Tag Archives: Local Health Integration Network

LHINs — Opening up the “integration” process

The Local Health Integration Networks (LHINs) were supposed to bring health service decision-making much closer to the communities.

At the core of that decision-making is the integration process. As we stated last week, “integration” can mean a variety of things. The Act that created the LHINs defines “integration” as

(a) to co-ordinate services and interactions between different persons and entities,

(b) to partner with another person or entity in providing services or in operating,

(c) to transfer, merge or amalgamate services, operations, persons or entities,

(d) to start or cease providing services,

(e) to cease to operate or to dissolve or wind up the operations of a person or entity.

In theory the LHIN integration process is to include the posting of integration proposals and the public is to be given 30 days to respond to that proposal before a decision can be made. In reality, it is far more confusing, inconsistent and complex than that.

Despite the clear definition, many of these “integrations” take place without ever being considered “integration decisions” for the purposes of public disclosure and response.

Last year the CEO of The Ottawa Hospital announced that his corporation was going to perform 4,000 fewer endoscopies, telling the media low risk patients could safely access this service at one of many private endoscopy clinics in the community (the majority, incidentally, run on a for-profit basis). That’s a big change for an entire class of health care user, yet there was virtually no opportunity for input even after the proposal became public.

One might argue that this would normally constitute an integration decision as it involves the wind up of a service, even if the general inferred concept is one of service transfer. An integration decision only requires one of the two parties to be a health provider under the jurisdiction of the LHIN, however, the LHIN cannot make any decisions regarding specific transfers to entities it cannot also fund. It can make a decision around a proposal that involves a situation where the hospital will cease providing services, which does apply in this situation.

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LHINs grapple with data to make decisions

What is sufficient data to make effective decisions about the health system? What is the quality of that data?

Two issues came up at Wednesday’s Central East LHIN board meeting to illustrate both questions.

The LHINs across Ontario are balking at a lengthy list of performance indicators from the province they claim are “too many and too detailed.” The CE LHIN says it would need additional staff to keep up with the data stream the province is asking for.

James Meloche, a Senior Director with the CE LHIN, said the list of indicators was not strategic, leading departing board member Ron Francis to suggest the LHIN should be asking the province what they are planning to do with the data generated by these indicators.

Three different bodies are presently generating lists of indicators without any coordination between them. The LHIN says Hospitals are “maxed out” by the requirement for an every increasing stream of data.

For all the data that is presently collected, the veracity of it came into question in an exchange between Meloche and CE LHIN board member Samantha Singh.

Singh had questioned CE Community Care Access Centre CEO Don Ford on the large number of children awaiting speech-language therapy in the LHIN. Ford confirmed that the wait list for speech language therapy was between two and three years.

Meloche chimed in that the LHIN had previously only had 70 people on the wait list for speech language therapy– including both children and adults. After a recent blitz, he said that list was now down to 10.

Singh was incredulous; saying one school she visited had eight children waiting for speech language therapy.

The LHIN board also had a lengthy discussion about delays in getting data. At the April meeting the board was just getting results from the third quarter of last year. Paul Barker, a senior director of the LHIN, said reporting periods were “all over the map.” The third quarter data showed two hospitals in deficit, whereas in fact he said only one – Peterborough – would finish the year in the red.

With delays in getting data, the board is sometimes left making decisions on information that is six months old.