North West Local Health Integration Network
Share Your Story, Shape Your Care Community Engagement Initiative
Full Report
May 2009
Share Your Story, Shape Your Care – Full Report i North West Local Health Integration Network
Table of Contents
1. Introduction 1
2. Our Approach 3
3. Participation Profile 13
4. Choicebook Results 24
Biggest Concerns 24
Missing Priorities 26
Primary Care 29
Specialty Care 31
Mental Health and Addictions Services 32
Long-Term Care 34
Chronic Disease Prevention and Management 36
Geography and Transportation 38
Troubles in Our Economy 39
Engaging Aboriginal Peoples 42
A More Coordinated or “Integrated” System 43
Electronic Health Records 44
Future Priorities 47
Stories About a “Well Integrated” Experience 49
Stories About an “Uncoordinated” Experience 54
Ideas for a More Integrated System 61
Evaluation 67
5. Story and Idea Findings 70
6. Conversation Guide 74
7. Conclusion 75
Appendix A: Participation by Community 76
Share Your Story, Shape Your Care – Full Report ii North West Local Health Integration Network
1. Introduction
The North West Local Health Integration Network (LHIN) launched its Share Your Story, Shape Your Care project in January 2009. This innovative community engagement initiative was conducted to involve local residents and health care professionals in a dialogue on priorities for the local health system. The results of the project will be used to inform the LHIN’s 2nd Integrated Health Services Plan (IHSP) and its ongoing allocation decisions.
This summary report describes the full results of the project, as part of the North West LHIN’s commitment to transparency and accountability. 1.1 Integrated Health Services Plan (IHSP)
All 14 LHINs in Ontario have developed Integrated Health Services Plans. These Plans are key documents that guide the activities and health care priorities of each region.
The North West LHIN’s 1st Integrated Health Services Plan was approved by the Board of Directors in 2006 and sets direction for the region until 2010. The IHSP was developed in an inclusive process and involved significant community engagement with local residents and health care providers across Northwestern Ontario. It identifies priorities for health system improvements in our region and sets out action plans to address these priority health care issues. These priorities are:
Access to care o Primary health care o Chronic disease prevention and management o Specialty care and diagnostics services o Mental health and addiction services Long-term care services Integration of services along the continuum of care Engagement with Aboriginal people French language health services Integration of e-Health Regional health human resources plan
With 2010 approaching, the North West LHIN has started to develop its 2nd IHSP, to set care directions for 2010-13. 1.2 Community Engagement and the 2 nd IHSP
Community engagement was a key component in developing our 1st IHSP. This will continue to be the case as we build our 2nd Plan, reflecting the North West LHIN’s ongoing commitment to listening to and working with our local communities and stakeholders in delivering quality health care to the people of Northwestern Ontario.
The Share Your Story, Shape Your Care project was a key part of this community engagement approach and used a blend of online or “web-based” and in-person tools to allow local residents and health care providers to share their personal stories about local
Share Your Story, Shape Your Care – Full Report 1 North West Local Health Integration Network health care and their ideas about how our local health care system could be further improved.
The first phase of Share Your Story, Shape Your Care received over 800 contributions from people across our region, including 666 Choicebook responses and 140 separate story/idea submissions. In total, the North West LHIN received over 190,000 words of comments from participants.
This summary report provides an overview of the responses received from participants.
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2. Our Approach
The Share Your Story, Shape Your Care project was carefully planned and designed to be accessible to local residents and focus on the health care issues that were most important to them. 2.1 Timing
Share Your Story, Shape Your Care was launched on January 12, 2009 and the first phase closed on February 28, 2009.
The engagement project was “live” for seven weeks, which, according to leading community engagement research and practice, is the optimal length for a project of this scope. It allows adequate time for people to learn about the initiative, take part and encourage others they know to consider doing the same.
Share Your Story, Shape Your Care was supported by a comprehensive communications strategy to raise awareness about the project across Northwestern Ontario and encourage people to consider taking part.
The initiative was launched in early 2009 to support the North West LHIN’s community engagement while developing its 2nd Integrated Health Services Plan (IHSP). The results of Share Your Story, Shape Your Care will be made available in the spring of 2009 and will be used both to inform the IHSP and to frame further community engagement activities in the latter part of 2009. 2.2 Why an Online Approach Was Used
The project used an online approach to engage local communities. This was done to make it possible for people across Northwestern Ontario to take part easily. People could visit the website and, within a short amount of time, learn about the health challenges facing our region, complete the Choicebook to identify their health care priorities and share a story or idea about improving the health care system.
The North West LHIN decided to use online technologies because they allow people to participate at a time that works best for them as well as from a location where they have convenient access to the internet – whether at home, work, school or a public building, such as a community library. It provides a way for local residents to overcome the travel barriers that may prevent them from participating in a North West LHIN in-person community event.
In fact, the North West LHIN has been the first of the 14 LHINs to conduct a large-scale community engagement project using online, internet tools.
Nevertheless, Share Your Story, Shape Your Care was also designed to be accessible to people who preferred or were not able to participate online. A “paper version” of the Choicebook and Story/Ideas tool was made available, the results of which were entered and analyzed alongside the online responses. Furthermore, a “Conversation Guide”
Share Your Story, Shape Your Care – Full Report 3 North West Local Health Integration Network was developed to allow people to discuss health care priorities with people in their own communities, families and workplaces.
Paper copies of all tools and surveys were available in health care facilities, on the Share Your Story, Shape Your Care website and could also be ordered from the North West LHIN office. 2.3 Engagement Tools
A suite of engagement tools was developed as part of Share Your Story, Shape Your Care. These allowed people to take part and submit their views to the North West LHIN using the tool most suited to their needs, whether this was answering closed ended questions in a survey format, writing to tell a story or describe an idea, or hold a meeting with friends, family or co-workers to discuss health care priorities for our region.
The tools developed were:
1 Share Your Story, Shape Your Care Website 2 Choicebook 3 Stories and Ideas Submission Tool 4 Choicebook and Stories/Ideas Paper Version 5 Conversation Guide
2.3.1 Share Your Story, Shape Your Care Website
A special website was built at www.northwestlhin.on.ca/myvoice. This site was the “launch pad” for people to take part by either completing an online Choicebook or submitting a story and/or idea.
The site provided background information on the project, a blog by North West LHIN CEO Gwen DuBois-Wing, a message from the Board of Directors and a place for participants to assist in raising awareness of the project by “telling a friend” about the opportunity to take part.
On the homepage, participants could watch a special video message from North West LHIN CEO Gwen DuBois-Wing. This YouTube-enabled broadcast included a personal welcome to the site and an invitation to take part.
An image of the Share Your Story, Shape Your Care Website is shown on the following page.
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An image of the Share Your Story, Shape Your Care Website
Other pages from the Share Your Story, Shape Your Care Website
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The regular blog by North West LHIN CEO Gwen DuBois-Wing provided weekly news updates on the project, summary reports on demographics and links to interesting participant stories on the site.
2.3.2 Choicebook
The principal engagement tool was the deliberative Choicebook. The Choicebook was more than a simple survey – it provided participants with facts, background information and fictional “scenarios” to consider before responding to questions about how our local health care system could be improved.
This meant that participants had access to some of the same information as decision- makers and allowed them to arrive at reasoned judgement on important issues, instead of just “top of mind” survey responses.
The Choicebook invited participants to assess the potential impact of proposed measures, identify their overall priorities for our local health system and share stories and ideas about health system integration and how it could be strengthened.
Selected slides from the Choicebook
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2.3.3 Stories and Ideas Submission Tool
To complement the Choicebook, Share Your Story, Shape Your Care also included a tool participants could use to submit either a personal story or experience to the North West LHIN or a specific idea to improve health care in our region.
Participants were invited to submit their stories and ideas under one of five topics. These, as well as the tool itself, are illustrated in the image below.
An image of the Story/Idea tool
Before submitting their story or idea online, participants were asked if they would either like to keep their story private or request that it be posted on the website for others to read. Many participants opted to have their stories shared on the “Read Shared Submissions” page, allowing other people across Northwestern Ontario to learn about and understand other people’s experiences and ideas for health care.
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Any “shared” stories and ideas were reviewed by North West LHIN staff to ensure they met with the criteria on the website before being posted. This included checking that posts did not contain personal health information (about a patient or provider), or other inappropriate content.
Shared stories and ideas were posted on the “Read Shared Submissions” page. An image of this page, along with a sample submission, is shown in the following image.
Images of the “Read Shared Submissions” page and sample shared story/idea post
The “Read Shared Submissions” page was designed to allow participants to share their experiences and ideas with other people across our region and to promote a community- wide conversation on ways to continue to improve our local health care system.
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2.3.4 Paper Version
To ensure participation in the project was accessible to everyone in the region, the North West LHIN developed “paper versions” of the Choicebook and Stories and Ideas tools. Structured like a paper questionnaire, participants could use a pen or pencil to complete them before returning them to the LHIN.
Paper versions were distributed across the region and were available in various health care facilities, public buildings and could be requested directly from the North West LHIN. They were also available on the website for participants who wished to download and print them easily.
Completed paper versions were returned to the North West LHIN by mail, fax and in bulk from health care facilities where administrative staff had been collecting copies finished by participants.
All paper versions received by March 4, 2009, were tabulated and analyzed along with all engagement tools completed online.
An image of the paper version of the engagement tool
2.3.5 Conversation Guide
The North West LHIN developed an additional, custom engagement tool to enable people to take part in small group discussions.
This “Conversation Guide” contained the same material and questions as the Choicebook, but included special instructions for a facilitator to record participants’ views and the degree of consensus or agreement on each option. The package also included a questionnaire for each group participant to complete at the end of the discussion. This allowed us to collect quantitative data on priorities to accompany the qualitative data recorded by the facilitator during the meeting.
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It was the North West LHIN’s goal to generate a broader dialogue on the future of our health care system in communities across our region. This supports the North West LHIN’s approach to community engagement that involves local residents and providers in finding solutions to our shared health care challenges and in identifying ways to improve our local heath system.
Images from the Facilitator’s version of the “Conversation Guide”
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2.4 Communications and Outreach
Share Your Story, Shape Your Care was accompanied by a comprehensive communications and recruitment campaign to ensure that people across Northwestern Ontario were aware that the project was taking place and could decide whether and how to participate.
The communications strategy used traditional media to reach local residents and providers, but also partnered with schools to reach students, and worked with community organizations such as churches and community centres to ensure a high level of awareness of the engagement project.
Media
The North West LHIN hosted a media event on January 12, 2009 to announce the launch of the Share Your Story, Shape Your Care project. This was followed by news releases, op-ed and commentary articles, and advertising including:
Newspaper Television Radio Local programming (community announcements)
Community Linkages
In addition to broad media communications, the North West LHIN partnered with local community organizations across the region to increase awareness of the project. This approach used existing communications networks to disseminate information, including:
Libraries Churches Municipalities Band Offices Friendship centres Post offices Gyms and community centres Seniors’ centres Facebook™ strategy “Tell a Friend” tool on the engagement site
Stakeholders
The North West LHIN has established relationships with a broad range of partner organizations across Northwestern Ontario. Many of these partners are involved in the management and delivery of health care services; however, others are involved in the health sector through education or professional development.
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The LHIN collaborated with these partners to distribute notices and advertisements to their constituencies or memberships with an invitation to participate in Share Your Story, Shape Your Care.
Health partners Health service providers Professional associations and colleges Trade unions All LHIN advisory team and community of interest members Professional networks
Education partners School Boards Lakehead University Confederation College Northern Ontario School of Medicine
2.5 Analysis of Results
The Share Your Story, Shape Your Care project gathered significant volumes of information about participants’ views for the North West LHIN to analyze. Understanding people’s responses, including their priorities, stories and ideas will help the LHIN to use this community perspective in making future decisions about our local health care system.
The Choicebook provided the North West LHIN with quantitative data (numbers or statistics). In addition, both the Choicebook and Story/Ideas tools generated qualitative data (words instead of numbers).
Quantitative Analysis
SPSS, a statistical analysis program, was used for quantitative analysis, to generate tables showing participant responses to individual questions. Frequencies and percentages were created, as well as n values for the number of responses received.
Qualitative Analysis
Participants’ stories or ideas were coded using NVivo version 7.0, a qualitative data analysis application that allows researchers to identify and categorize themes from raw data.
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3. Participation Profile
Through Share Your Story, Shape Your Care, the North West LHIN heard from local residents and health care providers across Northwestern Ontario.
Participants came from different age groups, educational backgrounds and geographic locations within our region. As a result, they “reflect” the diversity that exists in our communities – a diversity of perspectives, experiences and viewpoints.
Community engagement goes beyond quick five-minute surveys or random samples. Share Your Story, Shape Your Care allowed anyone to take part who had an important story or idea to submit to the North West LHIN. This approach has generated a set of participant responses that comprises a “reflective” sample rather than one that statistically represents broader regional views. 3.1 Overall Participation Levels
The North West LHIN was encouraged by the enthusiastic reception that Share Your Story, Shape Your Care received in communities across our region. There was a high level of responses, with participants sharing powerful and thoughtful stories and ideas to guide the North West LHIN’s decision-making.
