to Cen tral LH IN Stak eholder Equity t · Muscat for providing ASL Interpretation Services; and...

Toron

Consu

May 20

nto Cen

ultation

011

ntral LH

n Repor

IN Stak

rt

keholdeer Equity

P a g e | 2

Table of Contents

Introduction

Summary of the Equity Consultation........................................................................................................ 3

Results of the Consultation Discussion Groups by Theme

Theme # 1. Data collection of equity socio‐demographics, research and health equity indicators....... 4

Theme # 2. Interpretation and translation services...................................................................................5

Theme # 3. Providing care to non‐insured clients.....................................................................................7

Theme # 4. Organizational accountability............................................................................................... 10

Theme # 5. Health Equity Impact Assessment (HEIA).............................................................................11

Other themes............................................................................................................................................. 12

Appendices

Health Equity Indicator Development Approach Survey Results.......................................................... 13

Participant Evaluation Feedback Survey Results.................................................................................... 14

Toronto Central LHIN Equity Activity Backgrounder............................................................................31

Acknowledgements: Marylin Kanee and Suhail Rafiq at Mt. Sinai Hospital for hosting the consultation and providing logistical support; Heather O’Shea and Cindy Muscat for providing ASL Interpretation Services; and Camille Orridge, Janine Hopkins, Vanessa Ambtman, Cynthia Damba, Tharcisse Ntakibirora, Susana Hsu and Anthony Mohamed at the Toronto Central LHIN for organizing, presenting and contributing to the success of this entire event.

P a g e | 3

Non-insured Clients

21

Interpretation & Translation

26

Health Equity Impact

Assessment4

Organizational Accountability

17

Data collection & Indictors

33

Equity Consultation Summary

This pie chart is based on the number of

‘votes’ recorded in the dotmocracy

exercise for each theme in their order of

priority. Participants indicated that the

top three health equity priorities should

be data collection and indicators,

interpretation and translation and

access for non‐insured clients.

On May 5, 2011, a consultation was held at Mt. Sinai Hospital with 44 representatives of various

health networks, health service providers and key community health partners. The purpose was for

a variety of groups to provide expert advice to the LHIN regarding a focused set of priorities for

action on health equity in the next one to three years.

The following report is a summary of all the feedback received.

The agenda included a presentation by the Toronto Central LHIN CEO, Camille Orridge, on the

current strategic directions highlighting specific considerations on health equity. A pre‐circulated

briefing note provided a thorough overview of recent equity activities led or influenced by the

Toronto Central LHIN. Participants were asked to discuss pre‐identified themes and related

activities; identify new themes and initiatives for consideration by the LHIN; complete a survey on a

proposed approach to developing health equity indicators; and prioritize equity themes and

initiatives through a ‘dotmocracy’ exercise.

Dotmocracy is a commonly used tool where participants are provided with a specific number of

sticker dots, in this case three green dots, and asked to identify their priorities. Participants may use

all three dots on one theme or split them based on their own personal preferences. Similarly,

participants were provided with six red dots to place beside some proposed activities under each

theme. They were asked to use their red dots to identify whether the Toronto Central LHIN should

play a driver, influencer or other role (specifying the role). All following comments in this report

have been captured directly as provided under each health equity theme. Please note that

additional themes identified by participants have been incorporated into these five thematic areas

as appropriate.

In addition to the Discussion Paper, the LHIN has maintained on‐going equity based dialogue with

a wide variety of health networks, including the Noojimawin Health Authority, the Francophone

Planning Entity, and the Intersectoral Equity Roundtable, in collaboration with the Centre for

Research on Inner City Health, LHIN Sector Tables, a CEO Equity Advisory Group, the Inter‐

Network Collaborating Group, Greater Toronto – Community Health Centres (GT‐CHC) and the

Hospital Collaborative on Vulnerable and Marginalized Populations.

P a g e | 4

Theme # 1: Data collection of equity socio‐demographics, research

and health equity indicators (33 votes)

What is happening now? Tri‐Hospital Data Collection Pilot Project – 9 or 10 variables at Mt. Sinai

Hospital (MSH), Centre for Addiction and Mental Health (CAMH), St. Michael’s Hospital (SMH) and Toronto Public Health (TPH)

TPH is adopting Tri‐Hospital Project tool

CAMH is collecting variables in Emergency Department Pilot using the Toronto District School Board (TDSB) tool

IOM’s recommended language screening

ICES/CRICH study in ED at UHN

Bridgepoint Study – hour long interview with patients

“RAT”

Language questions already at various hospitals

Midwives – but data is collected inconsistently

TDSB Data (student census, languages, ethnicity, academic achievement)

Community Care Access Centre (CCAC) – Discharge planning equity related data

Long form census has no comparative data

Gender Identity collected at Planned Parenthood and Sherbourne Health Centre

Transpulse study – research with Rainbow Health Ontario “Envisioning Global LGBT Rights”

CRICH Health Equity Indicators Study

Lots going on but not always useful

What is data collection for? – to better access pop needs and to better serve patients

Equity data must be collected

One indicator should be specific to “disabled”; another to “LGBT”

CIHI data with links to CERIS

TPH Healthy Communities Data

Who else should be involved?

