The following are highlights of the Champlain Local Health Integration Network (LHIN) Board of Directors meeting held in Ottawa on January 24, 2018.
The Ottawa Hospital Civic Campus Redevelopment Project: Stage 1 Proposal
The Ottawa Hospital is planning a major capital project to replace its aging Civic campus on a new site to meet health-care needs for the 21st century.
“The project before us is of huge scope,” Champlain LHIN Director of Health System Accountability Elizabeth Woodbury told the LHIN Board. “It is a plan for the replacement of the Civic hospital with a new state-of-the-art facility. This plan, which is unprecedented in the history of our LHIN, has implications far beyond the Civic site. There will be implications for other sites of The Ottawa Hospital, as well as the health care system in the Champlain LHIN region.”
Officials at The Ottawa Hospital have led a detailed exercise to plan for the new site. They developed a proposal outlining the distribution of health programs and services at the new campus, as well as for the hospital’s General and Riverside sites. Seven principles were followed in creating the proposal:
- Enhancing the patient and family experience
- Improving health, wellness, and recovery
- Promoting innovation and research
- Educating future world-class talent
- Integrating with the community
- Helping to sustain the environment
- Boosting the economic engine of the community.
The role of the LHIN Board was to consider whether The Ottawa Hospital’s plan for future health services and programs were consistent with local health system priorities. The LHIN Board does not have purview over the specific siting of the new hospital, or over its physical design.
The Ottawa Hospital’s Executive Vice-President and Chief Operating Officer, Cameron Love, provided to Board members a summary of what the new site will offer. For example, specialized rehabilitation services would be consolidated at the new campus, co-located with the associated disciplines of neurosciences, trauma and vascular care. In-patient mental health services would also be consolidated at the new campus, with a high-risk observation area in the General’s emergency room for use by all specialties, including mental health.
|Cameron Love presents to the LHIN Board
Both the new campus and the General site would offer more single rooms to allow for patient privacy and to improve infection control. A number of other programs and services would be consolidated at the General campus, such as cancer care, lung care, and eye care. Services supporting emergency rooms would be offered at both inpatient campuses.
Mr. Love explained that the planners took into account the evolving nature of health care, particularly with respect to changing technologies and service-delivery models.
“We have had a lot of discussion about what we are doing today, and what we will look like in ten years, for every single service,” he said.
The LHIN Board endorsed The Ottawa Hospital’s submission, recognizing that it follows priorities outlined in the Champlain LHIN’s Integrated Health Service Plan 2016-19. It also aligns with the current and intended role of The Ottawa Hospital in the health system, and demonstrates the hospital’s commitment to working with its partners to co-create the health system of the future.
The proposal will now be shared with the Ministry of Health and Long-Term Care for further review.
Champlain LHIN Board Chair Jean-Pierre Boisclair thanked staff members of The Ottawa Hospital for their hard work on this critical initiative. “We know there is still a long journey ahead for you, and for us. We are delighted to be taken to the next stage.”
Pathways to Appropriate Levels of Care: Hospital Occupancy Pressures
Champlain LHIN CEO Chantale LeClerc and Vice President of Integration Cal Martell spoke to LHIN Board members about some of the most important challenges facing the regional health system today. The two focused on hospital occupancy and the transition of patients within the health system from one level of care to another.
Three hospitals in the Champlain region—The Ottawa Hospital, Queensway Carleton Hospital, and Cornwall Community Hospital—regularly struggle with high patient occupancy, which results in lengthy emergency-room stays for patients before they can be admitted. On the other hand, other hospitals in the Champlain region often have empty beds. On average, hospital occupancy at Champlain acute-care hospitals is 94 per cent. The Champlain region has 147 acute hospital beds per 100,000 people, higher than the provincial average of 122 per 100,000 people.
“The question is, are we using the beds appropriately?” Ms. LeClerc asked. She then emphasized the importance of improving the transfer of patients from specialized hospitals to hospitals closer to patients’ homes.
“Because of the big geography of the Champlain LHIN, we have certain specialty services concentrated in a smaller number of hospitals, so there is an influx of people from smaller towns who go to their local hospital to get stabilized and then need to be transferred to a larger hospital such as The Ottawa Hospital,” she explained. “Once their care is done, they need to get back to their referring hospital so we can free up more specialized beds for someone who needs that level of care. In this region, we are getting people back to their referring hospital within 48 hours, 60 per cent of the time. There is a great opportunity to repatriate people much more quickly, which would free up beds in hospitals with high occupancies, allowing someone in the emergency room to be admitted faster.”
Board members discussed ways in which these patient repatriations could occur more effectively across the health system. Such work is imperative, given recent data. In fact, the rate of hospital patients in the Champlain region waiting to be discharged to other levels of care (known as Alternate Level of Care or ALC patients) had decreased dramatically from 2010 to 2015, but unfortunately has worsened during the past couple of years.
Ms. LeClerc therefore proposed a re-invigoration of the Home First approach, which emphasizes discharging people from hospital back to their homes with supports in place as a primary goal, rather than automatically placing individuals on a long-term care home wait list. She also spoke of the Champlain LHIN’s sub-acute care strategy, which is adding more resources for rehabilitation services.
In addition, Ms. LeClerc provided information about activities the Champlain LHIN has supported and implemented with its partners to improve patient transitions and quality of care. They include strategies such as falls prevention programs to prevent emergency room visits, assisted living services to keep seniors healthy at home, and an expansion of community-based programs so people with complex health conditions (such as acquired brain injuries) can leave hospital sooner. In addition, she mentioned internal hospital performance improvements like cleaning rooms more efficiently after patients are discharged so that new patients can be admitted to beds more quickly.
“We have been doing a lot over the years to try to tackle this,” Ms. LeClerc concluded. “There is not one solution to fix this problem. We have to tackle it on multiple fronts at the same time.”
The LHIN Board passed a resolution to focus efforts on hospital discharge planning, including hiring a seasoned health professional to support patient flow among hospitals.
Quarterly Performance Report
The Champlain LHIN produces a report each quarter focusing on the 13 indicators the Ministry of Health and Long-Term Care uses to hold the LHIN accountable for the performance of the overall health system. These indicators reflect the effectiveness of the regional health system in the areas of health and wellness, quality and sustainability of care, system access and integration, and home and community care.
The report for the second quarter of 2017-18 (July to Sept 2017) showed that on average, the Champlain health system was 82 per cent of the way toward meeting its overall targets.
Allison Lampi, Champlain LHIN Senior Performance Specialist, said that the Champlain region has performed well in three key areas: lowering wait times for joint replacement surgeries, preventing hospital readmissions for chronic conditions, and decreasing the rate of repeat emergency room visits for people with mental health and substance use conditions.
|Senior Performance Specialist, Allison Lampi
Due to increased LHIN investments, more people than before received home-care services, a positive development. However, the rate of missed home-care appointments has climbed, an issue the LHIN is working to resolve with its contracted home-care providers. A provincial shortage of Personal Support Workers (PSWs) has contributed to this challenge.
Particularly problematic were length of stays in emergency rooms, both for complex and uncomplicated patients. Board members deemed these waits “unacceptable.” To help solve this issue, the LHIN put in place a number of measures to improve the flow of patients within and among hospitals (please see above for more details). The LHIN has also funded initiatives to prevent unnecessary hospital admissions, such as community paramedic programs.
Lastly, the LHIN Board received a report on corporate performance for the third quarter of 2017-18 (Oct to Dec 2017). The Champlain LHIN is tracking 53 initiatives aligned to the priorities in its Integrated Health Service Plan and its role in implementing the Patients First Act, 2016. Of the 53 initiatives, all except 3 are on track.
Health Service Provider Service Accountability Agreements: 2018-19 Local Obligations
Accountability agreements define the obligations and responsibilities of the LHIN and its funded health service providers. An agreement must be in place before the LHIN can distribute funding to a health service provider.
The LHIN Board heard an update on the 2018-19 agreements with hospitals, community health centres, long-term care homes, community support agencies and mental health and addictions agencies.
Each LHIN adds obligations and indicators to these agreements that specifically address local priorities and challenges. In Champlain, these local indicators and obligations support five themes, which are:
- Improving care for the most complex patients
- Fostering the improved flow of patients through various levels of care in the health system
- Advancing system transformation to provide the right care at the right time, and in the right place
- Providing culturally appropriate care
- Increasing the value and sustainability of the regional health system.
Next steps include completing consultations with health service providers, finalizing the wording of each local obligation, and then executing the 2018-19 service accountability agreements.
The LHIN Board supported the proposed Champlain LHIN-specific obligations, agreeing that they reflected the LHIN’s transformation mandate, strategic priorities, and performance metrics. Board Directors encouraged LHIN staff to increasingly pursue performance indicators that measure patient outcomes.
Health Service Provider List
Service Accountability Agreements