Transcript Building the Case for Change: All Seniors and Adults with

Review #2-3-4 – The Case for
Successful Execution:
Hips and Knees Priority Action Team
Presentation to the Strategic Advisory Group
April 14, 2008
Acknowledgements
This work would not have been possible if it were not for
the commitment of the:
 Hips and Knees Priority Action Team (PAT)
 Hips and Knees Task Teams
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Agenda
 Approach
 Key Drivers of Change
 Overview of the Recommendation
 Implementation Planning
 Implementation Strategy
 Evaluation of Decision Criteria
 Recommendations
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Approach
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Approach
The Hips and Knees PAT was identified as a Quick Start
opportunity in the Integrated Health Service Plan. The PAT
completed the following activities to fulfill the associated
objectives:
 Refreshed quantitative data
 Reviewed inventories of services and practices
 Conducted additional best practice research
 Developed a proposed model of integrated service delivery
 Implemented a community engagement strategy
 Engaged Task Teams to develop specific components of the
overall recommendation
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Health System Integration Methodology
Population or Program Integration Process
Quick Win Process
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Mission Statement
The hip and knee replacement delivery model strives to:
 Ensure that individuals have timely, appropriate and
equitable access
 Incorporate best practices and evidence-based care
 Utilize a common multidisciplinary pathway spanning the
entire continuum of care
 Enable services to be standardized, and delivered
efficiently in a coordinated manner
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Vision
Within the next five years, measures will show achievement of the
following elements in the evidence-based care and management of
hip and knee replacement patients:
 Clearly defined continuum of care available to all patients
resulting in positive clinical and functional outcomes
 Individuals have equitable timely access to services
 Reduction in surgical wait times
 The patient, family and/or their support system is an active
participant in their care and self management
 Demonstrated improvement in consumer satisfaction measures
 The model delivers high quality best practice care
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Values
The Values of the Hips and Knees PAT are aligned with those of
the South West LHIN and are as follows:
 Accountability
 Collaboration
 Coordination
 Efficiency
 Effectiveness
 Competence
 Integration
 Evidence-based practice
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Key Drivers of Change
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Rationale for Change
 Wait times are higher than the provincial benchmark
 Demand is expected to grow significantly
 System-wide capacity issues continue
This presents a challenge that demands change
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Target Population
The model will benefit individuals who:
 Have osteoarthritis requiring Secondary Prevention and
education
 Require hip or knee replacement surgery
The typical client profile for total hip / knee replacement:
 Approximately 2/3 of patients are over the age of 61 with the
average patient age being 68 years
 60% of patients are women
 80% of patients have osteoarthritis
 Over 80% of patients are overweight or obese (meaning that
they have a Body Mass Index greater than 25)
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Key Drivers
Rise in individuals requiring surgery
 Overall population growth
 Aging of the Baby Boomer generation
 Rising incidence of obesity
Rise in individuals requesting surgery at an earlier age
 Improvements in the expected life of materials
 Increased consumer awareness
Rise in complexity of surgeries
 High rates of chronic disease
 Longer length of stay and additional resources
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Current State
Arthritis
Society
Referring
Physician
LEGEND:
Focus on
prevention for
high risk
populations
Initial
Diagnosis
Black = Patient Flow
Orthopaedi
c Specialist
Office
Solid line = Always occurs
Dotted line = Sometimes occurs
Post Surgical
follow-up and
monitoring
Non-Surgical Care
and Treatments
incl. Monitoring
Referrals
to Surgeon
Patient self-referral
Red = Information Flow
In-home
assessment incl.
ensuring proper
equipment post-op
PreHab Patient
Optimization and
Education
If Revision