The Tri‐Hospital Pilot Project partners are the best place to start right now

Health administrators, IT professionals and decision support staff

Other Recommendations

No new projects with equity measures in place

Slice every quality initiative with equity

Gather socio‐demographic information with OHIP process – can add data when renewing card

Does this data collection tool include patients who use ASL (American Sign Language) and/or interpreters?

Social assistance rates, readmission rates, who is on waiting lists could be variables to collect

All health providers should have to complete a staff census in addition to collecting patient data

a) Collecting equity socio‐demographic variables by all HSPs in order to apply an equity lens to current health outcome indicators. These can be part of a larger

demographic survey of patients

at intake and be recorded directly

in the Electronic Medical Record

as proposed by the Tri‐Hospital

Data Collection Pilot Project.

b) At least one equity indicator to be measured by all HSPs and at least one sector‐specific indicator (Hospitals/CHCs/ Community Based HSPs). These should be based on what most HSPs are currently collecting. Suggestions mentioned: Diabetes

Demographic Outcomes Survey,

number of requests for

interpretation, which languages

are being requested and how each

request was met.

Re‐admission rates; indicators

specific to children and seniors.

34 red dots indicate the

TC LHIN should drive (lead)

these activities

4 red dots indicate the TC

LHIN should influence

(support) these activities

0 red dots indicate the TC LHIN

should play a different role

P a g e | 5

Theme #2: Interpretation and translation services (26 votes)

What is happening now?

Sick Kids (SK) Report Oct. 2010 (sponsored by the LHIN) – recommends a centralized model of interpretation: one host organization to serve all LHIN‐funded organizations using a hybrid model of face to face, phone and video

SK also received $7M in one time funding from CIC for cultural competency training and building capacity within the system

SK Project was not what organizations were looking for as it did not address money to help with interpretation and was not linked to health outcomes

TPH and hospitals use language line; Mt. Sinai Hospital ‐ LSA

Woodgreen Community Services language mapping exercise; working with grassroots senior organizations

Currently disorganized, inefficient, internal vs. external, access for smaller organizations is less

Negative health impact due to lack of quality interpretation

Toronto Rehabilitation Institute (TRI) incorporated central interpretation services with roster of freelance interpreters

Health based allocation models don’t take variable patients into account

Challenge is finding affordable and quality interpretation

No assessment of volunteer interpretation quality

It’s not just about language, also cultural interpretation

Community agencies cannot afford interpretation – this is noted as the largest barrier to care

Only a handful of agencies offer a handful of interpretation and translation services

Some hospital language and cultural interpreter services are funded internally such as CAMH, University Health Network, St. Michael’s and Mt. Sinai, others are not

Most community settings, including Sistering, look for multilingual staff and volunteers – can sometimes call for a paid interpreter if absolutely necessary

For deaf clients, the biggest issue is the quality of interpretation – recommend AVLIC

Ontario Rainbow Alliance for the Deaf provides training for LGBT community groups

Overlapping system navigation, cultural brokering is distinct but gets lumped into language and interpretation

Literacy issues within healthcare system – Mt. Sinai is offering ESL (English as a Second Language) courses to assist

Virtual nursing (MSH) and other clinician services was highly rated

c) Increasing the efficiency and quality of interpretation and translation services across the LHIN through shared services model among LHIN‐funded HSPs.


LHIN should drive (lead)

these activities





LHIN should play a different

role

P a g e | 6


City of Toronto should provide a “City Line” in multiple languages for use by all agencies

Public education systems

Newcomer and Immigrant Services Springtide (women who have experienced trauma) Courts and Police (some concerns raised by deaf communities) Silent

Voice

Bob Rumble Centre for the Deaf

George Brown College Internship

LHIN can set/negotiate rates for Interpretation Services and provide bulk funding

Look to Calgary and Winnipeg for funding and practice models

Access Alliance and TPH can facilitate some training to (Health Service Providers) HSP’s

National Cultural Competency Centre


City should have all general information

Need funding and incentive structures that align with equity

Regional Health Authority should run language services so they are coordinated and efficient

Need for skilled medically certified signers

LHIN advocate for regulation of standardized rates

Costs are not optimized as contracts are negotiated independently

Need a central pool of interpreters

A checklist or assessment of the quality of interpretation should be given to patients

How quality of information interpreted matched with what doctors are saying?

LHIN could fund research with Access Alliance about the cost of not interpreting or translating and measure ED visit returns and medical errors

Merge with AODA (Access for Ontarians with Disabilities Act) services – voice over capability

RFP (Request for Proposals) from the LHIN for a consortium to develop one cost, one deal

Apply interpretation to agency accreditation

LHIN should develop minimum standards for interpretation (i.e. not relying on family or friends)

Advocate for funding for language services such as systems in Calgary and Winnipeg (this recommendations received 8 red dots indicating the LHIN should lead this, 4 dots indicating the LHIN should support this and no dots for the LHIN to play a different role)

P a g e | 7

Theme #3: Providing care to non‐insured clients (21 votes)


Research at York University, Seneca and Women’s College Hospital (WCH) Uninsured Network (Michaela Hynie; Soheila Pashang)

WCH Uninsured Network – Promoting access but too much focus on OHIP

Hospital Collaborative working to name the issue; hospitals with reputations of providing this care get bulk of patients; trying to get common standards and agreements

Community Health Centre (CHC) Uninsured Funding through the LHIN, specific to select services only; this only serves 5% of population, not all uninsured

