Background
Methods
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A common vision;
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Accountability processes;
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Performance measurement; and
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A single governance structure. The latter had been identified during the retreat’s preparatory process as a potential barrier to regionalization (particularly given the relative independence of each service provider).
Background Information |
Definitions of palliative care and hospice care |
Real life case examples describing patient journey experiences across diagnoses, illness trajectories, needs and settings |
Evidence from other jurisdictions of the impact of regional programs and support of regionalization |
Key components of successful regional programs internationally |
Listing and description of current hospice palliative care services in Champlain |
The Planning Process that led to the development of the Business Plan |
Regional Supporting Data |
Expected population growth and causes of death |
Percentage of cancer patients dying in acute care hospitals in the regiona
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Percentage of cancer patients visiting emergency departments in last two weeks of lifea
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Total number of days patients spent waiting in Ottawa hospitals for admission to the Palliative Care Unit or hospice |
Mean and median number of days waiting for admission to a PCU or hospice |
Total number of new referrals and admissions to the Palliative Care Unit, hospices, home care services, hospital consultation teams |
Total number of PCU beds in region |
Total number of hospice beds in region |
Total number of Long Term Care (LTC) facilities and beds |
Provincial Supporting Data |
Costs of EOL care in Ontario |
Study of emergency department use by cancer patients in last 2 weeks of life |
Regulatory, legislative and policy barriers |
Recommendations |
Foundational, Priority and Supporting recommendations |
Guiding principles for Program Development |
Program Implementation Plan |
Governance Structure |
Priority tasks |
Evaluation framework with outcomes |
Terms of Referenceb
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Timelines |
Budget And Item Justifications |
Proposed budget items were: |
Executive members: Executive Director (full time), Medical Lead (part-time; 0.2 FTE); Decision Support/Informatics Coordinator (full time); Quality Improvement Coordinator (part-time); Local Network Support Personnel (1.5 FTE); Administrative Assistant (full time), operating expenses (translation, meeting & travel expenses, office rental, office supplies, etc.) |
Appendices |
Working Group recommendations |
Guiding Principles and Elements |
• A common region-wide vision and mission |
• A single common governance body that still allows for independence of the various service providers |
• An adequately resourced program and system |
• Evidence-guided care and diffusion of best practices through education and knowledge transfer |
• An accountability system of reporting and system-wide (macro) and institutional (micro) performance indicators |
• The establishment of standards for the region |
• Improve the capacity of primary care to provide primary-level palliative care (palliative care approach), with adequate resources to provide support to primary care clinicians |
• Ongoing role for the local End-of-Life Networks to enhance the role of the Regional Program |
Foundational Recommendationsa
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• Establish a Regional Hospice Palliative Care (HPC) Program |
• Establish a Program Council of Directors (later renamed “Board of Directors”) to oversee the Program, supported by an executive office |
• Establish formal agreements between the Regional HPC Program and the LHIN, and between the LHIN and service providers to: o Support the objectives of the program o Report on key performance indicators |
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The Terms of Reference for the Regional Program and its committees and members;
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A protocol outlining the accountabilities of a hosting agency or agencies (provincial legislation requires that funds can only be transferred by the LHIN to formally identified HSPs and the Regional Program would not be an HSP);
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The governance structure of the Regional Program (See Fig. 2 which shows the governance structure as of mid-2013);×
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An annual budget ($300,000);
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By-laws and governance protocols for the inaugural governing body (Board);
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A Work Plan, based on the most pressing priorities, for Year One of the Program’s operations;
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The competency grid of skills required for the Program’s Board. The competencies include those required of each individual member and the collective competencies needed of the Board. Individual competencies include the ability to think “systems” (putting what is best for patients and the system ahead of what is best for an individual service provider). Collectively, as a Board, the domains of competencies include expertise in Systems Development, Governance and Leadership, Project Management and Quality and Performance;
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The election process of the Regional Program’s first Board members.
