Canadian Government Executive - Volume 23 - Issue 02

February 2017 // Canadian Government Executive / 27 Design That changed in 2011 when the Bundled Care Program was piloted by St. Joseph’s Health System (SJHS) in Hamilton, Ontar- io to help patients in the transition from the hospital to their home. This program enables health care providers to decide on an integrated process to cover all the care needs of a patient as he or she moves from hospitalization to care at home. This ground-breaking method first in- volved two of the hospitals in the SJHS (St Joseph’s Healthcare Hamilton and St Mary’s General Hospital) who integrated their funding across a patient’s stay at the hospital and at home. It received support and financial backing from the Ministry of Health and Long-Term Care (MOHLTC) to test this innovative model. “In this model, we sat down with people who have never met before in home care and hospital care,” explained Dr. Kevin Smith, CEO of St. Joseph’s Health System. He pointed to an example of how a per- sonal support worker (PSW) caring for a patient at home and a surgeon doing surgery on the same patient would have served the individual along the continu- um “but they were never brought together in the same room” to see what could be done to provide outstanding care during every part of the journey for the patient. During the pilot stage, SJHS set up a single envelope of funding for patients hospitalized for thoracic surgery, hip and knee surgery, Chronic Obstructive Pul- monary Disease (COPD) and Congestive Heart Failure (CHF) to receive their hos- pital care and then be transitioned home for post follow-up care. This new initia- tive blossomed over the next three years. The teamwork shined as different work cultures collaborated. It resulted in high levels of patient satisfaction and success. In light of the successful testing in the pilot stage, the ministry then began scal- ing up the model with the assistance of some senior management leaders from St. Joseph’s Health System (SJHS) and the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Net- work (LHIN). A call for Expression of Interest (EOIs) was made and fifty applications were re- ceived from interested parties on inno- vative and solutions-driven approaches which were then assessed by a multi- disciplinary team comprising of members from Local Health Integration Networks, Ministry of Health and Long-Term Care staff and members of a ministry advisory team, including researchers, clinical ex- perts, and quality improvement experts. The assessors shortlisted 14 teams with the highest potential of success, and six were eventually selected to ride the first wave of scaling this bundled care model. For the new teams, this program began reaping instant results. Joanne Flew- welling, Executive Vice President Clini- cal Services at the William Osler Health System for the Hospital 2 Home team, related how patients with experience in traditional home care could sense the dif- ference with the new program due to “the continuity and the smoothing out of the transition.” Other benefits became appar- ent as a result of this program: a decrease in hospital admissions, a decrease in re- admissions and the reduction in the aver- age number of days spent in the hospital by patients. The results can attest to the success of this model, but implementing this type of integrated program had its share of chal- lenges. The leadership team understood integrated funding was not an easy task as, “Canadian healthcare appears to be particularly fragmented and peculiarly resistant to reform,” as highlighted in the Report of the Advisory Panel on Health- care Innovation. But the team exhibited the courage to face the challenge of going against conventional wisdom and took an approach that was strategic, planned and well-communicated of moving for- ward with the vision of patient-centred care. This approach allowed providers to integrate funding over a patient’s period of care, regardless of who is providing the care, or in what setting. This was a bold move that had a high degree of uncer- tainty, but the strong leadership stance to move forward and the initial success obtained provided the groundwork from which to build on. Margo Orchard, Team Lead from the Health System Quality and Funding Divi- sion, Ministry of Health and Long-Term Care, described a type of leadership that was instrumental in building the success of this program, “There is no ‘alpha leader’ on this initiative,” she said, “and this al- lows each organization’s individual role to be leveraged so that the whole is greater than the sum of its parts.” This was dem- onstrated by the SJHS leadership team which acted as role models in strengthen- ing the capacity of each of the six teams by providing confidence, reassurance and problem-solving support. Another aspect that helped in the growth of the model was the recognition of barriers by the leadership team and the use of its political skills, dedication, and perseverance to ensure that the pro- gram was moving forward to achieve ag- gressive timelines. One such timeline that was achieved within the stipulated period was from the issue of the EOI to the begin- ning of patient enrollment in the program which was completed within a rather short 8-month period. “Today, we now have six separate teams using IFM, and each has taken a different approach to delivering integrated, patient- centred care. It really shows how with the right leadership support, opportunities can take root and flourish,” says Melissa Farrell, Assistant Deputy Minister, Health System Quality and Funding Division, Ministry of Health and Long-Term Care. Given the success of the program to date of reduced length of stay, high rates of patient satisfaction, and improved effi- ciencies, the leadership team is currently analyzing data collected from the program to scale this to other healthcare providers in Ontario over the next year where this model can be replicated to meet the needs of other teams in providing outstanding care that is truly patient-centred. The Integrated Funding Models pro- gramwas recognized by IPAC and Deloitte as the Gold winner of the 2015 Public Sec- tor Leadership Awards program, which recognizes organizations that are making meaningful change to society in a way that leaves a lasting and positive legacy. M arcello S ukhdeo is Associate Editor of CGE “Canadian healthcare appears to be particularly fragmented and peculiarly resistant to reform,” as highlighted in the Report of the Advisory Panel on Healthcare Innovation.