Rural hubs are redefining health care


It would be a real shame if the Ministry doesn’t move forward and establish other rural health hubs because there are many other communities in Northern Ontario that could benefit from the model.”

– Sherry Frizzell, director, Home and Community Care, and Rural Health Hub Lead, North East LHIN



Three rural health hubs in Northern Ontario are at various stages of redefining the health-care system to enhance administrative efficiency and patient navigation. Manitouwadge, Espanola and the North Shore of Lake Huron are among five pilot sites in the province.
Manitouwadge, which is furthest along in the integration of health-care services, has achieved a single governance and administration model for almost all health-care services in the community, including the hospital, long-term care, the family health team, home care, diabetes education, local transportation and public health promotion.
The rural health hub in Manitouwadge is closely aligned with the framework set out by the Ontario Hospital Association (OHA), while the two hubs in Espanola and the North Shore of Lake Huron are following a framework developed by the North East LHIN. “In all likelihood, Espanola and the North Shore will not adopt a system-wide single administration and governance (structure),” said Sherry Frizzell, director, home and community care, and rural health hub lead for the North East LHIN.
Both northeastern Ontario communities have integrated acute and long-term care, and are working with a project management team consisting of Mary Ellen Luukkanen, former chief nursing officer in Blind River, and retired family physician Dr. Janet McLeod to decide how they will reorganize and restructure.
The process, dictated by the Ministry of Health and Long-Term Care, began with community engagement and a current state assessment, followed by the development of a work plan and the striking of work teams around defined priorities.
The North Shore work teams are focusing on home and community care, primary care, transportation and mental health, while Espanola teams are focused on home and community care, mental health and palliative care.
The objective, said Frizzel, is “to better align services, fill gaps and work better together.”
Additional administrative integration is possible, but isn’t necessarily the end goal. For example, she added, “If it made sense for the hospital to assume responsibility for home and community care, we could look at that.”
Another goal is to reduce the administrative burden of processing separate quality improvement plans (QIPs) for hospitals, long-term care and primary care through the development of a cross-sectoral QIP.
“One of the good things that has come out of the process is that cross-sector agencies and providers are sitting at the same table, talking about the services they provide (and coming up with solutions),” said Frizzell.
As an example, she cited a discussion at a meeting of the North Shore transportation work group about the challenges of transporting patients within the community.
“One agency representative said, ‘We have a van, we just don’t have a driver,’ at which someone else said, ‘We have a driver, can you loan us your van?’ As a result of that, transportation service has already improved on the North Shore,” said Frizzell.
Manitouwadge has completed its current state assessment and work plans and is now working on a strategic direction for 2018 to 2022, said Jocelyn Bourgoin, CEO of the recently renamed Manitouwadge Health. “We basically accomplished most of what’s spelled out in the OHA (rural health hub) model, so this year we’re focused on transformation of health care at the front line with a targeted focus on prevention.”
Four clinics have been set up, Using the data from the family health team’s electronic medical record system, the first in the series of clinics targets patients with high blood pressure, cholesterol, lipids and blood glucose with the goal of modifying behaviour and avoiding the risk of diabetes, strokes and heart attacks.
A second metabolic clinic strives to stabilize patients who are already borderline for chronic disease. There’s also a pain management clinic to help people with conditions such as fibromyalgia develop coping mechanisms, and what Bourgoin calls an ALC and memory clinic for patients who could end up filling acute care beds if they can’t be cared for at home and if there are no vacancies in long-term care. The goal for the latter clinic is to identify these patients, support families to care for their loved ones as long as possible at home and educate them about how to navigate the system and access the services they’re entitled to.
The rural health hub model shows a lot of promise for streamlining and improving health care, but there are still opportunities to further reduce the bureaucratic burden of multiple accountability agreements and reports, while the sanctity of separate funding envelopes remains a source of frustration.
For example, explains Bourgoin, a small surplus at the hospital can’t be used to offset a deficit at the family health team. It has to be returned to the Ministry of Health and Long-Term Care.
The designation of future rural health hubs may depend on the conclusions of a Ministry-commissioned report due in January.
“It would be a real shame if the ministry doesn’t move forward and establish other rural health hubs because there are many other communities in Northern Ontario that could benefit from the model,” said Frizzell.

Jocelyn Bourgoin, CEO of Manitouwadge General Hospital


Filed in: News

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