Sick Kids Research on non‐insured children, pregnant women

Some negative attitudes within health sector towards uninsured clients – results in clear discrimination, disrespect and lack of access

Informal and formal partnerships – some tension around formalizing issue

TPH, Midwives, Scarborough Clinic and some hospitals provide services to this population: Areas appear to be working well, even without OHIP administrative barriers – relies on goodwill and volunteer physician services – physicians have no incentives

Initiatives to remove the 3‐month waiting period (RNAO – Registered Nurses Association of Ontario, OMA – Ontario Medical Association and Toronto Board of Health)

Some talk of coordinating CHC funding envelope

Some hospitals are being asked for financial data through a TC LHIN survey – currently being analyzed

A lack of specialized services for undocumented newcomers (including LGBT)

Inner City Health Program at St. Mike’s will support people for care for uninsured but it is due to goodwill as it is not funded to provide this service

MHA (Mental Health & Addictions) assessments covered in hospitals; private assessments are very costly

Children are often used as interpreters – not appropriate for health environments

Having money leads to unequal health outcomes – some can get drugs while others cannot

Coordination of funding cap’s across CHC’s (Community Health Centres)

Inner City Health Model – put physicians on salary then people will not need to be insured

Downtown hospitals tend to be more responsive to need

Dr. Vicky Stergiopolous at St. Michael’s Hospital was funded to go into shelter system to provide services, including uninsured

CAMH SharedCare in Hospitals

d) Increasing consistency of care across LHIN for individuals who are non‐insured or undocumented.


LHIN should drive (lead)

these activities





LHIN should play a different

role

P a g e | 8

What is happening now? (continued)

The climate at the City of Toronto is that people are worried about “medical tourism” and feel that providing services to undocumented clients is against the law. They need to understand why this makes sense from a cost and business perspective, not just a social one. Sick Kids is currently capturing some costs but we need to start talking about how Canadian children are being impacted. This is the lever.

Ideology of who is deserving of care and who is not has prevailed; not in line with Excellent Care for All

Equity is often dismissed as only about “customer service” not actually having better health outcomes

CCAC Inner City Access Pilot with 3 Shelters – tracking ED visits – may drive cost benefit data

Out of the Cold Program

Wellesley Health Bus

Hassle Free Clinic

Dr. Walker’s research on ALC (Alternate Level of Care) patients

Very difficult to determine what type of non‐insured patient at intake


Schools

Look at European countries who provide Emergency care; Quebec and other provinces

WSIB

Charities and Churches

Settlement Services

Researchers can help to provide cost benefit analysis

Ontario Association of Midwives

Ethno‐specific groups

Health for All

Shelters

No One Is Illegal

Right to Healthcare Coalition

Toronto Oral Health Coalition

Organized labour

Faith groups


Need tools to measure and define who is non‐insured

Need to ensure CHC funds are appropriately utilized

LHIN must play a role in eliminating the 3‐month waiting period

LHIN can encourage primary health care teams to use their resources to support undocumented/uninsured

LHIN advocate for diabetes, women and a federal health plan to cover uninsured

P a g e | 9

Other Recommendations (continued) Primary health care providers to capture data related to

undocumented/uninsured to identify priorities

Should define uninsured/undocumented specific to a lack of OHIP

Agencies should have a compassionate care model that earmarks a % of funding resources to this population

Have an in‐depth analysis of health records to identify non‐insured clients seen and outcomes

Clearly communicate who uninsured are and why they are here

LHIN can be a central clearing house for all data on a user‐friendly website

Uninsured services must consider outside of physician care (i.e. drugs, physio, psychology, dentistry, etc.)

P a g e | 10

Theme #4: Organizational accountability (17 votes)

What is happening now? Equity within Quality Improvement Plans

Hospital Health Equity Plans

Community Advisory Panels keep agencies aware and responsive of needs

CAMH – aligning all programs using HEIA – Health Equity Impact Assessment; holds health equity meeting regularly; has a gender and linguistic strategy; involved in Tri‐Hospital Data project

CHC’s are currently doing an equity plan together

The equity plan process was grassroots and the LHIN took our advice – we should encourage this process, including what the LHIN should be looking for in the plans

Equity is stated as part of the TPH mission


Hospitals

CHC’s

Community partner agencies for specific populations served and not served (for example, Aboriginal people)


Management accountabilities vary – make it high in the organization and tie to incentives and pay

Enable bottom up as well as top down support for HE

More prevention and health promotion needed – backed by incentives

TC LHIN must require each HSP to account for resources and responsibilities for equity

TC LHIN and partners create forums and infrastructure to share, build upon innovations

Next phase of Hospital Health Equity Plans should focus on identifying a few priority equity initiatives and then held accountable for their completion – can be done as a sector collectively or each hospital

Cultural validity of prevention programs has never been tested. Presume the interventions are useful but we don’t know. This is a key to partnership with researchers

Meaningful participation of clients in organizational decision making (i.e. Community Advisories)

Look at health as a human rights issue

Boards should reflect communities that they serve

LHIN should be a model of equity for HSP’s (Health Service Providers)

Equity must be a consideration when cutting costs and programs

Clients of the system, not just their organizations, should be part of the decision making process

I need clarity on the LHIN’s role and capacity in the system

Influence FHT’s (Family Health Teams) to target access to Primary Care populations who are especially marginalized (i.e. LGBTQ, homeless, refugee, people with disabilities, etc.)

