The following are the highlights of the Champlain Local Health Integration Network Board of Directors meeting held in Ottawa, Ontario on November 28, 2018.
Champlain LHIN CEO, Chantale LeClerc, provided an update to LHIN Board members on the following:
- The LHIN and its partners have launched a tele-home monitoring pilot project for people with Chronic Obstructive Pulmonary Disease (COPD). The project leverages the University of Ottawa Heart Institute’s tele-home monitoring system, which is already in place for cardiac patients. The Ottawa Hospital’s respirology unit and COPD outreach team are also participating in the new program. The aim is to deliver more care at home and decrease the number of repeat emergency-room visits.
- To reduce wait times, The Ottawa Hospital is conducting additional surgeries for patients requiring spinal implants. The funding for these procedures comes from unspent dollars in other areas of orthopedic care in the region. This redistribution of funds is a good example of how the LHIN and its regional orthopedic-program partners are working together to better address the needs of patients and families.
- The LHIN reconvened its regional surge working group to plan for the influenza season. The group includes health-system planners, home-care staff, and paramedics, as well as representatives of community health providers, long-term care homes, hospitals and public-health units. Members of the group work together to boost public education and ensure sufficient health-system capacity during a time when patient demand increases.
- The province-wide eNotification program automatically alerts the LHIN’s home-care team, as well as primary care physicians registered with OntarioMD, when their patients visit an emergency room, are admitted to hospital, and are discharged from hospital. The Champlain LHIN has played a key role in the implementation of this digital health program, which improves continuity of care and quality of care for patients.
The intent of this cutting-edge program is to support a well-run health system that’s built to last. To date, 11 Champlain hospitals have joined the program. They are Arnprior Regional Health, Bruyère Continuing Care, Carleton Place & District Memorial Hospital, Cornwall Community Hospital, Glengarry Memorial Hospital, Kemptville District Hospital, Hôpital Montfort, Pembroke Regional Hospital, Queensway Carleton Hospital, Renfrew Victoria Hospital, and St. Francis Memorial Hospital in Barry’s Bay. (In 2019, four more hospitals - Hawkesbury General Hospital, The Ottawa Hospital, University of Ottawa Heart Institute, and Winchester District Memorial Hospital—are also expected to participate).
Patient Storytelling and Regional Hospice Palliative Care – Progress, Challenges and Directions
This month, the LHIN Board began a new initiative welcoming patient storytellers to its meetings. Storytellers will now be an integral part of every monthly Board meeting, and will speak about topics aligned to LHIN strategies and activities. The objective for Board members is to better understand directly from patients how they experience the health services in our region, in order for the LHIN to make more informed, person-centred decisions.
| Janet Dunbrack
Janet Dunbrack, introduced as the Board’s first patient storyteller, discussed her experiences with hospice palliative services and gave advice on how the health system could be made better for patients.
A retired health policy consultant who is now a cancer patient, Ms. Dunbrack is past chair of Hospice Care Ottawa now serves on the Board of Directors of Carefor.
As a patient, Ms. Dunbrack said she has generally received excellent care, and noted two possibilities for improvements in health care services.
First, she said there is a need for cancer-care navigators, which are available in Nova Scotia, Alberta, Newfoundland and parts of Quebec. In those jurisdictions, each newly-diagnosed cancer patient is assigned a nurse navigator acting as a case manager to help them access the right services in a timely manner. She noted that patients and families often identify navigating the health care system as a major source of stress that consumes a great deal of their time.
Second, she proposed a hands-on training program for family caregivers focused on practical skills, such as basic infection control, changing a bed with a person in it, moving a person from their bed to a chair, sponge bathing, and toileting.
She explained that currently, there are many psycho-social and peer supports for family caregivers and disease-specific information, but “what is lacking is hands-on training for basic home-care skills. I think there’s a demand that’s not being met. We have an aging population and an emphasis in the health care system on devolving care to the community. If we’re going to ask family caregivers to take on an increasing role, we need to give them some basic skills. This would lessen caregiver stress, possibly reduce injury and ER visits, and allow caregivers to create social networks with others in the training sessions, which would help reduce the social isolation often experienced by caregivers.”
Ms. Dunbrack also emphasized the value of advance care planning. “I’m a great believer in preparing for things now. Don’t wait until a crisis hits,” she advises.
To provide a complete picture of hospice palliative care in the region, Nathalie Gilbert (Champlain LHIN Director) and Nadine Valk (Executive Director of the Champlain Hospice Palliative Care Program) made presentations to the LHIN Board.
The Champlain Hospice Palliative Care Program, which is organized and funded by the LHIN, brings together experts to plan and coordinate services, measure performance, and educate health professionals and the public.
“The Champlain LHIN took a leadership role in 2010 to create a regional hospice palliative program,” Ms. Gilbert said. “In fact, it was the first such program in the province, and has remained a leader ever since.”
Hospice palliative care services continue to evolve in the Champlain region, and are becoming increasingly integrated into the overall health system. Many different types of these services are offered across the region. For example, the Champlain LHIN, as part of its role in delivering home care, provides bilingual palliative services region-wide in people’s homes, with an annual budget of roughly $21 million.
In addition, the LHIN funds other organizations to serve clients in this area of health care.
- For instance, in the region, there are 62 residential hospice beds in 8 locations, a regional palliative consultation team of 11 nurses and nurse practitioners, a 31-bed sub-acute palliative care unit at Bruyère Continuing Care, and 9 community agencies with visiting volunteers and bereavement services.
- The LHIN has supported the development and operations of the Inàdizowin End-of-Life Journey Project at Algonquins of Pikwàkanagàn First Nation, an innovative program created to meet the physical, mental and emotional needs of clients.
- New services are now available. They include 3 new hospice beds in Pembroke in partnership with the agency Marianhill and 10 new hospice beds in Ottawa delivered by Hospice Care Ottawa.
- A new perinatal palliative program at Roger Neilson House in Ottawa is the first of its kind in Canada. “This is for families who have a pregnancy, are anticipating that the child is either going to be stillborn or will not live very long after birth,” Ms. Valk said. “It puts supports in for the family right away, so that they can create memories, have a palliative approach to care, and have some choice into how they manage that family situation.”
Despite recent expansions of hospice palliative services across Champlain, a number of challenges are now being addressed by the LHIN and its regional program. These barriers are:
- Most people don’t know how or where to find the services they need.
- Caregiver support, respite care, grief and bereavement services are not always readily available.
- Rural, Francophone and vulnerable populations face additional barriers to accessing care because of their location, language or life circumstances.
- Transitions in care between different provider organizations are sometimes poorly coordinated.
- Not everyone who can benefit from a palliative approach to care receives it. For example, people may not be identified early enough, especially if they have a non-malignant disease.
- Aging, death and loss are universal, normal and inevitable, yet many people (including service providers) avoid having conversations about advance care planning, palliative care, goals of care, and treatment choice.
Future LHIN plans include expanding residential hospice care in Hawkesbury and in Orléans (a suburb in eastern Ottawa); additional acute-care palliative beds at The Ottawa Hospital; the development of a better process for patients to access services (e.g. through a central referral system); and incorporating more tele-palliative care into services using videoconferencing.
Ms. Valk thanked Ms. Dunbrack for her suggestions, adding that providing hands-on, skills training for family caregivers was an excellent idea that would be seriously considered and actioned.
Lastly, Champlain LHIN Board Chair Jean-Pierre Boisclair acknowledged the presenters’ insights on hospice palliative care. “This has been a very worthwhile discussion,” he said. “I can’t express enough our appreciation for your generosity of spirit in coming here today and sharing what you have shared. It will not be forgotten.”
The Champlain LHIN is embarking on a new approach to build a more patient-engaged culture within the organization. This means prioritizing the needs of patients in all aspects of our work such as personal care and health decisions, program design, and development of strategies and policies. A patient-engaged culture will permeate the entire LHIN agency, including front-line staff, other staff, management and Board members.
Patrice Connolly (Champlain LHIN Vice President of Human Resources and Organizational Development) provided details about the new approach. She said a number of positive results are expected from a patient-engaged culture. These include greater collaboration between patients and providers when making decisions about personal health care; increased patient satisfaction; better health outcomes; and higher LHIN-employee engagement.
“If you place patients at the table, it definitely changes the conversation,” Ms. Connolly said.
The LHIN’s Patient and Family Advisory Committee will continue to play a key role in the roll-out of this important initiative to further our organizational culture.
As examples, in early 2019, patients will become involved in the hiring of LHIN staff, and caregivers will help design programs for people with dementia and those receiving home care.