Constant Contact Survey...

Constant Contact Survey ResultsSurvey Name: Health Leaders Survey 2 Response Status: Partial & Completed Filter: None 3/21/2016 11:39 AM EDT

Rate the extent to which you support the Ministry's key structural change proposal to: "Expand the roleof the LHIN's"--beyond their current planning/funding/oversight/accountability roles to extend toproviding patient services (Case Management) which would be relocated to the primary care sites(FHTs/CHCs) and to hospitals within a sub-LHIN/Health Link area; as well as being responsible formanaging the performance of primary care service providers.

Answer 0% 100%Number of

Response(s)Response

RatioOpposed 57 29.3 %Don't Support 41 21.1 %Neutral 16 8.2 %Support 43 22.1 %Strongly Support 35 18.0 %No Response(s) 2 1.0 %

Totals 194 100%

Rate your level of support/ trust/ respect/confidence in your LHIN to undertake these expanded roles within the servicedelivery system.


Response(s)Response


Totals 194 100%

Name three (3) adjectives that best describe themanagerial/leadership capacity of your LHIN.

191 Response(s)

Rate your level of support for the government'sproposal to "enhance the LHIN's accountability to theMinistry"--where "LHIN activities would be carefully defined, with performanceplans enforced by the Ministry."


Response(s)Response


Totals 194 100%

Rate your level of support/ trust/ respect/confidence in the MOHLTC to manage the LHINs with their proposed "enhancedauthority" over them.


Response(s)Response


Totals 194 100%

Name three (3) adjectives that bestdescribe the managerial/leadership capacity of the Ministry of Health and LongTerm Care.

190 Response(s)

Please see detailed responses at the end of the survey.


Rate the extent to which you support theproposal to bring the Public Health Units into the family of healthcare serviceproviders at the Sub-LHIN/Health Link level--includingplanning/funding/accountability to the LHIN--the same as all HSPs.


Response(s)Response


Totals 194 100%

Rate your level of confidence in the consultation process on the MOHLTC's Discussion Paper proposalsbeing conducted by the LHINs and the Ministry before they finalize their "proposals"


Response(s)Response

RatioNo Confidence 53 27.3 %Not Much Confidence 62 31.9 %Neutral 39 20.1 %Some Confidence 32 16.4 %Great Confidence 6 3.0 %No Response(s) 2 1.0 %

Totals 194 100%

Rate the extent to which you think the structural changes proposed by the MOHLTC would --incombination-- result in a healthcare delivery system that is "more patient-centred"..


Response(s)Response

RatioNo Extent 44 22.6 %Little Extent 56 28.8 %Some Extent 42 21.6 %Good Extent 38 19.5 %Great Extent 12 6.1 %No Response(s) 2 1.0 %

Totals 194 100%

The Ministry's Discussion Paper did not provide anyspecific role for Health Service Providers' Boards and CEOs in the creation ofa more integrated, patient-centred system of services. What roles do you thinklocal governance and CEOs could play in creating a "Patients First HealthSystem". (350 words)

190 Response(s)

What do you hope to see in the government'sfinal policy after their consultation? (350 words)

190 Response(s)

Tell us what category best describes your perspectives


Response(s)Response

RatioAcute Care 33 17.0 %Home & Community Care 43 22.1 %Public Health, Primary Careor LTC

36 18.5 %

MOHLTC/ LHIN/ CCAC/ 24 12.3 %Other 56 28.8 %No Response(s) 2 1.0 %

Totals 194 100%



Name three (3) adjectives that best describe the managerial/leadership capacity of your LHIN. Answer Respondent

limited, biased underperforming Anonymous inexperienced, sycophant, autocratic Anonymous progressive, accommodating, transparent Anonymous limited,lack of expertise, not strategic Anonymous self-congratulatory, incompetant, boastful Anonymous incompetent; top-down; autocratic; lack EQ + SQ Anonymous Limited, unprepared, potential for development Anonymous Strategically aligned, unprepared, project-based Anonymous Collaborative, skilled and determined to succeed Anonymous Stays on purpose, shares info, stays on course. Anonymous overwhelmed; well-intentioned; inexperienced Anonymous Bureaucratic, weak, ineffective Anonymous Lacks demonstrated successes;ideology not clear an Anonymous none working under the legislative framewo Anonymous Arrogant, provincial politics trumps all, Anonymous experienced, local, lean Anonymous novice Anonymous trustworthy integrity consensus building Anonymous inexperienced, marginal,overestimated Anonymous unknown Anonymous target and numbers focused business oriented Anonymous Bureaucratic, limited operational experience Anonymous unknown, aloof, metric-driven Anonymous Indecisive,risk averse Anonymous bio-medical focus, invisible, inequitable Anonymous bio-medical focus, invisible, inequitable Anonymous Incompetent lacking Health Care Management Anonymous collaboration, consensus, compromise Anonymous test Anonymous test test test Anonymous controlling pushy unreasonable Anonymous Competent, listeners, understanding Anonymous bureaucratic, uninsightful, self-centred Anonymous Hand-maiden to QP. Not an advocate for community. Anonymous Unclear, confused, inadequate Anonymous test Anonymous biased disconnected unaware Anonymous they follow orders from Toronto--they don't lead Anonymous non-strategic, optical illusions, political Anonymous lacking. dysfunctional self important Anonymous Inefficient, inexperienced, and unrealistic Anonymous

limited acute care focused sickness only Anonymous Political, Administrators vs. leaders Anonymous performance focused, authoritative, Anonymous distant,pediatric ignorant,political Anonymous Autocratic, non-evidence based, financial focus Anonymous patient oriented, systems thinking, collaborative Anonymous Mirco management through data, efficiency focus Anonymous Reactive unrealistic overinflated Anonymous competent, strong, focused Anonymous inexperienced, unprepared, unsupported Anonymous Absent, ignorant, hipocrotical Anonymous Out of touch, archaic, obstinate Anonymous politically focused,bureaucratic,non-responsive Anonymous no existent, uninformed, hospital focused Anonymous compromised, conflicted, stretched Anonymous Inconsistent, unknown, biased Anonymous insular, bureaucratic, dollar-driven Anonymous Creative, hard working, team builders Anonymous Proactive, relevant, informed Anonymous uncommunicative,unresponsive, uninterested Anonymous flexible limited dedicated Anonymous stifled, secretive, immature Anonymous needing capacity Anonymous no experience in service delivery, Anonymous collaborative, progressive & upfront Anonymous Risk averse System planners-not operations Limited Anonymous lacking, disconnected, unskilled Anonymous Bureaucratic, inexperienced, expensive Anonymous UNMANAGEABLE/NOTHING LOCAL ABOUT THEM/FOLLOWING OR Anonymous DK Anonymous limited, well intensioned, overwhelmed Anonymous variable vision, inexperienced, lacking power Anonymous adaptable, capable, complex Anonymous Collaborative, Effective, Optimize Anonymous overwhelmed, dedicated, financially focussed Anonymous narrow focus, bureaucratic, uneven Anonymous Siloed, narrow, self focused Anonymous Self interested; limited systems view Anonymous Unilateral, closed, command and control Anonymous CEO lacks leadership, indecisive, inefffective Anonymous Bureaucratic, unstructured, uneducated Anonymous Dictatorial, Autocratic, Self serving Anonymous weak uncertain questionable Anonymous Afraid, demoralized, overwhelmed Anonymous Adequate, closed, beaucratic Anonymous limited, underdeveloped, misaligned Anonymous Disappointing,narrow-minded,unimaginative Anonymous

Ineffective, unaccountable, incompetent Anonymous accountable, transformative, strong Anonymous micromanagement, conflict of interest, lack transp Anonymous operationally-challenged, prone-to-micromanagement Anonymous Have spent 10 years "integrating" our local system Anonymous directive, control, command Anonymous slow, bureaucratic, but open to change Anonymous Limited capacity and unclear expectations Anonymous blaming, short sighted, lacking in transparency, Anonymous short sighted, inexperienced, unreliable Anonymous Self-centred, self-serving. Anonymous Capable, Transparent, strong partner Anonymous arbitrary, complex, overhead Anonymous inconsistent, uninformed, myopic Anonymous risk adverse; timid; dull Anonymous limited. dedicated. unempowered Anonymous Financial Management; Stakeholder Management, Anonymous adequate, inflexible, lacks a rural perspective Anonymous weak; inexperienced perationally; indecisive Anonymous Action, respectful, honest Anonymous Non-existent, inept Anonymous Incompetent bureaucratic unnecessary Anonymous Dishonest uninformed selfish Anonymous Ambitious, cautious, risk-averse Anonymous bureaucratic, mercurial, one inch from MOH Anonymous Progressive, open-minded, patient-centred Anonymous conservative, hand-cuffed, hopeful Anonymous No skills--command and control behavior Anonymous Weak, vacant, bureaucratic Anonymous Capable, competent, nimble Anonymous Harried, Anxious, Professional Anonymous Strength, commitment, support Anonymous conservative, capable, caring Anonymous n/a Anonymous poor system design expertise Anonymous receptive to change; lacking at middle mgt Anonymous underdeveloped subordinated Anonymous Unengaged, arrogant, changeable Anonymous Limited capacity Anonymous System Thinkers/Planners, Proactive, Experienced Anonymous bureaucratic tunnel vision insular Anonymous progressive, caring, efficient Anonymous narrow, insular, lacking Anonymous consultative, hands-on, fair Anonymous Inexperienced, unpredictable, fragmented Anonymous bureaucratic, removed, collaborative Anonymous limited operational experience, top-down, Anonymous Efficient visionary capable Anonymous