e) Equity is stated as a formal dimension of each Health Service Provider’s (HSP) Quality Improvement Plans under Excellent Care for All.



these activities


TC LHIN should influence




f) Expand HSP health equity plan process to other sectors (Hospital/CHC/Other).



these activities


TC LHIN should influence




P a g e | 11

Theme #5: Health Equity Impact Assessment (HEIA) (4 votes)


CAMH tested HEIA in a program and the tool will be used more broadly, including training with senior staff delivered in collaboration with the TC LHIN

Only 4 people in my group have seen this tool; not easy to get from Ministry website

It is a good tool

United Way using a different tool; Ontario Health Protection and Promotion has another tool

There are plans to further advertise the tool; LHIN wants to raise awareness and apply to funding applications

Woodgreen uses HEIA and attached to funding; has limitations – not so useful at getting at who is being reached

TPH uses other planning tools but may consider HEIA

Mt. Sinai has rolled it out in some areas

All hospitals piloted it as part of the 2010 Health Equity Plan refresh

CAMH uses HEAI for program planning; communicating result of pilot

How you use it affects the outcome, based on knowledge, willingness to be thorough

Helps you to identify what can be done if there are gaps in your project


Community partnerships should be involved as well

Inter‐sectoral group should be established to advise LHIN on equity

The tool needs leadership and support from agency executives


HEIA need to be applied to an entire organization and not just the clinician/patient relationship

Need incentives to use tool (funding, accreditation rating)

g) Define what Health Equity leadership looks like, including adding clarity to the current profession and career ladder. Currently, a common factor among

practitioners is a connection to

community engagement. The role

should provide equity leadership

internally and be reflective of the

organization’s commitment to

applying equity throughout the

organization, sector and community


should drive (lead) these

activities


should influence (support) these

activities



h) Advancing use of a standard Health Equity Impact Assessment tool among HSPs and the LHIN.


should drive (lead) these

activities


should influence (support)

these activities



Other

(not in

• Does

could

seeki

• Can t

comm

Toron

• LHIN

of kno

(e.g.,

r them

nclude

the LHIN

d refer m

ng infor

he Equit

munity?

nto did.

role in s

owledge

central

mes, co

ed else

N have a

members

mation?

ty Round

Reach o

supporti

e and sta

place fo

ommen

ewher

a contact

s of the R

?

dtable in

out to OA

ng know

andards

or data a

nts an

re)

t person

Rainbow

nclude m

AD and O

wledge ex

and cha

nd infor

d ques

n, fluent

w Alliance

members

ORAD, si

xchange

ange beh

rmation

stions

in ASL to

e of the

s of the D

milar to

e to supp

haviours

on equit

s

o whom

Deaf

Deaf

o what Pr

port upta

ty initiat

P a g e | 12

m I

ride

ake

tives)

2

P a g e | 13

TC LHIN Structures

Steering Committees

Advisory Committees

Task Groups

Working Groups

TC LHIN

Indicator

Task Group*

Sector Tables

Community Health Centres

Community Support Services

Hospitals

Long-Term Care

Community Care Access Centre

Community Mental Health and Addictions

Health Equity Indicator Development Approach

Survey Results

In addition to the feedback received from the small and large group

discussions and the dotmocracy exercise, participants were asked for input on

the following proposed approach to select health equity indicators. The results

of the completed surveys are below. Please note that all comments are direct

quotes.

This approach would include:

A time limited TC LHIN Indicator Task Group to develop and lead the

indicator selection process

Seek input through current TC LHIN structures (e.g. TC LHIN

Community Engagement Task Group; Mental Health and Addictions

Steering Committee; Health Professionals Advisory Committee, etc.)

Deliberate about proposed indicators through current sector tables

comprised of CEOs and Executive Directors for all LHIN‐funded sectors

Identify and apply an equity lens to 1-2 health outcome quality indicators

P a g e | 14

Agreement on Proposed Task Group for Data Collection & Indicators

0

2

4

6

8

10

12

14

16

18

20

Agree Disagree

Survey Results:

Do you think that this is the right approach to select indicators to measure health equity?

19 agreed

1 disagreed

0 had no opinion

Please explain why you Agree or Disagree:

Strategic but ensure marginalized group and users have a say and voice in decision making

There are a limited number of people at this meeting but maybe it is robust enough of a sample to select HE priorities for the LHIN

One direction of a quality strategy must be equity driven and tied to performance measurement and management

Add this to Excellent Care for All Act (ECFAA) implementation guidelines for all agencies.

The longer we deliberate on what is the perfect indicator, the less time we have to start collecting the data. We just need to get going.

Broaden the engagement to ensure the indicators selected are representative of different parts of the community

Impossible to know the impact of activities/programs/initiatives without the data: show the ROI

Difficult to convince some leaders of importance with data to support

I would just add that it might be helpful to expand the list of sector tables a bit. By bringing in a few additional sectors more distant from health services, you might develop an approach that is transferable to other sectors. You could consider even the private sector – for example, banks are subject to some equity requirements, and some have a strong interest in social infrastructure. You could consider funders like United Way of Greater Toronto or a collaborative like Civic Action that are also interested in measurement, evaluation and impact.

Validates that health is a basic human right (WHO declaration) and it needs to be wide spread in policy making levels in the health care sector. Also across sectors the message needs to be conveyed.

