Aohc annual report 2013 14 by Alliance for Healthier Communities

Association of Ontario Health Centres

Annual Report 2013-2014

VISION The best possible health and wellbeing for everyone: • A future without systemic barriers that prevent people from reaching their full health potential, a future in which everyone can make the choices that allow them to live a fulfilling life. • A future in which individuals, families and communities are served by, and are able to actively participate in, trusted healthcare systems that respond to people’s and communities’ needs in coordinated and comprehensive ways. • A future in which people share responsibility with their health providers for their health and wellbeing.

MISSION As the voice of community-governed primary healthcare in Ontario, AOHC works: • to promote public policy that supports health and wellbeing and that emphasizes health promotion and illness prevention through a strong focus on the determinants of health. • to advocate for eliminating systemic barriers to health and to champion health equity.

Association of Ontario Health Centres Report 2013-14 TABLE OF CONT ENT S 1

Board Chair Message

Model of Health & Wellbeing

Strategic Plan 2012-15

Advancing Healthy Public Policy, Health Equity and the Elimination of System Barriers

Promoting Quality Primary Health Care

Comprehensive and Integrated Services

Supporting Member Centres

Community Primary Healthcare Research and Evaluation

A Strengthened AOHC

AOHC Board of Directors 2013-14

• to promote people — and community-centred innovations in the primary healthcare system that improve health and wellbeing and support healthcare sustainability. • to support our member centres to continuously improve the quality and efficiency of their services and to advocate for the resources they need to deliver high-quality care. • to advocate for the protection and improvement of medicare, ensuring that reforms to our publicly funded system focus on keeping people well and benefit everyone.

This report is also available in French upon request.

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Annual Report 2013-14

Attributes of the Model of Health & Wellbeing are: • Accessible • Anti-oppressive and Culturally Safe • Interprofessional, Integrated and Coordinated • Based on the Determinants of Health • Community-Governed • Grounded in a Community Development Approach • Accountable and Efficient

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Meanwhile, at policy tables our interventions are also advancing positive change. A particular example, among others you will read about in this report, is the concentrated effort that resulted in improvements to publicly funded dental programs for children from low-income families. We

These are the values and principles that unite us: • Highest Quality Health & Wellbeing • People and Community Centred Health & Wellbeing • Health Equity and Social Justice • Community Vitality and Belonging

As we move forward applying our Model of Health & Wellbeing and advancing health equity, how are we going to demonstrate to decision makers that they need to apply a more comprehensive approach to health & wellbeing? And how are we going to measure our impact? Read on to find out the strides we have made this year working with our member centres applying the Canadian Index of Wellbeing (CIW) Framework. At the Woodstock and Area CHC, where I am the Executive Director, we’ve found that the CIW is helping us to better understand the essentials that support our community health & wellbeing vision.

This past year, a large concentration of AOHC’s efforts have been guided by our newly refreshed Model of Health & Wellbeing, first approved at our 2013 annual general meeting. The model, and the charter which accompanies it, sets out the values and principles that unite us, and the attributes we apply to successfully practice these values and principles.

AOHC’s Health Equity Charter, which is now taking hold with our members across the province, is another excellent tool which we can use to lead by example. The Charter includes specific commitments to health equity and social justice, core principles that members and AOHC itself continually strive to embody.

Model of Health & Wellbeing

One of the most important ways to start making the shift upstream is to lead by example. Our newly refreshed Model of Health & Wellbeing provides a highly effective tool to do this. It’s anchored in the goal to provide the highest quality primary health care that is both people and community-centred.

Cate Melito Board Chair, Association of Ontario Health Centres

Far too many people experience avoidable illness and injuries because they cannot access the services they need or afford the Cate Melito, AOHC Board Chair basics like housing and nutritious food. Moreover, our healthcare system remains poorly equipped to deal with these realities; working downstream treating illnesses after they happen instead of upstream, addressing the non-medical determinants that cause the illness in the first place.

