Canada: Overview Of The Second Report Of The Premier's Council On Improving Healthcare And Ending Hallway Medicine: Part II

Health Bulletin
Last Updated: July 31 2019
Article by Laurie M. Turner

Introduction

At the end of June, the Premier's Council on Improving Health care and Ending Hallway Medicine (the "Council") released its second Report, A Healthy Ontario: Building a Sustainable Health Care System (the "Report"-PDF). The Report followed the Council's first report, Hallway Health Care: A System Under Strain (the "First Report"-PDF), which was released in January of this year. The key findings of the First Report were summarized by Fasken in a previous bulletin, Hallway Health Care: A Symptom of Broader Challenges Facing Ontario's Healthcare System.

This bulletin is Part II of a three-part series on the Report. The first bulletin, Overview of the Second Report of the Premier's Council on Improving Healthcare and Ending Hallway Medicine: Part I ("Part I"), summarized the first five of ten recommendations given by the Council in the First Report (the "Recommendations"). A complete list of the Recommendations, which are organized into four categories,1 is included at the end of Part I.

This bulletin will summarize the principal findings of:

  • Chapters 1 and 2 of the Report
  • Recommendations 6 to 8, which fall within the category of Efficiency & Alignment

The final bulletin in this series will focus on Chapter 4 of the Report (Reporting Progress Throughout the System) and Recommendations 9 and 10, each of which relate to the capacity of the provincial health care system.

Chapter 1: We Hear You, Ontario

In the first chapter, the Council confirms that in preparing the Report, it relied on:

  • The professional experiences of its members.
  • The perspectives and ideas collected by the Council from over 1,500 patients, caregivers, families, health care professionals and organizations from across Ontario through engagement sessions (held in-person and virtually),2 initial dialogue with Indigenous communities and partners, surveys, email feedback received in respect of the First Report, and input from leaders in the health sector who participated in six of the Council's sub-committees.

This chapter also sets forth some of the "common feedback" that was received by the Council through its engagement process. Among this feedback was the desire for improved experiences for patients and their providers in accessing health care, through (for example):

  • Publicly available health care services that are easily understood, accessed and navigated.
  • More flexibility and options in accessing health care services -- for example, by expanding options for use of digital solutions to access health care, and enhancing access to health care in alternative, non-hospital, settings (in particular, in respect of home and community care and mental health services).
  • The health care system's provision of support to patients in their use of the health care system, including by taking steps to cause patients to be "engaged and empowered."
  • Additional collaboration among providers of housing, social services and health care services, and partnership and integration more generally throughout the health care system.
  • Health information being more: (i) accessible to patients and health care providers; and (ii) shareable among health care providers (at the patient's discretion).

Chapter 2: The Vision for Health Care in Ontario

This chapter introduces the "Quadruple Aim" framework to the Report, being an "internationally-recognized framework"3 which is comprised of four objectives:

  1. Improving patient and caregiver experience
  2. Reducing the per capita cost of health care
  3. Improving the health of populations
  4. Improving the work life of providers4

The Council regards the Quadruple Aim framework as being "well-aligned" with its new vision for health care in the province and the Recommendations as being responsive to each of the framework's four objectives.

The remainder of Chapter 2 focuses on the movement towards a more integrated health care system, a system in which, for example:

  • The "resources would follow the patient".
  • Prevention and well-being would be emphasized and the diversion of patients to health care settings outside of hospitals (as warranted) would be supported.
  • Integrated digitation solutions would, with the patient's permission, enable a patient's full health care team to access all of their medical records / history.

Chapter 3: Ten Recommendations to Improve Health Care

As noted above, the Recommendations are divided into four categories, and the Recommendations falling into the first two categories (Integration and Innovation) were summarized in Part I. The Recommendations included in the third category, namely, Efficiency & Alignment, are set out below together with a summary of some of the "Action Items" proposed by the Council to give effect to such Recommendations.

Recommendations 6-8: Efficiency & Alignment

The Recommendations in this category are said to support the elimination of the "traditional barriers" to the fulfilment of an efficient and sustainable health care system. Unlike in respect of the preceding Recommendations, Recommendations 6-8 include both "short term" and "long term" Action Items.