Alignment of HSO’s (Health Service Organizations) to support LHIN equity agenda

Accountability

Foundation for an equity “continuous improvement” process

This is a good place to start

In theory I agree. I need to know what the Quality Indicators are to determine if this approach is helpful. Example – mortality rates, readmission rates, etc. of variables of the SDOH’s (Social Determinants of Health) compared to white, middle‐class, English speaking, straight patients

P a g e | 15

Move process along quickly – we must not spend more time on research in order to decide next steps

Great to embed equity indicators in the quality agenda, but don’t stop there – we need discrete equity system indicators

This appears to be a thorough process that has a small group select the indicators and have them discussed as the various existing structures of the TC LHIN. There is enough opportunity for further feedback.

Sort of. It may be too little information to be useful. It also doesn’t allow hospitals to respond to community desires/needs to be counted. But it’s better than nothing.

Good only if the following is true: Must include accountability to clients/patients of health care system so, for example, TC LHIN consumer/survivor initiative network and client advisory group (blanking on the name!) should be involved.

What socio‐demographic variables should be considered for collection?

Variables mentioned by more than one participant:

Socio‐economic status (10) Preferred language of service, language needs or access to translation (8) Homelessness or Housing status (5) Sexual orientation (5) Disability (4) Gender identity ‐ includes transgender/transsexual (3) Ethnicity (3) Race (2)

Other variables mentioned and comments for consideration:

Do you have health insurance? – dentist, prescriptions, eye care

Have you experienced barriers, discrimination, bad treatment, put downs because of your ethnicity, identity or personal characteristics?

People with disabilities are marginalized in health care planning – need to be emphasized, not just seniors or the aged.

Years in Canada

Questions from the Tri‐Hospital Data Collection Project

Clarify fundamental principles of data collection through all sector tables – all institutions should collect the same equity data consistently from the start;

All quality improvement indicators must be in line with equity objectives

Have you been deaf since birth?

Do you use ASL (American Sign Language) or LSQ (la langue des signes québécoise)?

Country of birth (we can build from there)

I would choose variables known to be important both in terms of health income and in terms of outcomes outside of health – again the issue is potential transferability, creating leadership that transcends health services.

Immigration status (undocumented)

Mental disability – one of the greatest loss to social economy and also overarches many sectors

Access to health care

Access to trauma informed counseling

Base it on evidence of most critical “explanatory” socio‐demographic variables in health outcomes

May 5, SURVEY

1. The me

Strongly

Agree

Neutral

Disagree

Strongly

2011 Equi PAGE 1

eeting has m

y Agree

e

y Disagree

ty Stakeho

met its stated

older Discu

d objectives

ussion ‐ Pa

s.

articipant E

Res

Pe

13.3%

80.0%

6.7%

0.0%

0.0%

Evaluation

sponse

ercent

%

%

%

%

%

n:

Respons

Count

2

12

1

0

0

P a g e | 16

se

t

6

2. The me

Strongly

Agree

Neutral

Disagree

Strongly

3. The ph

eeting was w

y Agree

e

y Disagree

hysical envir

well‐organiz

ronment for

zed, started

r the meetin

on time and

ng was appro

d ran on sch

R

opriate.

edule.

Response

Percent

53.3%

33.3%

6.7%

6.7%

0.0%

R

P a g e | 17

esponse

Count

8

5

1

1

0

7

Strongly

Agree

Neutral

Disagree

Strongly

y Agree

e

y Disagree

Respon

Percen

33.3

60.0

6.7

0.0

0.0

nse

nt

3%

0%

7%

0%

0%

Response

Count

5

9

1

0

0

P a g e | 18

e

5

9

1

0

0

8

SURVEY

1. There w

assistanc

Strongly

Agree

Neutral

Disagree

Strongly

PAGE 2

were no bar

ce, access to

y Agree

e

y Disagree

riers for par

o premises, c

rticipants wi

communicat

ith our meet

tion aids).

ting (e.g., ca

Response

Percent

50.0%

28.6%

14.3%

7.1%

0.0%

are of depen

%

%

%

%

%

ndants, gene

Respon

Count

7

4

2

1

0

P a g e | 19

eral

se

t

9

P a g e | 20

2. The methods used in the meeting were appropriate (e.g., style of speaking, overheads, small

group discussions, etc.).

Response

Percent

Response

Count

Strongly Agree 60.0% 9

Agree 40.0% 6

Neutral 0.0% 0

Disagree 0.0% 0

Strongly Disagree 0.0% 0

P a g e | 21

3. Participants had adequate time to review pre‐circulated documents prior to the meeting.

Response

Percent

Response

Count


Agree 40.0% 6

Neutral 13.3% 2

Disagree 6.7% 1


P a g e | 22

SURVEY PAGE 3

1. I was provided an opportunity during the meeting to present my point of view.

Response

Percent

Response

Count


Agree 20.0% 3

Neutral 6.7% 1

Disagree 0.0% 0


P a g e | 23

SURVEY PAGE 4

1. I felt respected during the meeting.

Response

Percent

Response

Count


Agree 20.0% 3

Neutral 0.0% 0

Disagree 0.0% 0


P a g e | 24

2. I have learned from others during the meeting.

Response

Percent

Response

Count


Agree 26.7% 4

Neutral 0.0% 0

Disagree 0.0% 0


P a g e | 25

3. We identified and discussed opportunities for achieving change with the current system.

Response

Percent

Response

Count


Agree 46.7% 7

Neutral 20.0% 3

Disagree 0.0% 0


SU

1.

