Abstract

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LHINs: A Made-in-Ontario Approach

The creation of LHINs, a made-in-Ontario approach, is, in part, a response to the challenges and limitations faced by Regional Health Authorities (RHAs) across Canada in engaging the broader community. Simply stated, the LHIN model is unique in Canada insofar as it attempts to capitalize on the strengths of voluntary local governance. Unlike RHAs, LHINs were designed to work alongside, rather than replace, health services providers, thereby creating a dynamic that is daunting on the one hand, yet rife with potential on the other hand.

Why this is so fundamentally different is that LHINs, in endeavouring to engage their communities, have the distinct advantage of drawing on, and enlisting the help of, the health service providers, including hospitals, long-term care homes, mental health and addictions agencies, and community support service organizations. In contrast, RHAs have undertaken community engagement on their own, and in the absence of the support and involvement of health services providers. For LHINs, working alongside providers could be a huge asset in that each of these providers has a governance structure, leadership team and frontpline staff that are potentially invested and grounded in their communities and the constituents they serve.

This is particularly true of the boards of many providers, in which voluntary local governance is characterized by a combination of individuals who bring both professional credentials and personal commitments to their responsibilities as governors. If "co-opted" to facilitate the engagement of their communities in the mission and activities of the LHIN, these providers could be a differentiating factor in successful engagement of the broader community/public.

Conversely, LHINs have a major challenge in first engaging the health service providers before successfully and effectively enlisting them in engaging the broader community. Convincing these providers that the LHIN is enabling rather than limiting could be a key "tipping point" in earning their support, and to help LHINs in engaging their collective communities.

The Central LHIN - Stakeholder Engagement Strategy

The Central LHIN, along with other LHINs has recognized that engagement extends to all providers and communities. Our Stakeholder Engagement Strategy, validated and subsequently released in Winter 2006, identifies several principles of engagement, including transparent, timely, inclusive, appropriate, accessible, balanced and accountable.

The goals of the Central LHIN stakeholder engagement strategy are to

  • focus on the people who use health services - by placing the user at the centre and engaging directly with those who are most knowledgeable about their experience and degree of satisfaction with healthcare services - the users themselves;
  • enhance local accountability - by vesting accountability at the local level through providing direct opportunities for input into decision-making;
  • balance priorities - by informing and engaging the public and fostering a shared sense of responsibility for achieving balance among competing priorities;
  • develop system capacity and sustainability - with a belief that communities are the best source of knowledge about their own needs and their own solutions, and by drawing on this knowledge and capacity, to identify needs and gaps and help build sustainable, long-term solutions.

Our Stakeholder Engagement Strategy identifies and defines the spectrum of stakeholders, sets out the continuum of engagement methods and identifies multiple options for various approaches to engaging the spectrum of stakeholders. Our strategy can be best characterized as multi-faceted; it based on the philosophy that many different methods and means are needed to meet and respond to the many different needs and abilities of our communities. As such, each of the five phases of our strategy employs specific approaches and techniques to engage different constituents.

Foundational to our Stakeholder Engagement Strategy are six key elements:

  1. a geographical approach intended to make engagement as geographically accessible as possible for all residents and communities within the Central LHIN, built on existing population distribution and geographical realities of the LHIN;
  2. the establishment of Regional Stakeholder Groups in each of the five geographical areas was instrumental in helping to identify and connect with the hundreds of community-based groups, organizations, affiliations and leaders;
  3. the recognition of the need to engage Health Interest Groups, who typically have a particular or well-defined interest or focus;  
  4. the establishment of Governance Councils comprising Board Chairs of all the health service providers, meeting with the Central LHIN Board Chair and board members to discuss issues from a governance perspective;
  5. multiple levels of engagement that accommodate varying degrees of interest and ability to participate, and provide flexibility for engaging stakeholders relative to the complexity of the issue; and
  6. an evaluative component to measure the extent to which the engagement strategy is achieving its intended goals and outcomes.

Where Are We (Going)?

The Central LHIN Stakeholder Engagement Strategy does not offer something new or unique relative to what is identified in the RHAs by Quigley and Nickoloff. What is new and unique is the situational context within which the various components of the strategy are being employed. The end result is a unique blend of strategies that emphasize two key differences between RHAs and LHINs, these being in the legislated LHIN mandate to engage the public and the need to both enlist and engage the many health providers who continue to operate as independent organizational entities.  

The ultimate success of the made-in-Ontario LHIN model will likely be determined by the ability of LHINs to leverage providers and enlist their cooperation, support and influence in engaging the broader community of stakeholders in general and the public in particular. The Governance Councils could play a key role because they reflect and enable the board-to-board agreements and relationships required under the legislation. These relationships are expected to yield both enhanced accountability and collaboration - concepts that usually compete, rather than align.

About the Author

Ken Morrison is the Board Chair and Hy Eliasoph is the CEO of the Central Local Health Integration Network (LHIN), an area encompassing north central Toronto (North York), York Region and South Simcoe, with 1.5 million residents. LHINs have responsibility for planning, coordinating and funding health services for hospitals, long term care homes and community services.   For more information, please contact Hy Eliasoph at: Hy.Eliasoph@lhins.on.ca.