Overall, there were 806 contributions to the project. These are broken down in the following table.
Engagement Tool Response Choicebook Entries 666 Story and Idea Submissions 140 Qualitative data received 190,000 (number of words)
The North West LHIN was especially encouraged by the volume of total qualitative submissions from participants. When Choicebook and Story/Idea submissions were added together, participants sent more than 190,000 words for the LHIN to review. To put it in perspective, that is equivalent to two standard-length fiction novels!
The North West LHIN asked local residents for their stories and ideas – and they responded.
The following sections describe the demographic profile of participants in the online Choicebook. 3.2 Gender
The majority of Choicebook participants described themselves as female. 79% of participants were female compared to 21% who were male.
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This gender profile does not closely reflect the overall population of Northwestern Ontario. According to Statistics Canada census data, 50.5% of the population in the region is female and 49.5% male.
3.3 Age
Participants who started the online Choicebook came from a broad range of age groups. 28% were aged 34 and under, representing the perspectives of young residents in our communities. An additional 48% were between the ages of 35 and 54.
Participants also included older age groups, with 14% aged 55-54 and 11% aged 65 and over.
N=643
The age of participants who started the Choicebook reflects the overall population of Northwestern Ontario. The following chart compared the Choicebook age groups with census data for our region. It shows that the project received a slight over- representation of those aged 18 to 64, along with a slight under-representation of those 65 and over.
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There was a significant gap between the proportions of Choicebook participants who were under 18, compared to the proportion of Northwestern Ontario’s population of those under 18 years. However, many of the region’s population aged under 18 are younger children who were not a target audience of the project. In fact, Choicebook participants under 18 likely came from local residents in high schools, since the secondary school system was part of the North West LHIN’s communication strategy for the project.
3.4 Language
A large majority of Choicebook participants indicated that they spoke English at home. This is an indicator of first language preference. 96% of participants responded that they spoke English at home, compared to 3% who spoke French and 1% who answered that they spoke another language at home.
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N=643
Participants could enter their “other language” that they spoke at home. The most frequent responses among this 1% of participants included:
Oji-Cree Ojibway Finnish
The language profile of Choicebook participants broadly reflects the overall language profile of Northwestern Ontario. According to census data, 92% of people in our region speak English as a first language, 1% French and 6% other languages. 3.5 Sub-LHIN Region
Participants could also select their specific community of residence within Northwestern Ontario. Participants could select these from lists, organized by three districts: Thunder Bay, Kenora and Rainy River.
During analysis, the North West LHIN decided to separate the Thunder Bay District into two variables: Thunder Bay City, and Thunder Bay District. This was done to highlight any differences in responses between participants who lived in the City of Thunder Bay itself and participants who lived outside the City, in surrounding areas.
As a result, participants’ home communities are presented in four “Sub-LHIN Areas” throughout this report. These areas are shown in the following map of our region.
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The demographic profile of Choicebook participants closely reflects the overall population profile for Northwestern Ontario.
50% of Choicebook participants lived in Thunder Bay City, 10% in Thunder Bay District, 29% in Kenora District and 12% in Rainy River District.
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N=643
In comparison, census data shows that, of Northwestern Ontario’s population, 52% live in Thunder Bay City, 11% in Thunder Bay District, 28% in Kenora District and 9% in Rainy River District. This closely reflects the Choicebook participant profile.
A detailed list of participation by specific communities is included in this report as Appendix A.
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3.6 Education
In addition to having a broad age range, people who started the Choicebook also came from a broad range of educational backgrounds.
In response to a question that asked for their “highest level of education completed”, 4.2% responded primary/intermediate (up to grade 8). This group of participants was partially comprised of the 3.6% who were under 18 years old and in high school. However, the 4.2% also includes members of the adult community in the region.
13% had completed high school and an additional 13% had completed “some college or university”. Choicebook participants also included people with more advanced degrees, including 28% with a college diploma, 22% with an undergraduate degree and 20% with graduate degrees.
N=648
An attempt was made to compare the education profile of Choicebook participants with census data on the broader Northwestern Ontario population. However, Statistic Canada’s categorization of education and training was more detailed and did not align with the education options presented in the Choicebook, which were selected to be simple and user-friendly. 3.7 Employment Status
Choicebook participants included those who were employed and those who were not employed. The majority (76%) responded that they were employed, compared to 24% who responded that they were not. Those who responded that they were not employed likely include retired persons and students.
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N=652
3.8 Work Sector
Choicebook participants worked in various sectors of Northwestern Ontario’s economy. Just over half (56%) responded that they worked in the Health Care sector. Other participants worked in Government (8%), Education (9%) and Service (9%) sectors, and smaller groups of participants also came from Forestry, Mining and Manufacturing sectors.
16% of participants responded that they worked in a different or “other” sector. These responses included a number of retired workers, as well as a broad range of specific work assignments or sub-sectors that participants chose to identify. Examples include “Social Services”, “Child Welfare”, “Construction”, “Homemaker”, “Engineer”, “Tourism” and “Transportation”.
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3.9 Registered Health Professional?
Participants were asked to indicate whether they were a “registered health professional”. This question was included to allow the North West LHIN to examine the specific responses of health providers serving in Northwestern Ontario.
Around two-thirds (70%) of Choicebook participants said they were not registered health professionals, while the remaining one-third (30%) indicated that they were.
The North West LHIN realizes that the term “registered health professional” does not capture all the various professionals who serve in our local health system, but was used to identify provincially-classified providers in service delivery.
N=661
3.10 Health Profession
Participants who responded that they were “registered health professionals” were taken to a dedicated page in the Choicebook that contained additional demographic questions about their status as a health professional.
Health professional participants were asked to identify their specific profession from a pre-determined list. Overall, Choicebook participants represented a broad range of health professions and roles in our health system – from physicians and nurses to massage therapists, physiotherapists and psychologists.
A detailed breakdown of the health professions that were represented by participants is shown below:
Registered Health Profession Number of Participants Registered Nurse 72 Registered Practical Nurse 22 Nurse Practitioner Under 5 Physician 9
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Allied Health Professions… Chiropodists and Podiatrist Under 5 Chiropractor Under 5 Dental Hygienist 5 Dentist 7 Dietician 7 Message Therapist Under 5 Medical Laboratory Technologist 5 Medical Radiation Technologist Under 5 Occupational Therapist 5 Pharmacist 6 Physiotherapist 15 Psychologist Under 5 Speech-Language Pathologist Under 5 Other 36
Responses to the subsequent question on health sector indicate that participants who chose “other” as their health profession included:
Social worker Educators And other health professionals
3.11 Health Sector
Health professional Choicebook participants were also asked to identify the health care sector in which they worked, from a short, pre-selected list.
Participant responses show a range of health sectors. The most frequent sector was acute care (29%) followed by community (16%) and rehabilitation (15%).
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N=661
Some participants, instead, selected “other” (22%) and identified additional sectors using a textbox that was provided in the Choicebook. The most frequent responses were:
Social Work Primary Care Education Complex Continuing Care Mental Health and Addictions Private Sector Multiple sectors in the same position
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4. Choicebook Results
One of the engagement tools that participants could use to share their stories, ideas and viewpoints with the North West LHIN was the Choicebook. This tool provided participants with background information, facts and fictional scenarios to illustrate key health care challenges, before gathering views through a series of open and closed- ended questions.
This section of the report provides a detailed overview and analysis of participant responses to questions in the Choicebook. It is organized chronologically, reviewing questions in the same order that they were answered by participants.
As it analyzed participants’ responses, the North West LHIN conducted some statistical analysis, comparing responses based on different Sub-LHIN areas, health professional and public perspectives, and, where appropriate, age differences. The results of this analysis are included for each question. 4.1 Biggest Concerns
Early in the Choicebook, participants were asked to rate their level of concern about major health care issues facing our region. Using a likert scale, they described their level of concern about each of these priority areas – from “not too concerned” to “very concerned”. The list of areas was drawn from the North West LHIN’s first Integrated Health Services Plan.
Their responses are show in the table below.
Biggest Concerns (%) Not Too Very I Concerned Concerned Don’t 1 2 3 4 5 Know Access to primary care 4.0 5.4 11.3 20.3 58.5 0.3 Access to specialty care 2.3 2.8 9.0 23.2 62.1 0.5 Chronic disease 4.5 8.6 19.7 27.2 38.3 1.7 prevention & management Long-term care 3.1 3.7 11.1 25.4 55.8 0.9 Access to mental health 6.5 7.9 16.7 27.9 40.0 1.1 and addictions services Integration of services 1.7 4.2 13.2 26.5 52.8 1.7 Aboriginal engagement 12.9 11.7 22.6 23.3 25.7 3,9 French language services 26.6 19.3 25.7 15.9 8.3 4.2 Integration of e-Health 4.5 7.8 17.7 28.5 39.3 2.2 Regional health human 1.1 1.7 6.9 19.9 68.4 2.0 resources plan
Bigger Concerns
Participant responses show that several priorities emerged as bigger concerns. Health human resources was identified as the biggest concern for participants, with 68% responding that they were “very concerned” or a 5/5 on the likert scale.
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Access to specialty care was also rated as a large concern, with 62% assigning it a rating of 5 or “very concerned”. Access to primary care received a similar rating, with 59% of participants assigning it a high level of concern.
Finally, Long-term care and Integration of services were also identified as leading concerns with 59% and 53% respectively responding with a 5 or “very concerned” using the likert scale.
Comparative Analysis
Sub-LHIN Area
When participants’ responses were compared by sub-LHIN region, health professional or public perspective and age, some differences were identified.
Participants from Thunder Bay District were more concerned about French language services than those from other regions. 16% of participants from this District gave the services a 5 and said they were “very concerned”. In contrast, only 3% from Kenora District and 5% from Rainy River said they were “very concerned”.
Age
The level of concern about most health priorities increased significantly with age, which was an expected finding. However, this trend varied in degree and level between age groups and priorities.
Concerns about Access to primary care increased steadily with age. The percentage who gave it a rating of 5 and said they were “very concerned” increased from 18% from those under 18, to 38% aged 18-24, 46.5% of those 25-34, 64% aged 35-44, and continued up to 73% aged 65 and over.
Long-term care is obviously a concern for many seniors living in our region. 74% of participants aged 65 and over gave long-term care a rating of 5 and said they were “very concerned” about it. The youngest age groups gave it a lower rating, with only 22% of participants 18-25 saying they were “very concerned”. However, the level of concern about long-term care increased significantly in the 35-44 age group (58% “very concerned”) and stayed the same for older age groups up to 65 and older. This suggests that concerns over long-term care access are high among middle-aged adults as well as seniors.
A similar “jump” in level of concern for middle-aged participants was noticed for the Integration of services. Only 35% of participants aged 25-34 gave Integration a rating of 5 and said they were “very concerned”, but this increased to 62% of participants aged 35-44.
Health Professional / Public Perspectives
When the responses of registered health professionals and members of the public who are not health professionals were compared, no significant differences were identified.
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This suggests that levels of concern about various health care priorities are the same for local residents as they are for health professionals who serve communities in our region.
4.2 Missing Priorities
After learning about the priorities identified in the North West LHIN’s first Integrated Health Services Plan (IHSP), participants had the opportunity to suggest additional issues or priorities that they thought were missing.
A broad range of suggestions for missing priorities was received, ranging from alternative care treatment to respite care and less “red tape”.
However, a number of common themes emerged from participants’ responses as shared missing priorities for the North West LHIN. These are described in the table below, along with the number of mentions each received in different participants’ submissions.
Missing Priority Number of Mentions Prevention 29 Integration and Navigation 26 Home Care 22 Recruitment and Retention of 21 Health Human Resources Transportation 20 Education 13 Geriatrics and End-of-Life Care 13 Alternate Level of Care 13 Wait Times 12 Client Service and Support 10
An overview of participant views on each of these proposed missing priorities is included below.
Many of the priorities described as missing by participants were, in fact, included in the North West LHIN’s first Integrated Health Services Plan (IHSP). For example, home care was included under long-term care in the IHSP. Nevertheless, the North West LHIN will use the participant feedback to determine whether these items need to be given greater emphasis or made more prominent in the second IHSP.
Prevention
Some participants suggested that there is a need to make preventing illness a higher priority. They felt that scarce health care resources could be used more effectively if conditions, especially chronic illnesses, were prevented.
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“Clearly the best medicine is prevention, especially in Northern Ontario. I think that programs for prevention, (particularly in disease's that are prominent here in the north, e.g. diabetes, and right now due to lack of employment, stress and mental health) are the best and most effective route to take.”
“The prevention of disease (Primary Health Care) should be a much larger focus of the LHIN strategy in my opinion. Most of the diseases that are so prevalent in the NW LHIN are "lifestyle diseases" which are highly preventable. Heart disease, stroke and diabetes are all VERY preventable diseases. We should be doing more to prevent their incidence. ”
Integration and Navigation
Other participants encouraged the North West LHIN to make integration a priority, but to do so in ways that make the health system simpler and more user-friendly to navigate.