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As this annual report goes to press, Ontario’s voters are about to go to the polls. This is definitely an interesting time for a provincial association that is committed to a system-wide transformation. And though we don’t know which party will form the next provincial government, we do know that change lies ahead. Our role is to shape that change so that it leads to our vision: the best possible health & wellbeing for everyone. Guiding us is the strong belief that the quality of life in Ontario will improve when the province applies a more holistic, integrated and proactive approach to keep people, and the communities where they live, healthy and strong.

In closing, I would like to send many thanks to those people that have been working diligently towards change and are contributing to shared goals: the staff and board members at our member centres. I would also like to welcome our new members, including the many new Nurse Practitioner-Led Clinics (NPLCs) who have joined us this year.

Leading by Example

are also making a difference as the province’s Health Links initiative rolls out across the province. And the electronic medical records (EMR) project is 75% of the way through implementation; the largest EMR deployment initiative in Canada.

Board Chair Message

Annual Report 2013-14

Advancing Healthy Public Policy, Health Equity and the Elimination of System Barriers

Strategic Plan for 2012-2015

STRATEGIC DIRECTIONS

ADVANCING HEALTH EQUITY, HEALTHY PUBLIC POLICY AND THE ELIMINATION OF SYSTEMIC BARRIERS TO HEALTH

Advocate for the elimination of systemic barriers to health through the development of healthy public policy.

QUALITY PRIMARY HEALTHCARE Champion equitable people — and community-centred primary healthcare that fulfills its mandate as the foundation of the healthcare system.

COMPREHENSIVE AND INTEGRATED SERVICES Promote comprehensive, integrated, coordinated health and social services

ENABLING DIRECTIONS

SUPPORTING MEMBER CENTRES Support member centres to build capacity to continuously improve the quality and efficiency of their services.

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Shifting to Community Health & Wellbeing

COMMUNITY PRIMARY HEALTHCARE RESEARCH AND EVALUATION

In 2013-2014 AOHC rolled out the first stages of a new initiative called Shift the Conversation: Community Health & Wellbeing. This will be an ongoing province-wide conversation and dialogue with those who share our vision. And the conversation will extend far beyond health and the health care system. The current way most people talk about health care doesn’t capture a big enough picture. The conversations often take a narrow focus on treating illness. As a result of this narrow focus, what we really have is a sickness care system, not a health system at all.

Lead and participate in datadriven, evidence-informed research and evaluation initiatives to document and assess the impact of community-governed primary healthcare.

In making the shift AOHC is supporting its member centres to lead by example. To do this we are supporting members to become early adopters of the Canadian Index of Wellbeing, one of the world’s leading initiatives to measure societal progress. By analyzing eight domains, the index goes beyond economic indicators and measures quality of life relative to what really matters to Canadians: Community Vitality, Democratic Engagement, Education, the Environment, Healthy Populations, Leisure and Culture, Living Standards and Time Use.

A STRENGTHENED AOHC

Over the past year, with the generous support of the Ontario Trillium Foundation, AOHC has been working with over a dozen centres as they apply the CIW framework in a wide variety of ways: to conduct more effective strategic planning and community engagement processes, as a framework to build community-wide partnerships, as a tool to advocate for healthier public policy, to support

AOHC will ensure it is sufficiently resourced, aligned with partners and positioned in the larger health and political enivronment to be an effective leader in community-governed primary healthcare in Ontario.

Annual Report 2013-14

more effective system navigation for those we serve. The most exciting element is the preliminary work we have done to report on the impact of community initiatives that are so integral to our work to build resilient communities. Shift the Conversation: Community Health & Wellbeing was also the theme of this year’s Community Health & Wellbeing Week (CHWW) and will be the theme over the next few years as we build momentum. This year 37 centres participated with over 100 events held throughout the week and 23 stories appearing in local media. Other organizations outside of our membership also participated to highlight the urgent need for a more comprehensive approach to improving the health of individuals, families and entire communities. This coming Community Health & Wellbeing Week takes place September 28 - October 4 2014. Join us!

AOHC’s Health Equity Charter Adopted in 2012, AOHC’s Health Equity Charter is an excellent tool to guide our commitments to health equity and social justice. In September 2013, the AOHC Board approved an implementation strategy to ensure meaningful adoption of the Charter. The strategy’s five objectives are: awareness, understanding, endorsement, action and change.

