"The desire to understand the world and the desire to reform it are the two great engines of progress." - Bertrand Russell-

Lessons from our Commonwealth cousin: Change Foundation report offers timely & targeted health integration advice to Ontario

"This is an outstanding report because it provides a clear analysis of how Ontario can learn from the NHS experience. This advice is politically very powerful. Now the task before you, is to conceive the organizational strategies that will enable your system to respond to these recommendations," - report reviewer, Professor David Knowles, Senior Associate, Kings Fund

Ontario needs to expand public voice and choice, engage physicians and other providers in reform and e-health, and develop funding and incentive models to better integrate primary and secondary care. Oh, and it should brace itself for more restructuring as this is just part of getting it right. These are just some of the key policy lessons Ontario can learn from England's National Health Service (NHS) according to The Change Foundation's new report: Integrated Health Care in England: Lessons for Ontario, the first in a series of international case studies drawing instructive lessons from other systems. England was chosen because its health care is also publicly funded and regionally run, and has undergone massive reforms through the 90s to present.

The report offers system-level advice to Ontario's health-care leaders in six digestible sections and concludes with ten key integration ingredients to help guide decision-making within a LHIN landscape.

"I congratulate The Change Foundation on an excellent report. It covers a lot of ground and history and truly reflects the challenges that both jurisdictions face which are very similar," says Tony Woolgar, a former CEO of an NHS hospital and a former LHIN CEO asked to respond to our report because of his rare bi-national experience. Read Woolgar's commentary and listen to his wide-ranging Q & A video podcast.

The report was also reviewed by Chris Ham, Health Services Management Centre, University of Birmingham, and David Knowles, Kings Fund, London UK. Read a thought-provoking Q and A by third reviewer Jamie Burn of the Policy Exchange (see below.)

Read the report, download two related charts; Key NHS Characteristics, and A Comparative Analysis With Ontario. Learn more at the UK Health Service Journal website. The Change Foundation will focus next on Denmark's health system to continue to offer comparative big picture learning.

British reviewer injects analysis of politics, power and culture in companion Q&A on England's health reforms

"Cultural expectations of the NHS, in the prosperous, service economy of modern Britain, had also changed since its inception. The ethos of public sector paternalism, treating disempowered, impatient patients, was thought behind the times, and a source of growing unrest. Long waiting lists and dirty hospitals were headline news. And the only voice option was through the political system, placing pressure on accountable politicians" -Jamie Burn-

If you want to know what's really going on, you ask a local. In this case, we turned to a very in-the-know NHS guide, Jamie Burn, to give us a contextual overview of the strengths and weaknesses of that system's reforms under former prime ministers Margaret Thatcher (1979 to 1990) and Tony Blair (1997 to 2007). Burn is a former research fellow at England's respected Policy Exchange and one of the report's three reviewers. He holds an MSc in Social Policy and is completing a PhD in Health Service Management.

Among our queries: What accounts for the greater willingness of England's National Health Service (NHS) to experiment and change? How did that system get doctors and nurses working together despite a conservative clinical culture? How devolved is decision-making at the Primary Trust Level and how does the public relate to them versus the central government? Do commissioners actually have authority to reallocate funding? Read Jamie Burn's considered and comprehensive Q & A, Health System Reforms in NHS England: Context, Culture, Power, a companion piece to our new report Integrated Health Care in England: Lessons for Ontario. Read the report, download two related charts; Key NHS Characteristics, and A Comparative Analysis With Ontario.

Meeting of the Minds 2009 puts fine minds to tough topic: how to foster accountable, connected, and quality primary health care?

The Change Foundation's 2nd exclusive invitational dialogue for senior health leaders and thinkers is dedicated to a difficult issue that inhibits the integration and quality of health services - the relative isolation of primary health care, its less-than-robust accountability and performance requirements, and its scarcity of linkages to other parts of the system.

The June 16, 17th 2009 Meeting of the Minds, First things first: fostering accountable, connected, and quality primary health care, tackles a tough topic, but you can see from the program that we're putting some fine minds to it. The event opens with an evening debate between Emergency physician and broadcaster Brian Goldman and Champlain LHIN CEO Robert Cushman about whether the LHINs should have authority over primary health care. The next day features presentations and discussions about how jurisdictions inside (BC/QC) and outside (UK/US) Canada have brought primary health care into the fold -- to good effect. Says Change Foundation CEO Cathy Fooks: "The point of the day is to generate informed dialogue between government, LHINs, providers, policy experts and others about the practical possibilities for primary health-care reform in Ontario -- and how to make change more likely and lasting." A summary report will be prepared and shared. See report from Meeting of the Minds 2008.

CHQI at The Change Foundation update: FLO wraps up but QI learning & legacy continue in Ontario

Many participants indicated that they "don't feel as much like they are working in silos, there's now more respect for one another, and there is enthusiasm and excitement about the hospitals and CCAC s working together to solve problems." -Common statement by senior leaders, The Flo Collaborative: Quality Transitions for Better Care-

Improvements in length of stay, ALC days for patients, and greater collaboration between physicians and other health providers are some of the promising outcomes reported in CHQI's wrap-up report: The Flo Collaborative: Quality Transitions for Better Care. The project focused on improving the quality of care and health-care experience for patient "Flo" as she moved from acute care to her next setting. The report summarizes key collective and collaborative learning from its first large scale 16-month quality improvement effort involving 46 organizations in 29 partnerships with Community Care Access Centres (CCACs), acute care hospitals, and rehabilitation and complex continuing care facilities.

"As we conclude this phase, I am happy to report that Flo's care needs have been identified and communicated sooner to her, her family and care providers, resulting in fewer hassles and delays in getting the right care at the right time," says CHQI's Executive Director Paula Blackstien-Hirsch. "Overall, we hope this initiative sparks long-term collaboration among providers and sectors and stimulates a paradigm shift in process redesign and patient flow."

While the project ends, QI efforts continue through local Improvement Advisors and other senior leaders charged with spreading changes. LHINs will be actively engaged in this "spread" through new regional partnerships. Read the executive summary and full report.

The Change Foundation, P.O. Box 42, 200 Front Street West, Suite 2501, Toronto, ON, M5V 3M1, Phone: 416.205.1353, Fax: 416.205.1440

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