“Patient / client navigation throughout any health care setting ("what do I need, where do I find it, how do I get in").”
Home Care
Although they recognized that long-term care was included in the North West LHIN’s first Integrated Health Services Plan (IHSP), some participants recommended making home care a separate priority to support seniors, persons with disabilities and their family members to help people receive care in their homes.
“It is understandable that there are waiting lists for placement in long-term care facilities however more measures need to be explored to increase in-home services to allow for care at home while waiting for placement and thus to take pressure off of family caregivers.”
“Making it easier and safer for seniors and people with disabilities to stay in their homes as long as possible.”
Recruitment and Retention of Health Human Resources
In addition, participants suggested that the priorities in the first Integrated Health Services Plan lacked a specific emphasis on recruiting and retaining skilled health care professionals in Northwestern Ontario. They recommended steps to encourage local people to train for these careers and ultimately to practice within the region.
“I am mostly concerned about nurses staying in Northwestern Ontario when we graduate. I am about to graduate myself from nursing and the only thing Ontario is offering is 6 months guaranteed work, well that is basically a given. Financial bursaries and incentives should be offered to new grads so they don't leave the region. ”
Transportation
Other participants commented that, while access to primary, specialty and other types of care have been established as priorities, providing transportation services to further support access to care has not been. They recommended making transportation within the region a priority, particularly for seniors and vulnerable people.
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“With the aging population in Northwestern Ontario - another priority needs to be transportation to the larger centres especially in the winter period.”
“TRANSPORTATION for seniors - especially in smaller rural communities. Those seniors without vehicles or licenses cannot leave their home to get to the clinics or to programs offered in the community that will help them socially, mentally and physically. ”
Education
In a suggested new priority related to recruitment and retention, participants recommended changes to the admissions processes for local colleges and universities to focus student recruitment among people in the region. They believed this would be an effective way of ensuring these skilled health professionals stay in Northwestern Ontario after graduation.
“Educating our own health professionals, it is very hard for students to be accepted into our local colleges and universities i.e. MRT in Thunder Bay is a very hard course to get in to. ”
Geriatrics and End-of-Life Care
With an aging population in Northwestern Ontario, some participants suggested that care for seniors should be a dedicated priority in the future. This included targeted home care, long-term care and end-of-life care.
“Enhancement of end-of-life care for area residents would be another priority I would like to see included in the plan.”
Alternate Level of Care
To address wait times and shortages, some participants felt that alternate level of care should be a focus for the North West LHIN. They suggested finding appropriate ways to meet people’s health care needs outside the hospital – in the community and their own homes.
“Finding places for those who need alternate level of care so they do not take up beds in hospital.”
Wait Times
Although wait times is a policy priority for the federal and provincial governments, a smaller group of participants said that this should also be a specific focus for the North West LHIN.
“Having low wait times to see a doctor should be first and foremost available for everyone's convenience - this means having access to any kind of doctor with minimal waiting time - whether it's at one's own regular family doctor, or at a walk-in clinic, hospital (including Emergency), etc. Too many people have to wait an extremely long time to see any kind of doctor (not just specialists).”
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Client Service and Support
Finally, some participants recommended that the North West LHIN make client service a priority, and ensure all patients feel supported and cared for when they are receiving health care.
“A personal touch to have a staff take the time and explain all procedures and provide support through the entire process.”
4.3 Improving Access to Care
In the main section of the Choicebook, participants learned about and were asked a series of questions about priorities for improving access to health care services.
These were drawn from a list being considered by the North West LHIN for inclusion in its second Integrated Health Services Plan (IHSP):
1. Access to primary care 2. Access to specialty care 3. Access to mental health and addictions services 4. Long-term care 5. Chronic disease prevention and management
Participant views on each priority are described in the following sections.
4.3.1 Primary Care
Participants were presented with facts and a fictional scenario to illustrate the primary care challenges facing Northwestern Ontario. They were then asked to respond to a series of proposed measures the North West LHIN is considering to improve access to primary care.
There was considerable support for both approaches described. Almost two-thirds of participants responded that the measures would have a big impact on improving access.
Primary Care Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know More health care teams (such as Nurse Practitioner-led clinics, Family Health 1.1 2.4 10.5 21.7 62.2 2.1 Teams, and others) Re-design the way clinics and other parts of the health care system work to increase access to family doctors (like making sure 1.4 2.6 9.2 21.3 64.1 1.4 people can talk about more than 1 health problem at each appointment with a doctor)
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Comparative Analysis
Sub-LHIN Area
Participants from Rainy River District rated the “More health care teams…” option as having a smaller impact than participants from other Districts in the region. 47% of those from Rainy River District gave the measure a rating of 5, compared to 64% in Thunder Bay City, 64% in Thunder Bay District and 63% in Kenora District who rated it as a 5.
The data also showed that more participants from Thunder Bay District rated the “Re- design the way clinics…” measure as having a big impact than those from other Districts. 78% of participants from Thunder Bay District gave the measure a rating of 5, compared to 61% from Thunder Bay City, 67% from Kenora District and 64% from Rainy River District.
Health Professional / Public Perspectives
No significant differences were present between the responses from registered health professionals and those from other members of the public.
Additional Primary Care Ideas from Participants
Participants could also suggest additional measures to strengthen access to primary care. The North West LHIN received a large number of insightful and helpful ideas for consideration, a sample of which are included below.
“If people had access to primary health care, issues could be detected sooner, leading to a healthier population.”
“I think we need to rethink how health care is delivered. Access to family doctors is not the most important thing. In most cases a nurse or other allied professional could address the person’s concerns.”
“Maximizing the use of skill sets of current health care providers, including an awareness of upcoming changes to scope of practice will improve access to primary care. ”
“More doctors and nurse practitioners able to see clients in their own home. ”
“Educate the public about when to use the ER and alternatives to going to the ER. ”
4.3.2 Specialty Care
Further into the Choicebook, participants considered measures for increasing access to specialty care in Northwestern Ontario. They rated several options being considered by the North West LHIN and were also able to suggest their own ideas.
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Of the three options presented for response, two received higher levels of support: “Better manage wait lists…” and “Increasing access to telemedicine…”. These received a rating of 5 (or “will have a big impact”) by 54% and 50% of participants, respectively.
In contrast, “Set standards so that patients only get referrals…” was rated as having a smaller impact on improving access to specialty care. While few participants said the measure would have “no impact”, only 30% gave it a rating of 5, or that it would have a “big impact”.
Specialty Care Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Better manage wait lists to make sure "urgent" patients always get seen right 1.0 3.0 10.9 28.0 53.5 3.5 away Set standards so that patients only get 4.4 12.1 21.2 25.0 30.0 7.3 referrals to specialists when necessary Increasing access to specialist doctors 1.1 4.2 12.8 24.8 49.5 7.7 using “telemedicine"
Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
Additional Specialty Care Ideas from Participants
Participants could also suggest their own ideas for strengthening access to specialty care. Examples of these submissions are included below, and all ideas will be considered by the North West LHIN for use in our health care system.
“Have centralized booking facilities for specialists so primary care physicians can refer and patients can be assigned to the specialist with the shortest wait list. ”
“Have specialists visit communities and/or the Family Health Teams (bring the specialty services “closer to home”).”
“If urgent patients always get seen right away and people that are not so urgent keep getting bumped because of that, then the not so urgent patients of today will soon be the urgent patients of tomorrow. Is it not better to get to the root of some problem earlier instead of later? ”
“It [telemedicine] meant for me that I did not have to live in a nursing home in Toronto for a minimum of the first 3 months of treatment and I had the care and support of my family and friends.”
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“Telemedicine makes sense...access to consultations without the expense/stress of traveling, not to mention the stress of waiting up to a year or more for the consultation. ”
“Use well organized referral system so that medical tests/blood work/x-rays are ordered and completed with results available to be presented at the time of the appointment with the specialist.”
4.3.3 Mental Health and Addictions Services
A series of potential ways of improving access to mental health and addictions services were presented for review and response.
Overall, the measures received similar and comparatively high levels of support from participants. Around three-quarters of participants gave the approaches a rating of either 4 of 5, saying that they would have a “big impact”.
However, “Focus services on helping ‘vulnerable’ people…” was rated as having a slightly smaller impact than the other two measures. 42% gave it a rating of 5, compared to 51% who gave a similar rating to “Improve the care options available for people - outside the hospital…” and 49% to “Give health workers more information…”.
Mental Health and Addictions Service Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Improve the care options available for people - outside the hospital (e.g. early psychosis intervention, eating disorder 1.9 1.9 11.7 28.2 50.6 5.5 programs, peer support, supportive housing for people with addictions) Focus services on helping "vulnerable" people who need it the most (such as youth or people who have both mental health 1.5 4.4 15.8 30.6 42.0 5.7 disorders and drug/alcohol addictions at the same time) Give health workers more information about places where people with mental health and 2.0 6.4 11.3 26.8 49.4 4.2 addictions can get help, so they can refer patients to the best place
Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
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Additional Specialty Care Ideas from Participants
In addition to rating the potential measures being considered by the North West LHIN, participants could also suggest their own ideas to strengthen access to mental health and addictions services.
The North West LHIN received a broad range of ideas, a sample of which is included below.
“Work with the community to make them aware that a mental health problem is a valid health problem and must be dealt with the same as a heart attack.”
“Community based services should be a top priority rather than focusing solely on hospital. I work in a community based mental health organization outside of the hospital. We have less staff, less pay and more clientele. Oh and we actually travel to individuals homes as accessing services is very challenging in the North; we don't have adequate, affordable transportation here for individuals to access services.”
“Use of telehealth for mental health counselling. This will increase client contacts for MH counsellors.”
“Family Health Teams should have mental health services as a mandatory/core service so that patients can get these services where they see their doctor.”
“Peer Support and access to Crisis Intervention Services are paramount in assisting people with Mental Health and Addiction Related Concerns. Also wait times for counselling services must be addressed. Wait lists are unacceptable; often people feel rejected and may choose not to access services if made to wait.”
“Not only health care workers can pass along such information: Canadian Mental Health Association did a pilot project years ago involving training cab drivers, hairdressers, bartenders, etc. to do active listening and to provide information on available services. The more people with information, the more likely it is that those in need will be able to access service. People who work in the community in other areas than health care may be the sole point of access for a number of vulnerable people who may not ever visit a health care facility.”
4.3.4 Long-Term Care
Under the theme of access to health care, participants had the opportunity to express their views on ways to strengthen access to long-term care services.
While the North West LHIN is currently examining a range of approaches to improving access to long-term care services, the Choicebook included two about which local residents’ views were sought.
Both approaches received high rankings, with the large majority of respondents indicating that they would have a “big impact” on improving access. 68% of participants gave a rating of 5 to “Help seniors to stay in their homes…” and 71% gave the same high rating to “Expand alternatives to long-term care…”.
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Long-Term Care Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Help seniors to stay in their homes and stay healthy (e.g. homemaking, home 0.6 2.3 8.2 19.6 68.2 1.1 maintenance, nursing) Expand alternatives to long-term care (e.g. 0.8 1.3 6.2 18.3 71.3 2.1 supportive housing)
Comparative Analysis
Sub-LHIN Area
No significant differences were present between participants’ responses from different districts in Northwestern Ontario.
Health Professional / Public Perspectives
An analysis of the data showed that more registered health professionals gave a high rating to “Expand alternatives to long-term care…” than members of the general public. 85% of registered health professionals gave this approach a rating of 5, compared to 66% of the general public.
Additional Long-Term Care Ideas from Participants
A number of participants submitted additional ideas for improving long-term care. The North West LHIN has reviewed each and will use them to design new approaches for long-term care in the future. Examples of these ideas include:
“I want to be independent as long as possible. Homecare - even in small amounts - can fill in things that become difficult for persons caring for themselves. ”
“Once again, there is a huge need for programs that will support seniors in staying in their homes - services such as snow removal, homemaking, even friendly visiting programs. There is also a huge need for the expansion of supportive housing programs.”
“Persons with physical disabilities do need additional assistance. Their needs are much different than seniors; they often need more hours that are flexible. Supportive housing (SH) for persons with physical disabilities is much different than SH for seniors. You can provide more services to seniors in SH versus SH for persons with physical disabilities. Often the disability changes/deteriorates requiring increased hours/visits therefore requiring increased services/dollars.”
“Many seniors require some assistance to remain in their own home such as Meals on Wheels or visiting homemakers, and these services are cost effective practical ways to make this possible. Home maintenance services such as snow removal and odd job services such as changing a ceiling light bulb are services that would also be useful.”
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“The Aging at Home Strategy has made very successful strides. However, there is still much that can be done to support adults with physical disabilities, and the psychogeriatric populations, especially in the area of respite care for families.”
4.3.5 Chronic Disease Prevention and Management
Participants were presented with some of the measures the North West LHIN is considering for continuing to improve access to chronic disease prevention and management services, and provided with an opportunity to provide their views on the impact these measures could make.