Healthcare for Migrant Farmworkers Through a partnership with the Occupational Health Clinics for Ontario Workers, AOHC explored opportunities to improve access to primary health care for the 18,000 migrant agricultural workers who labour in Ontario farms and greenhouses. A report with recommendations for a provincial population health strategy with CHCs, CFHTs and NPLCs playing key roles was presented to the MOHLTC. This report was also shared with the Hamilton Niagara Haldimand Brant LHIN where two CHCs have now received new funding from the LHIN to serve local migrant agricultural workers.

The first objective of the strategy, awareness, will be promoted during fiscal year 2014-15 through a series of communication materials. To further advance understanding, Health Equity Charter resources will also be identified and distributed online, enhanced by learning opportunities that will deepen our members’ collective understanding of how to bring the Health Equity Charter to life for the diverse people and communities we serve.

Poverty as a Determinant of Health

Reducing Health Disparities

In January, at a Queens Park press conference organized by AOHC, representatives from CHCs and FHTs joined community groups and unions calling for an increase in Ontario’s minimum wage. This appeal cited research showing poverty as the biggest barrier to good health. The event was well covered in print, radio, television and social media. Following the community-led campaign, Premier Wynne announced an increase to $11.00/hour in June, with indexation to inflation. Because this is not enough to ensure workers earn above the poverty line AOHC will continue to call on the Ontario government to commit to a $14.00/ hour minimum wage.

Advancing the health & wellbeing for the specific populations facing barriers to accessing services continued to be a focus of our work this year.

Refugee Health Working with like-minded organizations this past year, AOHC helped bring attention to the suffering and confusion caused by the federal government’s 2012 decision to cut the Interim Federal Health program. These cuts had a devastating effect with many refugees being denied health care, often in emergency situations. Through this period Ontario’s Community Health Centres continued to serve refugee claimants who were no longer covered.

Affordable, Accessible Oral Health Programs In December, in response to recommendations from Ontario’s Chief Medical Officer of Health and advocacy work by AOHC, the Ontario Oral Health Alliance and others, Ontario’s provincial government streamlined and expanded access to public dental programs for low income children.

In December AOHC and our member centres welcomed an announcement from the MOHLTC of the new Ontario Temporary Health Program which will ensure refugee claimants, who are not eligible for healthcare under the new federal rules, will be able to access most primary care and urgent hospital services, as well as medication coverage. As we approach a federal election in October 2015 we will continue to call for the federal government to reinstate the Interim Federal Health program. 5

Annual Report 2013-14

Ever since the government first introduced its Healthy Smiles program to provide oral health services to children from low-income families, AOHC and others have voiced concern about the eligibility criteria. All too often staff at our member centres have turned away children from low 4

Annual Report 2013-14

Promoting Quality Primary Health Care

income families in high need of treatment. With the new changes the government has introduced to the eligibility criteria, approximately 70,000 more low income children will now qualify for the Healthy Smiles program. AOHC will monitor this rollout with a particular interest in making sure Healthy Smiles Ontario delivery partners do a better job conducting outreach to vulnerable families. Another health equity issue for Ontario is that adults, as well as children, cannot access dental services because they cannot afford to pay dental fees. AOHC has also been actively advocating on this issue. In October, an AOHC showed 58,000 emergency department visits annually due to dental problems. Publishing this report led to strong media coverage. As a lead partner in the Ontario Oral Health Alliance, AOHC will continue to call on all parties at Queens Park to extend public dental programs to low income adults and seniors.

Achieving health equity for people with environmental illnesses An important step was made this year for achieving health equity for those with chronic, environmentally-linked illnesses. Working with the Myalgic Encephalomyelitis Association of Ontario (MEAO) AOHC presented a business case to the ministry for an Ontario Centre for Excellence in Environmental Health. One of the requests within the proposal was recently announced by the MOHLTC: six environmental health fellowships over three years for a total of $560,000. This will build capacity among primary care clinicians and help ensure that primary care providers can deliver the right care to assess, diagnose and treat these conditions. Charles Pascal delivering plenary presentation at 2013 Working Better Together conference

The new fellowships will be offered by the University of Toronto’s Department of Family and Community Medicine and the Dalla Lana School of Public Health, in collaboration with physicians at the Environmental Health Clinic at Women’s College Hospital. This coming year we will continue to make the case for the other requests in the proposal that will help improve the outcomes for the individuals and caregivers whose lives are impacted by these debilitating conditions.

