Research Agenda on Issues of Integration The Change Foundation Gail Donner, Board Chair Cathy Fooks,...
Transcript of Research Agenda on Issues of Integration The Change Foundation Gail Donner, Board Chair Cathy Fooks,...
Research Agenda on Issues of IntegrationThe Change Foundation
Gail Donner, Board ChairCathy Fooks, President and CEO
Discussion with the LHIN CEOs
November 15, 2007
Rebranded Foundation
• Foundation has rebranded its mission and work focus
• Now a policy think tank focused on key issues important to Ontario’s health system
• Three strategic directions:– Integration is first priority– Quality improvements for community services is second– Informing public debate is third
Why Are We Here Today?
• We are here today to:
– Review our progress to date – Get your feedback and comments – is this relevant to your
mandate?– Explore potential opportunities for collaboration
Our Take Thus Far• No commonly accepted definition of integration• Many potential indicators of integration but no core set that
actually measures progress (proxies for other things)• Not yet a focal point for accountability agreements • Cultural shift as important as governance and measures
• Integration is instrumental rather than an end in itself• It supports the achievement of system and population health
goals
Existing Efforts on Form
• Generally, two ways to do this (based on lit review)
1) Structural integration – develop service based goals, consolidate authority and budgets, streamline reporting relationships
2) Functional integration – focus on actual working relationships and proximities which may cut across structures
• It is possible to have functional integration without full-fledged structural integration but more commonly there is structural integration with persistent functional fragmentation
Message for us: lets get a framework to shape discussion
Existing Efforts on Measurement• Great deal of effort on performance measures in general• Integration often, not always, a category• But, measuring actual integration has proven difficult• Some combination of looking at structures and transitions
between along with assessment of experiences • Experiential has been more provider focused than patient• Difficult to draw conclusions on perceptions and a small number
of limited variables
Message for us: gaps to be filled
Existing Congruence on Values
• Success or failure of strong organizational culture depends very much on the presence or absence of shared values
• Would be surprising if new organizations attempting to unify a diverse and somewhat competing range of interests found a ready-made culture willing to embrace integration
• Suspect LHINs are struggling with this
Message for us: attempt to identify the convergence and divergence of values – could help realign incentives
Initial Work on Framework
1) Foundational paper – can we get to the same language?• What are we talking about?• How does it compare to others?• What can we learn from others?
Status: underway
Timeline: final draft in February
Potential collaboration: interested LHINs reviewing and providing feedback
Initial Work on Framework and Measurement
2) Focus Groups with Users of the System• Perspective on integration• Perspective on transitions• Assist with development of what we should measure to assess
integration
Status: RFP being developed
Time line: initial results for June 2008
Potential Collaboration: interested LHINs as partners?
Initial Work on Measurement• Creating a measurement collaborative with ICES, Ontario
Health Quality Council, Cancer Care Ontario
Status: Initial discussions to understand each other’s work and interest - Next discussion to divide up work
Timeline: Foundation to produce an annual integration report each June – could contain some of this work
Potential Collaboration: linkage with LHINs performance measurement work?
Initial Work on Lessons Learned
• First event in a new Series titled “Meeting of the Minds”
• Focus on what can be learned from others – session with former RHA CEOs, Deputy Ministers and provider CEOs
• What would they do again and what would they avoid?• Invitational and closed door
Status: underdevelopmentTimeline: March 2008
Potential collaboration: interested LHINs participating
Potential Year Two Activity
• Series of surveys to deal with values questions
• Populating an integration indicator framework (with others)
• Slicing up the pie – looking at whether upstream investments have increased in regionalized systems