Compared to responses to other policy areas in the Choicebook, participants rated the impact of several of these measures as mixed. 37% of participants gave a rating of 1, 2 or 3 to “Create peer support groups…” suggesting that they did not feel it would have a big impact on improving access. A similar message was heard regarding “Doing more health promotion activities” where 35% of participants gave the measure a rating of 1, 2 or 3.
In contrast, participants rated “Increase the number of visits with a health care team…” as having a big impact, with 54% giving it a rating of 5 and 83% giving it a rating of either 4 or 5.
Chronic Disease Prevention and Management Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Create peer support groups to learn to take 2.1 10.7 23.9 29.2 30.2 3.8 care of their own chronic disease Increase the number of patients who have regular visits with health care professionals 1.6 5.2 16.7 35.0 35.0 6.4 to avoid complications (such as fixed "check-ups" every few months) Doing more health promotion activities 2.7 9.8 22.2 30.0 32.5 2.8 Increase the number of visits with a health care team (where a dietician, nurse 0.8 4.3 9.1 29.7 53.7 2.3 practitioner, social worker and/or doctor work together)
Comparative Analysis
Sub-LHIN Area
No significant differences were present between participants’ responses from different districts in Northwestern Ontario.
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Health Professional / Public Perspectives
More registered health professionals gave a higher rating to “Doing more health promotion activities” than members of the general public. Just under 40% of health professionals gave the measure a rating of 5 (or “will have a big impact”). 30% of general public participants gave the measure the same rating.
Additional Chronic Disease Prevention and Management Ideas from Participants
The following quotations illustrate the range of thoughtful ideas received from participants about how to strengthen access to chronic disease prevention and management services.
“I just learned that I have diabetes, I received all the papers telling me what to eat and not to eat, yet it was all still confusing. At a meeting with one of the travelling nurses, I mentioned that if they could give a few hours to go to a grocery store and help you choose the right foods, sometimes a hands on can teach more than trying to read through piles of papers.”
“Our diabetes support group is having a wonderful and positive impact in our communities…More support for organizations like ours would be awesome. We are able to give people incentives to take charge of their own heath care plan and become more vocal.”
“Partnering with other agencies is something to look at. A joint monthly clinic i.e. diabetes, heart disease, in each community with the Public Health Units, or Health Access Centers on reserves with a health care team might be something to look at.”
“Provide support to primary care physicians (time, training, access to teams or centres that support the treatment and management of chronic diseases).”
“Team-based care makes a difference.”
4.4 Overcoming Barriers to Care
People in Northwestern Ontario can face significant barriers to accessing health care. Our vast geography can mean people have to travel longer distances for treatment than elsewhere in the province. Other challenges, like changes in our local economy and social circumstances can also make it difficult for local residents to access the care they need.
Some people in our region face other barriers to care. Aboriginal peoples and francophone residents can face language and cultural barriers, as can people with hearing and other disabilities.
A section of the Choicebook informed participants about the barriers to care in our region and allowed them to express their views on a number of health care priorities related to overcoming these barriers:
1. Geography/transportation 2. Troubles in our economy
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3. Aboriginal engagement 4. Integration 5. Electronic health records 6. Using our health human resources
4.4.1 Geography and Transportation
The North West LHIN is considering various ways of supporting access to health care through transportation support services. Transportation measures being examined were included in the Choicebook for participant feedback.
Over three-quarters of participants gave the proposed approaches high ratings, responding that they would have a big impact on helping people overcome transportation barriers. However, as shown in the Comparative Analysis section below, there were differences in participant responses across different districts.
Geography and Transportation Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Mobile vans (like the "breast screening van") that can travel to different 0.7 2.1 9.4 25.5 59.2 3.1 communities and provide health care More "telemedicine" so health workers can treat patients via video link, so patients 1.3 3.6 10.7 24.9 56.4 3.1 don't need to travel too far
Comparative Analysis
Sub-LHIN Area
Some significant differences in response patterns on geography and transportation approaches were identified across the North West LHIN’s Districts.
Fewer participants from Thunder Bay City and Kenora District gave high ratings to “Mobile vans…” than participants from Thunder Bay and Rainy River Districts. 56% of those from Thunder Bay City gave this approach a rating of 5 (or “will have a big impact”), and 58% of those from Kenora District did the same. However, 75% of participants from Thunder Bay District gave this approach a rating of 5, as did 68% of people from Rainy River District.
A similar response pattern was identified for the second approach, “More ‘telemedicine’…” where more participants from Rainy River District (69%) and Thunder Bay District (64%) gave the measure a rating of 5, compared to Thunder Bay City (52%) and Kenora District (57%).
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Health Professional / Public Perspectives
No significant differences were present between the responses from registered health professionals and those from other members of the public.
Additional Geography and Transportation Ideas from Participants
The North West LHIN received a series of suggestions from participants on other ways to overcome geography and transportation barriers in our region. These include the following:
“De la télémédecine pour les visites pré et post-opératoires. ”
“Coordinating appointments so that they can be accomplished in one visit rather than with repeated/separate visits.”
“Return travel grants in timely fashion. For those who cannot afford transportation [between travel grants] should be paid in advance.”
“Add to the vans: Skin cancer screening van (this is done in the states), eye vans that will go up the 599 and the 527, colonoscopy vans, foot care vans or foot care nurses coming to the clinic, dental hygienist vans with dentists on board - the visiting van thing works absolutely fantastic but they can't be scared to go up the most northern highways (not just the 11/17).”
“There must be assistance for people to get to and from out of community specialists. Otherwise, people won't go or will be reduced to poverty and then won't go. The closer to home the service is, the better.”
4.4.2 Troubles in Our Economy
The North West LHIN understands that people across our region are being affected by changes in our local economy. Research has shown that job losses in industries like mining, forestry and transportation have an impact on people’s health. In the Choicebook, participants had the opportunity to tell the North West LHIN how changes in the economy had affected them or their region.
Our findings suggested that changes in the economy are indeed affecting people in our region. Two-thirds of participants reported that economic troubles had led to violence in the home and divorce that had affected them or people in their region. 63% reported that economic problems had made it impossible for people to fill prescriptions.
Although reported by fewer participants, many reported that economic troubles had caused anxiety (36%) and more depression (33%).
The North West LHIN realizes that the question asked participants to make generalized statements about their communities, and that the results cannot lead to firm epidemiological conclusions. However, the intention of the question was to scope
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Has affected “you or people in Effect of Economic Change your region” (Yes, %) Violence in the home 67.3 Divorce 67.0 Inability to fill prescriptions 62.8 Drug or alcohol abuse 45.7 Hard time affording healthy foods 36.9 Suffering from anxiety 35.6 More depression 33.0
Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
Additional Participant Stories About Troubles in Our Economy
Participants had the opportunity to go beyond the pre-determined responses to the likert question about health affects of problems in the economy and tell their own stories about how economic challenges had affected then. These are several of the many moving and inspiring responses the North West LHIN received.
“When people don't have the skills to cope they are unable to live wisely and well.”
“As well, it seems the unemployment has created the single parent syndrome. One parent or both are leaving the family home to find work. The family will lose money if they sell their home and move so again one or both parents leave the home in search of employment. Kids are usually left with relatives (grandparents) adding financial and emotional strain.”
“Do more to promote a positive message - the media does enough damage by promoting a negative message. Promote community gardens, kitchens, good food box using a method that reduces the stigma associated with "a hand out".”
“Having to choose between buying prescription eye glasses or spending that money on food. ”
“My only main option was to go back to school and to re-educate myself in a field where I know there would be potential employment…. I am a RPN student with Confederation College and my dreams are to relocate in an area where there's a real high need of nurses. I have plans of relocating to a northern community after which I've completed the RN course, hopefully!!! ”
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“If someone requires physiotherapy services but cannot afford to pay or does not have health care benefits through an employer, it is important that this service is available. ”
“Inability to afford to put themselves or their children in organized sport or to afford healthy activities such as gym memberships, public swimming, swimming lessons, curling, etc. ”
“Individuals are accessing other community services at an increasing rate. Can no longer afford to pay for children's sports, resulting in an increase in crime; have to visit the food bank regularly as they can no longer afford basic needs. Difficulty paying bills including necessary ones such as Hydro to heat your home. O/W & ODSP often do not meet a family’s basic needs, creating further despair and feelings of helplessness. Seniors in particular are being hit hard, as they do not want to access outside help feeling that someone else could use the service more. ”
“It has hit home with the force of "Katrina". I have lost all, my job, home, life savings, etc. just trying to keep what's left. It's a battle and a half!”
“It is so difficult - people need to retrain - we are desperate for health care providers. It would be so helpful to train and hire people to be professionals, health promoters, peer support. ”
“Lack of access to healthy foods (go to a grocery store on the reserves and see what is available.).”
“Many school children are now coming to school without breakfast or lunch. Provider in the home has just been laid off (pulp mill especially) and the parents have to call the school and explain why their child does not have a lunch. School will provide but it is so demeaning for the parents and the children. Parents can "fast", children cannot!”
“Our seniors are beginning to rely less on family because family are moving away (out west to the jobs) or are in dire-straits financially and cannot afford to pay gas/insurance for their automobiles. Seniors are not "wanting to bother" their kids and are beginning to show great signs of low mood and anxiety around the issues and problems that they see their children going through. ”
“We are seeing people not fill their prescriptions even for medications such as insulin or decreasing the amount they take to make it last longer and keep themselves just above the point where they get really sick.”
4.4.3 Engaging Aboriginal Peoples
The North West LHIN is committed to working with Aboriginal communities to improve access to health care services for Aboriginal peoples in our region. In the Choicebook, participants were invited to rate the potential impact of measures the North West LHIN is considering to engage Aboriginal peoples.
The results indicate a mixed review of the measures’ potential impact. 47% rated “Create a protocol or guide…” as either a 4 or 5. However, 39% rated it 3 or lower, with 13% responding that they did not know.
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Participants rated “’Reach out’ to work more closely…” slightly higher, with 62% rating the approach as either a 4 or 5.
Engaging Aboriginal Peoples Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Create a “protocol” or guide on how to work with Aboriginal people to improve their 9.1 10.4 19.7 22.2 25.2 13.4 health and health care “Reach out” to work more closely with 5.4 5.7 16.2 23.4 38.7 10.6 Aboriginal organizations on health issues
Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
Additional Ideas from Participants on Engaging Aboriginal Peoples
Aside from the ideas listed for review in the Choicebook, participants had other suggestions on how to engage Aboriginal people on health care.
“1. Try to hire people with their language either to translate or as providers 2. Involve the people themselves in their own care by traditional healing and dietary advice.”
“An aboriginal liaison has been hired by our facility to help weave our way through barriers and provide guidance to adhere to traditional healing. This is by far the most effective form of assistance I have witnessed in many years as a hospital employee.”
“Cross-cultural training is a must. The Aboriginal culture is a unique and strong culture. Most barriers I have seen include language and the general misunderstanding of the culture.”
“Have trained staff working on-reserve - training & education for aboriginal community members so people living on reserve can work within their community. ”
“The protocol will only work if is created in concert with Aboriginal people and includes cultural training for health care providers as part of the protocol.”
4.4.4 A More Coordinated or “Integrated” System
The North West LHIN is working on creating a more coordinated or integrated health care system. This means ensuring the various “parts” of the system work together to produce a more seamless experience for patients.
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The Choicebook contained some of the approaches the North West LHIN is researching to make the system more integrated, and participants were able to rate the potential impact of these approaches on a scale of 1 to 5.
Fewer participants rated “A ‘one-stop’ place…” as having a big impact, compared to the other two approaches, with 40% giving it a rating of 5 (or “will have a big impact”). In contrast, 53% of participants rated “All health service providers (e.g. nurses, doctors, dieticians) will share information…” as a 5, and 50% gave the same rating to “Decrease ‘duplication’ of services…”
Approaches to Create A More Coordinated or “Integrated” System (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know A “one-stop” place to learn more about health services available in Northwestern 4.3 10.3 16.3 25.8 40.0 3.2 Ontario (like an easy-to-use website or brochure) All health service providers (e.g. nurses, doctors, dieticians) will share information 1.2 4.0 11.6 28.2 53.1 2.0 necessary to access and move between services Decrease “duplication” of services so that new services can be provided where, right 2.3 3.0 12.2 28.0 50.4 4.0 now, there are “gaps”
Comparative Analysis
Sub-LHIN Area
Some significant differences in response patterns were identified across the North West LHIN’s districts.
“A ‘one-stop’ place to learn more about health services…” was rated higher in some districts than others. 51% of participants from Thunder Bay District gave the approach a rating of 5 (or “will have a big impact”). This was higher than the 35% of participants from Kenora District who gave the approach a rating of 5, and 38% from Rainy River District who also gave it a rating of 5. 41% of participants from Thunder Bay City gave it a rating of 5.
Health Professional / Public Perspectives
No significant differences were present between the responses from registered health professionals and those from other members of the public.
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Additional Ideas from Participants on Creating a More Coordinated or “Integrated” System
Participants were able to send the North West LHIN their own ideas for creating a more coordinated or “integrated” system. Each of these will be reviewed and evaluated to see whether it could be implemented. Examples of participants’ ideas include:
“A "one-stop" place like a website is great for those technologically able, but a community program with people who are able to sit down and outline all of the different programs is what's really needed. A confidential place to go where the information isn't just there, but where someone is there to look you in the eye and explain it to you is even better.”
“A Community Inventory of Health Care Support Services available and how to access them. ”
“Complement the website with a telephone service so those who are not as familiar with computers i.e. seniors, can get their needs meet and their unique issues addressed (a brochure can't troubleshoot).”
4.4.5 Electronic Health Records
New technologies provide new tools for sharing patient information between health professionals, allowing for more integrated health care for patients. The North West LHIN is considering several measures for using technologies to create and use electronic health records. A couple of these were included in the Choicebook for participant feedback.
Both measures received high ratings from participants. “Develop an e-Referral system…” was rated as 5 (or “will have a big impact”) by 61% of participants, and 65% gave “Build a full electronic health record system…” a rating of 5.
Electronic Health Record Approaches (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Develop an e-Referral system so referrals to specialists include a patient’s health 0.5 2.2 9.1 23.6 60.6 4.0 information Build a full electronic health record system so all health professionals can share 0.5 2.3 8.1 19.8 65.3 4.0 patients’ health records
Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
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Additional Ideas from Participants on Electronic Health Records
Participants submitted a large number of comments about the importance of the North West LHIN successfully using electronic health records and other information technology to support greater access to health care services. Some examples of these are shown below:
“This is the single most important initiative in my eyes....”
“A lot of time will be saved by doctors and health care workers if this is implemented!”
“Access to medical history may actually help better and proper diagnosis. ”
“The hospitals in Thunder Bay and some of the district communities are already connected with electronic medical records and it would be great for all communities to have access. ”
“The advent of computers in health care was at first daunting for some who had no clue as to their operation, but, it became apparent very quickly just what a valuable tool they are. ”
“It is important that the patient knows who has the information and who it is being shared with and that the information is secure.”
4.4.6 Using Our Existing Health Human Resources
In a final section of the Choicebook on access to health care services, participants had the opportunity of exploring ways the North West LHIN could use Northwestern Ontario’s health human resources more effectively to support greater access.
Both the potential measures included for feedback were rated fairly high by participants, as likely having a big impact. Over three-quarters of participants rated the approaches as either a 4 or 5. “Look into education and training…” received a slightly higher level of support, with 52% rating the measure as a 5.
Approaches to Using Our Existing Health Human Resources (%) Will have Will have a I no impact big impact Don’t 1 2 3 4 5 Know Fund “creative” ways of organizing health care so nurses, nurse practitioners, 1.7 4.7 10.0 31.2 45.5 7.0 pharmacists and other health workers can use all their skills Look into education and training so health workers keep building new skills to help 1.3 3.0 10.1 30.5 52.0 3.0 patients
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Comparative Analysis
No significant differences were present between the responses from registered health professionals and those from other members of the public, or by sub-LHIN area.
Additional Ideas from Participants on Using our Existing Health Human Resources
In addition to the approaches included in the likert scale, participants could send the North West LHIN their own ideas for making better use of the region’s existing health human resources. Some examples follow:
“All providers should be working to their full scope of practice. ”
“There should be housing provided for locums and those wishing to become doctors that are specifically built to get physicians to stay here. There needs to be a way of helping new families who are moving here to be integrated into the community quickly so they will want to stay here longer.”
“Encourage our youth to consider health care as a career by promotional activities and career fairs. Provide flexible working conditions for older health workers. ”
“The demand for health care providers can be decreased by increasing access to reliable online health information (one site that health care workers can refer patients to), increasing the use of telephone and email communication with doctors (and reimbursing fee-for-service physicians for those modes of communication), and having group appointments with patients who have a shared diagnosis.”
“Innovative models of care delivery need to be piloted and evaluated. Ongoing education for all health professionals needs to be a priority, interprofessional learning opportunities that can be delivered via telemedicine or e-learning approaches.”
“Look into Aboriginal mentoring programs for other programs besides just nursing. We need to support this.”
“Funded tuition would go a long way to help.”
4.5 Future Priorities
After reviewing each of the main challenges facing Northwestern Ontario’s health care system, participants were invited to rate the importance of each, using a scale from 1 (“Not That Important”) to 5 (“Very Important”).
The North West LHIN will use participants’ responses to help inform the priorities identified in its second Integrated Health Services Plan (IHSP).
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Future Priorities (%) Not That Very I Important Important Don’t 1 2 3 4 5 Know Access to primary care 0.0 0.8 2.7 11.3 85.0 0.2 Access to specialty care 0.2 0.5 4.8 22.6 71.7 0.2 Access to mental health 1.3 3.3 15.3 26.8 51.8 1.3 and addictions services Long-term care 0.0 1.2 7.5 24.1 66.2 1.0 Chronic disease 0.7 2.8 13.6 30.3 52.1 0.5 prevention & management Geography/transportation 0.7 2.2 12.3 28.2 56.1 0.7 Troubles in our economy 1.0 3.7 15.0 31.2 47.3 1.8 Aboriginal engagement 5.0 7.0 17.4 25.9 40.3 4.3 Integration 0.8 1.2 9.9 25.0 61.6 1.5 Electronic health records 0.7 2.3 9.8 25.3 60.9 1.0 Using our health human 0.2 0.5 6.5 25.4 66.1 1.3 resources
Higher Priorities
Participant responses highlight several priority items that were rated as more important.
Access to primary and specialty care are still leading priorities for people in Northwestern Ontario, with 85% and 72% rating them as 5 or “very important”, respectively. Long-term care was also a higher priority, with 66% of participants assigning it a rating of 5.
In addition, a number of other priorities emerged relating to health system design and integration. 66% of participants rated “Using our health human resources” as 5 or “very important”, 61% gave electronic health records a rating of 5 and 61% of participants gave integration a rating of 5.
Comparative Analysis
Sub-LHIN Area
When participants’ responses were compared by sub-LHIN region, health professional or public perspective and age, some differences were identified.
Participants from Thunder Bay District and Rainy River District rated Access to specialty care as more important than participants from other Districts. 86% of those from Thunder Bay District and 85% from Rainy River District rated Access to specialty care as 5 (or “very important) compared to 65% from Kenora District and 71% from Thunder Bay District who gave it the same rating. Participants, however, rated primary care, similarly across these districts.
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Those from Rainy River District rated chronic disease prevention and management as being more important, compared to participants from other districts. 66% of participants from Rainy River District rated this priority as 5 or “very important” compared to 48% from Kenora District and 52% from both Thunder Bay City and Thunder Bay District who gave it a rating of 5.
In a final sub-LHIN area difference, more participants from Thunder Bay District and Rainy River District rated geography and transportation as very important. 72% of those from Thunder Bay District and 68% from Rainy River District rated the priority as 5 or “very important”. In contrast, 49% from Thunder Bay City and 58% from Kenora District gave it the same rating.
Age
The level of concern about most health priorities increased significantly with age, which was an expected finding. However, this trend varied in degree and level between age groups and priorities.
Access to primary care was not rated as being very important by participants aged 18 and under, 43% of whom rated it as 5 or “very important”. However, those who gave this priority a rating of 5 increased to 80% for those 18-24 and stayed between 80% and 90% for all age groups up to those 65 and older.
Following the age-based trend in the data, the older the age groups the higher participants rated the importance of each health priority. Long-term care followed this pattern, but with higher ratings of importance at specific age groups. 37% of participants aged 18-24 rated access to long-term care as a 5 or “very important”. This increased to 52% for those aged 25-34, and to 69% aged 35-44. The percentage of those who rated the priority as a 5 increased more gradually between ages 45 and 65, with 82% of participants 65 and over giving it this rating.
Health Professional / Public Perspectives
When the responses of registered health professionals and members of the public who are not health professionals were compared, no significant differences were identified. This suggests that relative health care priorities are the same for local residents as they are for health professionals who serve communities in our region.
4.6 Stories and Ideas on Integration
The North West LHIN is currently taking steps to make our local health care system more integrated. This is a key process for making our system truly “patient-centered” so that people from across Northwestern Ontario can access the services they need, when they need them and without feeling as though they could “fall through the cracks”.
Although certain integration measures are already being implemented, the North West LHIN sought stories and ideas from health professionals and members of the general public on how our health care system could be further integrated.
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The Choicebook contained a section focused on integration and asked a series of open- ended questions to which participants could respond by sharing their experiences or ideas:
Please describe a time when your care was well integrated and the health system worked well for you (as a citizen) or one of your patients (if you’re a health professional). Please describe a time when your care was not well integrated and the health system did not provide you or your patient with integrated care. Please tell us your ideas for creating a more integrated system.
The North West LHIN received a large number of responses from participants in response to these questions/themes. The follow sections of this report provide an overview of the themes and ideas that emerged from participants’ submissions.
4.6.1 Stories about a “Well Integrated” Experience
Participants described a broad range of experiences where, as patients, family members or friends of patients, or health providers, they observed well integrated care being provided in Northwestern Ontario.
Several common themes or threads emerged from participants’ submissions during the North West LHIN’s review and analysis. These are outlined in the table below, along with the number of separate mentions they received from participants.
Theme Number of Mentions Prompt access to care 32 Patient-friendly follow-up and scheduling 26 Coordination between providers 24 Team approaches to care 16 Open communication with patients 16 Follow-up contact 13
Prompt Access to Care
The most frequent positive or well integrated experience described by participants concerned prompt access to quality health care in our region. This included access to emergency treatment, as well as other primary and specialty care.
Access to Emergency Care
In many instances, participants found they could access emergency care quickly and were able to recover from hazardous health situations. These participants found that
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“Emergency care is terrific when you are really sick (heart attack) or injured badly. ”
“Taken to Emerg. Dept at [local] Hospital by ambulance. X-rays and transported by air to Thunder Bay Regional Health Sciences Centre and had surgery within 48 hours, and transported by air to [local] Hospital within 72 hours of surgery. Recovery at [local] Hospital was 7 weeks. Very satisfied with care at both Hospitals.”
“I had an allergic reaction and couldn't breathe. I went to the ER and was looked after immediately, I didn't have to wait 1 sec.”
Access to Other Primary Care
While many participants expressed difficulties accessing primary care, others described being able to see physicians, nurse practitioners and other providers in timeframes they considered reasonable and appropriate.
“I have been fortunate in that I have a doctor who sees me when I need him. ”
“I have no problems whatsoever getting an appointment with my nurse practitioner, and if she requires a consultation with the doctor she can get it in seconds. Now I can get the aid of a social worker if I need one or any other professional that I might require for my health. I have been provided with a health care passport, where I carry all my pertinent information. Improvements are happening.”
Quick Diagnosis and Treatment Involving Specialty Care
Participants described well integrated experiences with specialty care. In these cases, participants were able to receive diagnosis and treatment promptly after initial referral at the primary care level.
“From the time of a suspicious mammogram to a biopsy to a mastectomy was about 6 weeks. ”
“I attended a local clinic and I was immediately sent to the eye doctor and was able to start proper treatment for glaucoma and iritis. In the clinical setting using an integrated approach I was able to see the on-call doctor and a specialist within hours of each other. ”
“I did have a health problem and was sent for a test, which led to having another and another and another to follow up on the results of the previous test. This was all done in a very timely manner and there was a minimum wait of only 7-10 days between tests once the results were obtained, so that was very satisfactory.”
Patient-Friendly Follow-up and Scheduling
Participants’ stories indicated that effective integration involves follow-up on referrals and scheduling appointments in ways that are sensitive to people’s schedules and their
Share Your Story, Shape Your Care – Full Report 49 North West Local Health Integration Network geographic locations. Integrated scheduling is done to balance health professionals’ availability with times that work for patients, and appointments are also made to help people see the health professionals they need in a single visit to a major community or health facility.
Available for Appointments
Participants’ stories expressed appreciation for health professionals who took steps to ensure they were as accommodating as possible to schedule appointments with patients. They felt this was a key part of a patient-centered service.
“I was able to have appointments with both physicians (family doctor and specialist) at regular intervals.”
“I have a family physician who treats my spouse, children, and me. He organizes his practice so that we are always able to make appointments with him within a week of calling the clinic. When we go to see him, he is always able to meet with us on or near our appointment time; he is never over-booked. This means that we can almost always see a physician with whom we are familiar when we need (non-emergency) medical help. This encourages us to seek help for problems before they become severe, since we know that the process of seeking help won't be difficult and we will meet with someone we believe is genuinely concerned about our well-being. ”
Integrated Scheduling Experiences
Participants said that they had well integrated experiences when they could schedule appointments at times that respected their lives and schedules, and could see the appropriate health professionals during the same visit to the facility.
“After visiting a dentist I was informed I needed to have my wisdom teeth out. The dental office contacted an oral surgeon and arranged the appointment for me. I was easily able to book a time to have the teeth removed with the surgeon. The office was very helpful and provided plenty of information on my care as well as signs to watch out for. Follow up appointments where easily arranged.”
“The Neurology Day Program… is a well integrated service. Clients have access to a variety of professionals (e.g., PT, OT, speech language therapist, psychologist, therapeutic recreationist, social worker, and rehab. assistant). Upon discharge, a follow-up appointment is booked where the client is able to meet with the professionals who have been involved in their care, all on the same day. Family are also invited to attend, so they may ask their questions too. ”
Others described well integrated experiences when they could schedule flexible appointments if travelling longer distances. This allowed them to avoid missing important meetings due to factors outside their control, such as hazardous weather.
“I have been helping an individual go into a program in Thunder Bay. We have done a lot of travelling. People have been very helpful and supportive in Thunder Bay and doors are opening for this individual. I have found that workers are very understanding of the long drive and have given us flexible times.”
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Coordination Between Providers
Participants described experiences where greater coordination between health professionals had led to more integrated and better quality patient care. Many of these participants were providers who described working arrangements where different health professionals shared information about patients, discussed care or treatment approaches and, in some instances, cooperative case management.
“As a nurse practitioner working in an isolated region I depend on the ability to collaborate as necessary and attempt to bridge the health care services for patients. This works especially well when all the pieces are in place, willing team collaborators etc. Telehealth is a good example--I encouraged a specialist to utilize the telehealth services for a patient…instead of travelling several times for an appointment. The specialist used the service for the first time with this patient and was so impressed with the quality that he had a second follow-up. This is an example of how the system can work on a more patient-centred approach. ”
“At [my health facility], team meetings take place with social work, rec staff, nursing staff, doctors etc. Goals of care are looked at, and revised. This ensures the client is getting the care that is needed, and that there are objectives that staff can easily see when coming on shift. The next round for said client is scheduled at an interval fit for the type of concerns that were discussed. ”
“I am a health care professional and I find that Inter-professional collaboration is a strength in our community! As allied health professionals, we often discuss cases and give each other pertinent feedback! Access to professional development is sometimes limited therefore we must learn from each other.”
Team Approaches
In a theme closely related to collaboration between providers, participants regard team- based approaches to care as key tools for developing a more integrated and patient- centred health system.
“Family health teams work! We won't be able to necessarily see all the results for several years but they work if they are funded and supported. They work not only for patients but for the entire team...one person didn't cause our healthcare crisis and one person can't repair our healthcare crisis. It takes people working collaboratively together to really make a difference. ”
“I work with an interdisciplinary team where we all work together to assist patients in achieving improved functioning. Patients are able to access counselling, leisure life skills, dietary, occupational therapy, nursing, etc in both individual and group formats. ”
Open Communication with Patients
Participants’ stories indicate a strong belief that open communication is an integral part of a well integrated health system where care is patient-centred. Patients expressed thanks for providers who took time to answer all their questions, and do so in language they could understand. They also wanted to have honest answers to their questions, even when the response may indicate unfortunate news.
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“… She was impressed that the staff took her symptoms seriously and ran a variety of tests that took most of the day. They told her how long it would take to do the tests and why. The result was that she could go home assured that her heart was healthy. ”
Follow-Up Contact
Participants’ stories indicate that follow-up contact from a health professional or their office staff is an important component of an integrated health system experience.
People expressed significant fear of “falling through the cracks” or where they could not access the care they needed because they had not been contacted to schedule an appointment. Participants reported feeling reassured when follow-up was done following initial diagnosis, whether to schedule further assessments or to “check-in” to ensure they were recovering well.
“A patient came into our clinic to obtain a travel grant and complained she had heard nothing from a specialist outside our area. A complication had arisen during her last visit and she was to have surgery and then heard nothing. She attended another appointment with a different physician and still had heard nothing. One of our staff sent her in my direction and I was able to contact the different doctor’s offices and explain the situation and find out the direction the patient was heading. I was then able to explain the information to the patient giving some piece of mind. My position as a navigator affords many opportunities to get patients back on track or on a track if they feel they are in limbo!”
“My mother-in-law had excellent discharge planning by an interdisciplinary team from a chronic care facility - 1 hour with professionals - it would have been so wonderful if someone could have checked in on her and kept up the good work done in the planning. ”
Other Themes on Well-Integrated Experiences
Several other themes were contained in submissions, though were mentioned by fewer participants. These were:
Friendly “client service” from providers A caring attitude from staff A “can-do” approach by health professionals Benefits of navigation support
4.6.2 Stories about an “Uncoordinated” Experience
Participants submitted a wide range of stories about negative or uncoordinated experiences they had had with the health care system in Northwestern Ontario.
A number of common themes or threads emerged from participants’ submissions during the North West LHIN’s review and analysis. These are outlined in the following table.
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Theme Number of Mentions Lack of follow-up on referrals 30 Perceptions of uncaring treatment 27 Non patient-centred appointment scheduling 27 Poor communication between providers 20 People who have “fallen through the cracks” 20 Suspicion of incorrect diagnosis or treatment 18 Family physician shortage 18 Difficulty travelling within Northwestern Ontario 15 for care Long wait times for referrals 14 Problems simply navigating the system 13
Lack of Follow-Up on Referrals
The leading cause of perceptions of uncoordinated care among participants was a lack of follow-up on referrals that had been submitted.
After being referred for diagnosis or other treatment, participants reported that they had received little or no follow-up communication to schedule an appointment. Even in the event of serious conditions, participants reported a lack of follow-up for months or even years. This left them feeling alone, frustrated and as though they had “fallen through the cracks”.
While some decided to be proactive and call to verify the status, others did not know where to start in discovering the status of referrals.
“My father was very ill yrs ago. Nothing was found from the various tests completed in Thunder Bay, the doctor referred us to Toronto to put us on a wait list for a test that is not available in Thunder Bay. It is 2 years later and we have heard NOTHING! ”
“I regularly tell my patients who are waiting for an appointment with their specialist or for radiology to call the clinic and confirm that a referral was actually received. You would be surprised at how many referrals either don't get sent or are misplaced. I think that this is a result of a larger problem - overworked healthcare workers in an underserviced area. ”
“My mother, 84, went to a walk-in clinic and received a referral to a specialist. It's been over a year and she has heard nothing. She has to go back and sit and wait at the walk-in clinic, just to ask what is happening with the referral.”
Perceptions of Uncaring Treatment
A number of participants submitted stories in which they described negative experiences with the health care system that they felt were related to integration.
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In these stories, participants believed they had received uncaring treatment and that, in the specific experience, care had not been truly patient-centred. To address this perception, some participants suggested that health providers should take a little extra time to ensure patients do not feel rushed or ignored.
“My family doctor is too busy. When I need to see him I have to wait 6 weeks for an appointment. When I finally did get in to see him (with my baby) he was rude to me. I tried to ask him questions (about my newborn!!) and he ignored my questions and gave my infant his vaccinations. My baby started crying loudly and my doctor could not hear my questions and left the room. Then I started to cry because I was overwhelmed and needed some help. Every time I go to see him he is rude to me and my family. He completely ignores us when we ask him a question. ”
Non Patient-Centred Appointment Scheduling
Participants submitted stories in which they felt that the health care system had presented them with scheduling options for medical appointments that were either inconvenient or impossible for them to attend. Limited daytime hours can make it difficult for many to attend. Oversights in scheduling also left some people learning about their appointment times after the date had already passed.
While people realize that appointments may have to be cancelled to make room for urgent or emergency cases, they suggested that greater efforts be made to accommodate people driving long distances. If cancellation is done “at the last minute”, these people may only receive this news when they arrive, after a long drive.
“Discharge planners, utilization coordinators, social workers, dieticians etc work mostly Monday to Friday 8am to 3pm. It is very difficult to do anything outside these hours and since their hours are limited it often takes more than one day during the day time weekday hours for these people to consult and help coordinate care.”
“A senior travelled to Thunder Bay for a specialist consultation. His wife accompanied him, as he was not able to travel alone. The appointment was scheduled for 9am, so the couple travelled the evening before. The next morning the appointment was cancelled. The clinic had called the man's home, but of course, he was already in Thunder Bay. No one signed their travel grant, they had to wait another 3 months to see that specialist, and it caused a lot of stress with driving on winter roads.”
Coordination of appointments
Several participants also reported frustrating experiences when appointments for testing and assessment were not arranged with enough time in-between to allow the results of one appointment to be available for the next. This resulted in appointments of limited value, where insufficient information was available to enable the health provider to make their assessment or treatment decisions.
“I had a specialist appointment in Sault Ste Marie (a 5 hr drive for me), when I got to my appointment the specialist was upset that I hadn't had the blood work he had requested by sending a note to my family doctor. He was also upset that my family doctor had not sent the information about my past medical history he had requested. I had no idea as the local medical clinic had not informed me that I needed to have blood work done. In all, my trip to the Sault was
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pointless. I had to come back home, have the blood work done, get all the information from the clinic and go back. It was very frustrating as I had to take time off work and drive all that way! ”
Poor Communication Between Providers
A number of participants, both health providers and members of the general public, submitted stories in which integrated patient care had been adversely affected by sub- optimal communications between health professionals. They described scenarios in which patient information was not shared between providers, whether this was in the same health facility or through referrals.
This made it challenging for administrative staff to schedule appropriate referral appointments, for providers to access information about ongoing patient care, and for patients or family members to receive integrated care.
“Communication is critical- often referral requests are received with poor or no information that make it difficult to appropriately schedule.”
“I had to re-explain things to every doc and nurse that changed shift...stressful. ”
“I had to go for a surgery in Toronto. They scheduled me for pre-appointments beforehand. They were scheduled for the week before. I called and explained how far away we were. They then had to change all dates to fit appointments together. We had to reschedule flights and rooms. When we arrived they told us that an appointment had been cancelled and rescheduled for the following week. No phone call was ever made to tell us that it was cancelled. I know that this survey is about the North West but it would be nice if our doctors or nurses could work closer with the specialist that we are referred to. Also if they could work on setting up appointments instead of us waiting to hear from the specialist with the details. This would save a lot of headaches and frustration.”
“In the community working as a physiotherapist I have found it difficult at times to have good communication with the referring physician and difficulty accessing services for clients when needed. I have had clients who have been referred to several different health professionals at once for the same problem, with no organized follow-up, and no one managing their care. An integrated health team would definitely help this problem. ”
People Who Have “Fallen Through the Cracks”
Participants’ stories and ideas indicate significant apprehension about being in a situation in which they feel they left without options for care or means to contact an appropriate authority for information or news. The North West LHIN heard from people who felt as though they had “fallen through the cracks” of the health care system and were not receiving integrated care because they had no care advocate helping them through the system.
“Fourteen years ago I had a heart attack and [the hospital] provided me with little or no information. Thank goodness I had enough wherewithal to do my own research when I started to feel better and eventually got in touch with the necessary agencies that provided aftercare and
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education. I had fallen through the cracks at discharge. I hope that never happens to another patient - it was most disconcerting.”
“In order for my father to get a new wheelchair he needed a referral from an occupational therapist. The occupational therapist completed the necessary paperwork and forwarded to the appropriate agency… My father died without any word of a new chair. What happened in that year? Definitely felt like he fell through the cracks.”
Suspicion of Incorrect Diagnosis or Treatment
The North West LHIN received several stories about unfortunate patient experiences with the local health care system. People reported feeling as though they had received lower quality care and that errors had been committed in their diagnosis or treatment. In many of these instances, people did not feel that their health concerns or reported symptoms had been taken seriously, and that their care experience had not been patient-centred.
“I have been high risk for breast cancer for years, and because of this, am very diligent in getting mammograms, ultra sound, etc. I noticed a sizeable lump in my right breast went to the doctor and he arranged a mammogram. It showed nothing abnormal. A few months passed and the lump was growing. I went again to my doctor and he ordered an ultrasound. This also came back saying it was a cyst nothing serious to worry about. My doctor then referred me to [another health facility], where I had [many] biopsies. Within a week, I was told I had both in situ and invasive breast cancers. Why did the specialists (radiologists) here miss that??? I have since had a mastectomy and am awaiting chemotherapy. If my own doctor was not so vigilant, I might be dead before they would have found the cancer here. ”
Family Physician Shortage
Participants told the North West LHIN that they understand that increasing the number of family physicians in Northwestern Ontario is challenging, and most are comfortable with other options for accessing primary care, such as through nurse practitioners.
However, they did observe that difficulty accessing a family physician, whether through long wait times or the lack of a family physician altogether, led to poorly integrated care where patients were “bounced” around within the system trying to access treatment.
“I had to wait a week to get in to see a doctor, who wasn't my family doctor (I would have had to wait a month to see him) and was faced with retelling my story/medical issues to a doctor who didn't know who I was.”
Difficulty Travelling Within Northwestern Ontario for Care
While many participants understood that accessing care in Northwestern Ontario requires them to travel to health facilities, some suggested that greater efforts could be made to make various services or appointments more accessible for people travelling
Share Your Story, Shape Your Care – Full Report 56 North West Local Health Integration Network long distances. This was especially true for people who were trying to access ongoing, regular treatment at a facility that could be a long distance from home.
While a reality for many in Northwestern Ontario, participants suggested that difficulty travelling within the region led to less integrated health care.
“At 82 years of age it is difficult for me to travel to Thunder Bay (250 miles) for an extended period of time to participate in a Rheumatoid Arthritis program (exercise, therapy, etc). ”
“My mother has an appointment in Thunder Bay in the next week. She will be travelling by the Greyhound bus for this appointment. This would be a return trip, however she just found out that she has another very important appt. in Sault Ste Marie, which means that she is to remain on the Greyhound for an additional 6 hours to get to that appt. Hmmm...I'm just thinking that to reduce the amount of travel time from one city to another, why wouldn't there be both health professionals in just one city?”
Long Wait Times for Referrals
In their story submissions, many participants understood that shortages in health professionals meant waiting to access care in some instances. However, some reported long wait times after being referred for specialized care that they believed to be unacceptably long. Waiting six or 12 months without hearing from a specialist’s office, left participants with the feeling that they had “fallen through the cracks” and that their care had not been adequately integrated.
“My biggest complaint is the time it takes from the date of a referral to the date of your appointment with a specialist, I know it's because we don't have enough of them in our area, but I have had to wait over 12 months for several appointments. ”
“I went in to see my doctor regarding a persisting bladder infection. She referred me to a specialist. I went back to see her for a check-up and asked whether she had referred me to a specialist as I had not yet heard anything. It has been 9 months and I still have not yet heard back from my doctor’s office or the specialists office.”
“J'ai été référée à un spécialiste. Il était en vacances mais je ne le savais pas. J'attendais un téléphone. Rien n'arrivait. Je suis allée au bureau et la réceptionniste m'a expliqué la raison du délai. J'ai continué à attendre pour mon rendez-vous après son retour. J'ai enfin téléphoné et la réceptionniste m'a avisé que le spécialiste avait dit qu'il ne pouvait pas m'aider. ”
Problems Simply Navigating the System
Several participants commented that the health care system seems complex and hard to navigate, so that patients simply do not know where to go within the system to access the care they believe they need.
“I do not have a story but would like to say that there are several aspects of the overall system that are poorly marketed to those who may need the information. Many people do not know of
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services offered/rendered for years and do not have the people or processes in place to assist them along the way.”
Other Themes on Well-Integrated Experiences
Several other themes were contained in participants’ story submissions, though were mentioned less frequently. These were:
Poor wait time management Uncoordinated home care services Coordination problems “fragmented” mental health and addictions services Patient health records not shared between providers Workload and stress for health professionals Poorly integrated care outside the region Integration problems caused by walk-in clinics Wait times to access surgery, primary care and other types of care
4.6.3 Ideas for a More Integrated System
After sharing their stories about experiences with well coordinated and poorly coordinated care, participants had the opportunity to suggest their own ideas about how to create a more integrated health system in Northwestern Ontario.
A number of common themes or threads emerged from participants’ submissions during the North West LHIN’s review and analysis. These are outlined in the table below.
Theme Number of Mentions Improved electronic health records 30 Patient navigation support 20 More team approaches to care 14 More nurse practitioners 13 Transportation support 13 Better collaboration between providers 13 Coordinated appointment management 13 Better communication with patient 12 Integrated care for seniors 11
Improved Electronic Health Records
Among participants’ submissions, by far the most popular idea for creating a more integrated health care system was the development and use of electronic health records. While they want assurances around security of personal health information, participants,
Share Your Story, Shape Your Care – Full Report 58 North West Local Health Integration Network both providers and members of the general public, see electronic records as a key step towards strengthening our local health system.
“An electronic health record - saves time! Saves duplication! Saves resources! Improves patient centred care - just by being there!”
“Create an electronic medical document system, ensuring it is safe and secure. Require all medical personnel, social workers and any person having involvement with the patient to have taken an oath not to divulge named patient information.”
A participant called for the development of a common system to be used by health providers across Ontario, and with the ability for other provinces like Manitoba to access the information. They felt that if LHINs developed their own, it could lead to further coordination problems, especially for patients in Northwestern Ontario who may need to travel to other parts of the province to access care.
“We can only be a more integrated system if the system is provided by the MOH and all facilities use the same software.”
Another participant commented that electronic health records are already in operation, but noted that there is still a need to ensure the records are updated and shared effectively among providers.
“EMRs already exist. There needs to be more automatic sending of information and booking of appointments. While staff are entering data online, it doesn't appear that the information is being communicated well, or automatically triggering appointments/ending up on patient charts. ”
Patient Navigation Support
Another popular approach for strengthening integration was the suggestion for a case manager, coordinator or “navigator” that would stay in contact with patients to help them navigate the health care system and access the care they needed. These workers would help schedule appointments, arrange appointments on the same day for patients travelling in from out of community, follow-up on referrals and treatments and, in doing so, help patients feel that they had not “fallen through the cracks”.
“A coordinator, navigator or case manager is a truly useful idea. Having someone to help a client through the system, and having someone to call when there are snags makes sense in getting people the care that they need. The navigator should also be able to cross barriers. A mental health professional should be able to help a client get help for a physical issue, just as someone working with a client with chronic disease should be able to help them access counseling services or help for social issues.”
“I also feel that fully funded patient advocates that assist in coordinating the care of patients with many providers would be a very good use of resources.”
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More Team Approaches to Care
Participants expressed significant support for “teams” of health care professionals. They find it helpful to receive collaborative care from various providers who share ideas and respect each other’s training and advice. Participants also enjoyed the convenience of being able to see different professionals at the same time, especially when managing chronic diseases which required coordinated care.
“Health teams that do away with hierarchies, respect the advice of multiple disciplines, including health promoters, kinesiologists, nutritionists/coaches, counsellors and nurses will go a long way to solving our acute care and chronic needs.”
“Make sure that you have teams that include all aspects of health care from the recreation therapist to the doctor and have them all working consistently together. ”
More Nurse Practitioners
In their suggestions, participants expressed considerable support for allied health professionals and especially for nurse practitioners. They felt that nurse practitioners provide a solution to physician shortages and help ensure more integrated care by allowing patients to see a health professional regularly without long wait times. Some also suggested that nurse practitioners could help shorten wait times in emergency rooms by screening patients and providing primary care themselves to less complex cases.
“Use of nurse practitioners who can work directly with people who would otherwise wait to be seen by a doctor.”
“Have all patients (walk-ins/emergencies) screened by nurse practitioner first; only refer to doctor when/if necessary.”
Transportation Support
Because geography and transportation are a unique challenge for residents of Northwestern Ontario, participants suggested that support services to help people travel to and from their health appointments would strengthen “patient-centred” care.
Some called for transportation services for seniors, especially those living outside major communities in the region. Others suggested a broader level of support, to help people with the accommodation and living costs incurred while away from home for health care needs.
“Needs of transportation for out-of-community seniors.”
“There needs to be a transportation system to get patients to Winnipeg, the airport, etc. and less reliance on the ambulance service which is there to provide emergency care. ”
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“One area that is lacking is financial support for patients travelling for diagnosis or treatment from Northwestern Ontario. If a patient must travel to Thunder Bay for health care, there is no support to find lodging or transportation for the patient and family...For example, shuttles from hotel to hospital, discounted places to stay (residencies). In larger centres, there are residencies where families can stay for nominal rates ($14 per day). In our economic crises, families sometimes cannot afford to stay in hotels, eat out and cover the cost of transportation. ”
Coordinated Appointment Management
A number of participants suggested that scheduling appointments for patients would be more integrated and patient-centred if done by a central booking office. This would help patients and staff find times when patients could see several health providers in a single trip into an urban centre.
Other participants added that, if booked centrally, people would always know where to call to confirm the status of a referral.
“Central booking for visits to specialists with anticipated dates of community visits. ”
“Centralized coordinators for chronic disease management. ”
Better Collaboration Between Providers
Several participants suggested that collaborative or interprofessional care is an important part of providing integrated and patient-centred care. They felt that when various health professionals work together, share experience and expertise, they look at the “big picture” of a person’s health which strengthens health outcomes. It ensures that all health providers are aware of and involved in treatment decisions, ensuring that medications are well coordinated and complementary.
“I believe the single most important building block is to abolish the idea of working in silos and making people work collectively and collaboratively and making people accountable to this ideal. ”
Better Communication with Patients
In their submissions, a number of participants called for better communication with patients. They believed that a more open dialogue between patients and health providers would lead to higher quality and more integrated care. Patients, especially, wanted to feel that providers had listened to their reported symptoms without minimizing them or giving them inadequate attention.
“Have doctors truly listen to what you are saying about your health; after all you know your own body; tests can tell some things but you yourself can tell how you feel. ”
“I think that whenever a member of the public comes in touch with the health care system, they should be greeted with respect and honest curiosity about how we can help them get the services
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they need. I think that if the services provided at the site where the person has presented are not the services that fit, the person who has made the contact should find where those services are offered, make contact with the provider and ensure that it is the proper referral point, and give the information to the person.”
In one case, a participant described how her daughter was able to communicate more effectively and directly with health providers using information technology.
“My daughter recently moved to [the United States] and is under an HMO. She can log on to their site and get any info she wants. All test results are listed. She can email her doctors at any time. Her records show everything about her, when she has sought health care, and much more. It seems like a wonderful system. She can also make appointments on line. It would be nice to have that access. I sometimes call 4 or 5 times to my family doctor just to find out I need to wait 4 to 8 weeks for a regular appointment.”
Integrated Care for Seniors
Some participants felt strongly that seniors were in particular need of well integrated health services. They asserted that seniors often have chronic or complex health care needs, require treatment by a range of providers who need to share information about their various courses of action, and that seniors may not be able to advocate strongly on their own behalf in order to access care.
With a growing population of seniors, these participants encouraged the North West LHIN to take additional steps to create a more coordinated approach to seniors care through greater system integration.
“Trying to provide a one-stop shop for the elderly or ill patients to get information and care on their illnesses.”
“I would really like the LHINs to consider looking at the Regional Geriatric Program (RGP) structure for the North. We need to link things like older adult mental health in Thunder Bay to the great work that is being done in Fort Frances. We need to share resources, assessments, consultation and training with each other. By joining the RGP, our resources will become 10-fold with all of the Geriatric experts across Ontario contributing. It is a win-win situation for NOSM (in a geriatric sense..because all of the other medical schools are members) and it creates a truly integrated and coordinated system for geriatrics....I see it as maximizing resources, minimizing duplication and augmenting all the great things that are already being done. It's about time that we pull together all of these services, networks etc. and arrange them in a sensible way. It is a collaborative effort...one in which it is in everyone's best interest to see everyone succeed...a true example of inter-organizational collaboration.”
Other Ideas for a More Integrated System
Smaller numbers of additional participants described other ways of creating a more integrated system. These included:
Longer appointments and more time spent with patients
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Greater use of family health teams Recruiting more health professionals Less paperwork for providers Patient education about patients’ role in creating a more integrated system Emphasis on prevention and health promotion More telehealth
4.7 Evaluation
At the end of the Choicebook, participants had the opportunity to evaluate the tool and their experience. The results were positive and showed that participants enjoyed the experience and would consider doing another Choicebook in the future.
72% of participants agreed or strongly agreed that they enjoyed completing the Choicebook. Furthermore, 80% either agreed or strongly agreed that they would consider doing another Choicebook in the future.
The evaluation results also show that the Choicebook helped participants understand the difficult choices that the LHIN needs to make, and that after being part of the project they would follow the LHIN’s work more closely.
Evaluation (%) I Strongly Strongly Disagree Neither Agree Don’t Disagree Agree Know I enjoyed completing this 1.7 2.4 20.2 44.3 14.9 2.4 Choicebook Doing this Choicebook helped me understand the 2.6 4.4 18.9 52.2 19.4 2.6 “tough choices” the LHIN has to make about health care The facts in the Choicebook 1.5 2.0 5.3 62.4 27.8 1.1 were easy to understand Based on this experience, I would consider doing 3.8 9.0 9.0 56.1 24.3 3.8 another Choicebook in the future After being part of this project, I will follow the 1.5 2.6 16.8 53.9 21.0 4.2 LHIN’s work more closely
Participants could also submit comments on their experience. Many thanked the North West LHIN for listening to the community when making important decisions, and hoped they would be able to contribute again in the future. Others had suggestions for improvements in the process.
“Thank you for the opportunity to share my ideas!”
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“Thank you for your efforts to consult the community.”
“I follow the North West LHIN's community engagement efforts with great interest. You are to be commended for implementing such a streamlined tool to gather input from across your great geography. I look forward to hearing the results! They will spark many opportunities for research, I am sure.”
“Engaging your consumer is always the way to go. Congratulations on the "Share Your Story, Shape Your Care" Project!”
“I think the opportunity for the public to voice their opinions is fabulous and look forward to the results.”