Results
Early activities and early successes
Activities | Description |
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Activities Completed | |
Ottawa Hospice Plan Phases 1 and 2 | New 10-bed residential hospice in Ottawa and opened hospice in city’s west end. |
Service Agreements between the LHIN and HPC Service Providers (entities providing HPC services) | Ensure standards and coordination. |
Vetting of Proposals for HPC services to the LHIN | All proposals related to HPC services submitted to the LHIN by various service providers have to be first vetted by the Regional HPC Program Board. |
Standards for HPC services across different settings | Standards to guide performance indictor development across sectors created. |
Performance Indicators for the Region | 22 priority performance indicators have been identified for the region, as well 40 other micro indicators for individual service providers. |
Central Referral and Triage System for referrals to Hospices and the Palliative Care Unit (PCU) in Ottawa | One single referral point for patients being referred to Ottawa’s hospices and PCU; can be done online. |
Merger of PPSMCS and NPs to establish strong regional community-based consultation and support team (Regional Palliative Consultation Team (RPCT)) | (The only region in province to do this). |
Expected Death in the Home (EDITH) Protocol | Protocol that allows funeral homes to collect bodies of deceased patients who die at home (expected deaths) without requiring a death certificate to move the body; the death certificate is then completed within 24 h. |
Madawaska Rural Program Plan | Rural Hospice Palliative Program in rural and remote south western part of region. |
Telelink Project | Video conferencing link ups between all the region’s hospice and palliative care programs for education and telemedicine. |
Information Strategy for health professionals and public | Development of a Program website with information for the public, patients and health professionals (http://www.champlainpalliative.ca). |
Engaging Family Health Teams Project | Increasing involvement of three out of four family health teams in providing palliative care. |
Testing of Emergency Medications and Supplies Box | A rural model and an urban model. |
Rural Hospice Palliative Care Retreat | Initiate the process of developing a framework for the implementation of rural- and remote-based HPC. |
Framework for Rural and Remote HPC Services | Begin to implement framework. |
Coordinated Education Strategy for the region targeting physicians, nurses and pharmacists | Using, amongst others, the Pallium LEAP courseware and online learning modules. |
3-Year Work Plan | Work Plan for 2012 to 2015. |
Activities Underway | |
Palliative and EOL Care in Long-Term Care Framework | |
Family Physician Registry | Registry of Family Physicians who provide palliative and end-of-life care for their own patients and those who are interested in taking on new palliative patients. |
Challenges: past and present
Facilitators and enablers
▪ A history in the region of attempts at initiating a regional program; |
▪ A funded full-time coordinator; |
▪ Support from the Local Health Integration Network’s (LHIN’s) CEO and Board of Governors; |
▪ Starting the process using an Appreciative Inquiry approach; |
▪ Early commitment by most stakeholders; |
▪ Maintaining and sustaining momentum throughout the process; |
▪ Co-chairing of the process by two co-chairs ; |
▪ Significant community and stakeholder engagement; |
▪ Exemplars in the region of other regional programs, specifically Stroke and Geriatrics-Care of the Elderly; |
▪ Use of a “Change Management” approach; |
▪ Creation of a common vision early in the process; |
▪ Flexibility to adapt and modify the emerging plan and process; and |
▪ Establishment of a competency-based Board, instead of one that represents specific service providers, settings and sites of care. |
Discussion and reflections
Systems approach
Change management
Conclusion
Abbreviations
Acknowledgements
Funding
Availability of data and material
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The Program’s initial business case and proposal;
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The key elements in the accountability agreements (Memorandum of Agreement) between the LHIN and the Regional Program, as well as between the LHIN and local Service Providers;
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The Terms of Reference of the Champlain Hospice Palliative Care Program’s Board;
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The Terms of Reference of the Board's various committees; and
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The Competency Grids (Collective and Individual) of the competencies required of Board Members for the Champlain Hospice Palliative Care Program’s Board.