That pretty much says it all, according to Central Local Health Integration Network (LHIN) CEO, Hy Eliasoph.
Leonard Domino & Associates was impressed with Eliasoph’s article in a recent Longwoods review. His technical analysis of the strengths and weaknesses of Ontario’s new health care system made us realize that Eliasoph is one of the heavy hitters in the new world order of LHINs.
Eliasoph agreed to be interviewed by Leonard Domino & Associates – and to give some straight talk advice on how your health care organization can achieve a strong position within the new system when it’s all said and done. In his words, “Be provocative, tell the truth”.
We could feel his frustrations. A lot of materials on LHINs appear to dance around the hard reality: LHINs are here to stay in Ontario, but that doesn’t mean that the current list of health care organizations will remain constant.
In fact, everything that we have learned about LHINs, since our early findings through senior high ranking political and bureaucratic officials, tells us that one of the goals of the LHINs is to refine the number of service providers, while increasing the standards, capacity, efficiency and quality of health care in Ontario.
Below are the highlights of an open and honest conversation of LHINs and the health care philosophy driving the decision making.
Are LHINs Here Permanently, Would a New Government Take a Different Direction?
- “History speaks for itself: Nine other provinces had a regional system introduced and no one went back – we’re here to stay”.
How Will The Role of a Board and Senior Management Change?
- “The vast majority of providers need to undergo a paradigm shift”.
- “They were focused on their local clients and constituents in the past, not the whole system”.
- “The leading people are thinking about the broader system, and know that they must meet the needs across the entire system”.
What is the Role of LHINs in Achieving Change in the System?
- “Hospitals and long term community health provided through CCACs are funded through LHINs. We are a purchaser and a payer, not a provider”.
- “Don’t complain to us, we are only the funder”.
- “When someone has a problem with service, we may track it, but we send them back to the source of the complaint – the health care provider”.
- “We see our role in helping to evolve organizations’ ability to think in a ‘change management’ context”.
- “If we can hurry this along, and make it work, it will be more robust than a linear system. Our ability to do this will determine whether the LHIN model remains or whether we need to move to a more ‘regional based’ model like the other provinces”.
How Will LHINs Balance the Needs of Smaller versus Larger Organizations?
- “Some LHINs have more people within their borders than entire provinces”.
- “Let’s face reality, smaller organizations may have a seat at the table, but their one voice will be limited due to their size”.
- “Hospitals take up two thirds of the budget”.
- “In our LHIN, there are organizations that are coming together as a group, not merging, but speaking with a common voice. We didn’t tell them to do this, they self organized for a bigger voice”.
Working Together With Past Competitors:
- “You better find a way to partner with other organizations to gain more critical mass and pool resources”.
- “LHINs won’t care that you were competitors in the past, they need to find ways to work together. Look at the private sector, they compete for work, often that means businesses have to work together to fulfill the demand”.
- “Just because you compete in the marketplace, doesn’t mean you can’t partner up and work on issues together”.
How Can an Organization Be Successful in the New World of LHINs?
- “The more in tune an organization is with the direction of the Ministry, the LHINs, and the CCACs, the better positioned they will be for success”.
- “People have to stop thinking that it is “either / or”, rather it should be “and”.
- “The knowledge and power of independent boards is an asset to health care. They should be an enabler, not an obstacle to change”.
What are the Consequences of Inaction?
- “Those with their heads in the sand will be left behind”.
- “Some are pretty good in health at playing the victim mentality, however, over the next couple of years they must step forward – those who do will become the leaders. The rest will be relegated to the past”.
- “You may not like the LHINs, but you’ll like the alternatives a lot less”. The suggestion being made was that if the LHINs are unsuccessful, that there will be a move to a regional health model that will dismantle community boards, amalgamate executives, and deliver services through the model used in other provinces.
- “Organizations must, at the governance level, change. However, the window is open now but it is slowly closing for those who are not embracing the change”.