“It made me realize that there are movements towards improvement and the ideas presented are great!”
“I have always followed the work of the LHINs and feel that this is a useful and informative service. I think it's wonderful that MOH patients are finally getting to give input into their own and their loved one's care. I hope that my concerns are not taken as personal, but are understood more globally in context. I want my healthcare dollars spent wisely, and on those at risk and in need. Thanks for allowing my input!”
“Good job! It's important to get feedback from the service providers who can easily identify problem areas and make suggestions for improvement. Thank you for asking us! ”
“Great opportunity to have my voice heard. Thank you and we all need to remember we as citizens are in this together...we all have a responsibility to use our health care services responsibly and wisely.”
“I attended a meeting when the LHIN was established. I watch items in the local paper. I think it is important to have a measure of local control in health care. All geographic areas have unique situations. One size - from the central government cannot possibly fit all. ”
Hope that Feedback Will Be Used
Several participants commented that they hoped the North West LHIN would give careful consideration to participants’ submissions and that they would “make a difference”.
“Hope my comments made a difference and the ideas will be considered. Thank you. ”
Constructive Suggestions for Improvement
A number of participants also suggested ways that the North West LHIN could improve the community engagement process if it were used in the future.
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Several suggested ways in which the questions in the Choicebook could be rephrased and the facts more closely aligned to support participant consideration of the issues.
Others commented that the Choicebook took longer than the expected 20-25 minutes to complete.
“You should have asked us to prioritize the different options so you would have an idea what we think is more or less important.”
“The Choicebook was well set up for understanding; well done on that point. It is an excellent tool for education of health issues as well as giving people an understanding of what LHIN's mandate. It did, however, take a great deal of time to complete which could be a deterrent. Sometimes the issues at hand are not as simple as choosing a level of agreement. Most people filling out this questionnaire may not be aware of what the implications of their choices may be. For each issue being considered, there are many factors that have strong implications… With that said, I ask that the responses are treated respectfully and used appropriately. All in all, it is a positive step to engage the public.”
“Enjoyed competing the survey, but unless I am slower than the normal responder, it takes longer than 20 minutes.”
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5. Stories and Ideas
Aside from the Choicebook, participants could submit their views to the North West LHIN using the Stories and Ideas tool. People could send their experiences and suggestions directly and decide to have them posted online for others to read, or only for review by the North West LHIN’s research team.
Participants submitted their stories or ideas in response to several categories or topics identified by the North West LHIN. These were:
I have a story about… 1. Problems finding or “accessing” healthcare – about me or someone I know. 2. What’s working well or a “success story” about providing better health care.
I have an idea about… 1. How to make Northwestern Ontario a healthier place. 2. How health professionals (e.g. nurses, physicians and others) can work better together. 3. How our local health system could be improved.
Through the tool, the North West LHIN received a wide range of moving personal stories and thoughtful ideas for strengthening our local health care system. Storybook
The North West LHIN will be releasing a “Storybook” to accompany this report. The Storybook contains all of the story and idea submissions that participants gave permission to be made public.
To access a copy of the Storybook, please visit http://www.northwestlhin.on.ca/myvoice Main Themes
While participants’ story or idea submissions addressed a broad range of topics about health care in Northwestern Ontario, several key common themes emerged.
Theme Number of Mentions Shortage of family physicians 18 Stories about high quality health care 14 Stories about lower quality health care 14 Concerns over patient/client service 11 End-of-life care 11 Mental health and addictions services 10
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Shortage of Family Physicians
The most frequent theme in story or idea submissions concerned the difficulty finding family physicians. People reported searching but being unable to find family physicians in the region who were accepting new patients. Consequently, many of these participants indicated that they either go to hospital emergency rooms to access primary care, or forgo seeing health professionals at all when the were experiencing minor or moderate symptoms.
Participants understood that Northwestern Ontario has a shortage of family physicians. Nonetheless, they encouraged the North West LHIN to work with other levels of government to find solutions this challenge.
“I have lived here all my life and cannot find a doctor.”
“We moved to [community] three-and-a-half years ago, and promptly registered with OHIP. We are still waiting for a physician.”
Stories About High Quality Health Care
Several participants shared stories about occasions when they received care that they felt was high quality and patient-centred. Most of these submissions involved shorter wait times, caring and friendly care from providers and good health outcomes.
Some examples of these stories are contained below. To read the Storybook containing all the shared stories received by the North West LHIN, visit http://www.northwestlhin.on.ca/myvoice.
“I must give a special credit to all of the wonderful nurses for all of their dedicated work. ”
“I now have a fantastic family doctor. He is on time; I don’t have to wait three hours in the waiting room. He answers my questions and does pre ops for his patients instead of sending them to walk in clinics. He also takes the time to come in and see his patients in the hospital!”
“I entered the ER where I was seen immediately and treated very well. Nurses and Doctors alike were courteous and helpful and I felt like I was their priority. The following morning the Orthopedic Surgeon, was called and I was immediately considered a priority and within 40 minutes of seeing him I was in the OR having surgery. The entire time I was well taken care of by everyone including nurses, doctors, rehabilitation therapists, and cleaning staff. I am happy to say I am on the mend and I feel my recovery is due to great emergency care and a thorough and professional surgeon. Keep it up!”
Stories About Lower Quality Health Care
Other participants shared stories about experiences with our local health care system that they felt were negative. These participants described occasions when they believed their care had not been integrated.
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“Health professionals need to listen to their patients; give them information or refer them to people who can provide the information they need to make informed decisions.”
Concerns Over Patient/Client Service
Several participants told stories about receiving care services that they thought was not truly patient-centred. They recognized that providers are busy, but encouraged health professionals to balance workload with patient care.
“I have lots of health concerns .I have tried to go and see my doctor and can never seem to get an appointment.”
End-of-Life Care
With an aging population, several participants encouraged the North West LHIN to place greater emphasis on end-of-life care. They believed that greater resources should be allocated for hospices and locations to care for patients in the final period of their lives.
“It is unacceptable that we, who are living in Northwestern Ontario, are without a residential hospice. In the Province of Ontario, LHIN 14 is the only one that does not boast of a residential hospice for its residents. Kinloch Manor Hospice, now under the leadership of St. Joseph’s Care Group, is a community facility for the dying that must be built and supported with the necessary funding to secure its on-going operations. Caring for the dying in this most desirable setting confirms the value and dignity we place on a life lived. By offering a residential setting, the dying, their family and friends can find some comfort in the remaining days. Too frequently, our care and conviction for the most vulnerable as life ebbs is challenged. Inevitably, we will all face death. My hope is that priority will be given to the building and adequate funding of a residential hospice for the day we personally will need it.”
Mental Health and Addictions Services
Some participants felt that mental health and addictions services could be improved. They suggested that more effective training for health professionals would be an effective way to improve service delivery in this area.
“Unfortunately her nursing care while in hospital was very inconsistent. Immediately after surgery nurses checked her regularly - vitals, drainage, sutures, etc. but few paid any attention to her mental state and clearly did not understand the needs or limitations of a person with dementia. ”
Other Story and Idea Themes
While they were mentioned by smaller numbers of participants, a series of other themes emerged from story and idea submissions:
Assisted living shortages Need for improvements in home care services
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Benefits of a healthy lifestyle Importance of a greater role for nurse practitioners Value of increased respite care for family members of patients
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6. Conversation Guide
The North West LHIN developed a Conversation Guide as part of Share Your Story, Shape Your Care. This tool adapted the Choicebook into a tool that small groups of participants could use to hold their own “focus groups” or conversations about health care priorities for our region. People were encouraged to use them for discussions with friends, family, co-workers or community groups. People Used Other Tools to Participate
The North West LHIN wanted to make sure people had a range of tools available to participate, so they could choose the one that worked best for them to send us their stories and ideas.
Despite initial interest in the Conversation Guide within communities, there was limited uptake on the tool.
However, the North West LHIN learned that small group discussions did happen as a result of the project. In these cases, participant groups chose to return their comments using the online or paper versions of the Choicebook, rather than through the Conversation Guide. This is illustrated in the following excerpt from a Choicebook submission.
“The members of the Black Bay Friendship Club (55+) are a group of older citizens who live in the Dorion area. At our February meeting, we generated a list of suggestions of ways to enhance health care for seniors in this region. Our ideas include…. ”
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7. Conclusion
Share Your Story, Shape Your Care generated valuable community input on ways to strengthen the health care system in Northwestern Ontario.
The North West LHIN would like to thank all participants for their stories, ideas and suggestions submitted during the project. We are continuing to accept completed paper Choicebooks and will add results gathered from these to our findings.
The North West LHIN will use this information to inform the development of its second Integrated Health Services Plan (IHSP), as well as ongoing allocation decisions. Share Your Story, Shape Your Care built on existing community engagement efforts and the North West LHIN looks forward to a continuing dialogue with communities about ways to strengthen the health care system in our region.
Again, thank you to all who participated and/or supported others to share their story!
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Appendix A: Participation by Community Thunder Bay City
Thunder Bay City Community Number of Participants Finmark Less than 5 Fort William 10 Fowler 0 Hymers 0 Kakabeka Falls 5 Lappe Less than 5 Murillo Less than 5 Neebing 5 Nolalu 0 Oliver Paipoonge 5 Pass Lake Less than 5 Rosslyn Lake 0 Shuniah 5 South Gillies Less than 5 Stanley Less than 5 Thunder Bay 284 Wild Goose Less than 5
Thunder Bay District
Rainy River District Community Number of Participants Allanwater Bridge 0 Armstrong 0 Aroland 0 Auden 0 Beardmore 0 Caramat Less than 5 Cloud Bay 0 Collins 0 Dorion Less than 5
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English River 0 Ferland 0 Geraldton 9 Geraldton East 0 Graham 0 Greenstone 0 Gull Bay Less than 5 Gull River 0 Heron Bay Less than 5 Hillsport 0 Hurkett 0 Jellicoe 0 Kashabowie 0 Lake Helen 0 Long Lake 0 Longlac Less than 5 Macdiarmid 0 Manitouwadge 7 Marathon 6 Nakina Less than 5 Nipigon 5 Osnaburgh 0 Pic Mobert North 0 Pic Mobert South 0 Pic River Less than 5 Red Rock Less than 5 Rocky Bay 0 Rossport Less than 5 Saganaga Lake 0 Savant Lake 0 Schreiber 7 Shabaqua Corners 0 Shebandowan 0
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South Bay 0 Suomi 0 Terrace Bay 8 Upsala 0
Rainy River District
Rainy River District Community Number of Participants Alberton Less than 5 Atikokan 29 Arbor-Vitae 0 Bergland 0 Black Hawk 0 Caliper Lake 0 Chapple 0 Couchiching 0 Dawson Less than 5 Devlin 5 Emo 7 Fort Frances 31 Gameland 0 Government Landing 0 La Vallee 0 Lake of the Woods 0 Mine Centre 0 Morley 0 Morson Less than 5 Northwest Bay 0 Pinewood 0 Rainy Lake 0 Rainy River 0 Sapawe Less than 5 Seine River Village 0 Sleeman 0 Stratton Less than 5
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Kenora District
Kenora District Community Number of Participants Balmertown Less than 5 Barwick Less than 5 Borups Corners Less than 5 Bearskin Lake 0 Cat Lake 0 Central Patricia 0 Clearwater Bay 0 Cochenour 0 Crow Lake 0 Deer Lake 0 Dinorwic Less than 5 Dryden 98 Dyment 0 Eabametoong/Fort Hope Less than 5 Eagle Lake Less than 5 Eagle River Less than 5 Ear Falls 5 English River 0 Eton-Rugby Less than 5 Fort Severn 0 Grassy Narrows 0 Hudson 0 Ignace Less than 5 Ingolf 0 Islington 0 Jaffray Melick Less than 5 Jones 0 Kasabonika Lake 0 Kee-Way-Win 0 Kejick 0 Kenora 31 Kingfisher Lake 0 Kitchenuhmaykoosib 0 Lac Seul Less than 5 Lansdowne House 0 MacDowell 0 Madsen 0 Machin 0 Malachi 0
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McKenzie Island 0 Migisi Sahgaigan 0 Minaki 0 Minnitaki Less than 5 Mishkeegogamang 0 Muskrat Dam Lake 0 Nestor Falls 0 North Spirit Lake 0 O'Brien’s Landing 0 Oxdrift Less than 5 Osnaburgh 0 Perrault Falls 0 Pickle Lake 0 Pikangikum 0 Poplar Hill 0 Red Lake 9 Redditt 0 Rushing River 0 Sabaskong Bay 0 Sachigo Lake 0 Sandy Lake 0 Shoal Lake 0 Silver Dollar 0 Sioux Lookout 19 Sioux Narrows-Nestor 0 Slate Falls 0 Starratt-Olsen 0 Summer Beaver 0 Vermilion Bay Less than 5 Wabigoon 0 Wapekeka 0 Weagamow Lake 87 0 Webequie 0 Werner Lake 0 Whitedog 0 Whitefish Bay 32A 0 Wunnumin Lake 0
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