Working better together: a conference to promote our vision In June 2013, AOHC presented our annual conference under the theme of Working Better Together. This conference centred on collaborating to achieve the best possible health & wellbeing for everyone in Ontario by promoting quality primary health care.

LGBT A membership-wide survey was conducted by the AOHC LGBT Advisory Group in March 2013 with a 47% response rate. The survey looked at community programs, services and policies of member centres. Three key recommendations came from the survey by the LGBT advisory group:

The conference highlighted services and programs designed to prevent illness, keep people well and lessen pressure on the health care system. Discussions and analysis arising from the sessions and plenaries looked at the pillars of what make a strong primary health care system and the types of public policy that address the root causes of illness and injury.

1. Mandate endorsement and implementation of the Health Equity Charter 2. Increase training opportunities for AOHC members on LGBT issues 3. Ensure AOHC members’ EDs enable their staff and Board’s participation in LGBT related training

Health Links and other Ministry of Health Action Plan priorities of Ontario’s provincial government also played a major role at the conference and continued to be a focus of our work throughout 2013/14. Health Links aims to provide coordinated, efficient and effective care to patients with complex needs. The overall goal is to improve access and forge better connections to other parts of the health and social service system. AOHC has also been hosting monthly information sharing meetings that are open to all members that are part of a Health Link.

The LGBT advisory group also developed a work plan incorporating these recommendations. As a result, this year AOHC sponsored Rainbow Health Ontario Conference and the LGBT Advisory Group facilitated an in-depth learning session at the February 2014 CHC and AHAC ED Network meeting. This vitally important work will continue in 2014-15.

Annual Report 2013-14

Comprehensive and Integrated Services

CHO is aiming for broad endorsement of the strategy prior to developing an action plan for the implementation of priority elements of the strategy in order to improve health and social service delivery across rural, remote and northern Ontario.

Hospital Report Manager (HRM) AOHC started the year implementing regional hospital report integrations. In North East and North West LHINs the Physician Office Integration (POI) was integrated with Shkagamik-kwe and Kapuskasing. The Central East LHIN connected the Timely Discharge Information System (TDIS) to Oshawa and Scarborough and the Southwest Physician Office Interface to Regional EMR (SPIRE) System was connected for West Elgin, Grand Bend and South East Grey CHCs. The delivery of comprehensive, coordinated services depends on member centres being connected with other parts of the health system. For this reason AOHC has been working with Nightingale and OMD on implementing the provincial model for sharing hospital reports. Access Alliance will be the pilot site for the provincial Hospital Report Manager. This member organization will soon benefit by being able to receive patient hospital reports electronically and once the pilot is complete other centres will start to transition from their regional solution to HRM.

Community Health Ontario: Toward a Rural Health Strategy AOHC has been working in a strategic alliance called Community Health Ontario (CHO). Other members of the alliance are Addictions and Mental Health Ontario (AMHO) and the Ontario Community Support Association (OCSA). The vision of the alliance partners is a strong, integrated and holistic community-based health and social services in Ontario.

Ontario Lab Information System (OLIS) The Ontario Laboratories Information System (OLIS) is an electronic system that allows private labs as well as hospital and community laboratories to share lab test results with health care providers. As a result of deploying a provincially certified EMR system, OLIS integration comes without any additional fees for our members. It is part of the standard implementation plan for all centres going live. The next step for OLIS is to automatically download labs to the provider. The AOHC is working with eHealth Ontario to pilot the OLIS Provider Query which automatically shares lab results with the health care provider.