Minimal Anonymous incompetent, uninformed, conflict of interest Anonymous absent, void, weak at best Anonymous Secretive, non-committal,ineffective Anonymous Inexperienced,status quo,risk adverse Anonymous committed uncertain limited Anonymous unorganized uninformed not stable Anonymous big variety between LHINs Anonymous Possible underdeveloped autocratic Anonymous Inconsistent, poorly informed, political Anonymous autocratic, inexperienced operationally, bias Anonymous Trendy Anonymous Weak, inflexible, lack vision Anonymous competent, good, adequate Anonymous Effective, competent transparent and inclusive Anonymous no opinion Anonymous Focused, patient-centred, high-quality Anonymous Willing, knowledgeable, committed Anonymous Ego ego ego Anonymous Invisible, ineffective, waste Anonymous Attentive, Understanding, Insightful, Caring Anonymous Political, conservative, cautious Anonymous focus on hospital, no understanding of community Anonymous neutral, non imperial, underpaid Anonymous unqualified unqualified and understaffed Anonymous Immature, overstretched, non-transparent Anonymous Cautious, Anonymous weak, lacking operational experience, naive Anonymous weak, limited, short-sighted Anonymous Rubber stamping, unengaged with patients, politicaL Anonymous knowledgeable; passionate; thoughtful Anonymous Engaging focused hand-cuffed Anonymous Political, diverse, engaged Anonymous inconsistent, superficial, inept Anonymous collaborative, relational, engaged Anonymous Not easy job, but they are not helpful. Anonymous Trusted, Competent, Resourceful Anonymous secretive, ineffective, politicized Anonymous aloof/apart, conceptual Anonymous incomprehensible, informed, sad Anonymous non-strategic, bureaucratic, tick-boxy Anonymous remote, bureaucratic, political Anonymous ok Anonymous willing, scattered, unprepared Anonymous strong, consultative, supportive Anonymous Innovative, balanced, consultative Anonymous Undermanned, wrong skill base Anonymous Facilitative; Strategic; Engaged Anonymous

overhead Anonymous forward thinking, experimental, inspiring Anonymous Local consultation, Good change management process Anonymous Not well enough informed to answer this Anonymous pathetic, limited, sad Anonymous out-of-touch, impractical, non-need driven Anonymous

Name three (3) adjectives that best describe the managerial/leadership capacity of the Ministry of Health and Long Term Care. Answer Respondent

controlling focused biased Anonymous bureaucratic, uninspired, obstructionist Anonymous controlling, narrow focus, overstaffed Anonymous limited, not patient focused, lacking Anonymous visionless, unaccountable, adversarial Anonymous Not trustworty.incompetent,autocratic,self-serving Anonymous Extremely limited, highly unprepared, almost 0 pfd Anonymous Vision, political driver, micro-management Anonymous Organized ethical and focussed Anonymous unreal expectations, not enough money support, Anonymous political; ridiculous; uninspired Anonymous xxxxxx,xxxxxx,xxxxxx Anonymous Progressive and competent Lhin b hoodwinking; Anonymous micro managers Anonymous Too politicized Anonymous weak, controlling, distant Anonymous silo naive Anonymous evolving effective efficient Anonymous remote, overweening, arrogant Anonymous interfering and too centralized Anonymous organized focused and directed Anonymous Bureaucratic, micro managing, Anonymous strategic, political, metric-driven Anonymous Non strategic, politicized, Toronto centric Anonymous inexperienced, inequitable, bio-medical focus Anonymous inexperienced, inequitable, bio-medical focus Anonymous Inexperience, Poor,incompetents Anonymous micromanagement, control, fear Anonymous test Anonymous test test test Anonymous top people great public servants not at all great Anonymous controlling, lack of accountability, inefficient Anonymous Bob=great/Eric=values-based/ civil servants=power Anonymous

Focus on optics/slogans/politics/media moments Anonymous Out of touch? Anonymous test Anonymous disconnected unaware misinformed Anonymous bullying, self-interest, public relations-oriented Anonymous misinformed, misdirectrd, controling Anonymous limited politically motivated Anonymous Autocratic, bureaucratic, and unaware Anonymous stagnant misdirected unprepared for future Anonymous Bureaucratic, Political Anonymous insular directive unilateral Anonymous isolated, disconnected, geriatric Anonymous limited, non-innovative, financially focused Anonymous expectations without authority, arbitrary, Anonymous Myoptic,control,efficiency Anonymous Unqualified unrealistic uncoordinated Anonymous diffused, strained, optimistic Anonymous Ineffective, inconsistent, uninformed Anonymous Out of touch, archaic, burocratic Anonymous fragmented, disjointed, confused Anonymous bureacratic, uninformed, acute care focused Anonymous disconnected, unclear, veiled Anonymous short-sighted, top-heavy, unreliable Anonymous remote, policy driven, provider focussed Anonymous Elusive, top down, constipated Anonymous Inept, bureaucratic, dictatorial Anonymous distant, not accountable, too large Anonymous risk averse inflexible cumbersome Anonymous political, beleaguered, limited Anonymous engaged Anonymous power hungry, out of touch, no commitment to equit Anonymous loose, quantity & hands-off Anonymous Strategic vision, Collaboration, Accountability Anonymous out of touch, dictatorial, unpatient centred Anonymous Bureaucratic, inexperienced, expensive Anonymous TOO BIG/CUMBERSOME/IGNORING IDS Anonymous slow, complicated, conflicted Anonymous non existent, political, fleeting Anonymous variable capacity, lacking vision, inexperienced Anonymous ineffective, bureaucratic, unsustainable Anonymous Cooperative, Flexible Anonymous political, cost focused, cautious Anonymous out of touch, unwilling to listen, insular Anonymous Siloed, narrow, not accountable Anonymous micro management; ponderous Anonymous Unilateral, closed, command and control Anonymous lack of experience, indecisive, medical model Anonymous disconnected, aloof, ill-informed Anonymous

Young, open to learning, NaÌøve Anonymous Unskilled, detached unaccountable Anonymous punitive, protective, reactive to issues Anonymous Encouraging,insular, hopeful Anonymous underdeveloped, unfocused, bureaucratic Anonymous disfunctional,under-achieving,disrespectful Anonymous Unconnected, politically motivated, arrogant Anonymous reactive, lacks engagement, unrealistic timelines Anonymous no holding the LHIN accountable Anonymous distant, unresponsive, dithering Anonymous Bullies. Control freaks. Unprofessional. Anonymous Limited, short-term, blowing with the wind Anonymous narrow focused, unprepared, partial Anonymous No Comments Anonymous cloud based, unreal, poor oversight Anonymous political,controlling,arrogant Anonymous Process-focussed not outcome focussed. Anonymous N/A Anonymous high level, non-communicative, arbitrary Anonymous limited, uninformed, reactive Anonymous anti physician; political; kafkian Anonymous bureaucratic. uninformed. distant Anonymous Budgetary; political; strategic Anonymous waffling,uncommitted,lacking real consultation Anonymous lack policy underpinning; no operational experienc Anonymous Cautious, inconsistent, meaningful Anonymous Non-existent, inept Anonymous Same 3 Anonymous Evasive deceitful irresponsible Anonymous Idealistic, physician-centric, male Anonymous bureaucratic, slow, arbitrary Anonymous Rigid, slow, non-communicative Anonymous risk-averse, politically driven, believing Anonymous Don't get healthcare but want to be in control Anonymous Void, top heavy, autocratic Anonymous slow, secretive, controlling Anonymous Strong at the top, weak in the middle Anonymous Determined, forthright, unwavering Anonymous challenged, confused, conflicted Anonymous n/a Anonymous lacking vision, lacking courage to make bold moves Anonymous out of touch; not knowledgeable; in Toronto only Anonymous Underdeveloped Anonymous disconnected, political, desperate Anonymous I don't know enough on their leadership capacity Anonymous Broad experience/perspective, system thinkers, Anonymous bloated egotistic bureaucratic Anonymous confused complicated beaurcratic Anonymous

out-of-touch, hospital-focused, autocratic Anonymous armslength, presriptive Anonymous Politicized, reactive, adversarial Anonymous bureaucratic, absent, political Anonymous dysfunctional, punitive, unreasonable Anonymous Competent visionary supportive Anonymous Depends Anonymous naieve, uninformed, sceptical Anonymous absent, governance role only, micro management Anonymous Bureaucratic, ineffective, invisible Anonymous bureaucratic,risk adverse, variable. Anonymous baffling uninspiring limited Anonymous engaged bureaucratic interested Anonymous lake of transparency, bad time management Anonymous Command and control Anonymous Inconsistent/too hospital focused/top heavy Anonymous better conceptually than practically Anonymous Delayed til next fiscal year... Anonymous weak, lack vision, cautious Anonymous weak, not visionary, not strategic Anonymous high level, non-communicative, arbitrary Anonymous

limited, uninformed, reactive Anonymous anti physician; political; kafkian Anonymous bureaucratic. uninformed. distant Anonymous Budgetary; political; strategic Anonymous waffling,uncommitted,lacking real consultation Anonymous lack policy underpinning; no operational experienc Anonymous Cautious, inconsistent, meaningful Anonymous Non-existent, inept Anonymous Same 3 Anonymous Evasive deceitful irresponsible Anonymous Idealistic, physician-centric, male Anonymous bureaucratic, slow, arbitrary Anonymous Rigid, slow, non-communicative Anonymous risk-averse, politically driven, believing Anonymous Don't get healthcare but want to be in control Anonymous Void, top heavy, autocratic Anonymous slow, secretive, controlling Anonymous Strong at the top, weak in the middle Anonymous Determined, forthright, unwavering Anonymous challenged, confused, conflicted Anonymous n/a Anonymous lacking vision, lacking courage to make bold moves Anonymous out of touch; not knowledgeable; in Toronto only Anonymous Underdeveloped Anonymous disconnected, political, desperate Anonymous I don't know enough on their leadership capacity Anonymous Broad experience/perspective, system thinkers, Anonymous

bloated egotistic bureaucratic Anonymous confused complicated beaurcratic Anonymous out-of-touch, hospital-focused, autocratic Anonymous armslength, presriptive Anonymous Politicized, reactive, adversarial Anonymous bureaucratic, absent, political Anonymous dysfunctional, punitive, unreasonable Anonymous Competent visionary supportive Anonymous Depends Anonymous naieve, uninformed, sceptical Anonymous absent, governance role only, micro management Anonymous Bureaucratic, ineffective, invisible Anonymous bureaucratic,risk adverse, variable. Anonymous baffling uninspiring limited Anonymous engaged bureaucratic interested Anonymous lake of transparency, bad time management Anonymous Command and control Anonymous Inconsistent/too hospital focused/top heavy Anonymous better conceptually than practically Anonymous Delayed til next fiscal year... Anonymous weak, lack vision, cautious Anonymous weak, not visionary, not strategic Anonymous Fragmented, not inclusive, not evidence based Anonymous no opinion Anonymous improving, patient-focused Anonymous accountable, determined, exploratory Anonymous Need to revisit Anonymous Lacking, confused, unorganized Anonymous Beaurocratic, slow, not intuitive, not innovative Anonymous Constrained, bureaucratic, concerned Anonymous inconsistent, lacking knowledge, weak Anonymous hospital centric, Toronto centric, controlling Anonymous disorganized, uncoordinated, disfunctional Anonymous Non-transparent, political, slow Anonymous Narrow, limited, Anonymous inexperienced, lack understand, won't listen Anonymous poor, limited, disorganized Anonymous Poorly informed, misdirected, Toronto focused Anonymous redundant; unrealistic(no reality base); excessive Anonymous Meddling, scared, hand-cuffed Anonymous Tough love, decisive, bossy Anonymous micromanaging, disconnected, bureacratic Anonymous un-informed, in-experienced, overwhelmed Anonymous Bureaucratic, lacking insight, control-oriented Anonymous obtuse, fearful, hyper-complex Anonymous distant,promising,visioning Anonymous unknown Anonymous absent, unable, empty-headed Anonymous

micro-management, uninformed, go for optics Anonymous Political, bureaucratic, remote Anonymous weak in operations; great at policy development Anonymous disconnected, directive, unprepared Anonymous political, bureaucratic, competent Anonymous well intentioned, courageous, cumbersome Anonymous Interventionist, overreaching Anonymous Centralized; Isolated; Politicized Anonymous novice Anonymous cautious, careful, Anonymous Transparency Anonymous unequal distribution of funds re acute vs ltc Anonymous there is none Anonymous ok, so-so, varied Anonymous

The Ministry's Discussion Paper did not provide�any specific role for Health Service Providers' Boards and CEOs in the creation of a more integrated, patient-centred system of services. What roles do you think local governance and CEOs could play in creating a "Patients First Health System". (350 words) Answer Respondent

they need to have stronger accountability for what their organizations are delivering Anonymous Current LHIN local governance is not capable of exercising these roles. When LHINs were first developed the governors were supposed to be selected based upon their skills. This was moderately so at the beginning, however, over time, the government process ensured the placement of partisan sycophants.

Anonymous

"Rate the extent to which you think the structural changes proposed by the MOHLTC would --in combination-- result in a healthcare delivery system that is ""more patient-centred"".."

Anonymous

this is a huge issue. they need to be intimately involved and held accountable. Anonymous The patient first system is a joke and is a ministry first system. Capitation should be abolished first and a blended system with bonus paid for keeping people healthy should be in place. I have worked with docs who have doubled their incomes and cut back by 50% in their hours. And all they are doing is following MINISTRY GUIDELINES.

Anonymous

Most LHINs are incompetent.NOBODY listens to feedback that has been repeatedly provided to the Minister and DM. The buck stops there. Shame on you Dr. Hoskins, Deb Matthews and Dr. Bell! Sadly, are serving yourselves rather than patients? There is no understanding of healthcare needs beyond the GTA. Are you all too privileged to understand ON needs

Anonymous

Health service providers actually provide the service and if not fully co-opted into the initiative the goals of the Patient First Health System will be frustrated. Anonymous

Establish sub-LHIN leadership council with shared accountablility for system level quality improvement plan Anonymous

By being collaborative, engaged fully, take risks and focuses on the system Anonymous the roles they could consider,would be best served by having a say in local issues , we are not all cities with lots of transportation. Issues are very different some local areas, these issues need to be considered.

Anonymous

Delivery of services should transfer to those with a track record for delivery. Simply Anonymous

removing a board and perhaps some senior management, while good itself, will not inherently change the patient experience. xxx,xxxxx,xxxxx Anonymous the Mohltc,localBoard of Health & it's MOH work together with local Medical services CEOs should be at the level of decision making. Otherwise your risk failure of constant duplication and limited asset management . Not a good way to be nimble, to understand community needs identify solutions and asset management. The best predictor of success .

Anonymous

support and represent patients Anonymous CEO's can provide regular feed back to the community piece as to whether they are receiving to back up needed to move people out of medical beds leading to higher volumes of service and better access to medical beds etc.

Anonymous

must include patients and physicians (primary care) in governance structure HSP boards should be dissolved and CEOs accountable to LHIN Board

Anonymous

Could consult with patients and provide valuable patient perspectives via this. Hospitals have structures, processes in place to support integrated patient centered systems (quality, risk, governance, patient satisfaction, best practices) so they are positioned to be foundational pillars with their boards and CEOS

Anonymous

remove them and centralize .. like a health authority. Power bases have corrupted and destabilized health care in hospitals Anonymous

Each LHIN , strengthened in respect to the experience of its members in governing/leading things, should have the authority to pick the hymn but NOT Sing. Tthe Providers' Boards and CEOs should do the singing.

Anonymous

local goverance is the key but it must be established within a strong but not overburdening accountability structure Anonymous

? Anonymous The people who actually work with patients should be consulted. The best brains are in the academic centers in the Province and manage the most complicated issues . There are excellent examples of regional patient centered care on other provinces, why are we reinventing everything

Anonymous

I am doubtful that the local governance and CEOs will express themselves with candour. Anonymous

Non hospitals should be the magnet Anonymous strive for a population health/ health equity focus. Role model inclusiveness and cultural competency, champion by advocating publicly on social issues, use SES population health data not just bio-medical, focus on those with the shortest life expectancy. Invest in mental health; engage and include social service sector

Anonymous

strive for a population health/ health equity focus. Role model inclusiveness and cultural competency, champion by advocating publicly on social issues, use SES population health data not just bio-medical, focus on those with the shortest life expectancy. Invest in mental health; engage and include social service sector

Anonymous

If they take the responsibility and accountability could make a meaningful difference Anonymous Ensure that the money truly follows the patients and their families. Currently, it still is provider-oriented, with lip service being paid to "patient-centered". Anonymous

test Anonymous test Anonymous Because we are accountable to our boards, and not to an ADM, we were left out of the proposals. There is a significant amount of good work we can do in the system--that is why I was pleased to see the emphasis on the sub-lhin level. We can get our act together at the local level and demonstrate how to create a patient-centred system.

Anonymous

Local governance should play the role they have always played in the system - not really sure the MOH or LHINs want HSP boards to continue Anonymous

They can collaborate at the local level to create the seamless system that patients want. Anonymous

CEOS run organizations that provide care--they should be mobilizing their people to provide high quality patient-centred care across the continuum of care. MOH and their local Lhin offices don't provide care. Local governance and management ought to be the focus of any strategy that pretends to be "patient-focused". How does enhancing there authority of MOHLTC and the LHINs produce a more patient-focused system?

Anonymous

Advocacy and awareness. Support and leadership in execution. Anonymous test Anonymous Those who provide and their agencies understand the needs of those they serve. The MOHLTC needs to trust the local level to put forth what is needed and to have it supported.

Anonymous

It is the health service providers who deliver care. There is no role for them in this paper because Queens Park does not control them. That why they have focused their attention on "bureaucratic empowerment" and calling that "Patient centred" Where is the Minister and Deputy in this? Are they the ones who believe that we need more bureaucracy?

Anonymous

Yeah! Why? Because the HSPs are not directly controlled by the authors> Therefor instead of having a role for the people who deal with patients (HSPs), the paper only deals with the bureaucratic desire for more and more power and more and more centralized control -- which they then market as being "patient-centred". Why silence from health leaders?

Anonymous

They should be the one to integrate the home and community care. NOT the NELHIN. Anonymous They could easily design a system that would work locally. The size of the locale and complexity of its services would depend on how many boards and CEOs were involved in its construction. Certainly, in northern Ontario, the hub hospitals would be the obvious starting point for locales.

