Essays

Essays March 2019

Lessons from the LHINs as Health System Enters New Era

Anthony Dale

lessons 

The health transformation vision recently announced by the Ontario government rightfully aims to provide better-connected care that breaks down siloes within the fragmented system. It is a change the Ontario Hospital Association (OHA) and many others have been requesting for years – and a goal that governments have set before.

Ontario’s Local Health Integration Networks (LHINs) were created with the vision of building a better integrated system. A decade ago, the OHA said that the true test of their success would be whether they could decrease the number of patients waiting in hospitals for an alternate level of care in other settings, a growing health system concern at the time. Today, that number has grown to a record high at nearly 5,100 patients across the province and hospitals are in a state of semi-permanent overcrowding.

It is clear that contrary to their name and despite their best efforts, Ontario’s 14 LHINs largely did not achieve significant integration of services. Instead, they focused on accountability and efficiency. Due to such pronounced emphasis on oversight and reporting, coordination of services and long-term planning took a back seat. With too many narrow lines of sight, it’s easy to lose track of the big picture.

There are valuable lessons to be learned from this experiment.

As outlined in The People’s Health Care Act, the new government’s vision includes simplifying provincial oversight and encouraging service providers to create integrated care delivery systems called Ontario Health Teams (OHTs). These collaborative groups – which can be made up of hospitals and other service providers across the continuum – could be customized to flexibly meet the needs of patients.

Notably, OHTs will focus on integration of services rather than the integration of entities. This important distinction puts the focus on patient services rather than on structural re-organization. By asking service providers to voluntarily come together and apply to become OHTs, the government makes room for diverse models of care suited to certain geographies and populations. It isn't practical to require corporate integration among such diverse providers, especially given the range of different services, structures, employee groups and work environments that currently exist. Instead, partnerships allow providers to work together, focused on the needs of patients and communities.

There are certainly risks associated with the proposed change. The government must listen closely to service providers as they refine their plan to avoid any unintended negative consequences or barriers to integration, and tangibly support them as they begin the task of transforming care. The Ministry of Health and Long-Term Care and the new agency, Ontario Health, should also play an important role in accountability and performance management, while facilitating integration.

On the whole, however, this new approach to integration empowers service providers to take a leadership role in advancing system integration, rather than waiting for it to trickle down from above – a welcome change. As the government asks for local solutions and removes administrative barriers, the onus is on providers to venture out of their silos and jointly design patient-centred care journeys for the people of Ontario.

By working closely with service providers, the Ontario government can avoid repeating the mistakes of the past during system transformation. As overburdened hospitals struggle to maintain access to care, failure is not an option. We simply can’t afford to wait any longer. 

About the Author

Anthony Dale is President & CEO of the Ontario Hospital Association @AnthonyDaleOHA

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