Tag: Members Only

AFHTO representatives met with the Ministry’s Primary Health Care (PHC) Branch on November 3, 2010.  AFHTO’s aim is to work collaboratively with the Ministry to support the success of FHTs in delivering accessible, high-quality, efficient care to Ontarians; AFHTO was encouraged by the open discussion and positive response.   This e-mail reports on the following highlights from that meeting; scroll down to read more on each:

• Good news beginning to emerge in FHT evaluation
• AFHTO makes proposal for developing stronger governance and risk management in FHTs
• Accessibility for Ontarians with Disabilities Act: Ministry preparing guidebook for FHTs
• PHC Branch is working to improve funding processes
• Policy work underway in support of FHT access to Ontario Telemedicine Network
• MOHLTC to review blended salary model
• WERS issues are being resolved
• PHC Branch advocates to Trillium Foundation for FHT eligibility for innovation grants
• Government communications to build awareness of FHTs

Good news beginning to emerge in FHT evaluation While the findings from the first two years of MOHLTC’s 5-year evaluation of FHTs have not been released, AFHTO has learned that preliminary evidence is showing that the following outcomes were found to improve as FHTs mature:

• Overall satisfaction of providers with their role & team
• Participation in quality-related initiatives
• Coordination & comprehensiveness
• Community orientation
• Cultural competence

Team “maturity” was determined from site observations for the134 FHTs from Waves1-3 who are participating in the evaluation.  About 1/3 of teams were found to be ‘mature”, 1/4 are “early stage”, and the rest are in middle. AFHTO makes proposal for developing stronger governance and risk management PHC Branch has indicated it is open to considering a proposal from AFHTO to strengthen governance of FHTs in Ontario to promote effective and efficient delivery of accessible, high quality primary care to Ontarians and accountability for use of public funds back to Ontarians.  AFHTO presented a preliminary proposal to PHC Branch for feedback. Next step is for AFHTO to flesh out the proposal for further discussion in mid-December.   Findings from AFHTO’s November 2009 Leadership Retreat and the May 2010 Governance Survey indicate a very strong recognition among FHTs of the need to help FHT board members, many of whom have never served on a board before, to develop their capacity to govern and manage risk.  There is also the issue of board turnover, and the resulting need to develop the governance capability of completely new people.   Layered on top of this is further development of MOHLTC-FHT accountability agreements and the Excellent Care for All Act, which, once extended to include primary care, will give boards much more stringent responsibility for developing quality improvement plans, setting targets and linking executive compensation to performance. This is already beginning to take place with the Wave 5 FHT agreements, which will include added requirements related to after-hours care and advanced access, among others.   Key to this proposal is the need to reach common understanding of where the overall framework for FHT governance is headed in the future, i.e. the combination of:

• legislative and regulatory requirements
• accountability agreements between MOHLTC and the FHT
• quality and performance measurement
• population-based planning and the ability to meet community needs

As a result, the proposal calls for a table to be established for AFHTO and MOHLTC to work collaboratively to develop a “Framework for Good Governance of FHTs”.  The proposal also recommends a series of web-based learning modules and other tools to strengthen skills and support fulfillment of sound governance and risk management within FHTs. Accessibility for Ontarians with Disabilities Act: Ministry preparing guidebook for FHTs By January 2012, all FHTs must fully comply with the Accessible Standards for Customer Service regulation under the Accessibility for Ontarians with Disabilities Act.   PHC Branch is working with the Canadian Disability Policy Alliance on a guidebook to be ready in the near future.   If FHTs have common questions about how various requirements under Ontario’s legislation apply to FHTs, PHC Branch would welcome having them filtered through AFHTO and they will respond by preparing an interpretative bulletin. PHC Branch is working to improve funding processes Operating funds:   PHC Branch acknowledges the need to improve the timeliness and transparency of the budget and funding process.  The FHT Unit has said it is aiming to:

• Standardize the budgeting process through clear, transparent deadlines for budget submission and review
• Address lack of understanding by developing a reference document to ensure there is general awareness of the provincial government budgeting process
• Maintain open communication with FHTs through the submission and review process

PHC Branch reported there is a backlog of requests to be responded to from the previous and current fiscal years.  The FHT unit is currently cleaning up requests from last year and this year.  One-time requests that were submitted on time this year (i.e. by June 30) are also in process in addition to those that were sent after the June 30th deadline.  New accountability provisions within the Ministry means that FHTs should expect delays in receiving approval for funding requests.   PHC Branch committed that for the 2011-12 fiscal year, budget timelines & process will be more transparent, including firm, well-communicated deadlines.  In subsequent years the process will start even earlier, since the government-wide estimates process begins in November for the following fiscal year. Capital funds:   AFHTO raised the issue of the length of the approval process when bids typically hold for 30 days. PHC Branch reiterated that the new accountability requirements in MOHLTC are likely to result in approval delays.  Therefore, they recommend that FHTs put a requirement into their RFPs for bids to hold for 90 days and to work with their Senior Program Consultant who can assist in the various stages of the process.  AFHTO has also requested that PHC Branch find ways to provide more informational support for FHTs going through capital planning, since many are reporting they find it very confusing.     Income stabilization program for physicians:   There have been some problems arising from delays in FHTs submitting enrolment forms and MOHLTC entering the data.  PHC Branch assured they have caught up in entering enrollment forms and there is no backlog. Some changes to income stabilization provisions are being negotiated with OMA that would add targets to hit within the contract period and require forms to be submitted throughout the process.  There would be no change to the maximum one-year period for the program. Policy work underway in support of FHT access to Ontario Telemedicine Network (OTN) Under a pilot project, OTN equipment was installed in 75 FHTs. AFHTO has raised the issue that there are additional FHTs who are also in great need of OTN access to serve their communities.  Furthermore, the FHTs who have the equipment are struggling to afford the operating costs.  PHC Branch is doing policy work on this issue right now and is aiming to complete it in time of next fiscal.  AFHTO has asked for the opportunity for AFHTO comment on the draft policy. MOHLTC to review blended salary model The Ministry will have a consultation process on the blended salary model to get feedback on any proposed changes.  AFHTO has emphasized that both AFHTO and AOHC (the Association of Ontario Health Centres) should be involved in the consultation. WERS issues are being resolved AFHTO board members Brian Gray (ED, Harrow Community FHT) and Kavita Mehta (ED, South East Toronto FHT) have been working with PHC Branch to resolve a number of issues with WERS.  More remain and are being worked on.  The Branch will be doing an evaluation, including user survey. PHC Branch advocates to Trillium Foundation for FHT eligibility for innovation grants AFHTO reported that two main funding sources for innovative projects – Trillium Foundation and Ministry of Health Promotion – do not allow FHTs to apply for their grants.  Although they do provide grants to CHCs, they saw FHT work as being fully funded through government already.  Assisted by further information provided by AFHTO, PHC Branch is working to get a meeting with Trillium to educate them about what FHTs do. Government communications to build awareness of FHTs In the past three weeks the Minister of Health and Long-Term Care has made public announcements at four FHTs – Centre for Family Medicine, Wise Elephant, City of Kawartha Lakes and Caroline FHTs. For a précis of each, go to https://www.afhto.ca/news/feature-family-health-teams/ .   “Health Care Options” ads  are now running on TV and radio, following up from Premier’s Nov.1 announcement (http://news.ontario.ca/mohltc/en/2010/11/ontarians-have-more-health-care-options-than-ever-before.html ) and supporting the Health Care Options website (http://www.health.gov.on.ca/en/public/programs/hco/ ).