Clinical Program Integration

Future Demand

Now, and over the next ten years, the challenges for health care are enormous. Our population is aging, illness burden is high, resources are finite, our ability to measure benefits of investments is poor, and the economy is in transition. The HNHB LHIN Clinical Services Plan (November 2009) is an action call for a healthier population, improved ways of working together for better health outcomes and best practice organization, and distribution of programs. One of three strategies to achieve these goals is clinical program integration.

The Clinical Services Plan estimated that future demand for hospital services would grow by approximately 30% if the status quo prevails. The LHIN is committed to reducing demand for hospital services through strategies that improve overall health of the population, promote self care, and align community-based health services with independence, wellness and recovery goals.

What is Clinical Program Integration?

Clinical program integration will result in coordinated, LHIN-wide programs, led by one or more organizations in partnership, and reflect an agreed upon set of attributes. These attributes include:

• clear roles, responsibilities and accountabilities
• a commitment to best practice and the implementation of clinical standards and guidelines
• common admission, discharge, and referral guidelines
• elimination of unnecessary duplication of low volume, high-complexity services
• LHIN-wide population-based planning, evaluation and performance monitoring.

Each LHIN-wide clinical program will have, as its goal, equitable access to a coordinated system of evidence-based services across the continuum of care. To achieve this, strong leadership, mechanisms that support shared accountability and partnerships, and an enhanced communications infrastructure will be needed.  This means that all residents of our LHIN, regardless of whether they live in a rural or urban community will have equitable access to services. All aspects of care delivery for a particular program will be connected and coordinated, in a way that best meets population need, and optimizes use of available resources.

Why Do We Need Clinical Program Integration?

The health care system is large and complex. LHIN residents count on having the same access to quality care. Health care professionals expect timely referrals, access to an individual’s clinical information, access to best practices, tools, and equipment. It is essential for the future of our health care that we ensure accountability for appropriate access, quality of care (e.g. best practice standards, guidelines and performance metrics) and the efficient use of resources. As individual organizations realign services to meet budget constraints, clinical program integration will
provide mechanisms for organizations to work with their partners to integrate or transfer services more appropriately delivered in the community.

Clinical program integration will allow the HNHB LHIN to better respond to evolving population health care needs, advances in medical and information technology, and the scarcity of health human resources.

What Will Be Different?

Organizations will have clear roles, responsibilities and accountabilities. Clinical program integration will be achieved by a clear shared accountability by all providers that will result in equitable distribution of services, reduction in duplication of services, and a more efficient use of human and equipment resources.  The development of common clinical leadership teams, with clear referral patterns and repatriation agreements, will reduce wait times and improve consistent access across our region. It will be much easier for the residents of the HNHB LHIN to navigate through our health system. It will be an expectation that all HSPs will use best practice guidelines and clinical standards when providing care.

Implementation

Implementing clinical program integration will be a multi-year undertaking in partnership among leaders from across the HNHB LHIN.

Components of the implementation plan will include:

• recommended sizing and siting of programs and services
• mechanisms, structures and elements needed to foster shared accountability across the continuum of care (e.g. MOUs)
• implementation of appropriate best practice guidelines (assisted by our academic partners)
• identification of key enablers to implementation (e.g. standardized processes, information/communication technology)
• resource requirements, both human and infrastructure to support implementation.

It will be a staged process as follows: