We have all heard the sayings: “Home, sweet home”; “There’s no place like home”; “Home is where the heart is.” Home is a word that conjures up thoughts of peace, comfort, and joy: A sanctuary, or a place of relaxation where one is at ease and generally happy.
Anyone who has experienced a hospitalization will cheer at hearing the physician’s declaration that you can go home. They are often the sweetest and most comforting words. Most medical practitioners agree that being at home also accelerates the recovery time. However, for this to happen there must be a smooth transition of care from the hospital to home. This has been a challenge for many years within the medical field.
That changed in 2011 when the Bundled Care Program was piloted by St. Joseph’s Health System (SJHS) in Hamilton, Ontario 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 involved 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 personal 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 continuum “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 Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) to receive their hospital care and then be transitioned home for post follow-up care. This new initiative 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 scaling 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 Network (LHIN).
A call for Expression of Interest (EOIs) was made and fifty applications were received from interested parties on innovative 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 experts, 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 Flewwelling, Executive Vice President Clinical 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 difference with the new program due to “the continuity and the smoothing out of the transition.” Other benefits became apparent as a result of this program: a decrease in hospital admissions, a decrease in readmissions and the reduction in the average 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 challenges. 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 Healthcare 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 forward 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 uncertainty, 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 Division, 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 allows each organization’s individual role to be leveraged so that the whole is greater than the sum of its parts.” This was demonstrated by the SJHS leadership team which acted as role models in strengthening 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 program was moving forward to achieve aggressive timelines. One such timeline that was achieved within the stipulated period was from the issue of the EOI to the beginning 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 efficiencies, 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 program was recognized by IPAC and Deloitte as the Gold winner of the 2015 Public Sector Leadership Awards program, which recognizes organizations that are making meaningful change to society in a way that leaves a lasting and positive legacy.
The 6 Integrated Funding Models Teams
Connecting Care to Home: Optimizing Care for COPD and CHF Patients in London Middlesex
Project Partners: London Health Sciences Centre, South West Community Care Access Centre, St. Joseph’s Health Care London, Thames Valley Family Health Team, South West Local Integration Network.
Integrated Comprehensive Care 2.0: Hamilton Niagara Haldimand Brant (HNHB) LHIN-wide COPD and CHF
Project Partners: St. Joseph’s Healthcare Hamilton, Brantford Community Health System, Centre de Santé Communautaire, Grand River Community Health Centre, Haldimand War Memorial Hospital, Hamilton Health Sciences, HNHB Community Care Access Centre, HNHB Local Health Integration Network, HNHB Primary Care lead, Joseph Brant Hospital, Niagara Falls Community Health Centre, Niagara Health System, Norfolk General Hospital, North Hamilton Community Health Centre, St. Joseph’s Home Care, West Haldimand General Hospital.
Hospital 2 Home: The Central West Integrated Care Model
Project Partners: William Osler Health System, Central West Community Care Access Centre, Headwaters Health Care Centre, Central West Local Health Integrated Network, Ontario Telemedicine Network.
Putting Patients at the Heart: A Seamless Journey for Cardiac Surgery Patients in Mississauga Halton
Project Partners: Trillium Health Partners and Saint Elizabeth Health Care with support from the Mississauga Halton Local Health Integration Network.
One Client, One Team: Central and Toronto Central LHIN Integrated Stroke Care
Project Partners: Sunnybrook Health Sciences Centre, Providence Healthcare, North York General, Toronto Central Community Care Access Centre, Central Community Care Access Centre.
Integrating Specialized and Primary Care: The North York Central Collaborative for COPD and CHF Patients
Project Partners: North York Integrated Care Collaborative (North York General Hospital, Central Community Care Access Centre, Saint Elizabeth Health Care, Pro Resp Home Oxygen & Respiratory Care, Circle of Care, North York Family Health Team), West Park Healthcare Centre.
Marcello Sukhdeo is Associate Editor of CGE.