Hospitals
Assessment for
Surgery
If not a surgical candidate
CCAC
If surgical candidate
Wait Times Community
Information Health Care
System
Providers
Patient self-referral
In-home "OT PreHab
assessment" incl. Choice
assessment and decision
making for post-op
Required
Pre-Admit Clinic
Assessment and
Education
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Primary/Specialized Diagnosis
Home Care
Rehabilitation
Final Wait Time
Reporting
Wait Time 2
Reporting
Primary Health Care
Outpatient
Physiotherapy
CCAC coordinates
rehabilitation
treatment
Physiotherapy for
symptom reduction and
management
Population Health
Surgery
Discharged to
home, ALC
facility or
community
hospital
following
assessment &
initial rehab in
surgical unit
6 week
assessment of
surgery &
recovery
Primary Health Care - Pre-Operative Intervention,
Monitoring & Support - Speacialized as Required
Private
Physio
Rehabilitation
Public Reporting
Specialist Intervention
Primary Health Care
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Current State Challenges
System-wide capacity issues
 Health human resources shortages
 Bed shortages
Lack of common approach throughout system
 Multiple referral processes and wait lists
 Timing and content of patient education materials
 Approach to assessment and care
 Length of stay by hospital
 Timely pre-planning for Post-Acute care
 Availability of Secondary Prevention and Post-Acute Care
 Communication and coordination across providers
 Sharing of patient health information across providers
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Overview of the Recommendation
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High-Level Recommendation
Create an integrated model of care to improve service delivery
efficiency and effectiveness, resulting in:
 Decreased wait times
 Enhanced quality of care
 Equitable access
Fundamental goal is to ensure LHIN-wide consistency in service
delivery by incorporating evidence-based research and lessons
learned into the design of the model
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Building Blocks Framework
Step 3
–
•
program or population.
•
state design.
Target Population
Mission, Vision, Values and Goals
Oversight of
System
Performance
Scope of Services
•
System Level Design
•
Service Level Design
Approach to the flow of clients and
information through the system
•
•
•
•
•
•
Joint
Oversight
•
Performance
Management
•
Financial
Accountability
Entry and Access
Approach to Assessment
Care Coordination
Information Flow and Requirements
Linkages to and fit within the Continuum
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Future State
An Integrated Model of Care
Population Health
Entry to System
Focus on health
promotion/
prevention for
target
population
Primary Care
Support (actual
diagnosis)
Assessment
Centralized
Assessment and
Education Centres
(Multidisciplinary
Team)
Initial
Diagnosis
Secondary Prevention
LEGEND:
Bold = Key Components
Red = Information Flow
Solid line = Always occurs
Orthopaedic Consult
Pre-Admit Process
In-Hospital Care
Post-Acute
Waiting surgical consult & surgery
Secondary Prevention for Appropriate Surgical Candidates
Decision to
Operate
Link to Public
Health Units to
address risk factors
& Link to Primary
Care and Chronic
Disease Prevention
& Management
PATs
No
Referral
Link to community
resources &
Rehab PAT
Patient choice in
referral
Secondary
Prevention Streams
for Non-Surgical
Candidates
Surgical consult not
recommended
Yes
Orthopaedic
Consult with
Surgeon
(in office)
Surgery booked
based on
priority
Central Registry
Pre-Admit Clinic
Assessment,
Exercise,
Education and
Screening for postacute rehab
In-home
assessment
Post-op care plan
established with
family physician
Pre-op,
Surgery &
Post-op
Transition
from Acute
Care
Discharged home,
community facility
following assessment
& initial rehab in
*
surgical unit
Various streams:
- outpatient rehab /
private clinic
- facility based
rehabilitation
- home care
Post Surgical followup and monitoring
Common Clinical Guidelines, Outcomes, Indicators, Education Tools & Care Pathways
Information Technology, Health Human Resources and Patient Navigation
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Data/System Outcomes
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Scope of Services
Key Components of the Model:
 Standardized Referral Process
 Central Registry
 Assessment and Education Centres
 Secondary Prevention
 Pre-Admit / In-Hospital Care
 Post-Acute Care
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Standardized Referral Process
Who will provide the service and where?

