and

Introduction

1. Haliburton County

2. Haliburton Highlands Health Services

3. Provincial Health Priorities

4. Other Trends/Issues

References

The Environment Scan provides background and context to the strategic planning process. An effort has been made to keep it brief but with sufficient detail to give a sense of the landscape against which HHHS planning needs to occur.

The Scan is divided into three sections:

Haliburton County is a rural community covering a large geographic area. The population is widely dispersed with many families and individuals living in relatively remote locations. The permanent population was approximately 15,000 in 2001 (census data) and has been growing steadily over the past 5 years. The largest influx has been retirees. The population quadruples in the summer months.

The population of Haliburton County is significantly older than the provincial average and this segment is growing. Seniors place the greatest demand on health services and often require more complex high cost care than their younger counterparts. This factor, combined with education and income levels below the provincial average, predicts that there will be a continued high demand for health services with numerous challenges to meet specific needs.

HHHS was incorporated in May 1996 with the mandate to provide a full range of integrated health services to the community. Services are provided at 2 sites: Minden and Haliburton Village. Both sites include ambulatory/emergency care and long-term care (LTC), as well as community health programs (diabetes education, mental health, supportive housing). In addition, the Haliburton site has 13 in-patient beds and one maternity suite, and includes Highland Wood, a 30-bed LTC facility. The Minden site includes Hyland Crest, a 62 bed LTC facility.

Close working relationships exist with community partners such as the Community Care Access Centre (CCAC), the public health unit, and other health and social service providers (e.g., Family Services, chiropractors, chiropodists, physiotherapists) to facilitate smooth transition between hospital and community.

Family physician services in the community are provided through the Minden Clinic (2 physicians) and the Haliburton Medical Practice (8 physicians). In 2005 HHHS in partnership with the Haliburton Medical Practice and the CCAC was awarded a Family Health Team. Implementation planning is underway.

HHHS also works closely with its regional partners, Peterborough Regional Health Centre, Ross Memorial (Lindsay), Campbellford Memorial Hospital, and Northumberland Health Care Centre (Port Hope/Cobourg) to provide coordinated and accessible specialized health services.

Funding has been received for one of four requested nurse practitioners and recruitment is in process.

HHHS has about 200 full- and part-time staff and currently shares a Human Resources Manager (0.8 FTE) with Peterborough Regional Health Centre. This new role improves and centralizes the administration of HR functions, and oversees compliance with laws and regulations. The Manager will also become involved in training and development of HHHS employees, and facilitating a supportive work environment. This is expected to improve HHHS ability to attract and retain skilled staff, and continuously improve the organization’s performance.

The shortage of health care providers including physicians, nurses, physio and occupational therapists, technologists and others, is a growing challenge across Canada. The shortage is being especially felt in many northern and rural areas.

In Haliburton County, the shortage of family physicians, especially in the Minden area, has been ongoing. Rehabilitation professionals have also been in short supply at a time when requirements are growing with the special needs of an aging population. While the nursing shortage has not yet been felt locally, it is forecast to occur especially in the LTC and home care area.

In recognizing the economic benefits to the community of having a sufficient cadre of health care providers, the original HHHS Recruitment Committee has evolved to a county committee with a broadened membership which includes community groups that have also a vested interest in assisting with strategies to attract and retain physicians and other health professionals.

Volunteerism is strong in Haliburton County and a large number of dedicated volunteers compliment the work of HHHS staff by donating time and energy to an active auxiliary at each site. These volunteers provide countless hours of service to patients and residents.

The Commitment to the Future of Medicare Act (Bill 8) was passed in 2004 requiring hospitals to sign an accountability agreement in order to receive their funding allocation. The interim agreement explicitly states that hospitals must balance their budgets by 2005-2006.

HHHS currently is in a favourable financial position with a balanced budget for the coming year. A preliminary budget, based on the existing strategic priorities (demand for services, recruitment and retention, resource efficiency, and information systems) has been submitted to the MOHLTC in accordance with provincial guidelines. Some adaptations may be necessary if and as strategic priorities change.