Anonymous

To ensure grass roots health promotion and prevention are not supported less than they already are. Also to ensure a voice for equitable services. Rural accessibility.

Anonymous

As there is great collective intelligence and wisdom that exists at this level,it is most unfortunate that the MoH has simply focused on centralizing the authority. It will have the reverse effect of what they say they want in the end.

Anonymous

Leadership in local communities across the Province will be THE people who need to lead the change - unfortunately they have been leading institutions and silos and are incented to do so - we need a new generation of leaders who understand and can advance the vision of a population health model

Anonymous

appreciate and build on capacity within other funding structures ie. MCYS, MCSS. Patient Centred system cannot just reflect health system funding service systems. Leaders must understand/articulate needs of a patient/ family. Families don't all know what they are missing so may not identify or request ways to fill gaps.

Anonymous

They will bring the patient centric perspective from the front line to allow for nuances that make all the difference to impact with varying populations served such as First Nations, francophone, pediatric sub- specialties (see below). To date LHINs and CCACs have not taken this into consideration and have thereby severely limited their impact.

Anonymous

local governance taking the initiatives to develop there own Collaborative Governance Forums and dealing with well defined system problems. a good starting point would be MOHLTC "negotiated" Goals and Targets that we are not even close to meeting across all LHINs

Anonymous

# 1Distribute the Discussion paper and set up fair consultation process. Adding another layer of bureaucracy will worsen health care. Removing community boards will weaken responsiveness to community health. Public Health is an example of too much bureaucracy. This proposed model looks like public health and then some additional bureaucracy!!

Anonymous

There should be more input at the LIHN from all the stakeholders with many of the reps from the various HSPs rotating through positions at the LIHN level. They are reactive to needs, disperse funds based on their ideas without proper input and assessment from

Anonymous

HPS and usually lack a tool to provide accurate outcome based data from pilot projects. HSPB and CEOs have a vital role to play in delivering on the promise of a more integrated, patient-centered system. Their agencies deliver the services that allow patients to survive outside of the acute care system. Historically they have been left to read the 'tea leaves' of MOHLTC initiatives and implement. They need more support.

Anonymous

so long as health care providers and their CEOs are leading the development they will design a provider first health system and it will fail Anonymous

Key informants Anonymous I'm glad they are removing the bloated CCACs and their boards. I would like to see the LHIN responsible to the Ministry with limited Board authority.HSP boards and CEOs can provide planning advice just as they always have. The experts should have a key role in systems planning.

Anonymous

The key to rural patient care is the focus on local governance. CEO's in the community are far more capable of ensuring patient centered care than are those farther removed. Anonymous

First of all not all people are patients (which is a medical term implying doctors know best). The document is accute care focused and misses the boat on community and community governace, which in a few years won't exist so there is only a role in dismantling board structures and preparing foe a reginonal model.

Anonymous

community governance is essential current consultation about implementation and not about whether patients first is good idea. MOH needs more transparency about final intentions. Hard to support change when not sure what's really on the table sub lhin regions led by primary care CEO's not just docs

Anonymous

Bring community nurses together with less upper management. Offer a wage consistent with hospital nurses to gain higher quality nursing at the bedside. Make detailed criteria for who receives services and who does not.

Anonymous

Local governance represents the health care needs of the local community not the politically appointed LHIN board members who have served the party well and are rewarded with sinecure positions that contribute little to the management of healthcare meeting local distinct needs.

Anonymous

In our LHIN I believe this would not change significantly. We work hard to connect three times per year on governance in large forums and also participate in many board to board events and projects.

Anonymous

They can manage the system within the guidelines set by the MOHLTC Anonymous I believe the more done at a local level is more apt to achieve this vision. If not held accountable locally, the vision will be lost. I think hospital boards mainly rubber stamp what is offered to them by Senior management. The Senior staff could be managed more closely by the LHIN with true repercussions for not meeting benchmarks

Anonymous

need to change their mandates and incentives(financial and other)to align with vision for integrate patient centred system Anonymous

local governance is important, and leads to better care. as well the system is too big and complex at the lHIN level for just one board. Concerned though if all are maintained that we could end up with a plethora of governing bodies that add complexity and turf wars.

Anonymous

Structural change is an enabler but won't fix the process problems that exist. I'd prefer to see us focus on the 'big ticket' process items that require change and realign the structure to support those process changes

Anonymous

Indentured servants. The point is to centralize service and marginalize local communities. There is no role for boards. The point is predictable outcomes. Anonymous

Not being so removed from front line services to actually see how and why we are providing services Anonymous

Local governance and CEOs should have role in all 4 dimensions- access, connect, inform and protect. They need to identify the opportunities for improvement in accessing, providing solutions in improving the connecting, they need to work with patients/caregivers so that patient/SDM are informed and take a stand to protect our universal healthcare.

Anonymous

Without appropriate sub-LHIN infrastructure, including managerial/administrative support the result will always be a provincial solution that does not fit local need. Anonymous

Local governance and administration, particularly in remote, isolated areas of the province would be more accountable to the local population. In these areas there are few providers of care and care is usually more integrated and coordinated as a result of being isolated. I am not sure how this compares to the urban areas of the province.

Anonymous

COULD/SHOULD BE PART OF HEALTH LINKS Anonymous part of consultation/org/delivery development and delivery Anonymous There are many possibilities for local solutions to health care delivery which will likely need tyo vary even within a LHIN geography based on demographic and patient needs/desires.

Anonymous

HSPBs and CEOs could be useful in addressing power imbalances between hospitals/physicians and the communities they serve (including service users), if given appropriate support (for e.g., in governance and leadership, etc.).

Anonymous

Be central to the consultation process Anonymous Essential for Health Service Provider Boards and CEOs to collaborate and be an active participant in advising and supporting the LHIN with implementing a better health care system for current and future residents in Ontario

Anonymous

It would certainly be difficult for that group to leave their individual advocacy at the door, and the tendency to look at every change measured as a 'win-lose' for their profession or facility

Anonymous

- advisors Anonymous System focused, stay focused on the big picture to use resources provincially the best way possible. Use resources that exist to prevent duplication and use funds appropriately. They need to know the bigger picture

Anonymous

This is the beginning of the end for HSP boards, a long desired outcome in both the LHIN and Ministry Anonymous

Need networked model Need leaders across the board to lead changes Structural change will not address cultural change imperative

Anonymous

The acute care hospitals are in a better position to participate and create a more integrated, patient centred system of services rather than delegating this to the LHIN's. Through bundled care which has already been implemented through Quality Based Procedures, hospitals could lead this work.

Anonymous

Leadership, Insight, Stewardship Anonymous Hospital's have proven capacity and expertise to play important roles. Hospital's create most of the work and transfers to home care and should play a stronger role in managing that process.

Anonymous

local community governance is absolutely essential. Without it, there is no commitment to community centred care. There has to be a very strong and effective local network of services funded by the LHIN and operating according to provincial standards and policies.

Anonymous

Leaders from Boards and CEOs to have Input to system planning, implementation, and service provision for their communities. Boards and CEOs to be accountable for overall system performance in their community and their own organization's performance within the system.

Anonymous

Collaborative governance e needs to be emphasized. Much effort is required to bring providerorganization to understand an integrated system of service to individuals. Anonymous

local governance in particular is critical. Without leadership and vision at this level, implementation will not happen. governance must drive management to participate. At the CEO level there is a great need for leadership. Not just doing but enabling. The LHINs and MOHLTC do no have the capacity to make it happen on their own.

Anonymous

Put the grandiose headline projects aside and concentrate on following through with long term support for the simpler and less costly solutions that come from the ground up. (re)establish the faith of the health care providers that positive outcomes will be more than the "flavour of the month".

Anonymous

They could apply modern business models to shift resources to patient services. For example all hospital IT should be centralised on a single platform with single patient record like CCACs have. All procurement should be centralised to create huge savings especially pharmacare.

Anonymous

If the intention is to create a more streamlined and cohesive system then all parts of the system should be engaged in the dialogue for change. Understanding the challenges for patients, families and care services from all perspectives is imperative to ensure the journey through the system is well articulated.

Anonymous

Less discussion in the province about structures, more money for front line services, some LHIN services have been outstanding but in other areas they are not up to task, I would like to really like to see patients first, stop taking structures down like the regional office, district health on people

Anonymous

The fact that governance was added onto the paper as an appendix/afterthought is proof enough that the Ministry does not understand or value the role of local governance. Each subLHIN should have an operational leader reporting to the LHIN CEO and have a relationship with a subLHIN commuunity advisory board.

Anonymous

Governance and management of HSPs never addressed in the paper. Could the 15 ADMs at Queen's Park not think of any ideas on how Service Providers could make our system more patient-centred? LHINs and MOHLTC have enhanced authority--that does not result in a more patient-friendly system. It means public servants, not health professionals are in char

Anonymous

I think that the MoHLTC has not been successful in doing this for the first 10 years that LHINs have existed. It is challenging for them to do so, with such a varied range of influence from a big hospital with sophisticated governance to a mid sized local community agency.

Anonymous

Advocate for vertical collaboration/integration and get your organization ready to commit to working with community organizations within the local regions. Anonymous

I question whether or not they should have any role at all as it is a too big bureaucracy, it defeats the principle . Anonymous

Open honest solution focused discussions would provide an opportunity for insight into the real challenges of providing sustainable services. If there were real opportunity to do so perhaps the existing structures could "fixed" before any grand amalgamation strategy was considered. Merging two imperfect structures will result in nothing new.