Patients may be referred by a family physician, nurse practitioner or other
physician

Through Family Medicine practices, Family Health Teams, Walk-in clinics,
long-term care facilities, urgent care clinics or emergency departments
How will the service be provided?

A standardized referral form will incorporate patient choice and streamline
the intake process to expedite patients to receive appropriate services
What resources are required?

Creation, design, printing and distribution of new referral form

Recommend creation of electronic form to eliminate errors and redundant
data entry
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Standardized Referral Form
Introduces a common referral
process
Key features:
 Easy to use
 Ensures that all necessary
data is collected
 Reduces possibility of errors
or omissions
Content includes:
 Patient choice
 Requested surgery
 Diagnosis and symptoms
 Special needs
 Medications and assistive
devices
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Central Registry
Who will provide the service and where?
 Referrals will go through one Central Registry (one number, one location)
serving the entire LHIN
How will the service be provided?
 Referral forms will be forwarded to this single point of entry into system
 Forms will be assessed for completeness
 Form will be forwarded as appropriate in a timely manner
 The Central Registry will utilize a single wait list to help ensure wait times
are distributed appropriately across the LHIN
What resources are required?
 Available existing space
 Office set-up including telecommunications
 Creation of Central Registry database
 Clerical and managerial support
 Training
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Assessment and Education Centres
Who will provide the service and where?

Multi-disciplinary clinical assessment team

Three Assessment and Education Centres:
• One within each planning area
• Within an existing orthopaedic clinic at a surgical site
How will the service be provided?

An initial consultation will be performed to:
• Obtain required health information
• Assess surgical status
• Assess secondary prevention needs
• Identify post-acute care needs
• Educate the patient
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Assessment and Education Centres (cont’d)
What resources are required?

Available existing space and additional services upon consultation

Staffing requirements by full time equivalent (FTE):
• 1.88 FTE - Advanced Practice Therapists
• 1.88 FTE - Advanced Practice Nurses
• 0.43 FTE - Clerical resource
• 0.40 FTE - Managerial resource

Training
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Assessment Summary
Introduces a common
approach to initial
patient assessment
Alleviates some of the
work from the preadmit clinic
Content includes:
 General
assessment
 Physical exam
findings
 Clinical history
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Proposed Workflow for
Referral, Central Registry and Assessment and Education Centres
Initial Referral
Form completed
by Physician /
Nurse Practitioner
Where
is form to be
directed?
Specific
Surgeon
Enter into
Database
and fax to
Surgeon’s office
If
surgeon
chooses to use
Assessment and
Education Centre,
fax back to
Central
Registry
Yes
Faxed to
Central Registry
Shortest
Wait List
Is form
complete?
Enter into
Database
and fax to
Surgeon’s office
NO
Surgeon’s
office sets up
appointment
with patient
YES
Faxed back to
originator with
incomplete notice
NO
Assessment
and
Education
Centre
Enter into
Database and fax
to appropriate
Assessment and
Education Centre
Centre sets up
appointment
with patient
Patient
presents at
appropriate
Centre
Does
patient require
surgery?
NO
Send notification
letter to
originator of
referral
YES
NO
NO
Is this
URGENT?
YES
Centre sends patient
to Surgeon working
with Centre that day
NO
Does
patient require
Secondary
Prevention?
Legend:
YES
Originator of referral
Central Registry
Surgeon’s Office
Assessment and Education Centres
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Centre to provide
patient direction for
appropriate Secondary
Prevention Resources
Centre coordinates with
appropriate Surgeon’s
office (based upon
Patient choice)
Surgeon’s
office sets up
appointment
with patient
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Secondary Prevention
Who will provide the service and where?
 Various providers throughout the South West LHIN
How will the service will be provided?
 Assessment at earliest point possible:
• Identify the Secondary Prevention needs of surgical and non-surgical
candidates
• Provide patients with available options and arrange care
 Secondary Prevention service providers provide range of services to:
• Improve patient's knowledge and empower the patient
• Identify and address safety issues
• Improve level of fitness and function
• Enable patient to remain at work and/or at home longer
• Improve overall quality of life and outcomes
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Secondary Prevention (cont’d)
What resources are required?

This model recommends enhancements to the role of Secondary
Prevention to address gaps in provision and access
What are the supporting guidelines and tools?

Common assessment tool

Common guidelines for provision of Secondary Prevention services
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Pre-Admit / In-Hospital Care
Who will provide the service and where?

Multi-disciplinary teams

Each of the surgical sites
How will the service be provided?

Pre-admit clinic will be streamlined due to work done in advance at
Assessment and Education Centres

Utilize common clinical care pathway and Teaching Checklist to ensure
patient treatment is equitable and in accordance with best practices

Adherence to pathway in combination with the Assessment and Education
Centres and Secondary Prevention should result in a standardization in
the length of stay
What resources are required?