Excellen

Good

Average

Needs W

Poor

Commen

Ten

URVEY PAG

Toronto Ce

nt

Work

nts:

The new direcnvironment.

GE 5: TOPIC

entral LHIN

ctions make . Glad to see

Strategic Di

much more how woven

irection Pre

sense in a co in.

sented by C

Res

Pe

omplex

amille Orrid

sponse

ercent

78.6%

21.4%

0.0%

0.0%

0.0%

dge

Re

C

P a g e | 26

esponse

Count

11

3

0

0

0

1

6

2. Equity

Excellen

Good

Fair

Needs W

Poor

Commen

A

Wuto

y Workplan G

nt

Work

nts:

A bit of confu

We probably nclear aboutopics, etc. Bu

Group Work

usion about h

needed mort whether weut I think we

k Facilitated

how much ti

re time to dise should be pe accomplish

d by Anthony

ime we had.

scuss things posting our nhed a great de

y Mohamed

and were a l notes, discuseal in the tim

and Janine

Respons

Percent

42.9%

57.1%

0.0%

0.0%

0.0%

little ssing all me we had!

Hopkins

se

t

R

P a g e | 27

Response

Count

6

8

0

0

0

2

7

3. Partici

Excellen

Good

Fair

Needs W

Poor

Commen

se

ipatory Activ

nt

Work

nts:

ee above

vities Dotmoocracy and Q Quality Indi

icator Survey

Resp

Per

y

ponse

rcent

28.6%

42.9%

14.3%

14.3%

0.0%

R

P a g e | 28

Response

Count

4

6

2

2

0

1

8

4. Next S

Excellen

Good

Fair

Needs W

Poor

Commen

N

teps Presen

nt

Work

nts:

Nothing subs

nted by Janin

tantive

ne Hopkins

RResponse

Percent

25.0%

50.0%

25.0%

0.0%

0.0%

%

%

%

%

%

P a g e | 29

Response

Count

3

6

3

0

0

1

9

P a g e | 30

5. Do you have any other comments/ suggestions or questions?

I would like to suggest the involvement of labour organizations if this hasn't been done yet. Although the LHIN may not have direct impact on labour, the work of the LHIN has impact on labour since the health care work force is part of implementation. Perhaps this is an area that at the very least can be explored under the "influence" strategy.

The e‐mail request for this survey went into my Junk Mail folder. Perhaps others have had that problem? Very high quality attendees ‐ well‐selected. But not sure if we moved the discussion forward. Would like to hear a more substantive summary of the next steps/emergent wisdom from the day. Thanks for the invite. Equity is key.

Attend to sustainability: I expect all participants are committed to the work, but require some nurturing and support to carry the message and momentum back to their home organizations.

Would love to receive a summary of what the LHIN took from this meeting!

Looking forward to working in partnership with the LHIN

The instructions were a bit confusing in terms of discussing the items and reporting back

I am looking forward to the LHIN's leadership role in initiatives regarding interpretation services.

P a g e | 31

Advancing Health Equity in Toronto: Priority Setting for the

Toronto Central LHIN Health Equity Strategy

Backgrounder – Health Equity in the Toronto Central LHIN The following backgrounder highlights health equity initiatives and progress in the Toronto Central (TC) Local Health Integration Network (LHIN). In order for everyone to have a common understanding of the work to date as well as the opportunities for future action, it is important that participants read this note and the other materials in advance. This note does not capture all of the equity activities in the LHIN area, but rather highlights system-level or TC LHIN-led activities. Health equity is a core value and health system goal that has been advanced by the TC LHIN Board and leadership team since the LHIN’s early days. A growing body of evidence shows that disadvantaged and marginalized people have the greatest health care needs, poorer access to services and the worst health outcomes. The only way to achieve a healthier community and a sustainable health care system for all is by addressing disparities in access to needed health care services. Incorporating Equity into Heath System Planning TC LHIN’s 3-year health system plan – the Integrated Health Services Plan (IHSP-2) – launched in 2010 incorporates health equity within the priority initiatives: reducing ER wait times and ALC, mental health and addictions (MHA), diabetes, and value and affordability. A key feature of IHSP-2 initiatives is that they are designed to reduce care gaps encountered by specific populations, including people with mental health and addictions issues; people who are or are at risk of becoming homeless; the frail elderly; and other hard-to-place and marginalized individuals. The LHIN’s updated Strategic Plan puts health equity at the forefront as one of three TC LHIN priorities for achieving Excellent Care for All across the health care system: Quality, Equity and System Capacity. TC LHIN’s CEO will present the LHIN’s Strategic Plan at the May 5, 2011 session. The Excellent Care for All Act 2010 is the most important current initiative to advance health quality for all across the system. This year, the Act applies to hospitals and will be extended to other sectors in the coming years. Hospitals worked with their communities to develop a patient declaration of values which will be posted publicly in June 2011, and are submitting their first Quality Improvement Plans. The TC LHIN was one of the first LHINs to partner with the Ministry of Health and Long-Term Care to pilot a Health Equity Impact Assessment (HEIA) tool. This tool helps ensure that decisions and planning consider impacts on different populations. The LHIN required that all funded Aging at Home proposals complete a HEIA and is also using the tool for other system planning initiatives. The TC LHIN required hospitals to use the HEIA in the development of their 2010 Health Equity Plans. In addition, the LHIN has been supporting awareness and adoption of the tool through initiatives such as a workshop at the 2010 Healthy Connections conference and a web seminar for HSPs.