A capital debt of approximately $1,000,000 remains outstanding on the $21 million building project. The HHHS Foundation is working diligently and creatively to eliminate the building debt.

Information systems have been significantly enhanced over the past few years with the introduction and/or refinement of a number of programs such as the Point Click Care Documentation in long-term care and streamlining pharmacy systems. Video conferencing is now available at the Haliburton site and will be expanded to the Minden site shortly. A telehealth suite was opened earlier this year in Haliburton, allowing real-time consultation with specialist physicians in other locations, and reducing the need for patients to travel long distances. As well, it has opened up opportunities for in house continuing education for all staff.

Additional information technology (IT) will be acquired as necessary to improve financial, administrative and management functions. The IT role is a shared service with Ross Memorial Hospital in Lindsay.

Excellence in All We Do is the HHHS Vision. There is a high level of commitment to the provision of high quality service ranging from direct patient care to administrative and business practices. In 2004, the organization adopted a "Balanced Scorecard" approach to measuring performance against external benchmarks. The 4 priority areas selected for 2004/2005 were quality risk management, financial performance, patient/communication, and work life.

A Board Quality Committee was established in 2005 to provide oversight and direction to quality initiatives and to reinforce the message that performance and continuous progress is a high priority.

In May 2003, HHHS underwent its first accreditation survey since its incorporation in 1996 by the Canadian Council on Health Services Accreditation (CCHSA). The process was extensive and the findings were generally satisfactory. Planning is underway for the second survey in 2005.

Board governance in the hospital sector is currently in the spotlight of both government and the Ontario Hospital Association (OHA) as it relates to accountability (particularly the board’s fiduciary responsibility) and to the efficiency and effectiveness of the organization. Some of the specific issues are:

1. • The mix of skills of board members.
2. • Board performance and evaluation
3. • Governance vs. management
4. • Responsibility for management oversight
5. • Board orientation and education

OHA has just released a Guide to Good Governance. It is a comprehensive document and provides practical advice in implementing the recommendation contained in Hospital Governance and Accountability in Ontario, published in April, 2001. The Guide is available on the OHA website www.oha.com. The HHHS Board of Directors is using both of these publications in its review of its policies and practices.

In the fall of 2004, the Honourable George Smitherman, Minister of Health and Long-Term Care (MOHLTC) announced his "transformation health care agenda" for Ontario.

It was based on the assumption that to deliver better health care, fundamental changes to the health care system are required, and the system must become more patient-focused, results-driven, integrated and sustainable. The goal could not be reached through incremental changes to funding and additional regulations or processes, but through a transformational change not only to systems and processes, but to ideas and culture.

A Health Results Team was established with three priorities:

1. • Reduced wait times for key services
2. • More Ontarians with access to primary health care
3. • A health care system that lives within its means.

Fourteen LHINs have been established across Ontario. The intent is to delegate to the LHINs much of the power and authority previously centralized in the MOHLTC. Their functions will be phased in, beginning with the planning and community engagement responsibilities, moving to service coordination and system integration and finally to funding and resource allocation.

As LHINs are phased in, they will enter into service agreements directly with the health services providers. These agreements are to ensure the delivery of services in the respective geographic area in accordance with Ministry policy. They will stipulate performance goals for all providers and the reporting requirements for outcomes.

HHHS is part of the Central East LHIN that encompasses a large geographic area from Scarborough to Cobourg and Peterborough, and north to just north of Haliburton.

The LHINs are considered a made-in-Ontario solution that will:

1. • respect and strengthen local governance of health delivery organizations,
2. • not provide direct services,
3. • be built and work alongside community voices,
4. • not be hard boundaries for patient access or physicians.

In addition to LHINs, which will take time to organize and operate, HHHS will seek to improve access and reduce costs by better integrating all its health services and administrative functions.

