Mississauga Halton LHIN Meeting of the Board of Directors June 28th, 2009

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1 Mississauga Halton LHIN Meeting of the Board of Directors June 28th, 2009 Chair s Report to the MH LHIN Board of Directors Dated Tuesday, June 16th, 2009 LHIN Leadership Accountability Consensus Conference - June 3/4, 2009 This conference grew from a discussion Bill and I had following the MOHLTC/LHIN Consistency Conference in which we speculated about the opportunities which might be possible if LHINs thought and behaved more proactively before entering into major new negotiations with the Ministry. Fortunately the LHIN side of the ADT agreed with this concept and hosted the conference earlier this month. All participants declared it a success. Attached for your information is a copy of the Executive Summary of this event. Currently efforts are underway to secure the desired meeting with the Ministry Senior Team to begin the exploration of what might be possible in a new gold standard MLAA for Metamorphosis Accreditation Conference June 5 th, 2009 As you are aware, MH LHIN inserted an accreditation obligation into all of its M-SAAs. This LHIN may have been the only one to do so. As you are aware hospitals have been subjected to accreditation for some time and proudly announce their results to their stakeholders at the conclusion of each accreditation event. Long term care homes similarly have a form of accreditation in place. Metamorphosis once again took the initiative in the CSS and MH & A sectors to host this conference to explore accreditation options collectively and to determine if there were any areas of efficiency which could be identified by a common approach. Dr. Ben Chan and I spoke to the conference however the most important presentations were given by representatives of four accreditation bodies and by local HSPs voluntarily utilizing each one of the four systems represented. The HSP presenters were unanimous in their praise for the benefits despite the hard work involved. Interestingly most if not all of them had voluntarily concluded that the potential benefits outweighed the cost and effort required. Metamorphosis is currently working to narrow the choice of accreditation firms to two and exploring ways in which cost efficiencies can be obtained and accommodations made for the wide variety of agency size and capacity variations that exist. Angela Jacobs is on the Metamorphosis working group for this project. 1

2 KPMG Conducted LHIN Board and Board Chair Assessments This process, which as you will recall resulted from the implementation of a recommendation of the MLER, is about to wind up for this year. Some HSP and MPP responses remain outstanding but KPMG will nevertheless present its final report to the Minister and to the LHIN Chairs on or before July 10 th, The report will be presented to each board by KPMG over the next month or so as part of the exercise of LHIN governance CQI. What additional steps may flow from the report for LHIN governance individually or collectively remains to be seen? Participation by board members in all LHINs has been very close to 100%. Thank you for participating. AGM Attendance by Board Members I wish to thank all board members for their generous attention to these important HSP events. Everyone who has attended one knows how important LHIN presence is to the board and staff of our HSPs. Respectfully submitted, John Magill, Board Chair Attachment: Executive Summary LHIN Leadership Accountability Consensus Conference.. leading health system integration for our communities 2

3 EXECUTIVE SUMMARY LHIN LEADERSHIP ACCOUNTABILITY CONSENSUS CONFERENCE From the LHIN members of the Ministry/LHIN Agreement Development Team ( ADT ) To the Deputy Minister and Assistant Deputy Ministers of the MOHLTC For the purpose of securing your participation in a meeting with LHIN side of the ADT to explore with us at a high level what the new MLAA could look like and to set a joint tone from the top message to the full Ministry/LHIN ADT in advance of their negotiations Negotiations for the development of the MLAA for are set to begin very shortly. Unlike the various documents that currently exist between us, which in most cases have been lightly refreshed, this document should illustrate what we have collectively learned and where we collectively think the system should be headed. In other words it should be designed from the outset to establish a new gold standard for accountability agreements. Earlier negotiations (MOU and MLAA) have been successfully conducted using a very simple set of principles. We are expecting these principles to be adopted once again by the ADT and we wholeheartedly support them. Not specifically mentioned in the list of principles, but vitally important in the success of past negotiations, has been the ability of the LHIN side of the ADT to reach up and secure brief DM and ADM participation in the negotiations to course correct, mediate and or expedite. Therefore a secondary purpose for requesting this meeting is to seek similar assurances of involvement by appropriate Ministry senior team members if required. Direct, ongoing involvement of Ken Deane and other ADMs in the work of the ADT would of course be most preferable. Attached for your review and consideration are the key themes which emerged from the LHIN Leadership Accountability Consensus Conference. LHIN leadership in this conference included Chairs, CEOs and Senior Directors. All LHINs were represented. This Consensus Conference was the first of its kind, an experiment if you will, designed to try and establish consensus in advance of major new negotiations, to show consistent system leadership and to better inform and instruct LHIN delegates to such negotiations. The conference was highly successful and illustrated the willingness, readiness and enthusiasm of the LHINs collectively to take on more responsibility in furtherance of the Ministry s change agenda. This is the background for our request for a high level leaders pre-meeting. We appreciate that this meeting would need to be called on short notice and we undertake to accommodate your needs in this regard to the fullest extent that we can. We would ask that you coordinate with Sandra Hanmer, CEO of the WW LHIN and co-chair of the ADT. Respectfully submitted June 15th, 2009 LHIN members of the ADT