P a g e | 32

Understanding Health Equity The ability to measure health disparities for different populations and establish meaningful metrics to demonstrate improvement must be a cornerstone of the LHIN’s health equity strategy. There is a variety of initiatives either being planned or underway to provide an evidence base for health equity. While the relationship between disparities, health outcomes and health system sustainability is well established, there are many unanswered questions which are critical to resolving health inequities. The following summarizes some key equity data and indicator initiatives in the LHIN. The 2008 TC LHIN Equity Discussion Paper, prepared by the Wellesley Institute, provided a blueprint for translating equity strategy into practical actions in the TC LHIN. The TC LHIN asked 18 hospitals to develop Hospital Health Equity Plans in 2009 to identify gaps and priorities for action to address health equity. These plans were updated in 2010 (see 2009 full report and Executive Summary at www.torontocentrallhin.on.ca and summary of aggregate 2010 plans attached). The Hospital Collaborative on Vulnerable and Marginalized Populations led the implementation of this initiative. Community Health Centres (CHCs) are also undertaking Health Equity Planning, with the first sector plans slated for summer 2011. The TC LHIN Service Capacity Overview Project helped confirm current system capacity for community MHA in the LHIN. The following priority populations were identified: 1. People Who Are Homeless; 2. Seniors; 3. Immigrants and Refugees; 4. Children and Youth; and 5. Aboriginal People This report led to a Homeless Think Tank which brought together health agencies, hospitals, City of Toronto and other stakeholders to develop strategies to assist homeless people with mental illness and addictions. Initiatives from this think tank are improving the circumstances for some homeless people. For example, the Coordinated Access to Care for the Homeless (CATCH) program provides coordinators who work with family doctors, psychiatrists, nurses and others to meet the needs of homeless people struggling with mental health issues and addictions. Resource Matching and Referral (RM&R) - Toronto hospitals long-term care homes and home care services in the LHIN use one automated system to match patients to the services that best meet their needs. The next expansion of the system will see community support services and mental health and addictions agencies using RM&R for their referrals. With RM&R, we can better help people who face barriers. The system shows who is waiting and who is being denied access. The LHIN and health service providers can use this information to close the gaps and challenge inequitable admissions policies. RM&R is now being implemented across the province. The TC LHIN’s Mental Health and Addictions decision support working group made recommendations for improving MHA data as well as performance and systemic monitoring indicators for adoption by the sector. The LHIN has funded a community-based research project entitled “Lemme tell you how it works: A consumer/survivor and user-led gap analysis of mental health and addiction services in the Toronto Central LHIN” whereby peers ask consumers to describe their experiences, how they access services and the kinds of supports and services they need. This research will help shape how MHA services are planned and evaluated in 2011/12. In April 2011, the LHIN asked selected hospitals to complete a Non-Insured Hospital Fees Survey. This was done to gain a better understanding of the variations in processes among hospitals for CHC-referred, non-insured clients. At the hospital sector

P a g e | 33

table, CEOs recommended tasking a cross-sectoral working group to make recommendations regarding standardizing processes, billing practices, etc. for non-insured clients referred by CHCs. TC LHIN’s Quality Indicator Working Group (composed of members of the LHIN’s Health Professional Advisory Committee, Health Quality Ontario and other stakeholders) conducted an analysis of existing quality indicators that the TC LHIN could consider adopting across the health care system. The multidisciplinary group also looked at equity dimensions of these quality indicators. There are a number of additional efforts across Ontario and the LHIN that inform the work of the TC LHIN including but not limited to: The POWER Study (Project for an Ontario Women's Health Evidence-Based Report), a multi-year

project funded by Echo: Improving Women’s Health in Ontario is producing a comprehensive set of evidence-based indicators

Tri-Hospital + One (Toronto Public Health) Equity Data Collection Project MAGIC Equity Data Collection Group Toronto Community Health Profiles City of Toronto’s Wellbeing Toronto Index

Addressing Barriers through TC LHIN’s priority initiatives The priorities of the LHIN’s IHSP-2 and enhanced Strategic Plan are designed to close gaps and reduce disparities in care for specific populations. Here are some examples: Aging at Home and other alternate level of care (ALC) reduction strategies – By design, Aging at Home and other complementary efforts to improve patient/client transitions and address ALC are targeted to some of the most high-needs and disadvantaged populations. Key Aging at Home initiatives such as Home First and House Calls (a mobile geriatric outreach team) enable frail seniors to live with greater independence at home or in the community. The Integrated Client Care Project (ICCP) for Seniors with Complex Needs links together a range of services for seniors with complex needs, helping them to transition to the best place of care. Specifically, ICCP links integration initiatives across the continuum such as Virtual Ward (provides short-term, transitional care to high-risk, complex patients right after they are discharged from hospital), Toronto Community Addictions Team (coordinates access to a range of services for people with addictions who are frequent users of emergency departments) and Home First and House Calls Funded through Aging at Home and led by the Toronto Central CCAC in partnership with TC LHIN hospitals, the long-stay ALC initiative is designed to prevent patients from becoming long-stay ALC, and to remove barriers and transition current hard-to-place individuals to the right place of care. Three multi-sector teams are addressing the needs of ventilator dependent individuals; people with mental health and addictions challenges; and clients in rehab and complex continuing care who have been in hospital for more than 40 days. The Senior Friendly Hospital strategy enhances the health and wellbeing of seniors and reduces their risk of functional decline while in hospital. This TC LHIN initiative is being rolled out province-wide.

