Elimination of regional health leadership
This week, the Ford government announced that the first Ontario Health Team would be established in Mississauga. Two weeks earlier, the termination of the Local Health Integration Networks (LHINs) entered its final stages with the announcement that 14 LHINs would collapse into five temporary bodies, which will disappear as up to 50 Ontario Health Teams appear across the province.
The replacement of LHINs with health teams is reason to evaluate the role of regional leadership in the health system.
Health teams are designed to integrate care in hospital and community, including primary care and home and community care. They are not designed to provide local oversight of health providers (given that health teams are led by providers, they cannot oversee themselves), nor are they responsible for implementing provincial change initiatives for a specified region or population.
Although they may serve a regional population at a point of undefined future “maturation,” it may be many years before the entire population of Ontario is covered by 50 Ontario Health Teams. At present, they serve the patients registered to the provider organizations in the teams.
The 14 LHINs, on the other hand, were responsible for providing two-way communication linking the ministry of health to their regions. Working in partnership with the ministry, the LHINs spread innovation in health service delivery across the province. On a daily basis, they ensured that health organizations were financially accountable and delivered the services expected of them.
According to the auditor general in 2015, the LHINs employed approximately 550 people receiving about $45 million a year while helping the ministry to oversee about $25 billion in spending.
Some recent contributions of the LHINs include:
▶ When three LHINs showed the success of clinics providing rapid access to diagnosis and treatment for patients with back or neck pain, the remaining LHINs implemented the program.
▶ When the Champlain LHIN found that wait times for surgical procedures were reduced by centralizing referrals to rapid access centres, this model was spread across Ontario by LHINs.
▶ The Waterloo-Wellington LHIN rolled out an e-referral system that allows consultation requests to specialists to be sent directly from primary care computers. This system is now being implemented in other LHINs.
▶ The Champlain LHIN supported development of an eConsult program to allow primary care doctors to request advice from specialists. In most cases, the consultant would provide consultation back to the primary care physician, usually without requiring the patient to travel. This program is now spreading across the province.
▶ The LHINs partnered with the homecare division at the ministry to improve standardization of home-care delivery. Contract rates for common home-care services were standardized across the province and care co-ordinators employed by the LHINs were tasked to reduce variation in home care provision by using common assessment tools.
▶ LHINs also reorganized services offered in both community and hospitals, such as integrating regional stroke acute care and rehabilitation services.
▶ The LHINs provided advice regarding regional investment. In the summer of 2017, the ministry proposed rapidly expanding system capacity to limit hospital overcrowding in advance of the 2018 flu season. The LHINs were the ministry’s “feet on the ground” in identifying 1,200 hospital beds that were opened with extra funding, as well as 800 supportive housing and transitional beds.
The question today is what will replace the LHINs in their regional leadership roles? The health team design principles suggest that regional leadership of the system is not important if local care is better integrated. This may be true but having experience in working with the LHINs to implement change in Ontario, I worry about the loss of a regional leadership structure.
Ontario Health Teams may eventually take over regional leadership. But at present we only have a single team announced and the LHINs are essentially finished. This is a precipitous change that may prove detrimental to quality improvement in Ontario health care.