Dependent on degree of variance between current practices and common
care pathway
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Common Collaborative Care Path
Introduces a common
approach to in-hospital
care
Outlines the key
activities that should
be completed each day
from pre-admit,
through to discharge
Covers topics such as:
 Diagnostics
 Treatments and
assessments
 Medications
 Teaching
 Exercise
 Discharge planning
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Post-Acute Care
Who will provide the service and where?

Three streams of post-acute care have been identified:
• Outpatient rehabilitation / private clinic
• Facility-based rehabilitation
• Home Care

Services are provided by:
• Physiotherapists, occupational therapists and others
• A number of organizations utilizing a mix of public and private funding
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Post-Acute Care (cont’d)
How will the service be provided?
 Early identification of most appropriate post-acute care stream
• Utilize common guidelines
• Pre-arrange with post-acute care service provider
• Confirm initial assessment while patient is in-hospital
 Post-Acute service providers will track patient progress against key
milestones and outcome measures to determine transitions between streams
and appropriate time to discharge
What resources are required?

This model recommends enhancements to the role of Post-Acute Care to
ensure access to all streams is equitable, in terms of both geography and
funding.
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Post-Acute Care – Guidelines
Introduces a
common approach
to post-acute care
Aids clinical staff in
identifying which of
the three post-acute
care streams is
most appropriate for
patient
Utilized early in
continuum to
ensure timely prearrangement of
post-acute care
services
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Post-Acute Care - Milestones
Introduces a common
approach to Post-Acute
Care
Identifies separate
milestones for:
 Hip vs. knee
replacement
 Each Post-Acute
Care Stream
Indicates:
 Week by week
activities
 Outcome measures
 Guidelines for
discharge
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Supporting the model
 Evidence-based review of literature and best practices
 Common clinical guidelines, outcomes, indicators, education tools
and care pathways
 Processes, systems and communications that enhance flow of
clients and information through the system
 Oversight of System Performance
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Education Tools

Research and best practices show that quality patient education can improve
patient outcomes, anxiety and discharge planning resulting in lower
healthcare costs and improved functional outcomes for the patients

The education tools will be
• Introduced as early as possible
• Standardized to ensure consistency
• Based on best practices
• Customizable for specific patient pathway
• Accessible

