|2007 Aging at Home: LHIN Community Engagement|
LHINs at Five years – What Now?
About the Author
John Ronson is a founding partner of Courtyard Group, a global company with offices in Canada, the United States and the United Kingdom that is dedicated to transforming the healthcare system.
Trying to predict the future is always dangerous. At the inception of Ontario’s Local Health Integration Networks (LHINs) Ronson wrote two pieces for Longwoods – “Local Health Integration Networks: Will “Made in Ontario” Work?” [1. Abstract below] and a commentary on an article submitted by the LHIN Chief Executives: Integrated Health Service Plans: From Planning to Action [2. Abstract below].
|2007 LHIN Community Engagement Session|
And more importantly, how have LHINs done and where do we go from here?
Form Follows Function
So what should change? The adage “form should follow function” may be old, but that doesn’t make it wrong. In healthcare in Ontario (and in Canada generally) we have split different healthcare delivery functions across multiple different types of organizations and then are surprised when we get poorly integrated care delivery at very high cost! With the creation of LHINs we attempted to split the planning function from actual healthcare delivery but we left a massive Ministry bureaucracy in place and hundreds of individual and separately governed healthcare organizations for LHINs to attempt to coordinate. Plus we left some of the most important functions (primary care, prescription drugs, etc.) outside of the model completely.
1. Will “Made in Ontario” Work? Ronson, J. 2006. "Local Health Integration Networks: Will 'Made in Ontario' Work?" Healthcare Quarterly 9(1): 46-49.
The Province of Ontario has belatedly followed the other nine provinces in moving to a form of regional healthcare governance structure with the introduction of the Local Health System Integration Act, 2005 ("Bill 36") in the Ontario Legislature on November 24, 2005. Bill 36 has received second reading and has been referred to a Legislative Committee for hearings early in 2006.
The recent creation of integrated health services plans (IHSPs) by Ontario's 14 regional local health integration networks (LHINs) is an impressive example of collaborative planning, well documented in the lead article. The list of potential areas for improvement in health and healthcare is a long one - and the IHSP process has identified them well. Unfortunately, excellent planning, while an important precursor, does not ensure implementation success. Moving from planning to action is where many well-designed strategies disintegrate.
Multiple dimensions of traditional healthcare power dynamics must be addressed as LHINs move from planning to implementation. The traditional power bases of hospitals and physicians, largely unthreatened in planning, will move to the forefront during implementation. The "command and control" nature of the Ministry of Health and Long-Term Care must also be neutralized if LHINs are to be successful. Action strategies must be adopted immediately or LHINs will be tempted to retreat to the refuge of yet more planning.
Osborne, D.E. and T. Gaebler. 1992. Reinventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector. Reading, MA: Addison-Wesley.
Smart Systems for Health Agency, Ontario. 2006. Smart Systems for Health Agency: Operational Review Final Report, November 6, 2006. Toronto: Author.