relationship entered into by two or more organizations to achieve common goals. Collaboration is the process of various individuals, groups or systems working together, but at a significantly higher degree than through co-ordination or co-operation. Collaboration typically involves joint planning, shared resources and joint resource management. Collaboration occurs through shared understanding of the issues, open communication, mutual trust and tolerance of differing points of view. To collaborate is to co-labor. (Source: Local Health Integration Network/ Health Service Provider. Governance Resource and Tlkit for Voluntary Integration Initiatives. December 15, 2008) Collaborative Governance - A structured process in which boards with a common interest engage in joint needs analysis, planning and implementation in service of the collective gd, and then share accountability for outcomes. (Source: Jim Rice, Presentation at HealthAchieve 2013) Discuss a draft document, Effective Governance Collaboration to Advance Integration A Resource Guide, which is meant to serve as a platform for discussing the wide range of possibilities for health system governance and that consists of a broad-based, preliminary inventory of existing commentary about board capacity and governance collaborations. The following report summarizes the roundtable discussions. 3 NOTES FROM A ROUNDTABLE ON

4 Roundtable Objectives & Questions 1. REFLECTIONS ON THE WORKSHOP Are there additional references that should be included? What were the key lessons learned from the presentations? Based on the presentations, what would you like to learn more about? Are there other leading examples of governance collaboration for advancing integration that should be showcased? What is the most effective way to disseminate this information to health service provider (HSP) boards? 3. NEXT STEPS What further action should the GCE take in relation to the key enablers and barriers to governance collaboration identified by HSP boards and executive leaders at HealthAchieve 2013? 2. DISCUSSION OF THE DRAFT RESOURCE GUIDE Is the draft Resource Guide a useful tl for supporting board engagement in governance collaboration? What else should the GCE be doing to support HSP boards in the area of governance collaboration for advancing integration? REFLECTIONS ON THE WORKSHOP Discussion Questions Participant Feedback What were the key lessons learned from the presentations? Patient-centred focus needs to be reinforced. Boards require further support to engage in discussions about governance collaboration (e.g., gaining understanding with respect to legal considerations for integration transactions for all parties involved). Individual board members require clarity regarding their role as governors working for the health system. Facilitating greater collaboration requires trust between organizations and their boards, as well as leadership, including clear direction supported by gd communication. 4 NOTES FROM A ROUNDTABLE ON

5 LHINs have faced challenges in building trust and have tried to be less authoritative. Immediate opportunities exist for LHINs to facilitate connections between Board Chairs; require organizations to collaborate in the development of strategic plans, including adoption of shared goals; encourage orientation and education support for boards with respect to governance collaboration; provide support tls to boards in moving from organizational to system-level thinking. Based on the presentations, what would you like to learn more about? There was consensus that bold and clear leadership at the board, policy and LHIN level - is needed. Participants suggested that governance collaboration could be furthered with a greater focus in the following areas: Greater clarity regarding system-level goals and expected outcomes to be achieved. There is a misconception that discussions regarding integration are predominantly focused on mergers as an outcome, and a lack of understanding of the broad diversity of ways in which integration can be attained. Questions for further consideration include: What are we trying to achieve? What is the common platform to motivate HSPs to engage in collaborative change processes? What are the issues that HSPs should be collaborating on to drive system change? What are the local and provincial outcome measures to assess the value and impact of integration initiatives? Concrete strategies and tlkits to support HSPs in educating and orienting their boards. The LHIN/HSP Governance Resource and Tlkit for Voluntary Integration (2008) could be updated to include an Integration Module to elaborate on the integration responsibilities of HSP boards. Questions for further consideration include: What are the practical tls and supports required by HSPs to educate boards in better understanding the system they are working within? What can be done to facilitate communication among boards to pursue opportunities for integration? Is there a way to facilitate governance training online? 5 NOTES FROM A ROUNDTABLE ON

6 Support in crdinating regional workshops to clarify goals and expected outcomes, and agree upon local and regional integration priorities. Questions for further consideration include: What is required to support regional workshops? What are all of our roles in working to move the health system in the same direction? Would it be beneficial if a local organization tk the lead in organizing local sessions? The following key challenges were also identified as important factors to address: Clarifying goals and outcomes; Building capacity in the community sector as well as engaging with smaller organizations so that they do not feel threatened; and, Clarifying the criteria for measuring performance (e.g., value for money with respect to the financial impact of integration activities, common criteria to measure performance). Are there other leading examples of governance collaboration that should be showcased? While it was acknowledged that there are a number of activities unfolding in Ontario, it is difficult to know whether the examples are effective. It was suggested that it would be helpful to understand the impact of these various initiatives. 6 NOTES FROM A ROUNDTABLE ON

7 DISCUSSIONS OF THE DRAFT RESOURCE GUIDE Discussion Questions Participant Feedback Is the draft Resource Guide a useful tl to support board engagement in governance collaboration? The Resource Guide was seen as being helpful in providing a high-level summary of the range of opinions, thinking and possibilities related to governance collaboration. The short length of the document, the currency of the articles, and the inclusion of links to full articles/reports, were acknowledged as strengths. There was support for broader dissemination of the document for use as a background resource for HSP boards. Are there additional references that should be included? The following additional resource was identified: The report of the National Youth Screening Project by the Centre for Addiction and Mental Health. What is the most effective way to disseminate this information to HSP boards? The following suggestions were provided with respect to disseminating the Resource Guide: Make the Resource Guide available alongside other existing tls. Consider identifying resource persons or mentors able to provide guidance and expertise related to the issue of governance collaboration. 7 NOTES FROM A ROUNDTABLE ON

8 NEXT STEPS Discussion Questions Participant Feedback What further action should the GCE take in relation to the key enablers and barriers to governance collaboration identified by HSP boards and executive leaders at HealthAchieve 2013? The enablers and barriers to governance collaboration were viewed as a starting point for the development of an action plan on how to support HSP boards in discussions about governance collaboration. It was suggested that the list could be augmented with additional issues arising from the course and roundtable. What else should the GCE be doing to support HSP boards in governance collaboration? The following suggestions were provided for the GCE s consideration: Develop a discussion guide, which could include key concepts related to governance collaboration, legal and fiduciary responsibilities, goals and expectations for HSPs, and practical tls (e.g., facilitation and communication) to support the planning of regional workshops; Engage with other provincial health associations to discuss ways to advance governance collaboration; and, Develop regional workshops based on the LHIN/HSP Governance Resource and Tlkit for Voluntary Integration Initiatives (2008). 8 NOTES FROM A ROUNDTABLE ON

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