Patient education materials will include
• Model of Care Brochure
• Hip and Knee Replacement Services Website
• Patient Education Binder
• Teaching Checklist
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Education Tools (cont’d)
Model of Care Brochure
 Builds awareness of overall model of care and links to other resources
 Available to health service providers directly involved in model of care
 Available to community
• Originators of referrals
• Community agencies
• Online
Hip and Knee Replacement Services Website
 Builds awareness and educates
• Online version of patient education binder
• Links to other resources
• Provides opportunity for community feedback
 Connects to South West LHIN and the Healthline websites
 Reflects the design of existing sites such as myjointreplacement.ca
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Patient Education Binder
Primary patient education tool
Valuable reference to patient,
family, other support and
health service providers
Materials will be customizable
as reflected by the draft table
of contents which identifies:
 Timing of receipt of
materials
 Type of content
 General vs. joint specific
 Standard vs. hospital
specific
 All patients vs. surgical
patients only
 Hip vs. Knee replacement
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Teaching Checklist for Providers
The Teaching Checklist for Providers
would serve to:
 enable communication between
providers
 reduce redundancy and
conflicting messages
 ensure key teachings are
demonstrated at the appropriate
point in time
A checklist specific to the South
West LHIN would be created:
 Using the Grey Bruce Health
Network Total Hip Replacement
Checklist as a guide
 Aligning with the final content of
other education tools, guidelines
and care pathways
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Approach to Entry and Access
How will individuals gain initial access?
 Consultation with physician/nurse practitioner resulting in referral to Central
Registry
How will providers and clients learn that the program exists?
 Emphasis placed on creating awareness among potential originators of
referrals and potential patients through:
• Community Engagement sessions
• Distribution of detailed information, brochures and standardized referral
forms to originators of referrals
• Brochures widely available at physicians’ offices and various community
agencies
• Hip and Knee Replacement Services Website, with links from various
health care websites
What are the supporting tools?
 Standardized referral form
 All referrals sent to one Central Registry (one number, one location)
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Approach to Assessment
What is the approach to Assessment?
 Determine surgical status of patient
(Assessment Summary)
 Determine the Post-Acute Care stream for surgical candidates
(Post-Acute Care Algorithm Guidelines)
 Determine Secondary Prevention requirements of all patients
(Assessment tool to be developed)
 Determine the education needs of all patients
(Patient Education Binder)
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Care Coordination
 Make the patient (and their family or other support) a partner in care
• Educate Patient
• Inform and involve patient in decision-making process
• Enable patient to be an active participant in their own care
• Make patient accountable for their care
 Provide linkages into other areas of continuum
 Assess Secondary Prevention and Post-Acute Care needs as early
as possible and re-confirm as necessary
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Linkages To and Fit Within the Continuum
 Overall improvement in communication
• Increased awareness of model and the key transition point
• Navigation process in place to support transition and appropriate
fit between patient and provider
• Consideration for additional communications between hospital
and community health service providers
 Improved navigation supported by:
• Increased availability of patient health information
• Guidelines, forms and clinical care pathways
• Teaching Checklist
• Patient Education Binder
• Feedback loop to referring physician on patient assessment
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Information Flow and Requirements
Information Technology Requirements
Short Term
Longer Term
Standardized Referral
Form
Phase One - not necessary
• Manual form faxed to Central
Registry
Phase Two - to increase efficiency
• Introduce electronic form with
automatic data transfer to Central
Registry
Central Registry
Phase One - linked to
• Wait Time Information System
• Enterprise Management Patient
Information
• Hospital Information
Phase Two - linked to
• Ontario Health Insurance Program
Information Sharing
Phase One - ensure links between
• Central Registry
• All surgical sites
Long Term - Consider links between
• All hospitals
• Family physicians
• Key health service providers
Performance Tracking
As soon as possible
• Enable hospitals to flag hips and
knees results for certain metrics
tracked at site wide level
Upon implementation
• Develop means to track additional
measures
• Consider utilizing Central Registry
database.
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Joint Accountability and Oversight
Ensure that the proper governance and accountability structures are in
place between the South West LHIN and various health service
providers during Pre-Implementation period:

Memorandums of Understanding

New Governance Structure
In the long term, the South West LHIN may consider modifying existing
funding mechanisms to drive desired behaviours