4 LHIN LEADERSHIP ACCOUNTABILITY CONSENSUS CONFERENCE Sheraton Gateway Hotel, Toronto Pearson Airport, Terminal 3 June 3 and 4, 2009 Summary of Key Themes

5 ON JUNE 3-4, 2009 the Local Health Integration Networks Leadership gathered for the first ever LHIN consensus conference on accountability. The purpose and objectives of this conference were: Purpose: Objectives: To provide an opportunity for LHIN Leadership to discuss approaches to moving the health system transformation to the next level. What are the skills, tools, expertise, expectations of ourselves and others as we continue the journey? 1. To share ideas and learn from experiences 2. To reach consensus on the LHIN collective view on accountability and system transformation 3. To provide guidance to the Accountability Agreement Development Teams as they take on their work The conference started with a dinner meeting on the evening of June 3, 2009 with Dr. Raisa Deber as guest speaker. Dr. Deber is a professor in the Department of Health Policy, Management and Evaluation at the University of Toronto. She spoke about, Approaches to Accountability: Implications of Goals, Governance Services and Subsectors. Her presentation was followed by questions and answers, reactions, and a robust discussion about the ideas presented. On June 4, John Magill and Sandra Hanmer started the day by welcoming guests and providing an overview of the agenda. John noted that the conference was a first-ever of its kind in the LHINs, and thus, was an experiment. Several members of the LHIN Leadership then led three major sessions on key strategic topics. Through several rounds of world café dialogues and large group discussion, the LHIN Leadership shared their perspective and responses to questions relating to these topics. Following are the key strategic topics and related focused questions discussed. Session I - Accountability & Systems Leadership 1. What did we learn from Dr. Deber s presentation and how can it help the Accountability Agreement DT with their work? 2. What are the respective roles and accountabilities of the LHINs and the MOHLTC and to what extent are they reflected in the current MLAA? 3. What needs to be changed in the MLAA to better reflect roles and accountabilities? Session II - System Transformation Evolution of LHINs 1. What have we learned from devolution to date do our experiences line up with our expectations on where we currently are? 2. Are LHINs standing still.sliding back or moving forward? What would moving forward look like, what would we need to do? 3. Should there be a strategic plan for continued devolution of authority if so what would this look like? Session III System Performance: Focus on Outcomes MLAA and SAAs form follows function 1. How do we determine that LHIN have made the right investments/decisions? 2. How do we know LHINs achieved value for the investments made? 3. What are the indicators of success? 4. What would we like to see in the new MLAA? The rest of this document outlines a summary of the key themes that emerged from the discussions. 1

