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Tag: government

  • Guidance Document for Ontario Health Teams Released

    Dear members,
     
    The Ministry has released the Guidance Document for proposals from groups that will be working to form Ontario Health Teams.  

    This document is detailed guidance on the process involved in becoming an Ontario Health Team. There will be a continuous readiness assessment process that will begin with providers’ self-assessment, followed by an application and an in-person visit.
     
    More information and resources are here, including rough timelines on the assessment process and details on a webinar for this Friday, April 5, at 2 PM.
     
    There is also a tele-town hall with Minister Elliott at 4 PM today, which we encourage you call in to, if possible on such short notice:
     
    Toll-free number: 1-855-340-1607
    Participant passcode: 7177840#
     
    We’ll send out more information and support for teams once we’ve had the opportunity to read this document and other information released today.
     
    Sincerely,
     
    Kavita Mehta
    Chief Executive Officer, AFHTO

  • Erythromycin Ophthalmic Ointment Shortage Update

    Memo from Chief Medical Officer of Health

    Mar 19, 2019

    TO: Medical Officers of Health
    RE: Erythromycin ophthalmic ointment shortage

    We would like to take the opportunity to provide a further update to share new information regarding the ongoing national shortage of erythromycin ophthalmic ointment, indicated for the prophylaxis of ophthalmia neonatorum.

    We are aware that limited supply has returned to the market in February and March, with reported estimated end dates in March and April. We will keep monitoring the supply and will provide updates as they become available. Please continue to work with your LHIN Drug Shortages Lead for further information and to support reallocation requests.

    Based on this ongoing shortage we continue to urge hospitals to conserve and prioritize access to the highest risk cases (i.e. high risk sexual behaviour, partner with STI, is homeless/under housed, has new or multiple sexual partners or partner does, and/or no prenatal care).

    The Ministry of Health and Long-Term Care (MOHLTC) has engaged the Provincial Council for Child and Maternal Health (PCMCH) to leverage their expertise on provincial supports for the shortage. To this end, with involvement from the ministry, PCMCH’s Maternal-Neonatal Committee and London Health Sciences Centre have developed algorithms for screening and response to lab results in order to support local decision making.

    It should be noted that PCMCH advises at this time that there is no recommended safe alternative medication to be used prophylactically for newborns instead of erythromycin. Therefore, it is recommended that the supply of erythromycin be monitored closely, and if adequate supplies are not available, administration be based on the attending health care professional’s assessment of the situation. Attached to this letter are the algorithms that attending health care professionals may wish to take into consideration in making their assessments. They can also be downloaded from PCMCH’s website at the following link: http://www.pcmch.on.ca/erythromycin-ophthalmic-ointment/

    Additionally, in order to support newborn primary care, facilities should include a note in the newborn health record that is provided to parents indicating whether erythromycin ophthalmic ointment was administered. Parents and all neonatal healthcare providers should also be made aware of the symptoms of ophthalmia neonatorum and advised to monitor for these symptoms within the first four weeks of life and to seek medical treatment at any signs of infection.

    The ministry will provide updates as further information becomes available. We would also like to remind all healthcare professionals that once the supply of erythromycin is returned to normal stock levels, routine administration of the ophthalmic prophylaxis to the eyes of newborns should continue as required under Regulation 557 Communicable Diseases – General under the Health Promotion and Protection Act.

    We request that you share the information in this memo with hospitals and other health system partners (e.g. primary and emergency care; midwives) in your jurisdiction.

    Thank you for your assistance.
    David C. Williams, MD, MHSc, FRCPC
    Chief Medical Officer of Health

    c: Roxana Sultan, Executive Director, PCMCH

    Relevant Documents

    public://2019-03/1. Screening Algorithm – shortage of erythromycin 2019March14.pdf

    public://2019-03/2 Response to Lab Algorithm-shortage of erythromycin 2019March14.pdf

    public://2019-03/CMOH Memo Erythro Shortage.pdf

  • An Update on The People’s Health Care Act, 2019

    An Update on The People’s Health Care Act, 2019

    On February 26th, the Minister of Health and Long-Term Care, Christine Elliott, announced the government’s plans for health system transformation by tabling the proposed legislation, Bill 74, The People’s Health Care Act, 2019. While some matters are still unknown with regards to the implementation of the legislation, there are two parts of the Act that may have impact for our members and are being highlighted.