Anonymous

MOHLTC has no interst in local authority and has ensured that the LHINs have none. Hosptial Boards will be tolerated only as long as they do not take positions which are inconvenient for the government of the day.

Anonymous

Boards and CEOs will be constrained to process optimization. The Minister will set strategy based on politics. Ideally the Boards and CEOs would look at outcomes, but will be 'accountable' for managing inputs and some processes.

Anonymous

Boards and CEO need to continue to look for opportunities to integrate and be good system partners. Anonymous

I see no role for a CEO at the LHIN and CCAC level. There should only be one if any. Boards could provide consultative governance not operational. Have an expert panel of professionals with many years front line experience chosen by the MOH be the guidance of the LHIN/CCAC. Too often the in depth knowledge of the frontline is overlooked.

Anonymous

With the added requirement to demonstrate a strategy to achieve local health requirements, local governance will perpetuate the politic of mistrust aimed at replacing medical/evidence based governance. Another layer of bureaucracy will lead us down the path of NHS.

Anonymous

Less administration. Anonymous Too institutionally focused, more concerned about institutions that the users. Anonymous Boards and CEOs should spend 60% of their effort on defining future direction and Anonymous

means to continue to improve client service and quality. The CCACs are doing an excellent job now and Toronto Central CCAC is a model that all other CCACs could learn from - both their leadership team and their Board governance. If given a real voice--they can play a strong role in addressing local needs--both in pop. health and healthcare. Anonymous

need skills based community driven board members and CEOs with the necessary skills base likely chosen through open competition to bring a community/patient voice to the transition

Anonymous

Boards must now act as system partners, lateral accountability with sub LHIN scorecards. CEOs help in managing flow into the community. Move quickly to establish bundled payment opportunities

Anonymous

Boards & CEO's should be part of the discussion recognizing inherent conflict of interest. Anonymous

None Anonymous The Boards and CEO's are certainly involved behind the scenes. Where I work our CEO and HR Director work with our LHIN 1-2 days a week. This report is all smoke an mirrors. Much of the ideas are already in the works.

Anonymous

In order for the structure to work, LHIN Boards need to actually be, and be seen to be, more powerful and more prestigious than health service provider Boards. Hospital Boards in particular need to recognise their subordinate relationship to LHIN Boards. The HSP Boards need to have a clear vision of the desired future state and to support it.

Anonymous

Finally a better understanding of the continuum. Hospitals do not know the community and community services at all. One governance for a full continuum will make a difference.

Anonymous

If the system is going to work, CEOs and Health Service Providers' Boards (hopefully including patient advisors) are going to have to play an integral role. Anonymous

Their accountability should be on collective outcomes, not institution outcomes... if the client doesn't do well, nobody is rewarded. CEOs should report to the LHIN and the Board (similar to the medical officer of health in some jurisdictions). If the outcome isn't for the system then everybody remains in their silos.

Anonymous

Provide local leadership and knowledge. If we want to be patient-centred,we need to empower the front line--not Queens Park and LHINs. Anonymous

Innovative solutions Anonymous They must be cheerleaders and champions Anonymous System boards should have more authority and responsibility than local HSP Boards Anonymous Take the leadership to bring about the inclusion that is being sought. Anonymous Truly engage in partnerships that hold each other accountable. Anonymous n/a Anonymous MOHLTC should encourage capacity building re local system design. Most HSP's and their boards have little ability to plan. They need to come together and think critically about how to develop a system design that spans community, hospital and primary care integration. However, MOHLTC needs to identify a provincial system design framework first

Anonymous

everyone needs to be at the discussion table. It will be next to impossible to affect change without the implementation team being included as part of the change discussions.

Anonymous

A crucial role, particularly as patient advocate for underserved diseases, areas,populations and independent monitor of quality, safety, and value for money. Anonymous

My organization is not officially a HSP as our funding is flowed thru from a third party therefore I know our Board would have no say in any of these plans. I think the Ministr would do well to include Boards of Community agencies in their over site as they are an easy way to get representation form the community by people who are already engaged.

Anonymous

This is difficult to answer.... Anonymous

Local Boards and CEOs are critical leaders in the transformation. They must listen to their patients, the same patients shared by many providers and develop a system that smooths transitions and decreases duplication. Enhanced governance collaboration is required to move the system along.

Anonymous

The Boards will stay - they need the volunteer hours. The Deputy has said as much Anonymous Provide direction to health care providers closer to the patient's home. Anonymous Ability to start building from the patients' perspective and front line realities. Nimbleness built from necessity. Innovative and creative. Anonymous

By working together more to achieve collective impact with respect to their shared vision/goals. Anonymous

The intrusion of governance has lead to the isolation of clinical care weakened under conflicting layers of bureaucracy. There is much tolerance for poor leadership and autocracy. Political persuasion counts for more than efficacy. CEOs and local governance hide behind the front lines. Success is about access to Queens Park.

Anonymous

. Anonymous Taking on a leadership role in determining priorities for local(sub-LHIN) integration and leading the re-design of services/processes, with our partners and patient/families to improve transitions and provide a better patient/family experience.

Anonymous

Collaborative governance amongst all stakeholders providing non-competitive direction to CEOs. Decision making must be in the best interest of persons served in each geographic location; inclusive of all cultures, norms and specific economic and environmental conditions applicable to the area.

Anonymous

Depends on the organization and what role the organization has in patient care Anonymous Boards and CEO's have been excluded and are seen as part of the problem in our NWLHIN. Respect has been lost (if it was ever there) even with the so called community engagement the fix is in and regional health authorities lead by hospitals are on their way.

Anonymous

Not sure it has been fully thought out. Need to create an integrated system. Anonymous Local governance, not controlled by the CEO, including patient and community involvement could play a much stronger and more effective role in creating a "Patients First Health System ".

Anonymous

Common strategic focus and accountability amongst HSP's is the only real way of affecting change, not structural wallpapering via the LHIN. The LHIN has not been the agent of change.

Anonymous

"could play" as opposed to "should play" - nothing will change - the leaders will continue to lead and the obstructionists will continue to obstruct Anonymous

they need to be accountable to the lhins to initiate patient and caregiver centred care with patient/caregiver advisory boards. Anonymous

Bring a more hollistic vision of health than the LHINs Anonymous I think at its best these leaders could Provide a more balanced perspective:in risk aversion and the value of data in terms of driving quality when the collection of the data may actually build in a less confident and less innovative culture these leaders need to make the new approach happen so critical to engage and inspire early

Anonymous

Local governance MUST remain. Relationships are built at the local level, not LHIN or provincial level. It's not all about physicians!!! Do the research...integration is often more expensive!

Anonymous

Have responsibility for designing the 'shared provider' roles and processes that are anticipated to evolve. LHIN roles to understand and as new owners of home care have a role but not a 'mandating' role that other community providers must follow. This needs to look and feel like local collaboration- to date, it's LHIN rhetoric only.

Anonymous

Patients in GTA vs Kingston vs Thunder Bay may have the same diagnosis. But available resources are different. Local governance should focus on local strengths to support patients, not complain about gaps.

Anonymous

They should be involved in the planning and execution of decisions involving changes to Anonymous

the system. Being accountable advocates who see the impact on the health care system. Anonymous Local governance and CEO's have a large potential role provided they can move towards a more integrated process for their services. To do this they need to consult both health care consumers and Primary Care providers. They key elements would be to identify and eliminate duplication of services and focus services on consumers.

Anonymous

no opinion Anonymous Health Service Provider Boards and CEOs could play a role supporting physicians, nurses and other front-line staff as they work to crate a more integrated, patient-centred system of services through patient-based design rather than focusing on protecting their organizations which is not patient-centred approach.

Anonymous

Integral and necessary: without this input it would simply be a top down approach (useless) Anonymous

Embrace the linkage to primary care but don't create monster organization like ccacs and large central mental health agencies Anonymous

evaluation of senior management positions & the duplication of LHIN governance positions is required to reduce costs and political posturing to move a patient centered agenda forward. A balance of roles and responsibilities to ensure that community needs are understood throughout all decision levels of health care ... individual->strategic.

Anonymous

The Role of CEO's and local governance cannot make decisions about Patients First policies without the input of patients. There should be patient advisors / voting members included at every decision making governance board.

Anonymous

Very little, most superficial. Anonymous The strategy of each HSP should be completely aligned with what the community needs (as the community owns the HSP assets, it shouldn't be about the HSP but its role in the community). If that is true, then the cumulative community visions are what the health system should be.

Anonymous

Bring on Regional Health Authorities, replace institutional boards with population based district boards within LHIN regions, and make CEOs into COO's truly reporting to a LHIN by LHIN senior management committee. Develop regional LHIN programs where hospitals become health care organization campuses not self standing organizations.

Anonymous

Since the boards and hospital CEOs are the only real strengths in the system, they should be appointed as the board of the Healthcare Networks at the SubLHIN level - see the East York Health Network.

Anonymous

Leadership, ensure community engagement, systems thinking, innovation, Anonymous Partners providing front line leadership Anonymous bring experience and perspective Anonymous Absolutely critical for the growth and success of any change. Anonymous None. They will be eliminated Anonymous eliminate them, too many boards, too many layers, reduce and have a general manager over multiple LHINs with a goal of alignment .....too many bosses not enough workers that impact the care. don't need CEOs or board to create a patient health system.....

