BOARD ITEM 8 A

Clinical Leadership Redesign

A component of LHIN Restructuring

Presentation to
South East LHIN Board
December 11, 2017

Dr. David Zelt

VP Clinical
South East LHIN
Evolution
Physician engagement within the South East LHIN is not a new
• concept
• Pre-LHIN – Regional Health Network (hospital Chief’s of Staff, Chief
Nursing Executives and CEOs)
• SECHEF – 2006
• 2008 – Health Professionals Advisory Committee
• Physicians aligned to MoHTLC initiatives/areas of focus
• Critical Care, Primary Care, Emergency Departments

• Clinical Services Roadmap – ‘Physician Executive Lead’

Medical Leadership
• Consists of having fully trained physicians occupying
leadership roles relevant to the practice of medicine

• Literature focuses on three dominant rationales:

1. Inherent tension between cost and patient welfare

2. Complexity of health care treatments and processes
3. Relationship between performances and efficiencies of
frontline organizational sub-units and medical outcomes
 Patients First
An Act to Strengthen Patient Centre Care
• Creates a more integrated health care system:
• Bill 41 is about transforming our health care system focused on the needs
of the Patients

• Ensure patients are at the centre of the health care system:

• Improve access to primary care
• Improve integration between health care providers
• Improve efficiency

• Enhance accountability
MOHLTC Mandate Letter Sets Priorities for the South East LHIN

• The overarching priority in

Patients First is Integrated
Health Care Planning and
Responsible Fiscal
Management

• LHIN’s will be responsible

for creating an integrated
delivery network
Requirement for Clinical (Physician) Input and Leadership

• Recognized within the health care literature internationally

and now nationally as a mandatory requirement to ensure
design of a high quality health system

• Similarly recognized by the MoH in Patient First Act and

mandated in the letter to the South East LHIN:
• Primary Care leadership and accountability
• Implementation of Clinical Leaders within the LHIN’s
Requirement for Clinical (Physician) Input and Leadership …

• Many challenges/issues exist now in the South East LHIN that

require urgent attention and a regional approach:
• Physician resource planning
• Gaps in clinical care – under and over utilization; transitions of care
Clinical Leadership
CEO South East LHIN
Paul Huras

VP Strategy, Planning and VP Human Resources and VP Home and

VP Operations
VP CLINICAL Integration
Sherry Kennedy
Organizational Development Community Care
Cynthia Martineau Paula Heinemann Joanne Billing
Dr. D. Zelt

Quality Clinical Lead (HQO)

Clinical Leads Sub Region LHIN Clinical Leads
Dr. C. Wilson

Leeds, Lanark and Grenville Primary Care Lead

TBD Dr. D. Russell
Quinte Emergency Department Lead
Dr. K. Moreau Dr. K. Edwards
Kingston
Critical Care Lead
Dr. D. Borschneck
Dr. J. Drover
Rural Frontenac, Lennox and
Addington
Dr. K. Morrison
Rural Hasting
Dr. C. Brown
 South East LHIN Clinical: Dr. C. Brown
Director: Jennifer Payton
Clinical: Dr. K. Morrison
Director: Laurel Hoard
Sub-Regions Clinical: TBD
Director: Carol Ravnaas

• Physician leads are

aligned with a Director

• Co-leadership model Clinical: Dr. D. Borschneck

Director: Darryl Tooley

Clinical: Dr. K Moreau

Director: Cheryl Chapman
The Clinical Committees in the LHIN
• Six principal clinical (physician participation) committees:

1. Primary Health Care Council – Dr. Deanna Russell

2. South East LHIN Sub-Region Clinical Leaders Committee
3. “SECHEF” Clinical Leaders Committee
4. Public Health Committee – Dr. Kieran Moore
5. Strategic Alliance (AMH Clinical Committee)
• Part of AMH redesign from Health Care Tomorrow Project

6. Quality Committee (TBD) – Dr. Colin Wilson

The Sub-Region Clinical Committee
• Co Chair:
• D. Zelt (VP Clinical)
• C. Martineau (VP Strategy, Planning and Integration)

• 5 Sub Region Clinical Leaders

• 5 Sub Region Directors
• Dr. Deanna Russel (SE LHIN Primary Care Lead)
• Joanne Billing (VP Home and Community Care)

• Reports to: SE LHIN Executive

Through Sub-Regions Committees:
• Plan at a sub-region level and seek input from family physicians and
others to identify what is getting in the way of them accessing care for
their patients;

• Produce sub-region plans aligned with Mandate Letter (5 priorities

and 39 goals)

• Better link Primary Care

• Focus primarily on vertical integration for sub-regions

Vertical and Horizontal Integration: Planning for Integrated Care
• From a ‘vertical’ integration perspective, ensuring that the
patients/clients/residents needs are met at the local level
• Primary care links with HCC, AMH, specialty care, hospitals
• Health links – integrated care for complex patients

• From a ‘horizontal’ integration perspective, ensuring

patients/clients/residents receive standardized care components that
are effective and measurable
• Hospital care: COPD, Hip #, lab services
• Older adult strategy
• Opioid strategy
• Palliative/hospice
• HIS
A refresh of the SECHEF Clinical Table
• Needs improved alignment to the LHIN
• Augment accountability
• Improved communication and connectivity to the health care system
• Improved awareness of initiatives and support by the LHIN
• ie The MoH Mandate

• Membership adjusted to meet the TOR

New SECHEF Clinical Table
• Chair:
• D. Zelt (VP Clinical)
• C. Martineau (VP Planning, Strategy and Integration)
• 6 Chief of Staff
• 6 Chief Nursing Exec
• VP Home and Community Care - Joanne Billing
• Regional VP CCO - Brenda Carter
• South East LHIN ED Lead – Dr. K. Edwards
• South East LHIN CC Lead - Dr. J. Drover
• South East LHIN Primary Care Lead – Dr. D. Russel
Potential Scope of the Committee
• Assess current projects
• COPD, # hip, endoscopy

• System changes that impact patient care wrt hospitals

• Link to the Primary Care Committee
• Link to the Sub LHIN Committee
• Link to the Public Health Committee
• Eg. HIS, HCT

• Regional Solutions
• Eg. HR issues, common credentialing

• System impact of service changes – slow downs, holidays

• Quality of care – MLAA/HSAA/QIP

“Special” Physician Relationships

• South East LHIN and Health Quality Ontario

• HQO Clinical Lead – Dr. Colin Wilson

• South East LHIN and Public Health