    Ontario Health (previously known as the ‘Super Agency’)

    This new agency would deliver health care province-wide through the consolidation of 20 current Crown organizations including:

    • Cancer Care Ontario
    • Health Quality Ontario
    • eHealth Ontario
    • Trillium Gift of Life Network
    • Health Shared Services Ontario
    • HealthForce Ontario Marketing and Recruitment Agency
    • 14 Local Health Integration Networks

    Ontario Health would be an agency under the Broader Public Service Accountability Act and would be governed by a 15-person Board of Directors that will be appointed by Cabinet.  A CEO search is underway, with a focus on people with a business background.

    Ontario Health Teams (previously known as ‘MyCare Groups’)

    Ontario Health Teams (OHTs) will be responsible for delivery of patient care in a defined geography with the intent to deliver, in an integrated and coordinated manner, at least three types of health services including:

    • Hospital care
    • Primary care
    • Mental health and addictions care
    • Long-term care
    • Home and community care
    • Palliative care

    Although there appears to be 30 unsolicited proposals already submitted to the Ministry, all proposals will need to undergo a formal Expression of Interest (EOI) and a readiness assessment, which will also include a site visit that would include speaking to all partners identified in the proposal. At full maturation, it’s anticipated there will be 30 to 50 OHTs across the province, each serving between 50,000 to 500,000 people with an average of around 300,000.

    How does this all impact team-based primary care?

    *NOTE: this is speculative and would need to be verified once more information is known on the roll out of the new agency

    Ontario Health:

    • The legislation defines that FHTs and NPLCs will now be defined as ‘health service providers’ which means at some point, all contracts will move over to the agency BUT at the moment things will be status quo until they sort out contract management – it appears that current FHT contracts will probably stay in effect for some time and the NPLC contract will need to be opened up to allow for an assignment clause to Ontario Health. This could all take some time.
    • The LHINs may be in existence for a while with the function of managing home and community care until they are transferred, possibly to the OHTs (ensuring continuity of patient care).
    • Five regional entities will be established under the agency to provide more oversight of health service delivery.
    • It’s not well understood if family physicians can be defined as an HSP but the legislation allows ‘any other person or entity or class of persons or entities that is prescribed’.

    Ontario Health Teams:

    • Primary care can apply to lead the development of an OHT in their community, especially if the size of the population that they serve are over 50,000.
    • Governance structures will remain but there would be one budget that the lead would be accountable for – the focus right now is on collaborative governance, with a focus on seamless transitions of care for patients.
    • There will be a readiness assessment with the early adopters and site visits – if a proposal indicates that partners are going to participate, they’ll visit and see what that means if there was true collaboration in developing the proposal.
    • OHTs will have supports from the government and will also be a conduit to identify legislative and regulatory barriers to success, barriers to integration, sharing or best practices, tools for digital health and communications and change management assistance.

    Overall – there aren’t many answers yet and more information will follow as the Ministry starts working on its implementation plan. AFHTO looks forward to working with stakeholders including OCFP, Section on General and Family Practice, NPAO, and others to ensure that primary care’s foundational role in health system transformation is recognized.

    Next Steps:

    • AFHTO will be setting up a webinar with H&K to walk through the Act and to explain the EOIs when they come out – anticipated date for roll out is mid to late March so stay tuned for more details.
    • Sign up for the Ministry e-newsletter which will send you updates as they become available: https://mailchi.mp/ontario/connectedcareupdates
    • As this rolls out there will be a lot of questions so please let us know at info@afhto.ca – we will be having ongoing conversations with the Ministry during the implementation of the Act and would like to let them know about concerns/questions from the field.
    • If you or your team is interested in leading and/or participating in the EOI when they become available, please let us know at info@afhto.ca so that we can ensure the decision makers in the Ministry are also aware.

    Reference Documents:

  • Winter 2019 Highlights: AFHTO Leadership Councils

    Below are the highlights from the winter 2019 leadership council meetings: Executive Director Advisory Council (EDAC), Physician Leadership Council (PLC), Board Chair Leadership Council (BCLC), NPLC Leadership Council (NPLC LC), and IHP Advisory Council.
     