Anonymous

Get out of the way Anonymous More responsibility over HCP and more respect from MOHLTC Anonymous Knowledge of community context, and of clients/ users of services those HSPs provides. Meaningful integration requires deep, trusting relationships, and Board members and HSP CEOs/Seniors Leaders are better placed to develop such relationships, and understand what relationships need to be developed in order to serve clients/community better.

Anonymous

we must have a collaborative, accountable, transparent relationship between all of the partners Anonymous

HSPs should have been at the centre of this paper. How can the system become patient-centred without the HSPs? Anonymous

Rationalize "governance" across a LHIN inclusive of sub-geographies. "Local Anonymous

governance" and "CEOs" should be subsumed in the rationalization. "Leadership" should be flatlined and real. local leadership empowered citizens Anonymous

need to be actively engaged can inform by providing information and best advice once decision is made, actions need to be consistent

Anonymous

Once again they are being largely left out. There is little comprehension that the real governed and management skills are in the provider sector and little within the LHIN and MOHLTC

Anonymous

Health Service providers don't seem to be on the MOHLTC's radar screen. Why? Because while they seem to directly control the LHIN, we have our Board. As the CEO with a great team and Board, I sure would have appreciated it if the government could see that we are the place that can make a difference to patients--not LHIN, not Toronto civil servants.

Anonymous

Ensuring a community-focused approach and oversight in terms of provider impact on initiatives Anonymous

no comment at this point Anonymous joint accountability for system accountability and performance toward population served; CEOs accountable for both organizational and system performance Anonymous

opportunity for HSP Boards and CEOs to hardwire incentives for managing health care from a systems perspective Anonymous

Individual HSPs require their independent boards for leaderhsip oversight. I suggest that the HSPs include their strategic plan in the M-SAA. In addition, to enable greater alignment between HSPs and LHINs in delivering patient focused systemic improvements, an advisory panel/relationship between HSPs and the LHIN boards/senior staff.

Anonymous

Pursuing local integration options Using existing organizational infrastructure to bridge inter organizational gaps Anonymous

Roles should be many and varied, depending on the specific circumstances. They should be proactive regardless, with existing players stepping forward to enable the change. In smaller and rural communities, hospitals should look to supporting the LHIN Sub-Regions administratively, through system accountability agreements with the LHINs.

Anonymous

Steering. Outcomes Anonymous I think that local governance, and connection to communities is very important. In particular, I strongly favour public boards. Anonymous

Advisory role Anonymous They need to be the go between all aspects of health care. Acute and ltc do not work together and should. Right now we are still working in silos when we should be working hand in hand.

Anonymous

dafasf Anonymous Significant advisory role and partner in re-designing and planning for provision for and with the people the system is not working for Anonymous

What do you hope to see in the government's final policy after their consultation? (350 words) Answer Respondent

That they will not give the LHINs patient care responsibilities it is not the right role for them Anonymous

If LHINs take these roles, they need to be enabled, something that has never been achieved. Governors need to be truly skills based and not selected based upon party affiliation. There must be funding equity between LHINs to ensure universal standards of service between LHINs.

Anonymous

A fully integrated healthcare system that is as focused on wellness and prevention as we are on acute care now. Anonymous

clear accountability for all players with focus on outcome and impact. Anonymous ABOLISH CAPITATION AS THE SYSTEM FOR REMUNERATION AND START WITH THE ACADEMIC CENTRES FIRST WHERE THEY ARE RAKING IT IN. Anonymous

I'm speechless. How futile is this exercise? MANY people have stated how various LHINs indicated a plan will be released just after March 1st? So, is this true engagement? This feels like a major social justice issue in ON Eric. I hope that there would be a major rethinking of government, LHINs (boards, CEOs, sr. teams) and the system. Feels futile

Anonymous

The govt should not try to manage the system. Primary Care or lHINs could drive it, but only if there was a dramatic enhancement and development of management expertise with these groups

Anonymous

LHIN boundaries re-aligned to municipal boundaries A high level milestones chart and 90 day plan revolving that is communicated A robust communication strategy to build momentum for support with the sector

Anonymous

Action Anonymous a financially stable plan that puts the residents/patients in the center of their care. Anonymous CCAC staff should become the employees of existing provider agencies. The HealthLinks should be the focus of primary and home care, and again, the existing providers should be running these; do not create new Director positions! The existing CCAC to provider contracts need to be re-done. If no change to the contracts, the LHINs cannot succeed.

Anonymous

xxxxx,xxxxx,xxxxx Anonymous Social determinants of health considered strongly. Educate politicians policy makers. I hope for a health care system that is wholly integrated with power carefully considered. Avoid Peter principal. Are we utilizing assets best? Is there protectionism for medical model?shared services.

Anonymous

stop micro managing Anonymous I hope to see a more enriched community sector including community mental health with counselling services to support people as they move more efficiently through the various community and hospital based services. It is interesting to note that community mental health and addictions is not mentioned below!

Anonymous

patient advocacy Anonymous LHINs do not have operational experience or capacity. Their boards are not focused in the direction to support CCAC transition. Would hope to see a very serious look at is this truly the best approach and are there others that would best serve patients and enhance outcomes, transitions, etc. Would like to see patients part of consultation.

Anonymous

a system of community base HEALTH care and a smaller role for hospitals defined as solely illness curative and academic Anonymous

a) specifics on how power would be shifted from the MOHLTC to the LHINs b) recruitment policies to strengthen the capacity of each LHIN to provide regional governance c) abandonment of the bad idea to give the LHINs operational responsibility over what used to be the CCAC mandate

Anonymous

more local governance and accountability for helath services. Greater accesibility for non-hospital health supports and especially homecare services Anonymous

? Anonymous Likely more bureaucracy and more rules, I am not hopeful at all Anonymous No comment Anonymous Clarity. And an end to consultations. Leveling of the field with reallocating to the north and high population areas Anonymous

Inclusive and equitably focused system; public health is not consumed by the primary care sector-health is not just about access to primary care- it is only one element, decisions are made equitably, decisions are based on underpinnings of psycho-socio-environmental approach as well as a medical approach. Its about people first, not just patients.

Anonymous

Inclusive and equitably focused system; public health is not consumed by the primary care sector-health is not just about access to primary care- it is only one element, decisions are made equitably, decisions are based on underpinnings of psycho-socio-environmental approach as well as a medical approach. Its about people first, not just patients.

Anonymous

Dismantling of MOHLTC and putting the Patient first at a local level Anonymous Something similar to what is occurring in the National Health Service (NHS) in England. Anonymous test Anonymous test Anonymous provide role for the providers11 Anonymous Total integration of all aspects of the health system, based on performance metric and quality with appropriate "single" envelope funding. Anonymous

They need to understand how silly it is to issue a policy paper in health care and have no role for the people and organizations that actually deliver care. Also, care co-ordination from the CCAC should be under the primary care/hospitals where they will be located. Don't put the LHIN in the care business. They plan, fund and provide oversight.

Anonymous

Governance and Management of case management ought to be with primary care--with provincial standards to address the need for consistency. Don't let the Ministry have even more control over the system--unless we make Queen's Park accountable for the results of this structure!

Anonymous

Clear plan, objectives and path forward. Consideration for the patient--high quality and compassionate care. Anonymous

test Anonymous A total change from their current way of thinking. Instead of creating another layer of bureaucracy, and eliminating local level agencies, they need to model the standards of successful agencies in to those that are struggling. It is not possible to create a province wide standard of care when each community has its own unique needs.

Anonymous

LHINs are asking HSPs--"so, tell us as your funder, do you agree we need enhanced authority". What kind of dishonest process is this? I understand why health leaders are simply skulking away doing their best to say nothing that will offend our funders.

Anonymous

To say: oops we misjudged the system. We thought they were spineless twits who would be compliant. As a result of excellent input, we have decided that maybe the HSPs have a role in the delivery of care and they bureaucrats at Q.P. and LHINS actually don't have a major role in delivering care to patients. So making them all-

Anonymous

powerful will not work. My hope is That a better system for providing home and community care be devised Anonymous An understanding that hospital boards are experienced, capable groups that can easily monitor the creation of a more integrated, patient-centred system of healthcare than currently exists. Hospital boards should be involved in the final scheme that will provide for local differences.

Anonymous

Health promotion and prevention as a priority and funded appropriately. Community governance preserved and valued. Rural services enhanced.

Anonymous

Empowerment of the front line. Realize that centralizing the control will not produce better results. (look at past experiences...) It simply undermines the great wisdom and innovation that they wish (or at least say)they want. Using the title of "patient first" is misleading as this seems more about the powers that be than the patient.

Anonymous

how they will manage the conflict of interest of the LHINs and how LHINs will become more than a monitoring mechanism for mediocrity Anonymous

Depth of understanding and operationalization of a rich, integrated scope of support for families especially for those with chronic palliative conditions. In pediatrics this includes home,school and community life, transition to an effective adult service model. Care managers must truly coordinate family support beyond health services.

Anonymous

Action on advocacy from Children's Treatment Centres (CTCs) and recommendations from reports led by gov't to transition the current CCAC funding for pediatric school and home rehab services from MOHLTC to MCYS where CTCs were shifted to in 2004 from MOHLTC. This oversight causes duplication of processes and fewer dollars to front line services.