Service Accountability Agreements

Wait Time Allocation Funding
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Joint Accountability and Oversight (cont’d)
Hips and Knees Governance Structure
Accountability Council
Implementation
Steering Committee
Implementation and
Ongoing Monitoring
Project Manager
Implementation only
Implementation
Task Team 1
Implementation
Task Team 2
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Implementation
Task Team X
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Joint Accountability and Oversight (cont’d)
Hips and Knees Accountability Council
 To serve as oversight role throughout implementation and beyond
 Monitor and evaluate need for change and refine model as required
 Membership represents the entire continuum of care and has the
influence and authority to affect change in their organizations
 Membership would consist of the following representation:
• Senior Director level or above from South West LHIN
• Member of the South West LHIN Board of Directors
• Surgeon and a Vice-President or CEO from each of the surgical
sites
• Individuals with the authority to influence their health service
organizations
• Members from the Hips and Knees PAT for continuity
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Joint Accountability and Oversight (cont’d)
Hips and Knees Implementation Steering Committee
 Support and direct the Implementation process
 Involve individuals with an operational role from key health service
provider organizations and members from the Hips and Knees PAT
Implementation Task Teams
 Operate for a limited time and in a facilitated environment
 Focus on final conceptualization and design of specific components
of model and then serve in advisory role during implementation
Project Manager
 Manage the entire scope of the project on a full-time basis
 Coordinate and facilitate all project implementation activities
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Performance Management Indicators
High-Level performance indicators have been identified
 Align with the Hips and Knees PAT Mission and Vision
 Align with Provincial Wait Time Strategy mandate
 Incorporate balancing measures (quality & efficiency)
 Include baseline, transitional and end-state measures
 Indicators and reporting requirements need to be confirmed with
health service providers
Service-level measures have also been identified
 Task Teams have proposed these additional measures
 Beneficial in monitoring and refining specific components of the
model
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Performance Management Indicators (cont’d)
Baseline and Transitional Performance Indicators (by site):
Reduce patient time in system
 Average wait time from referral to appointment with surgeon
 Average wait time from decision to operate to surgery
 Acute care length of stay
Increase utilization of system / ensure equitable access
 % completion of planned surgical volumes
Increase utilization of system / ensure equitable access
 Patient satisfaction with overall care
Ensure quality of care
 Post-operative infection rate (within 3 months)
 Post-operative infection rate (within 1 year)
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Performance Management Indicators (cont’d)
End State Performance Indicators (by planning area):
Reduce patient time in system
 Post-acute care length of stay
Increase utilization of system / ensure equitable access
 % patients referred through Central Registry
 % patients attending Assessment and Education Centre
 % patients receiving Secondary Prevention prior to surgery
 % patients receiving Post-Acute rehabilitation
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Financial Accountability
 Funding to be determined during pre-implementation
 High-level accountabilities will be reflected in the initial
Memorandum of Understanding
 Some funding is anticipated to come through cost and resource
sharing and would be absorbed by existing budgets
 Any funding controlled by the Hips and Knees project itself
• Hips and Knees Accountability Council and South West LHIN
will have oversight
• Project Manager would track budget and be accountable to
explain any significant variances
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Implementation Planning
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Barriers to Change
In order to achieve success it is important to think ahead to what
could go wrong and identify strategies to mitigate the risks.
 Unable to secure required resources on a timely basis
 Difficult to obtain desired level of involvement from:
• Key stakeholders
• Membership of governance structure
 Key stakeholders are not aware of or willing to adopt certain
tools or processes
 Concern that once implementation occurs, processes and tools
will become difficult to change
 Concern that tools will be difficult for providers to access and
update
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Mitigation Strategies
The strength of the overall project management, change
management plan, and communication plan will be critical to
successful implementation. These plans must incorporate:
 A strong value proposition
 Additional stakeholder engagement opportunities
 Adequate support for participants
 Change management processes
 Frequent and appropriate communications
* Specific mitigation strategies for each barrier are identified
on pages 62 to 64 of the Report.
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Change Management Plan
Overall goal: To support stakeholders by facilitating their preparation
and commitment to the proposed changes.
The Change Management Plan should build on the work done to date
and incorporate the following elements:
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Stakeholder Management
Leadership Action Plan
Project Champions
Training Strategy
Monitoring, Evaluating and Refining
Communication Plan
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Communication Plan
Closely aligned with the detailed project plan and tailored to stakeholder group.
Includes the following:
 Objective of communicating with them
 Type of message
 Specific communication methodology
 Individual or team responsible for communication
 Timing of communications
Strategy of cascading communication to ensure appropriate coverage:
 A variety of communication channels
 Provide timely and frequent communications