At the time of development of the Environmental Scan, the LHINs were at the early stage of organization and were just beginning to develop their planning frameworks. The Central East LHIN of which Haliburton County is a part has identified five clinical and five administrative priorities for the region. They are:

a) Patient Care/Service Integration Opportunities

According to the MOHTC a key dimension of the LHINs and the overall "transformation agenda" is to encourage partnerships and alliances that improve efficiency and effectiveness of care delivery, and simplify and speed access through all needed services for the patient. It is likely that services will be reorganized from one system manager to another. For HHHS, it is possible that some of its current programs (supportive housing, diabetes education, mental health and Health for Life) may be reassigned to another community sponsor.

The goal of the province’s Wait Time Strategy is a comprehensive system that ensures timely and appropriate access to health services by December 2006. Wait times are targeting in five key areas: cancer surgery, cardiac procedures, cataract surgery, hip and knee total joint replacement, and MRI examinations.

The overall FHT goal is to keep Ontarians healthy by improving access to multidisciplinary primary care models that provide comprehensive patient-focused care. The provincial target is 150 FHTs by 2007-08.

The principles include

1. • Flexibility and Choice: will recognize the diversity of communities across Ontario and be flexible regarding the size, scope and focus to Teams.
2. • Community And Provider Partnerships: community representative, local health delivery organizations and health care professional will be encouraged to work together to develop teams that reflect the unique needs of the population.
3. • Build On Existing Models And Successes: build on the strengths and learn from their challenges
4. • Team Based Care: interdisciplinary teams of providers including physicians, nurses, nurse practitioners and other health care professionals
5. • Local Integration: work to develop collaborative partnerships that will improve access and continuity of care
6. • Patient Focus: through patient focus and population based health planning
7. • Evidence-Based Balanced Approach: encourage use of evidence based practice, continuous re-evaluation, along with flexibility for innovation and responsiveness to local concerns.
8. • Transparency And Consultation: designed, developed, and implemented through a process of open communication and transparency.

The goal is to build a health care system that people can count on by providing decision-makers across the system with timely, accurate and relevant information that will improve health system performance, accessibility and accountability.

The Ontario Hospital Association (OHA) has noted that budget shortfalls, the government’s "transformation agenda" and labour market shortages come at a difficult time and will impact on the outcomes of negotiations. Union expectations are high, especially the Ontario Nurses Association (ONA).

The SARS crisis and the recent settlement between the Ontario Medical Association (OMA) and the Ontario government are key drivers behind ONA’s bargaining agenda. The service group unions are focused on job security and wages.

The federal government launched an initiative called "Infoway" in 2003 with the specific purpose of developing a national electronic patient record system. This initiative has changed the Canadian health network landscape. In Ontario the MOHLTC, in particular Smart Systems for Health (SSH), launched a number of initiatives including the deployment of an Ontario Digital Broadband Communications network exclusively for health. This network will permit the web-based transfer of health information including Electronic Patient Record, digital x-rays, MRI, remote health consultations, etc.

In a parallel and independent initiative, Haliburton County in conjunction with partners Trillium Lakelands District School Board and Fleming College, have undertaken to bring a true Digital Broadband capability to the County. Part of the initiative includes a separate secure digital broadband network for HHHS. This network will enable HHHS to implement IT applications either at SSH’s dictate or at the discretion of the HHHS administration. An example of a local program could be to develop a virtual hospital which would include all the HHHS services operating effectively as one hospital and would appear so to anyone requiring electronic access to health services.

Both the SSH and the County of Haliburton broadband networks are to become operational in the first half of 2006. It is anticipated that SSHA will initiate a number of new IT applications following the new Broadband network deployment.

Concern continues to grow around the potential for an Influenza Pandemic. The federal and provincial governments are well advanced in their development of comprehensive plans in the event that a pandemic hits. The provincial government current draft plan identifies the critical role of local communities in identifying resources and processes for dealing with an emergency of potentially very large proportion.

Central East Local Health Integration Network. 2006. A Framework for Community Engagement & Local Health Planning: A Proposal:

Ontario Hospital Association. 2005. Our Strategic Directions. (www.oha.com) :