Anonymous

While the LHINs have a significant amount of responsibility now and this will be significantly increased with the proposal, They have very little meaningful authority to encourage positive change. They have been successful in applying collaboration to a significant extent but on key goals have little authority to make change happen. Good Luck!

Anonymous

It this the consultation? Who knows about this discussion paper but the inter circle. If the MOHLC truly believed in quality, accessible health care for all, they would look to examples that worked. Already, doctors losing time with patients with data focus . Start by fairly informing sector of thispaper. Determinants of health must be included.

Anonymous

The LIHN will be more accountable to the public and stakeholders. The government needs to look at how board members are recruited to make sure they have experience and qualifications needed. Until this happens their powers should not be increased.

Anonymous

Strategy for monitoring the implementation of this policy and providing all stakeholders with real-time information. It cannot proceed as just another system transformation. This is our last and best chance to really put the patient and family at the centre of our system.

Anonymous

speed up the transition to community-based care with providers competing to service clients in order to let the market decide on the outcomes Anonymous

Stronger alignment with primary care, and greater accountability structure for overseeing LHIN's Anonymous

Disbanded CCACs. The majority of funding funnelled to direct patient care. Significant ministry oversight by qualified experts to ensure equality and best practice standards across the province. Limit the LHINs power. All health care providers working together to achieve common outcomes and high quality patient care. Fund hospitals well. Remove NVA

Anonymous

Change which would reduce the financial power and influence of the ineffective CCAC and place that responsibility in the hands of local bodies as opposed to reducing or Anonymous

eliminating their effectiveness. Local health care means a reduction in and not an increase in centralization of responsibility. What i hope for and what will happen are not related. the gov't is already advertising their direction on billboards. Anonymous

Real transparency about what is being proposed. A plan for how this will be implemented with clear timelines. What it means when it uses the term integration. Anonymous

No more CCAC! improved process for LTC placement services, better access to homecare and HBHC nurses. Anonymous

An approach that listens to the general patient centred tenets of the system and leaves opportunity for patients to be treated in their homes and closer to home. Keep the population educated and informed about their health, provide health hubs to encourage and deliver preventative and primary care using health teams and effective home care if need

Anonymous

I'd like to see a hold on terms of present LHIN boards to allow for a smooth transition. Extending all terms by three years would be important. Anonymous

Delegate, listen, fund and scale up innovation both public and private. Anonymous So many years have passed with no positive change in how health care is delivered. there has been a negative staffing change in most hospitals as a result of inadequate salary budgets. We require doers and thinkers who can make decisions on the front line, not RPNs and PSWs buddied with RNs staffing Emerg dep'ts and ICUs.

Anonymous

20% reduction in MOHLTC Staff so they lack capacity to micro manage decisions atLHIN/SUB LHIN level. Anonymous

an overall framework for who does what within the new integrated system Anonymous willingness to make changes as needed and comprehension that structure won't fix the process issues Anonymous

A transparent process for deciding Ministry priorities;recongniton of the value of health promotion and social determinants Anonymous

A more collaborative system that generates less waste and places the right services in the right places by the right people. Anonymous

I would like to see how this proposed change is going to effect and improve how care is provided for home and community, how the transitions between hospital and home/community care will be improved and how to streamline and improve the information flow between CCAC and service provider so that care is improved for patients and caregivers

Anonymous

I think there needs to be far more consultation with those who are responsible for delivering the care, rather than the short several week window that is part of this process.

Anonymous

A realization that the LHIN's are not the best agency to deliver client / patient care. Anonymous ELECTRONIC RECORDS FIRST Anonymous better org, more efficiency/ services directed to underserved sectors: mental health (esp for young males, secure housing, more seniors services directed to long-term care and palliation

Anonymous

I would hope some flexibility for local decision making on approach to integrated care delivery supports for home care. Anonymous

Performance based on outcomes (not outputs). I don't wish to see hospitals given more authority for health care, including managing home care. Their vested interests distort the use of resources and they have little understanding of what is needed or possible within the community. They lie to get people out of hospital, and they are expensive.

Anonymous

A solo governed home and community support services sector, rather than the current fragmentation. Clearly demarcation between the For Profits and Not For Profits with clear Policies to govern both sectors.

Anonymous

Heard the voice of health care consumers, acknowledge there will be some differences depending on where you live and collectively we all have a role in advancing the changes required for a better health and health care system

Anonymous

Real change that improves local care, by engaging practitioners in virtual teams Anonymous

overseen by sub LHIN 'local health authorities" with some resourcing, but not governance boardsÌ¢å�'å_please clear direction and appropriate policies and resources to support changes Anonymous Integrated system without duplication. Using resources available to the full. Understandable system that the public knows how to use to access the needed services and that the public can easily know about what services are available out there.

Anonymous

Role of Boards Anonymous An actual plan that sees progress and minimizes risk Anonymous Clarity is required in their final policy rather than leaving it up for interpretation by each of the LHIN's. Anonymous

Hope, Vision, Leadership Anonymous Strengthening the role of Hospitals and placing more governance in their sphere. Not increasing the power of the LHIN's any further. Providing an independent auditor of the LHIN's activity and authority. The MOH has now created 14 different healthcare systems in Ontario run by 14 different management styles without any audit process.

Anonymous

a clear demarcation of role of MOHLTC in setting policy and standards. Anonymous Close CCACs with savings. Devolve their community case management role to primary care. Devolve home based direct service provision to other HSP. Keep LHIN role as system oversight, performance monitoring, planning and SP contracts - primary care, community services, hospitals et al. We need separate public health role, independent from LHIN

Anonymous

End of private practice for family physicians Anonymous The more local integration is desirable but the policy lacks consistency and makes assumptions that are naive at best regarding the readiness to implement at the LHIN and sub LHIN areas. The policy needs much greater clarity on the "how" and the supports to make change possible.

Anonymous

That the money will follow the patient. Rather than a cold-hearted beauraucratic decision empathy and compassion will have a place in decisions.Some form of control for the over-inflated costly management structures that permeate LHINs, etc. Appreciation for innovative solutions "outside the box".

Anonymous

I expect they won't listen but forge ahead as they've always done Anonymous Seamless access and transitions for patients. Collaboration and transparency by service providers. No blaming, and instead changing culture to be solution focused and comprehensive in our delivery of care. Shared ownership and leadership of challenges and solutions with a patient voice guiding the way.

Anonymous

if the LHINs and CCACs are coming together there needs to be less of them, looking at their boundaries, not 90 mini LHINs such as the size of the HL that would bring more confusion

Anonymous

None. I strongly believe that regardless of public input the government will impose a new "made in Ontario" model that will not be based on any evidence and will be poorly thought out. Any new effort will be slow in coming and execution will lack any degree of precision and will be bathed in confusion and uncertainty of all key stakeholders.

Anonymous

Giving more power to Queens Park and the LHINs needs to be challenged in the Legislature. I hope others besides me step up and tell our MPPs that empowering Queens Park is not going to produce a more patient-centred health system.

Anonymous

Retaining the focus on patient and family centered care by continued involvement of these key stakeholders in the design of services. A better focus managing health outcomes and health equity.

Anonymous

A clear structure and specific deliverables. Emphasis on breaking silos and not creating ones. Anonymous

No Change as Public Health shouldn't be part of this Patients First Health Systems as this approach is too clinical and hospital oriented and defeats OPH's mandate. Anonymous

If there is over sight I trust it will be spelt out clearly and used consistently. I hope they will reconsider their strategy and fix what isn't working prior to creating chaos which will have to be "fixed" again.

Anonymous

MOHLTC needs to become focussed on health system strategy, strategic policy and legislation for the health professions, capacity planning, and funding models which work. Poltical culture stops this. Stronger LHINs with stronger leadership and greater autonomy from MOHLTC. LHINs need to be either funder/ planner or service provider not a hybrid.

Anonymous

Recognition that the current silos are due to band-aids of legislation and regulation. Structural change demands major legislative overhaul. Innovation (even importing good ideas) requires flexibility that is currently restricted.

Anonymous

No change from the proposal Anonymous reduced executive costs,more frontline staff, more diverse in roles and integrated as teams. (ie PCP's, Physician assistants, NP's,RN's,RPN's PSW's,SW,OT, NUT,PT all working together as teams in specific areas and those that require help in the home actually getting what they need based on their needs not on eligibility criteria.

Anonymous

Support for evidence based planning and delivery. Linking funding on outcomes. Focus on systems outcomes. Provision of options for social service networks to opt into integration, requiring adopt of medical standards and performance accountabilities.

Anonymous

More of the same, bigger LHINs - net more administration to cover the POLITICAL ass. Our government lacks the courage to make the real change necessary.

Anonymous

More of a patient role. Serious increase and ring fencing of funds for community and home based service. Anonymous

That the CCACs remain with current authority. Anonymous Nothing new--this is a 'done deal'--consultation is just window dressing for this Govt. Real stakeholder consultation would have been done to help create the discussion paper, AND the paper would have reflected the process.

Anonymous

just hope we see some policy after the consultation that begins to explain what the plan is, how it will work and why they see it as the solution Anonymous

Include specialists into planning accountability of LHINS The proposal should pass as it is

Anonymous

Focus needs to change from simplistic "Patients First" to a balanced system that delivers efficiency, health promotion, disease and injury prevention, and excellent, high quality and accessible service delivery. Need to identify and consider the delivery options before landing on the solution. No point in expanding a system that never worked!