 Mix of general and specific messages
 Include messaging in the voice of champions/stakeholders
 Build appropriate expectations with stakeholders
 Emphasize value proposition
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Value Proposition
Our overall value proposition for this change:
“In response to the current and evolving needs of this specific
patient population, the Hips and Knees PAT is recommending this
integrated model of care to improve service delivery efficiency and
effectiveness, resulting in decreased wait times, enhanced quality
of care for the patient and increased access. A fundamental goal is
to ensure consistency in the delivery of hip and knee care
throughout the South West LHIN, by incorporating a combination of
best practices and lessons learned from a review of comparable
existing models and associated research.”
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Implementation Strategy
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Moving from Planning to Implementation
Pre-Implementation
Implementation Period
Post-Implementation
First 3 to 6 Months
Phase One
– Next 6 Months
Phase Two – Next 24 Months
Following 12 Months
Governance and Accountability, Performance Management , Financial Accountability
Change Management Plan and Communications Plan
Monitoring, Evaluating and Refining
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Pre-Implementation Period
The success of the Pre-Implementation Period and the entire rollout of
the model is dependent on support from key health service providers
Activities:
 Finalize endorsements
 Finalize and implement new governance structure
 Finalize Memorandums of Understanding
 Confirm anticipated costs and funding sources
 Confirm funding for and hire Project Manager
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Finalize Endorsements
Review recommendation and receive endorsement from:
 Strategic Advisory Group
 South West LHIN Board of Directors
Obtain agreement in principle from:
 South West LHIN
 The seven surgical sites
 South West CCAC
 Other health service providers
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Finalize and Implement New Governance Structure
The governance structure is responsible for providing oversight
throughout implementation and beyond to ensure optimal performance
and achievement of the expected outcomes
 Disband Hips and Knees PAT
 Create Accountability Council and Implementation Steering
Committee
• Establish terms of reference to establish overall purpose and
structure
• Bring membership up to speed on current status of project
• Begin to determine what Implementation Task Teams will be
required and when
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Finalize Memorandums of Understanding
The Memorandum of Understanding will define the:
 Nature of the relationship and specific agreements between the
South West LHIN, hospital and community health service providers
 The objectives and goals of the initiative
 The conditions for participation:
• Responsibilities and activities for each organization
• Decision-making processes
• Scope of the initiative
• Contributions from the involved parties
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Confirm Anticipated Costs and Funding Sources
 Further clarify required resources
 Identify possible types of funding of required resources:
• Direct funding
• In-kind contributions
• Cost-sharing and other arrangements
 Establish possible sources of required resources:
• MOHLTC
• South West LHIN
• Health Service Providers
 Identify process and estimate time required to finalize commitments
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Confirm Funding for and Hire Project Manager
 Finalize funding for Project Manager role
 Hire Project Manager
 Familiarize Project Manager with role and work to date
 Revise detailed project plan to reflect additional information
 Begin Implementation Period
 Create additional Implementation Tasks Teams as required
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Implementation Period
Throughout the Implementation Period:
 Components of Phase One and Phase Two may occur in
parallel
 Confirmation of tools and processes will include
• Initial introduction at a specific location
• Refinements made before moving forward with LHIN-wide
implementation
 Monitoring, evaluating and refining components of the model
based on feedback
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Implementation Period – Phase One
Phase One
 Within 6 months from start of Implementation Period:
• Confirm tools and processes associated with Standardized
Referral, Central Registry, and Education Tools
• LHIN-wide implementation
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Implementation Period – Phase Two
Phase Two
 Within 12 months from start of Implementation Period:
• Confirm detailed design of Assessment and Education
Centres, Secondary Prevention, In-Hospital Care and PostAcute Care
 Within 24 months from the start of implementation period:
• Modify tools and processes associated with Phase One as
necessary
• Confirm tools and processes associated with all
components of the integrated model of care
• LHIN-wide implementation
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Post-Implementation period
 Project Manager will become redundant
 Governance structure will maintain oversight role
 Guidelines, care pathways and other tools will help ensure new
processes carry on
 Continuous monitoring, evaluating and refining of model
 Performance Management process will ensure stakeholders
remain focused on managing the processes behind the metrics
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Evaluation of
Decision Criteria
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Consumer-Focused
Focuses on the needs of the consumer and caregiver and emphasizes
consumer participation and accountability for their health outcomes
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The referral process allows for informed patient choice of preferred surgeon,
location or shortest wait time
Assessment identifies different patient needs and links them to the
appropriate care pathway and resources
Introduction of education and Secondary Prevention as early as possible
optimize patient’s condition
Education tools help ensure that the patient and family feel informed and
are able to participate in activities to improve the patient’s health outcomes