6 Key Themes from the Day The conference confirmed that LHIN Boards and Senior Leadership are enthusiastic and well positioned to evolve the LHIN model to the next level. There was great optimism and energy in the room for advancing the roles and responsibilities of LHINs. LHINs have the core competencies necessary to advance system change, are creating the structure, systems and process to operate as a collective where it makes sense and continue to build trust as they take on greater levels of responsibility. LHINs are excited and ready for the challenges ahead. I. Accountability and System Leadership Reflections on the respective roles and accountabilities of the LHINs and the MOHLTC and to what extent they are reflected in the current MLAA: To achieve true health system transformation, MOHLTC and LHINs must continue working together - differently and effectively. LHINs are catalysts for change. It was evident throughout the conference that the LHIN Leadership, collectively, has a great enthusiasm for change and is prepared to take this leadership role as a group. The authority of LHINs is clearly defined in the legislation - however, it is not clearly reflected in the current MLAA. The LHINs see themselves providing more direction to Health Service Providers (HSPs). LHINs should be seen by HSPs as the go to in all aspects and this should be reflected in the MLAA. MOHLTC is evolving to a new role of stewardship. However, some parts of the MOHLTC are still very much involved in their former management role. As TRUST continues to build, LHINs are ready and expecting more control over the system. LHINs would like to see senior MOHLTC officials at the MLAA negotiation table with a clear articulation of the MOHLTC vision and direction. The current MLAA is not clear about the definition or the level of community engagement, reflects little or no connection to IHSPs and does not reflect the overall goal of what the MOHLTC and LHINs are trying to achieve with system transformation. It would be helpful for the MOHLTC to clearly articulate its expectations with regard to community engagement and their vision of system transformation.. The current MLAA is not bi-directional and there was no two-way or mutual determination of funding, access and service needs. II. Evolution and System Transformation Perspectives on what moving forward EVOLUTION looks like: Trust and relationships are the foundations of a successful and proactive evolution of the LHINs. LHINs are enabled and allowed to utilize their current authorities as defined in the legislation. LHINs provide directions to providers and all funding letters come from the LHINs by July LHINs are the go to group for HSPs and MOHLTC does not meet with HSPs directly without coordinating with the LHINs. There is a clear definition of consistency and its application. LHINs have a scorecard to evaluate their success. 2

7 Best practice is entrenched in the LHIN model and is not optional. The role of the LHIN Liaison Branch (LLB) is re-evaluated in relation to achieving a successful evolution of the LHINs. The purpose of MMC/LHIN CEOs meetings is re-assessed to become a true forum for system transformation. III. System Performance THE NEW MLAA - what do we want to see? LHINs would like to see senior MOHLTC officials at the MLAA table. Keep the document simple, one-pager if possible, and leave the legal aspects in the appendices. The new MLAA should be clear about the role and authority of LHINs, MOHLTC, LLB and the Capital branch. It should truly reflect the notion that MOHLTC describes the what and LHINs are responsible for the how ; and acknowledges LHINs as system managers, allowing them to act on local needs within the provincial framework. It would be valuable to have a new MLAA based on broad principles whereby the MLAA is seen as a change tool. This would include articulating up front and clearly the purpose of what the MOHLTC and LHINs are trying to achieve together, as well as identifying the areas of shared and individual responsibilities. Change the MLAA from a prescriptive to a descriptive document. The MLAA would describe broad principles with onus on LHIN Boards to develop clear approval processes, response time expectations and consequences. The new MLAA needs to reflect the intent and visions of LHSIA and be aligned with the legislative authority LHINs already have. This would clearly illustrate/support the evolution of the LHIN model. The new MLAA needs to focus on one or two core areas that exemplify the transformation agenda. This includes articulating transparent SMART goals (specific, measurable, achievable, realistic, and timely) with corresponding performance matrix evaluating outcomes and impact. To this effect, LHINs need to develop the evaluation framework and negotiate the deliverables. Focused accountabilities must be clearly articulated in the new MLAA with indicators, measures and consequences for non achievement. The new MLAA should articulate definitions of community engagement and expectations as well as be reflective of LHIN IHSPs. HSPs should see themselves in the new MLAA. The new MLAA should include expectations and measures of integration. LHIN role in capital needs to be clearly identified and described in the new MLAA. The language of the new MLAA needs to be changed to set the tone of trust in the relationships, roles and guiding principles. Language should be enabling rather than inhibiting. Furthermore, to recognize continuing evolution, the new MLAA needs to provide flexibility to address new opportunities and challenges that arise during the term of the agreement. It is important for the new MLAA to reflect a significant change in Board leadership (Chairs and Directors) not to mention the next provincial election. It needs to reflect a broader than three years look at where MOHLTC and LHINs are collectively going and should be tied to the MOHLTC s ten-year strategic plan. There should be system level indicators transcending all agreements. Measures must reflect purpose and where the bulk of collective efforts are focused - an integrated system that improves access, efficiency and effectiveness. The new MLAA should include MOHLTC performance indicators on stewardship and guidelines regarding the MOHLTC s interaction with HSPs. MOHLTC interaction with HSPs should only be undertaken with LHIN coordination. 3