Anonymous

More interferences with less efficiency Anonymous I would hope to see a sensible, fair health care reform. These LHIN's are a Liberal creation, being run by majority Liberal supporters. There has been a severe lack of communication, transparency as well accountability. What exactly have the accomplished 10 years later, and over $100Million dollars spent

Anonymous

Reduction of LHINs to 7-10; LHIN boundaries defined by census dissemination tract and aligned to municipal borders; LHIN Boards expanded to 12; Drummond report recommendations followed (not just public health, but also EMS, primary care, etc.); "for profit" providers (including LTC) outlawed; HSP CEO compensation tied to SAA, not QIP, performance.

Anonymous

A system! Anonymous Leaving each LHIN to figure out how to best implement population based care in each area based upon the leadership available in each subLHIN. The worst thing that the government can do is to hand down a bunch of mandates that don't fit the needs of each community.

Anonymous

I want aggressive and visionary. I don't think slow and consultative will result in the Anonymous

sweeping changes we need. I want mandated EMRs, that transfer across organizations. I just don't see how we are ever going to have patients first without that. Also, I want more for primary care and less for acute, high cost, medicine. Case management managed by primary care and the hospitals where they are located. Anonymous Flexibility, empowered CHCs Anonymous A clear definition of the deliverables, responsibilities and accountability. Anonymous Strengthened primary care integrated with home care. Anonymous Commitment to absolute structural change. Anonymous A clan definition between planning and execution. I have found planners are not good at being held accountable for delivery of services. Anonymous

n/a Anonymous -a clearly articulated vision of the end state integrated system we are driving towards - CCAC mental health nurses in schools moved to children's mental health centres to promote integration & inter-disciplinary teams - CCAC nurses used as case managers widely in an integrated system

Anonymous

recognition that primary care reform cannot move forward without resolution of the OMA physician payment issue. Primary care doctors are central & key to patients' first strategy & implementation. MOH needs to mandate an IT infrastructure that everyone in province uses; collaboration should not require independent & costly IT solutions

Anonymous

I would prefer to see the MOH/LTC adopt a portfolio approach analogous to an investment manager trying to achieve returns expected by his clients as opposed to a conglomerate exercising control over subsidiaries and branch plants.

Anonymous

As above Anonymous Clear and detailing the process. Anonymous Clearer vision on the model and clearer articulation on the outcomes the changes are meant to achieve. Anonymous

there wont be any significant changes Anonymous Allow the LHINS to function in s business like manner. No political interference. Anonymous Mandatory consistency in application of policy, funding across all LHINs. Anonymous Follow through on the proposed efforts to enhance the client and caregiver experience of health care. Support for service providers to respond collaboratively, so that clients and caregivers can easily navigate the system to have their needs met in as effective and timely a manner as possible. Prevention is worth a pound of cure! Be proactive.

Anonymous

Analysis of structure handled arms length from government,. Anonymous . Anonymous Some acknowledgement of the tension between LHINs and service providers and the lack of trust that exists. No amount of structural reform will fix this. The structural reforms make sense, but until we address the management style/approach and the barrier that this creates to progress/system transformation we will not be able to move forward.

Anonymous

Close to proposed plan assuring accountability of all government, regional and health care providers. More accountability by consumers of health care required. Anonymous

Rethink it! Anonymous i have little hope other then to wish the MOHLTC sees the error of its way with regard to the LHIN expansion and ccac so called restructuring. Anonymous

A more regional model with real operational people. Anonymous Remove the bureaucratic and non-effective LHIN layer. Anonymous Acknowledgement that the current LHIN STAFF is not capable of being an operational regional health authority, and that sustained and real change must come from the HSP's Anonymous

themselves. Specific direction for LHINs - consistent execution - little to no "local" variation Anonymous to move forward with specific initiatives to reguire home care integration and less bureaucracy. Anonymous

Have clear directions on the how. Hope that things will move fast and that we won't be in transition for the next 5 years Anonymous

I would hope to see a focus on support for a health care culture of leadership, one that has compassion for the people it serves , accountability that recognized excellence and achievement as well as builds conversation and collective action around closing the gaps and builds collaboration and consistency ,so sadly lacking in the ccac structure

Anonymous

More interprofessional teams, genuine health equity for all, more system navigators working within primary care, increased mental health services, expansion of CHCs, funding of oral health.

Anonymous

Primary Care as a system player is evident as a collaborating partner in the community plan for service delivery. Anonymous

A commitment to accelerate decision-making within the MOHLTC. Deferring 'to the next FY' doesn't help patients in care now. Anonymous

A system that is accountable to patients for delivering the care they need. Anonymous a stronger health care system Anonymous Demonstrated that they have listened to the feedback and ensure that going forward they continue to include consumers and clinicians. Primary Care need to have a central role in policy decision making. The final policy needs to be based on evidence rather than political expediency and shift focus from acute to community care.

Anonymous

no opinion Anonymous Greater focus on patient-based design, greater role for clinicians and patients in design, breaking down the old lack of accountability, acute dominated health system. Anonymous

A strategy and well articulated plan. Enough discussion, time to act! Anonymous Decentralized services linked to primary care Anonymous Intelligence & practical modeling. A policy with clearly defined outcomes, supported by appropriate funding infrastructures for each level of care. Stop feeding on old reworked solutions-more creativity & innovation.Learn from other world health systems.An international panel to evaluate our healthcare system for sustainability.=fresh perspective

Anonymous

Inclusion, respect, attention, action based on PATIENT and FAMILY feedback and insights. Anonymous

Unpaid, volunteer board membership not dictated by politics. Anonymous Clearly defined roles and responsibilities of LHIN's and HSP's together with performance measures. Community mental health nurses, who never should have been in CCAC's, moved to Children's mental health centres to act as part of inter-disciplinary teams and system navigators. LHIN's strictly as system planners/integrators and performance maesured

Anonymous

Goal setting, letting folks get on with it but holding them to accountability. Keep Ministry out of the weeds. Anonymous

Elimination of the LHINs in favour of Healthcare Networks at the SubLHIN level. Anonymous Responsive to input received. Anonymous Real commitment focus and funding to strengthen community options beyond CCAC including recognition of social determinants of health Anonymous

don't really understand what their trying to solve Anonymous Nothing==It's a 'done deal'. Consultation was a smoke screen to say they 'did it'. Anonymous Admit they want a Regional Health Authority and go for it. Eliminate hospital boards and move all provider staff under LHIN management. Half measures won't do anything except disrupt the system and waste money.

Anonymous

reduce # of staff rolled into the LHIN Anonymous

significant cost savings focus on outcomes, versus the process to get to them being rewarded....dollars wasted at times reward the leaders/outcomes achieved The what, not the how Hospital boards gone All health care providers on salary

Anonymous

Actual change in the policy that reflects the consultations that have been conducted over the lat month. I say last month because of the launch of the paper (3 days befor xmas holiday period) was disrespectful of a full 3 month consultation process. The consultations only happened in the month of Feb due to the response date of Feb 29.

Anonymous

That they'll backtrack on the insane idea of LHINs becoming responsible for CCAC services, unless of course the government's real intention is to turn LHINs into true health authorities and get rid of agencies/boards - in which case, at a minimum, I would hope the government is honest and transparent about their true intention.

Anonymous

clear roll out plan, accountability factors, time measurements, patient inclusion, frequent evaluation Anonymous

They won't back down. They want control without accountability. They will misdirect us, and then hold is accountable. Anonymous

Real power,authority and accountability invested in the LHINs. Cut the QP "ties that bind". Anonymous

primary care physicians interested in serving the most vulnerable hard to serve populations Anonymous

transparent decision making factors/guidelines commitment to published 'report cards' on key standards and outcomes standards re: wait times, service quality clear complaints identification and resolution processes; clear feedback mechanisms with response time standards

Anonymous

A serious and significant re-think Anonymous Remove case management services from their "proposed" control. Keep performance oversight for primary care but don't put LHINs in charge of Performance Management of FHTs and the Health Centres.

Anonymous

A more community-based, patient friendly approach. Elimination of CCACs completely. Anonymous clearly defined delegated authority and accountability People first enabling integration

Anonymous

focus on health equity, person and community centred, Anonymous a supportive policy to guide the health care system and break down partisan barriers Anonymous Clarity in the scope and authority of the LHIN so they may perform and fulfill their mandate more effectively and that the continuity of care/pathways are more seamless through greater integration or centralization of oversight. Appropriate consistency of care and service delivery across the province and more equitable distribution of funding.

Anonymous

Maintaining LHINS role outside of service delivery and continuing with integration policy options Anonymous

A more integrated healthcare system, with delivery of all services wrapped closer to defined patient populations while maintaining and enhancing the strategic oversight role of the LHINs

Anonymous

Far less centralization and far more resources at the front line and the rural communities vs. being siphoned off for a centralized office. Anonymous

Maintaining the overall direction. I am concerned about the LHIN's becoming operational, with direct responsibility for home care. Anonymous

Clear directions - not open to different interpretations Anonymous Better distribution of resources and funding. Anonymous N/A Anonymous If they want the LHINs to hold that level of accountability, there needs to be far more Anonymous

accountability within the LHINs to the Ministry and to the community-I work in the LHIN and there is no accountability by the people in it and it has created a very damaging culture with very precarious consequences on day to day runnings of the system itself

Constant Contact Survey...

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