     
    A New Government and Health System Reform
    • Much is up in the air as the government undertakes health care reform. While nothing is final, documents leaked to the press in late January and early February give a general idea of the direction the government will go.
    • The draft Health System Efficiency Act, 2019 can be seen online through several media sources. A summary of it and of the other internal documents that were leaked are on AFHTO’s website. We encourage you take a look and become better informed about the proposed changes.
    • A key piece is the formation of a “super agency” that would oversee local integrated care delivery systems (ICDS) – MyCare Groups – whose function remains unclear.
    • AFHTO will work with our GR firm, H&K Strategies, to arrange a webinar to review and discuss the legislation and transformation agenda, including possible implications for our members, once the expected legislation is tabled. Please stay tuned for more details.
    • The Premier’s Council on Improving Health Care and Ending Hallway Medicine released its first interim report in late January. Its priorities align well with AFHTO’s pre-budget submission that was submitted a few days prior.
    • The Arbitrator’s Award was issued to the Ministry and the OMA on February 19. The news release from the Ministry is here.
    • AFHTO will continue to work with the new government to show that an investment in a robust primary care system will deliver a high-performing health care system, which will lead to better outcomes and patient experience.
    Meetings with the Minister and the Ministry
    • AFHTO met with the Minister on January 21. Mental health and addictions are among her top priorities. The meeting went well although the direction of primary care remained unclear.
    • AFHTO continues to meet with officials to discuss the direction of primary care in the province.
    • AFHTO is working closely with the Primary Care branch on issues such as an integration of mental health and addictions support in primary care, care coordination, and ongoing support for team-based care for more Ontarians. In a recent meeting, we were also notified that AOPs will likely be delayed this fiscal year.  AFHTO will keep teams posted on timelines once we learn more.
    • For the 10 or so pilot ICDSs, the Expression of Interest is expected soon. We’ll let teams know once we have more information. If your team is interested in possibly taking leadership in this new initiative, please let us know. We can ‘plant some seeds’ with the policy makers at the Ministry.
    • AFHTO continues to emphasise the importance of primary care being part of integration efforts.
    Local Advocacy – Time to Connect with Your MPP
    • We continue to encourage teams to meet with their local MPP to demonstrate the value of team-based care for the MPP’s constituents.
    • Tools and resources are online.
    • The tools include key messages to explain the value of team-based care and how it aligns with the government’s priorities.
    • AFHTO encourages teams be consistent with the main points to ensure the government hears the same message from MPPs about why team-based care is important as they undertake restructuring of the health care system.
    • Let us know when you’re meeting with your local MPPs! Send us your pictures, stories and tag us on Twitter @afhto.
    Continuing to Support Great Governance and Leadership
    • As we have already let members know, the G&L program did not receive project funding for 2018/19, and project funding for 2019/20 is unknown.
    • AFHTO still aims to provide support tools. Governance webcasts continue to roll out, and we continue to support teams transitioning to a skills-based board.
    • Integration and collaborative governance are an expected focus of the new government. AFHTO will align training and supports under this new direction to ensure teams are adequately equipped with the tools and knowledge needed.
    • A strategic planning toolkit is being prepared to support boards in developing a strategic planning process and a strategic plan. The final is expected in the coming month.
    • LeaderShift opportunities continue. Sign up now!
    Focus Shifting to Improvement
    • As noted with the G&L Program, the QIDS program also did not receive project funding for 2018/19, and project funding for 2019/20 is unknown.
    • To align with the government’s mandate, the focus of the program is shifting from measurement to improvement.
    • The main priority of the QIDS Program will be continued AFHTO support for QIDSS in the field and through the newly created “Quality Improvement in Primary Care” council, which will support QIDSS in the areas of advocacy, knowledge translation and improvement.
    • AFHTO is pleased that Dr. Kevin Samson has agreed to be the new Chair of the AFHTO Quality Steering Committee, which will be looking at a renewed focus on highlighting the value of team-based care.
    • On March 6 (Ottawa) and March 8 (Toronto), AFHTO will be hosting two KTE workshops based on our QI Enablers study called “Building together: how to become a high performing team.” A better functioning team is better care. Registration for Ottawa is now closed, and for Toronto it is February 22.
    • The Centre for Addiction and Mental Health spoke to several councils about OPTIMUM, a project funded by the Patient-Centred Outcomes Research Institute. They’re looking to collaborate with primary are providers to recruit 300 people for a project in optimising depression treatment in older adults. The presentation and contact information are here.
    Membership Renewals and Voluntary Contributions
    • A reminder that membership renewals will be going out at the end of February and early March.
    • AFHTO works to serve and represent our members to the best of our ability, and we hope to see you renew your membership! With all the health system reforms currently underway, now more than ever we need a strong voice for team-based primary care.
    • Please also consider a voluntary contribution to help ensure AFHTO can continue its work in advocacy, governance and quality. Contributions can flow out of the overhead budget line and there is no limit. Voluntary contribution forms will be sent with your membership renewal forms.
    Any questions or comments, please contact Bryn Hamilton, Provincial Lead, Governance & Leadership Program.
     