P a g e | 34

The fire at 200 Wellesley exposed the reality that vulnerable populations living in Toronto’s high-rise communities are not getting access to the services they need. The Community Care Access Centre, City of Toronto and other agencies provide important health services within the building, but they have not been well-coordinated until now. The LHIN brought together the CCAC and the City to develop a plan for coordinating services and better addressing the needs of residents. They are building on the 200 Wellesley plan and working with Toronto Public Health, the United Way are others to create a community health care model for all of St. Jamestown. This model can be tailored for other buildings in high-density neighbourhoods. Diabetes The TC LHIN’s Diabetes Strategy Steering Committee developed a diabetes model of care that led to the expansion of diabetes education teams in high-needs neighbourhoods. The LHIN invested in three diabetes screening and outreach teams for at-risk ethnocultural populations: South Asian (South Asian Diabetes Prevention Program at Flemington CHC), Aboriginal (Anishnawbe Health Toronto) and Caribbean (Live Free - Unison Health and Community Services). Mental Health and Addictions Toronto Community Addictions Team (TCAT) coordinates access to a range of services for people struggling with addictions so that they have a better chance at recovery. Hospitals, community agencies, and the City work as a team to get people into housing and treatment programs. There has been a 74 per cent reduction in ER visits (Q2 2010/11) for clients who use ERs the most. The Coordinated Access to Supportive Housing project (CASH) helps mental health and addictions clients get connected to supportive housing in the city. All 28 supportive housing agencies in the LHIN have one wait list and one system to help clients access housing options tailored to their needs. The LHIN is funding the first-ever supportive housing units for people with problematic substance use. Mental health and addictions agencies across the LHIN are using one common assessment tool designed by consumers. This tool allows clients to tell their story and prioritize their needs and treatments. It is being used by 50 per cent of local agencies for a range of services including case management and supportive housing. Homeless Think Tank in 2010. The LHIN brought together health agencies, hospitals, the City and other stakeholders across Toronto to develop strategies to assist homeless people with mental illness and addictions. Initiatives from this think tank are improving the circumstances for some homeless people, including the Coordinated Access to Care for the Homeless (CATCH) program. A second homelessness think tank for seniors with mental health and addictions was held in April 2011. In 2010, the LHIN tasked the Hospital for Sick Children to lead a working group in developing a proposal for a Centralized Interpretation Model – Improving Health Equity Through Language Access. Developed in cooperation with a wide variety of groups, this is one of the areas being considered as a LHIN priority.

P a g e | 35

Engagement and Partnership There are a variety of partnerships across the LHIN with both health and non-health care stakeholders that advance health equity. Here are some examples. In January 2011, the TC LHIN CEO established an Equity Advisory Group of health equity leaders to provide strategic advice and direction on the development of equity priorities. The May 5, 2011 consultation and the associated materials are the result of these discussions. In February 2010, the LHIN established an Equity Intersectoral Roundtable in partnership with the Centre for Research on Inner City Health to facilitate partnerships among health researchers, providers, the LHIN and non-health sectors such as the United Way and the Toronto District School Board. In addition to direct engagement of Francophone community stakeholders, the newly established French Language Health Services Planning Entity for the Toronto Central, Central West and Mississauga Halton LHINs will collaborate with the LHINs to engage community groups and plan services for Francophones in the region. Ongoing Aboriginal Community Engagement includes participation at the Toronto Public Health Urban Aboriginal Roundtable, and the Noojimawin Health Equity Project Advisory Committee, a partnership between Noojimawin, the Hospital Collaborative on Vulnerable and Marginalized Populations and the TC LHIN. The TC LHIN funded Aboriginal community agencies to develop a research project on the high rate of diabetes within this community. The TC LHIN also meets bi-annually with Aboriginal agencies and chairs the Provincial Aboriginal LHIN Network. The TC LHIN has Consumer Advisory Panels for Mental Health and Addictions (MHA) – consumers and families, and seniors. MHA consumer survivors worked with the LHIN to develop a peer-led process that trains consumers and their families to lead focus groups with other peers. The Hospital Collaborative on Marginalized and Vulnerable Populations including representatives from hospitals and TC LHIN staff. The LHIN has partnered with Solutions: East Toronto Health Collaborative and other stakeholders to deliver the annual Healthy Connections Conference since 2008. The Health Equity Council (HEC) honoured the TC LHIN’s CEO Camille Orridge with the Award of Distinction at their March 2011 AGM. Other Equity related groups include the Women’s College Hospital Uninsured Network and the Inter-Network Coordinating Group.

to Cen tral LH IN Stak eholder Equity t · Muscat for providing ASL Interpretation Services; and...

Documents

Transcript of to Cen tral LH IN Stak eholder Equity t · Muscat for providing ASL Interpretation Services; and...