Secondary Prevention improves patient’s overall quality of life and
outcomes
Early assessment and pre-planning for post-acute care allow for informed
patient choice, increased patient comfort and a better transition throughout
the continuum
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Focused on Population Health
Improves the heath status of the population
 Earlier intervention improves the overall health status of surgical
patients
 Earlier introduction of education and Secondary Prevention
optimizes the patient’s condition
 Secondary Prevention improves patient’s overall quality of life and
outcomes
Emphasizes a focus on health promotion and disease prevention
 The role of health promotion and disease prevention is recognized,
but was considered out of scope as Public Health is not under the
mandate of the South West LHIN
 Consider incorporating public health data into the Hips and Knees
data set, to assess impact of model on the population and to adjust
model in response to changes in population
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Evidence-based
The recommendation is supported by best-practice research
Recommendation incorporates:
 Best practices and lessons learned from reviews of literature and other
models of care
 Innovative ways to address gaps in our current state
 Modifications to suit specific local needs and incorporate stakeholder
feedback
Rationale is supported by qualitative and quantitative data:
 Hips and Knees Steering Committee Current State Report
 Hips and Knees PAT Current State Data Refresh
 Hips and Knees Task Teams inventories of current state
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Promotes Integration Innovation
Demonstrates systems thinking
Connects parts of the health care system to work better together
 Enables providers to work collaboratively together
 Changes how providers work as a team and individually
Creates additional capacity in the system
 Utilizes resources more effectively
 Streamlines service delivery
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Endorses Sustainability
Ensures the future viability of the service
 Establishes a framework for a sustainable health system
• Optimizes use of available resources
• Increases efficiency of service delivery
 Governance structure ensures high-level oversight and accountability
 Guidelines, care pathways and other tools will help ensure new
processes carry on
 Ongoing change management process will ensure tools and
processes are updated as required
 Performance management process will ensure stakeholders remain
focused on managing the processes behind the metrics
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Supports the Health System
Promotes improved access to services and enhances the ease of
movement through the system
 Emphasizes all possible avenues of referral
 Manages one wait list for all
 Common tools and processes will help ensure comparable patient
experiences
 Secondary Prevention and Post-Acute Care services to be
expanded to ensure equitable access
 Performance Management will assess results by site/planning area
 Effective coordination across the continuum results in:
• Process improvements
• Better ease of movement for the patient
• Better patient outcomes
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Advances Partnerships
Establishes or strengthens cross-sectoral networks and
partnerships
 Emphasizes the importance of
• Multidisciplinary teams
• Strong partnerships
• Communications
 Strengthens existing partnerships
 Forms new relationships
 Encourages providers to collaborate to achieve future state
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Aligns with Provincial Directives
Advances the strategic direction of the Province
 Renews community engagement and partnerships
 Improves the health status of Ontarians
 Ensures equitable access to health care to Ontarians
• Reduces barriers to access
• Contributes to reduced wait times
 Improves the quality of health outcomes
• Increases the focus on the consumer
• Improves integration and coordination of services
• Builds continuous quality improvement into the system
 Establishes a framework for a sustainable health system
• Optimizes use of available resources
• Increases efficiency of service delivery
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Aligns with South West LHIN Goals
Advances the South West LHIN goals for integration
 Develops local health care services in rural and urban settings
 Establishes a single system of providers that offers
• Equity in access to quality services
• Ease of movement throughout the continuum
• Informed and responsible consumer choice
 Leverages existing strengths and creates new ways of delivering
health care
• Achieves optimal health outcomes
• Supports health system sustainability
 Strengthens leadership in education and knowledge transfer to
support service innovation
 Promotes linkages with regional partnership and networks to
enhance service delivery
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PAT Decision Criteria Review
CRITERIA
SCORECARD
Hips & Knees
TOTAL
SCORE
AVG
SCORE
Consumer
Focused
Focused on
Population
Health
35.0
4.4
4.2
4.2
Evidence
Based
Promotes
Integration
Innovation
4.6
4.5
Supports
Sustainability
Supports
Health
System
Demonstrates
Partnerships
Aligns w/
Provincial
Directives
3.7
4.5
4.7
4.8
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PAT members scored based on the degree to which the recommendations
meet each of the criteria
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Sustainability: The PAT feels they have done as much as they can to this
point but understand that there are limitations to forecasting how sustainable
the recommendations will be due to our dynamic health care system

Partnerships: Have done well to build partnerships to this point but there is
still a lot of work to be done in our LHIN.
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Recommendations
It is recommended that the Strategic Advisory Group:
 Accept the Hips and Knees Case for Successful Quick-Win
Execution and move forward to Quick Win Step 5 Executing for
Quick Win Success, and
 Extend their thanks to everyone who worked on the Hips and
Knees PAT and Task Teams
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Comments & Questions
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