  • First interim report released by Premier’s Council on Improving Healthcare and Ending Hallway Medicine

    The first report of the Premier’s Council on Improving Health Care and Ending Hallway Medicine was released on January 31, 2019. The Council, chaired by Dr. Rueben Devlin, provides an assessment of Ontario’s health care system and lays the groundwork for future reports that will speak to recommendations for health system restructuring.

    The first report describes three key challenges facing Ontario’s health care system:

    1. Patients and families are having difficulty navigating the health care system and are waiting too long for care. This has a negative impact on their own health and on provider and caregiver well-being.
    2. The system is facing capacity pressures today, and it doesn’t have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures in the short and long-term.
    3. There needs to be more effective coordination at both the system level, and at the point-of-care. This could achieve better value (i.e. improved health outcomes) for taxpayer money spent throughout the system. As currently designed, the health care system does not always work efficiently.

    While there is very little mention about primary care, it should be noted that the report references that patients are going to the hospital when they could be treated in primary care, with a recognition that there should be additional focus on preventative measures and effective engagement with primary care providers.

    The essential role of primary care in providing mental health and addictions supports was acknowledged, with the report noting that about 1 in 3 adults who reported to an ED for mental health and addictions care hadn’t previously accessed physician-based care for their illness. And challenges in home and community care was highlighted, noting that the health care system is overly complex which makes it more difficult for patients and families to navigate.

    The report concluded with three opportunities for improvement: digital and modern health care, integrated care delivery and efficiency in the system.

    AFHTO was pleased to see that many of the findings in the report are consistent with AFHTO priorities and aligned with our most recent Pre-Budget Submission submitted to the Standing Committee on Finance and Economic Affairs:

    1. We need a health system that is truly integrated, one where patients don’t have to move from one part of the system to another part to get their care, especially care for mental health and addictions – primary care and mental health care providers need to work together to ensure that mental health and addictions investments are integrated in primary care.
    2. The relationship between primary care and home and community care can be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients.
    3. Support expansion of interprofessional team-based care across Ontario. This can start with communities that don’t have a team at all and then expand to all Ontarians who wish for it. Allow for local-level innovation but ensure that primary care providers are involved in the co-design on what would work best for them in their communities and for their patients.
    4. Look at existing models of performance measurement in primary care and facilitate and fund a strategy that spreads it across the system. This strategy must measure outcomes that matter to patients and providers while assisting in lower system costs. To support this, there needs to be further investments in quality improvement practice facilitators to help support front line providers.

    AFHTO members are already taking leadership in many of the areas that are highlighted as challenges in the report and we look forward to sharing your innovations, ideas and patient stories with the government so we can continually highlight that an investment in creating a robust primary care system will lead to a high performing health system with better outcomes and patient experience.

    Documents of Interest:

  • Draft legislation and other leaked documents on health system transformation

    A draft bill from the Ministry of Health and Long-Term Care was leaked to the media at the end of January. The Health System Efficiency Act, 2019 appears to be in early stages, but the draft provides a high-level overview of what may be a major structural overhaul of health services in the province.

    A summary of the draft legislation, as it read on January 31 when leaked, can be seen here. The draft legislation itself can be seen through online media.

    Additional documents that show major changes to the health care system were leaked on February 4. These provide more information on a policy that is being formed, including information about MyCare Groups, the “Super Agency,” and how the ministry may be restructured. Information about the February 4 leaked documents can be read here.

    While there is now more clarity about the government’s plans, much is still up in the air and will be seen in the weeks and months ahead. As we get more information, we’ll let our members know. In the meantime, we continue to encourage teams to reach out to their MPP to speak about the value of team-based care in their communities. Tools and resources are here. 

    If you have any questions, please contact Beth MacKinnon (Program Associate, Policy, Leadership and Strategic Communications) at beth.mackinnon@afhto.ca or 647-234-8605 x206.

  • MPP Meetings – Advocacy Tools & Resources

    A new government and many new Members of Provincial Parliament (MPP) were elected in June 2018. AFHTO members are encouraged to meet with  their local MPP.

    Establishing a relationship with new MPPs – or building on existing relationships with longer-serving MPPs – and communicating the value of team-based primary care is key to helping see MPPs do two things:

    • Advocate for investments in team-based care, and
    • Understand the value of team-based care for their constituents, so they can speak to it as the new government undertakes primary care reform.