Recommendation 6: Data should be strategically designed, open and transparent, and actively used throughout the health care system to drive greater accountability and to improve health outcomes.

Distinct from the Action Items for the other Recommendations (which are directed only to the government), the short term Action Items for this Recommendation - all of which relate to data collection practices - involve both the government and Ontario Health.5 For example, the Action Items call for the government and Ontario Health in:

  • Beginning to limit the collection of health data to health data that can be utilized to improve patient care (as opposed to health data that does not serve that purpose).
  • Standardizing the collection of health data between and among health care settings.

Among the long-term Action Items is the proposal that the government work with Ontario Health to "consolidate its data assets to help enable long-term and evidence-informed modernization", and leaders and providers in the health sector to employ predictive analytics and artificial intelligence with the aim of increasing efficiency and quality of care. In introducing these Action Items, the Report contemplates changes being made to the province's health privacy statute, the Personal Health Information Protection Act, 2004 (PHIPA) to permit health data to be used more effectively in the future.6

Recommendation 7: Ensure Ontarians receive coordinated support by strengthening partnerships between health and social services, which are known to impact determinants of health.

Once again, one of the short-term Action Items proposed for this Recommendation involves the government's collaboration with Ontario Health. In particular, the Action Item suggests that the government work with Ontario Health to enable planning and the sharing of health data (with a goal of enhancing health data integration) between various provincial ministries, such as the Ministry of Health and Long-Term Care and the Ministry of Municipal Affairs and Housing.

The single long-term Action Item presented for this Recommendation aims to eliminate any barriers to timely and quality health care caused by "governance structures", through the government's taking steps to increase integration: (i) among provincial ministries, orders of government (e.g. municipalities) and the federal government; and (ii) at the point-of-care at which health care is being delivered.

Recommendation 8: As the health care system transforms, design financial incentives to promote improved health outcomes for patients, population health for communities and increased value for taxpayers.

Included among the Action Items is a recommendation that the government consider the objectives for the health care system vis-à-vis the current funding models, in order to "ensure appropriate alignment between goals and incentives". The Council provides examples of how such alignment could be achieved, including through the implementation of new funding models that support value and quality of health care - e.g. creating incentives for health care providers in order to support integration and collaboration in health care delivery in the province.

Conclusions

Much of the focus of the Report, including Chapter 2 (summarized above) is on the integration of the healthcare system. Since Part I was published, significant steps have been taken in the province to support such integration. For example, on July 17, 2019 the Ministry of Health and Long-Term Care advanced the process for the establishment of the first Ontario Health Team Candidates by inviting selected groups to submit a full application to become Ontario Health Teams. Moreover, on the same date, two hospitals announced their definitive plan to integrate their resources and share health information with an identified goal of ending hallway medicine.

The final part in this series of bulletins on the Report, which will summarize Chapter 4 and Recommendations 9 to 10, will be published by Fasken in the near future.

Footnotes

[1] Specifically, Integration, Innovation, Efficiency & Alignment, and Capacity.

[2] The virtual engagement session included over 250 Francophone stakeholders and participants from 16 sites in Ontario.

[3] The Quadruple Aim Framework is an extension of the "Triple Aim Framework" which was developed by the Institute for Health Improvement (IHI) in the United States. The Triple Aim Framework has often been referenced in commentary on the provincial health care system - see, for example, the blog posting, The Next Step for Better Quality Care, by Dr. Joshua Tepper (the then President and CEO of Health Quality Ontario).

[4] The Quadruple Aim Framework may be familiar to some readers, including those who have been following or involved in the development of the Ontario Health Team model. The framework was referenced numerous times by the Ministry of Health and Long-Term Care in its guidance document on Ontario Health Teams. For example, that guidance document identifies the requirement for all Ontario Health Teams "to collect and report data on key integration indicators, aligned with principles of the Quadruple Aim" during the first phase of such Teams.

[5] The agency created by the Connecting Care Act, 2019 (Ontario) which it is anticipated will constitute a "central" or "super" agency that will be formed upon the dissolution of the local health system integration networks and the six provincial health agencies identified by that Act (e.g. Cancer Care Ontario and eHealth).

[6] The Council makes various recommendations throughout the Report as to how PHIPA should be amended to align with various Recommendations.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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