Mississauga Halton LHIN Community Consultation Feedback February 2016

Mississauga Halton LHIN Community Consultation Feedback February 2016 Introduction On December 17, 2015 the ministry of Health and Long-Term Care (ministry) released a discussion paper entitled Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. The ministry requested input on their proposal and was looking to hear from providers, patients and caregivers from across the province. In support of the ministry’s desire to engage Ontarians, the Mississauga Halton Local Health Integration Network (LHIN) undertook a six week community consultation process to gather feedback on the Patients First proposal. The consultation strategy consisted of three key mechanisms: 1. Face to face consultations, organized across the geography of the LHIN with primary care physicians, health service providers, patients and caregivers 2. An on-line survey and invitation to residents, primary care providers and health service providers to provide their feedback on the questions noted within the ministry’s discussion paper 3. Promotion of the ministry’s feedback link for community input Over the past six weeks, 35 in person consultations were planned, organized and executed. The primary care physician community was reached through 14 separate consultations. Nine of these took place within the community, including one within each Health Link geography and two that were open to physicians from across the LHIN. The remaining five consultations included groups of physician leaders as well as hospital family medicine teams, solo practitioners and walk-in clinic owners. Representatives from the Ontario College of Family This report is a summary of Practioners (OCFP) and Ontario Medical Association (OMA) attended the feedback provided by 570 and participated in a number of the consultation sessions, and helped participants and does not advertise and encourage physician participation. imply endorsement from the Health service providers were engaged through a variety of meeting Mississauga Halton LHIN. The forums. A broad scale consultation with health service provider summary is broken down by governors was also conducted, soliciting input from close to 100 proposal and then again by the community leaders. Health service providers were also encouraged to questions posed within the share the survey links with their staff and patients/caregivers to invite ministry’s discussion paper. additional input from people providing and accessing care. Key themes that were voiced are noted in bold. Specific The broader public was reached in person at two community organized comments/quotes are noted events. Consultations were also conducted targeting specific in italics. A detailed populations within the LHIN, including the Indigenous, Francophone, breakdown of the consultation new immigrant/ethno cultural groups and patient/caregiver advisors. sessions, including a statistical summary is noted in the Following each consultation, participants were invited to provide Appendices. additional feedback via feedback surveys that were posted on the LHIN website. Three unique surveys were created targeting the public, primary care physicians and health service providers. Patients First Discussion Paper – Community Consultation Feedback: Mississauga Halton LHIN Page 2 of 44 PROPOSAL 1 – MORE EFFECTIVE INTEGRATION OF SERVICES & GREATER EQUITY How can you/your organization be better supported to provide integrated care? - Open dialogue with primary care and the LHIN and home and community care. There must be recognition that solo family physicians will need drivers to engage; their capacity to “integrate” as a team of one is very limited/counter-intuitive. Enhanced resources to support primary care would also help. Services need to be realigned around primary care – “Vertically integrate with primary care; we go to the primary care provider and provide our services there.” “Even at the Family Health Team we are still not resourced the way we would like to be.” “Please improve the communication and connections between primary health care providers, hospital, Community Care Access Centres (CCAC)/LHIN and the Service Provider organizations who will be providing the care in the community. Too often there seems to be a disconnect between hospital, primary care providers, CCAC and the service provider which ultimately delays service to the patient.” - Clear communication from top down - any details about newly implemented programs should be communicated effectively to all stakeholders - not just management level but everyone in each organization. Better communication between agencies. More accountability and clarity in roles for service provision. Have clear guidelines to move the patient from one service to another (i.e. hospital to home) to make this move at the right time when the patient is ready. Have clear, up-to-date guidelines about each organization’s expected role. Each staff member should be telling the same story about what patient’s should expect from each organization. Have a communication guideline or technology that helps ensure the patient’s care is looked after at each step, especially when changing service or moving to another organization. “We are currently doing the role of care coordination for many clients which increases workload and takes away from our ability to provide quality dementia counselling.” - Bring the privacy commission to the table. Before we can have communication that works for patient and provider we need to focus on finding solutions to privacy issues. It is a huge barrier. “We can’t see who has been calling Emergency Medical Services three times a month to make sure that we connect with them to provide services – must be ways to do this better.” Make information available to entire circle of care. - More integrated communications across the LHINs and service providers. Breakdowns in service, communication and accountability occur as patients cross LHIN boundaries. Open dialogue between all stakeholders to understand the barriers around funding. Tracking the way different initiatives intersect is important – to avoid duplication of services. Patients First Discussion Paper – Community Consultation Feedback: Mississauga Halton LHIN Page 3 of 44 - Technology has to be a solution to enable communication. Technology linkages – shared care planning without duplication. Use of existing open platforms to share information. Patient owned/driven and easily accessible. Leverage technology to support consistency between people at planning tables. Ensure the emergency room provides discharge instructions and medications or other treatments on the Hospital Report Manager form, as currently this information only comes on the handwritten report days to over one week later. Leveraging technology to view the patient's journey between sectors including primary care and lab. Access to specialists to support community providers through the Ontario Telemedicine Network for example. - A health card with everything on it that people carry with them; “if a driver’s licence has all your driving history and the police can access it with a swipe of the card, why can’t health cards be the same?” “Patients need a card with a pin that would be associated with all of their reports – you can put in your pin and get all the reports. I have to call around and consent becomes a barrier – if they had a simple pin that could provide access, that would be easier.” - Community Hubs: “I am most interested in this community hub model on a bigger scale – let’s take these places and collocate them so they are seamless.” “Have services a short staircase or hall walk away. This will make it easier to wrap services around the client. Geo-proximity of services will also help manage waitlists.” “The biggest barrier is that my patients can’t afford the services and they can’t get there. It would be nice to have a hub where everyone would go“. Create opportunities to collocate with other services to offer interdisciplinary care without the challenge of technology, carrying large amounts of resources, charts, signs, etc. and supporting the collecting of clinical interactions including care planning. Minimize the culture of competition for resources. - Formally acknowledging the role of pharmacists and their services within the LHINs through enabling collaborative sharing of information between all health care providers, enabling pharmacists (and all health care providers) to practice to their fullest scope of training, and to establish a fair and reasonable funding model (which is likely the barrier right now to integration of pharmacists into the LHIN structure). Allow pharmacies to work with the LHIN. Many opportunities are only open to the non-profit sector. We would encourage focusing on delivery, costs and accountability rather than the corporate structure of the provider. - Ensure sufficient resources exist (clinical) to meet growing demand in the region. Currently insufficient psychiatric resources available to community mental health services delaying access and timely discharge. Incentives need to be made to strengthen recruitment of psychiatrists to community based services. Improve access to crisis psychiatry care locally other than through an emergency room visit. Provide psychiatric nurse practitioners to community service providers. There are few programs and thus graduates in this specialty field - this needs to be Patients First Discussion Paper – Community Consultation Feedback: Mississauga Halton LHIN Page 4 of 44 expanded to enable dissemination

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