    It’s important to include primary care providers and, where possible, a patient in these meetings. These are people the government is especially interested in hearing from. Where there is more than one team in an MPP’s riding, we encourage teams coordinate one meeting together, if possible.

    Working with Hill+Knowlton Strategies, our government relations firm, the following tools have been prepared to help with local advocacy:

    It’s important that teams across the province are consistent in saying why team-based care matters. The key messages are the main points to communicate, with proof points to back you up, but the document is not intended to be left with the MPP. The slide deck summarises the key messages, and it’s what can be left behind after the meeting.

    In the deck, be sure to add a couple success stories and accomplishments where patients – the MPP’s constituents – benefitted because of team-based care.

    Other tools, resources and references

    If you have any questions, please contact Beth MacKinnon (Program Associate, Policy, Leadership and Strategic Communications) at beth.mackinnon@afhto.ca or 647-234-8605 x206.

  • AFHTO’s 2019 Pre-Budget Submission

    AFHTO submitted its recommendations to the Standing Committee on Finance and Economic Affairs as part of the 2019 Ontario Pre-Budget Consultations in January. Our key recommendations are:

    1. We need a health system that is truly integrated, one where patients don’t have to move from one part of the system to another part to get their care, especially care for mental health and addictions – primary care and mental health care providers need to work together to ensure that mental health and addictions investments are integrated in primary care.
    2. The relationship between primary care and home and community care can be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients.
    3. Support expansion of interprofessional team-based care across Ontario. This can start with communities that don’t have a team at all and then expand to all Ontarians who wish for it. Allow for local-level innovation but ensure that primary care providers are involved in the co-design on what would work best for them in their communities and for their patients.
    4. Look at existing models of performance measurement in primary care and facilitate and fund a strategy that spreads it across the system. This strategy must measure outcomes that matter to patients and providers while assisting in lower system costs. To support this, there needs to be further investments in quality improvement practice facilitators to help support front line providers.

    Relevant Links:

  • AFHTO’s 2019 Pre-Budget Submission

    AFHTO submitted its recommendations to the Standing Committee on Finance and Economic Affairs as part of the 2019 Ontario Pre-Budget Consultations in January. Our key recommendations are:

    1. We need a health system that is truly integrated, one where patients don’t have to move from one part of the system to another part to get their care, especially care for mental health and addictions – primary care and mental health care providers need to work together to ensure that mental health and addictions investments are integrated in primary care.
    2. The relationship between primary care and home and community care can be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients.
    3. Support expansion of interprofessional team-based care across Ontario. This can start with communities that don’t have a team at all and then expand to all Ontarians who wish for it. Allow for local-level innovation but ensure that primary care providers are involved in the co-design on what would work best for them in their communities and for their patients.
    4. Look at existing models of performance measurement in primary care and facilitate and fund a strategy that spreads it across the system. This strategy must measure outcomes that matter to patients and providers while assisting in lower system costs. To support this, there needs to be further investments in quality improvement practice facilitators to help support front line providers.

    Relevant Links:

  • Internal Responsibility System (IRS) and Workplace Violence Prevention Initiative 2018/2019

    The Ministry of Labour regularly undertakes “Safe at Work Ontario” activities, such as initiatives to focus attention on important health and safety hazards or concerns.

    Between July 1, 2018, and March 31, 2019, health and community care workplaces may be visited as part of the MOL’s Safe At Work Ontario internal responsibility system (IRS) initiative to promote compliance with the Occupational Health and Safety Act (OHSA) and its regulations..

    The following IRS focus priorities will be integrated into MOL workplace inspections:

    • Training / information and instruction/supervisory competency
    • Personal protective equipment (PPE) / protective devices:
    • Reporting incidents of workplace violence and other reporting requirements
    • Notification requirements
    • Duties of directors and officers of a corporation

    A joint webinar with the Ministry of Labour & Public Services Health and Safety Association (PSHSA) on November 14, 2018, reviewed how “Safe at Work Ontario” activities may affect your workplace and what compliance support resources are available to help you with achieving compliance with the Occupational Health and Safety Act (OHSA) and its regulations.

    The slide deck is here.

    The webinar was also recorded:

    Speakers:
    Eunice John, Provincial Specialist, Ministry of Labour
    Sherri Bastos, Director of Prevention and Operations, Engagement and Retention, Public Services Health & Safety Association