How do we make decisions?

The Hamilton Niagara Haldimand Brant LHIN makes important decisions about the health care system in our area.  These decisions are made using a framework to ensure that they are good, fair, and transparent decisions. 

The framework has four stages.  A project or decision must pass each stage to be considered for funding. (Click on stage name for more details)

1.  Compliance - Does the project violate any existing relevant laws, regulations, or contracts?

2.  Evaluation - How does the project fit strategically, address population health needs, align with our values, and help with system performance?

3.  Cost/Benefit - Do the benefits of the project balance the cost?

4.  Readiness - Is the system ready and able to support the project?

Why use a framework?

The demand for health care exceeds available resources.  LHINs must make decisions in the context of competing system goals, diverse community needs, multiple stakeholder interests and finite information.  Therefore the HNHB LHIN requires a strategic evidence-informed and fair decision making framework to address these challenges.  The framework draws on ethical principles of fair process and economic principles of value for money. It is designed to help LHINs

• align resources strategically with system goals and community needs;
• facilitate constructive stakeholder engagement around meeting system goals with available resources;
• reach publicly defensible decisions based on evidence and values; and
• fulfill LHINs’ public accountability for health system resources.

Key elements of a fair framework

• Relevance: Decisions should be made on the basis of reasons (i.e., evidence, principles, values, arguments) that fair-minded people can agree on under the circumstances.  Fair-minded people are defined simply as those who seek in principle to cooperate with others to find mutually justifiable solutions to priority-setting problems.
• Publicity: Decision processes should be transparent and decision rationales should be publicly accessible.
• Revision: There should be opportunities to revisit and revise decisions in light of further evidence or arguments, and there should be a mechanism for resolving disputes.
• Empowerment: There should be efforts to optimize effective opportunities for participation in priority setting and to minimize power differences in the decision making context.
• Enforcement: There should be either voluntary or public regulation of the process to ensure that the first four conditions are met.

Critical Success Factors

Experience elsewhere has shown that successful development and implementation relies on

• Strong leadership and stakeholder buy in;
• Clear roles and responsibilities;
• Clear boundaries;
• Incentive and sanction mechanisms; and
• Commitment to evaluation and improvement.