An Integrated Health System for Residents of Waterloo and Wellington
The annual Fall Forum was held at the Arboretum Centre on Nov. 13. Bruce Lauckner, CEO of the Waterloo Wellington Local Health Integration Network [WWLHIN] discussed the strategic priorities of the network. The second speaker, James Downham, Manager, Systems Coordinated Access, Community Care Access Centre [WWCCAC] described current initiatives to make the system less complicated and to improve the transitions of care.
The WWLHIN is one of 14 in Ontario. The organization funds the local health system for 800,000 residents of the area. Mr. Lauckner identified the three priorities of the WWLHIN:
- enhancing access to primary care,
- creating a more seamless and coordinated health care experience, and
- leading a quality health care system using evidence-based practice.
Working towards these priorities has required the WWLHIN to hold agencies such as hospitals, CCACs, etc. accountable. This has not been done until recently. The integration of the health system has involved better coordination of resources. Mr. Lauckner said that this includes reducing wait times for services and increasing the focus on practices based on research. Another important task for the WWLHIN is to determine how the funding [$1 billion annually] can be better invested. Now, annual plans and three-year plans are developed and submitted to the provincial government. Performance goals are set; these did not exist nine years ago.
As an example of the steps to achieve the first priority, Mr. Lauckner noted that the WWLHIN is working to increase the number of doctors in the region, and, increase the number of family health care teams. A particular instance of successful integration of services is the Integrated Stroke and Rehabilitation Program with dedicated stroke beds based at Guelph General Hospital and the Freeport site of Grand River Hospital in Cambridge. The program is led by St. Joseph’s Health Centre, Guelph, and includes community based rehabilitation.
The WWLHIN funds close to 80 health service providers across the district but it does not provide any health services itself. It is responsible for planning, integrating, coordinating and funding hospitals, community care and support, community mental health and addictions, community health centres, and long-term care. It has facilitated the increased specialization of health service providers that is needed to achieve the sophisticated, evidence-based, best practice services.
James Downham presented an overview of the Coordinated Access initiatives in Waterloo Wellington. The WWCCAC has been asked by the WWLHIN to support the growth of Coordinated Access models in Waterloo Wellington to support the WWLHIN’s priorities outlined by Mr. Lauckner. The WWCCAC receives its funding from and is accountable to the WWLHIN. Its main function is to connect residents to community based care. Better coordination of access to health care is making it easier for health professionals to connect residents with publicly funded community service providers such as meals on wheels, mental health support, assisted living etc. With dozens of providers, hundreds of programs and services, each with varying wait times and covering different geographic areas, those seeking to refer residents, such as social workers, hospital care workers, discharge planners and physicians face a complex task. Each of the many providers in a service area publishes their own forms, has separate contact information, diverse wait times and provide somewhat differentiated services. This makes referrals and enquiries a daunting process, while residents might be left wondering what happens next, when will a service start, how will I find out and who will inform my doctor.
Coordinated Access is a collaborative, collective effort by a group of service providers to make access easier for a related set of services. In the case of Seniors Community Services, about 30 care providers working together created a single brochure, not unlike a pizza menu, listing 21 types of service available and what they might cost users. Along with the brochure is a standardized referral form with key information, a single phone number and single fax number that can be used by referrers to connect residents to diverse care providers. The form is faxed to the Community Support Service Resource Centre, hosted by the WWCCAC, who contacts the patient to connect them with the appropriate service provider. A radically different aspect of the form is that it is the residents who give the date and time they would like to be contacted by the WWCCAC, indicating the emphasis placed on meeting residents’ needs. The objective is to have a single entry and referral point: a sort of “one stop shop” as Mr Downham added. Recently a web site has been launched that allows health professionals to quickly and confidently find available services and book intake appointments directly with service providers.
Similar coordinated access initiatives have been launched in other areas as well. Addiction, Mental Health and Crisis Services launched Here 24/7 earlier this year, providing a single phone number to access a wide range of services from 11 different providers.
By making it really easy to get access to services, Mr Downham stressed, people are far more likely to use them potentially avoiding negative health outcomes. A one month snapshot showed that 98% of those referred through the Coordinated Access process for Seniors Community Services were successfully contacted and 85% of those referred through CCAC started the service. Participation since inception has increased dramatically, and there are indications that this is reduces the use of the overloaded hospital emergencies and expedites discharges from hospitals.
After outlining the benefits of Coordinated Access, under the headings of better health, better care and better value, Mr Downham indicated that the WWLHIN’s System Coordinated Access Steering Committee envisions and makes a priority the expansion in the region of coordinated access to other areas of the health system (such as medical specialists, chronic disease prevention and management, imaging and many others.) Both speakers engaged the audience in a most enjoyable manner.
–– Clive Southey and Susan Evers