What is the Future of You and Your Health Organization with LHINs in Ontario?
- “The next three years will be critical. Health organizations, their boards and their executives have three years to find partnerships and make the new system work, or if I was government I’d be looking at the alternatives”.
Leonard Domino & Associates’ Assessment:
The Future is with the LHINs – But that Doesn’t Mean You Cannot Have a Positive Effect on the Outcome.
It is clear that the Ministry of Health, LHINs, and CCACs have an unavoidable mandate to enact change. This change can occur voluntarily, or by force. The government has currently chosen to give health care providers the chance to make this change happen through self initiatives.
If organizations and their boards fail, this will not mean LHINs will fail. The government will choose to reorganize the health care providers to meet the underlining objective – local health integration.
The window is not closed - yet.
There is time for you, your board, and your organization to be successful in this new health care system. However, LHINs will be overseeing whether you are contributing to success, or acting as a barrier that must be removed.
LHINs will:
- Promote the opportunity for organizations and their leaders to embrace this new system and to excel through integration opportunities that are surfacing.
- Oversee and assess the level of success being achieved by organizations that coordinate to build a streamlined process with integrated partnerships.
- Within three years suggest to the Ministry of Health, a course of action:
- Continue with LHINs, while phasing out those who have failed to integrate.
- Or, determine that the system has failed to encourage organizations and its leaders to voluntarily integrate. LHINs would remain, but community boards would be dismantled, organizations merged, and a regional health model similar to other provinces adopted.
Leonard Domino & Associates’ Suggestions:
Strategies that We Suggest to Contribute to Success for You and Your Organization.
- If you are denying that integration will happen – stop.
- Educate your boards on LHINs, and how to build success. You can be certain that choosing to fight the LHINs will leave you out of the future of the system.
- Seek out horizontal partnerships with organizations that are in your sector. Opportunities will come in the form of efficiencies gained through knowledge and resource sharing. Binding together within your LHIN will also give your sector the voice it needs to be cohesive and to sit together at the table with your LHIN.
- Recognize that as a provider of a service, there is a continuum. Seek out vertical partnerships with organizations that flow patients or consumers to you. Also, seek out organizations to which you forward an individual. Finding the right spot for a patient or consumer will mean tearing down the barriers that may be trapping an individual in the wrong part of the system.
- Build relationships with hospitals. Hospitals have been made central to this new system. While the positives and negatives of this can be debated all day, recognize the reality that hospitals will play an ongoing and important role. This means that they are not the enemy, but a large and influential partner that can benefit the entire health care spectrum.
- Build relationships with Community Care Access Centers. CCACs have been reorganized to match the LHIN boundaries. This was intentionally done to align the mandate of the LHINs with the mandate of the CCACs. While LHINs view themselves as the funder, CCACs will actively tender, select, and manage contracts with service providers. They will choose the winners and losers.
- Identify standards of quality that the government is seeking for your sector. If your organization is to survive in the long term, ensure that you are developing your human resources and organizational capability and capacity. Since the CCACs will be tendering for services, if you can’t meet the standards, then you may find yourself and your organization left out altogether.
Leonard Domino & Associates Offers Five Essentials Services That Will Assist Your Organization to Be a Leader as LHINs Move Forward:
1. Board and Executive Training
2. Organizational Strategic Planning: Analysis, Review and Implementation
3. Horizontal and Vertical Partnership Building
4. Sector Wide Coalition Formation
5. Expedition of Your Lobby Campaign
Each of these five services can be provided separately, in areas where you need help, or as a full service strategy. We understand that all organizations have strengths and areas where assistance can be best focused. We’d like to offer help where it makes sense for you and your organization.
