Health care providers have found religion when it comes to involving patients in the planning and decision-making process. At this year’s OHA HealthAchieve every administrator was quick to extol the virtues of soliciting community participation.
In a meeting in Belleville yesterday, Paul Huras, CEO of the South East Local Health Integration Network, told us they constantly review new proposals from a patient perspective.
That, after all, is what this is all about.
LHINs are also subject to a parade of presentations by health care administrators that tend to gloss over the problems and highlight the progress, unless the problems are leading to a specific ask. Let’s face it, who wouldn’t want to look as competent as possible before the funding body they report to? That does mean, however, the LHINs are not always seeing the complete picture, especially the many realities not captured by scorecard data.
Contrary to former Ontario PC Leader Tim Hudak’s wild assertions about the LHINs being some huge bureaucracy, the reality is they are tasked with a big job and very little in the way of resources. We all want accountability, transparency, community consultation and responsive regional planning — the question is, how much are we willing to pay to get it? Last year Huras’ LHIN transferred a little more than $1 billion to provide health services in his region – about two-thirds of that going to hospitals. The amount Huras has to run his own administrative shop? In 2012-13 it was about $4.6 million – a drop of about $200,000 from the previous year. The LHINs have not been immune to government austerity.
Our meeting with Huras was the second around a proposed redesign of mental health services within the SE LHIN. In addition to OPSEU staff, there were front line representatives from Providence Care, Hotel Dieu Hospital and Frontenac Community Mental Health and Addiction Services.
Huras prefaced the meeting by suggesting the redesign would produce very little change for front line staff – his expectation was there would be no job loss beyond potentially a handful of duplicate administrative positions. He told us mental health is a priority and the expectation is that services would expand, not contract.
There is always some anxiety about jobs when change is in the air, but we didn’t leave after that assurance.
The people who work directly with patients on a day-to-day basis are deeply motivated to see the best outcomes. It’s not an abstract exercise when you’ve been to the patient’s house, seen his or her family, and the patient knows you by your first name.
There is deep frustration, particularly around mental health, that increased demand and rising acuity is not being met with appropriate funding from Queen’s Park. Ontario’s lengthy austerity may be connected to both cause and effect. To compound this, one of the consequences of the present campaign around stigma is that more individuals are likely to come forward for treatment. The question is, what will they find when they do take that important first step?
That frustration is certainly not news to Huras. The question is, how can we all work together to do the best we can? Huras has to work with what he has been given and discretionary funding at the LHIN level is extremely limited.
Involving labour is not always easy. We can still recall one hospital CEO being furious with us because of a letter we sent to a regional LHIN. Even though the issue was on the LHIN’s agenda, the suggestion was our relationship with that LHIN constituted going over her head.
In Thunder Bay we organized a facilitated discussion on mental health services with front line providers and the North West LHIN in 2012. While we cautioned the workers about revealing identifying details about their patients, we also asked that none of the names of the participants be made public to protect the workers from potentially upset employers.
The LHINs have to be cognizant that they are seeking input from a stakeholder community that feels largely restrained about what they can openly say. There is always fear of reprisal. That restraint certainly goes beyond front line workers. Huras reminds us that the LHIN itself is a Crown corporation. He doesn’t need to say more to let us know that he himself has limits to what he can publicly say.
For a system where people talk a lot about the importance of openness and transparency, the reality is very few of us are in a position to really do that.
Yet the perspective of the people who directly work with patients is valuable. The NW LHIN took copious notes during our roundtable in Thunder Bay. We were proud of our members who were remarkably articulate, showed a willingness to be constructive, generated good ideas, and were clear about the consequences of the missteps they have witnessed. Given the average hospital CEO serves in their position for about five years, the staff at these provider organizations often have more institutional memory than the people who authorize their paycheques. They should be listened to.
There is another reason why government and the LHINs should be seeking the perspective of organized labour: the encounter works both ways. We want to be understood, but so do the LHINs and others who are drafting public policy.
During yesterday’s meeting we expressed concerns about parts of the mental health redesign that involved the merging of provider organizations. Such mergers seldom save money, and in a flatlined environment for base costs, we warned that such costs could have a negative impact on staffing and workload.
We also highlighted other concerns expressed by front line staff, including anxiety that catchment areas could expand for community workers, leaving them to spend more time on travel and less on client care. The contracting model also made us nervous, especially given our direct experience in home care.
Given the lack of detail behind many facets of the redesign plan, we asked about future opportunities to respond once the details were known.
Hy Eliasoph, the first CEO at the Central LHIN, once brought us together to chat about expectations.
He said he wanted us to get to know one another, because when we found ourselves in conflict over a decision before the LHIN, we’d at least have built relationships where we felt we could pick up the phone and talk to each other.
With some LHINs we are already at that stage. At others we haven’t even started.
Dave Lundy, OPSEU’s Vice-President in the region that overlaps the South East LHIN, suggested to Huras that we get together and have these conversations quarterly. Huras agreed.
Huras said that during the LHIN hearings in the spring he heard about how the SE LHIN was not consulting labour, but said it was a two-way street. Labour wasn’t approaching the SE LHIN either.
We spoke about our relationship with other LHINs and how that worked.
At one point we did try to establish a labour panel in the Central East LHIN, but sad to say, there was considerable reluctance on the part of front line workers to fill such a panel for many of the same reasons we listed above.
None of this is easy. In the South East LHIN we have found a way to start talking.
Keep me in mind for LHIN 4
I’m not sure who actually wrote the article, but a big thanks for describing the situation, which seemed fairly put, with appreciation of all sides while painting a way forward, which seems to be -work hard, listen to others, keep trying to bring a fractured system… together.
This article appears relevant to thinking and aligning more with the front-line workers, patient care and governance and in the name of evidence informed organizational practice.
Healthcare Policy, 10(1) August 2014: 108-114.doi:10.12927/hcpol.2014.23984
Mind the Gap: Governance and Health Workforce Outcomes
Stephanie E. Hastings, Sara Mallinson, Gail D. Armitage, Karen Jackson and Esther Suter
Attempts at health system reform have not been as successful as governments and health authorities had hoped. Working from the premise that health system governance and changes to the workforce are at the heart of health system performance, we conducted a systematic review examining how they are linked. Key messages from the report are that: (1) leadership, communication and engagement are crucial to workforce change; (2) workforce outcomes need to be considered in conjunction with patient outcomes; and (3) decision-makers and researchers need to work together to develop an evidence base to inform future reform planning.