1. Board and Executive Training
Sometimes it takes an outsider to share a new view and help build consensus. Leonard Domino & Associates, for over 20 years has been the preeminent supplier of hands on training seminars on the do’s and don’ts of government relations with organizations and their boards. Often, organizations are bottlenecked by indecision. Something as big as LHINs make that indecision even more of a hurdle. Sometimes, it’s not even about what you are trying to say to government, often it’s a struggle over how it’s done and by who. Our training seminar is customized to meet your organization’s needs. We don’t just present a cookie cutter – we’ll talk to your board, executive, and seminar participants prior to the seminar to establish what are the real contentious issues that need to be hammered out. We’ll make every attempt possible to understand:
• What are the issues important to your organization?
• Does your team currently have what it takes to survive LHINs, and where is advancement necessary?
You can be sure of one thing: after our training seminar, your organization will be singing from the same song sheet when it comes to negotiating with government.
2. Organizational Strategic Planning: Analysis, Review and Implementation
Leonard Domino & Associates is the one stop shop for building and implementing a strategic plan specific to your organization – and your success in the new LHIN world. We are known for getting to the bottom of things. Getting the answers you need, means asking the right questions first:
• In the eyes of your LHIN, why is your organization necessary or needed?
• How does your core competencies relate to the wider objectives of LHINs?
• Do your current standards and practices meet CCAC and LHIN requirements?
• What potential does your organization have that you may not be aware of in the context of LHIN health priorities?
• Who are the friends and foes of your organization?
A Leonard Domino & Associates analysis is not a 1000 page binder that no one will read. We will prepare short debriefings as information is gathered that will allow your organization to make sound, fast decisions.
3. Horizontal and Vertical Partnership Building
LHINs will make every attempt to ensure that organizations like yours will be connected to the whole system of health care – you can’t be an island. Remember, the LHIN mandate – is the patient or client in the right place at the right time. Connecting your organization to others will help build you into the new health system, and not leave you relegated to the past. Leonard Domino & Associates will:
• Identify and open working relationships with those in your immediate sector.
• Build working relationships with organizations in adjacent sectors that the LHINs will expect you to be integrated with.
• Arrange meetings with the senior executive from all relevant organizations.
By helping your organization to reach out to others, you will be well prepared as CCACs begin the process of tendering contracts. You will be able to build new relationships where they hadn’t existed in the past.
4. Sector Wide Coalition Formation
Strength comes in numbers.
There will be cases where sectors are either left out or forgotten while the reorganization of the entire health care system takes place. Leonard Domino & Associates can help your whole sector to bind together to organize a successful effort to get the necessary Ministry of Health funding into the hands of your funder – the LHINs. To build a strong coalition in your sector, we will:
• Identify and organize the key sector players to establish the priorities. This may include organizations that might compete with you for CCAC contracts.
• Strategically, organize your messages for maximum impact.
• Organize joint strategy meetings with the coalition partners.
• Actively participate and assist the coalition in arranging meetings and delivering the coalition’s messages to the government.
Essential to the success of any coalition – do all of the members share enough in common to make a compelling case to government. We’ll make sure the right players are at the table and that a consistent message is developed and delivered to the right people in government.
5. Expedition of Your Lobby Campaign
So, you’ve got a strategic plan already or know the players, but want to expedite the lobby campaign. You likely have a good understanding of your needs – but do you know the needs of government that can help advance your issues into the limelight of their decision making? Leonard Domino & Associates is a leader in providing an ethical and strategic approach to government relations. We have organized hundreds of successful lobby campaigns over the last 22 years. Ministry of Health, LHINs, and CCACs will each respectively make decisions that will impact your sector and your organization. Systemic changes of this magnitude will mean that every health funded organization will be lining up at door of government. Will you be at the front of the line or the back? We will assist your board and executive to make it onto the radar of government – Ministry of Health, LHINs and CCACs. We’ll identify the key and influential decision makers, arrange face to face meetings, and assist to make sure your messages are heard and understood through the working relationships we will help you to enhance with government. We’ll help to make it possible for your organization to succeed.