This past year through funding from the Ontario Trillium Foundation, CHO conducted a review of published literature related to health services provision in rural, northern and remote areas of Ontario. The findings of this review informed the baseline of issues, opportunities and key questions for a series of consultations with rural health and social service providers. Approximately 80 organizations from community-based primary care organizations, hospitals, community support services, mental health, addictions and social services participated in consultations or key informant interviews. The results of these consultations were synthesized and formulated into a draft document entitled â&#x20AC;&#x153;Towards a Rural Health Strategy Discussion Paper.â&#x20AC;? In 2014-15, CHO is planning to validate the summarized report findings through consultation with participants as well as academia in the field of rural health in Ontario. Final revisions will be made to the report based on the feedback received. Through dialogue with key stakeholders,

Annual Report 2013-14

Supporting Member Centres was also the largest capital announcement in the history of CHCs. This announcement was long awaited and helped make some of the promises made in 2004 a reality; however there was still a waiting list of CHCs that could not be completed due to the lack of capital funding. This announcement was followed by another in April 2014 in which the province committed to increasing the dollars in the community capital fund. An additional $50M to be spent by 2017 was announced on top of the annual $25M. At the same time, the ministry announced the new Community Health Infrastructure Renewal Fund (CHIRF) for maintenance and repairs that will represent a total of $10 million by 2017. This new fund includes not only CHCs and AHACs, but NPLCs, CFHTs, FHTs and public health as well. These community investments are a big step towards expanding access for the communities we serve.

Information Management Strategy Achievements EMR Deployment By March 31, 2014 the Electronic Medical Record (EMR) project transitioned 58 sites to Nightingale on Demand, a centrally hosted and Ontario MD (OMD) certified Electronic Medical Record system. This represents 100% of the 10 AHACs. By the end of this coming fiscal year, 86 will have been migrated to the system representing the largest EMR initiative in Canada.

Safia Ahmed, Executive Director, Rexdale CHC, Romy Joseph Thomas, Treasurer, Board of Directors, Rexdale CHC, Deb Matthews, Minister of Health and Long-Term Care Adrianna Tetley, CEO, Association of Ontario Health Centers

The EMR project will facilitate higher-quality care by improving healthcare providers’ access to comprehensive client records. It will also enable knowledge and information sharing that will help identify trends and improve planning at each centre and across the sector.

AOHC membership continues to grow with 9 new Nurse Practitioner-Led clinics joining us this year and extending the reach of our Model of Health & Wellbeing. The AOHC membership currently is made up of a total of 75 CHCs, 13 Nurse Practitioner-Led Clinics (NPLCs), 14 Community Family Health Teams (CFHTs) and 10 AHACs. This year we also launched a new online magazine called Voices. This communication vehicle extends beyond our membership to offer information about emerging issues, innovative initiatives and a view into the world of community-governed primary health care. The objective is to feature our unique people, programs and give a space for the ‘voices’ of the communities we serve. Web statistics show that the publication has been well received and has spread widely via social media.

Legacy Management The Association has worked closely with eHealth Ontario to fund access to old files on legacy systems (out-dated systems). Short term funding has been provided to cover the work until December 2015. AOHC is working towards a long term solution to meet regulatory requirements. The transition from a legacy system to newer technology must be seamless and uninterrupted in order to ensure quality care.

Capital Funding for CHCs and AHACs For many years AOHC has been advocating for improvements to capital investments in our member centres. This past year, these efforts started paying off. In April 2013, the MOHLTC announced $70M for 12 CHCs and four Aboriginal Health Access Centres, this was the first time AHACs have received capital investment since the 1990s. This

Annual Report 2013-14

• • • • • • • •

Health Promotion and Community Development Annual Professional Learning Event Privacy Basics and Beyond Professional Learning Event New Data Management Coordinator Orientation Maximizing Information for Quality and Decision Support Annual Professional Learning Event Supporting Clinical Best Practices in Interprofessional Teams Professional Learning Event Quality Improvement Planning: Annual Quality Improvement Professional Learning Event AODA Project: Working with Clients and Communities with Disabilities (Hosted by ARCH Disability Law Centre) AODA Project: 112 member centres participated in 6 Webinars, 4 Teleconferences and 29 workshops on the AODA Integrated Standards Regulation

This year AOHC also worked with the Healthy Debate to create a “Primer for Primary Care Boards” that sheds light on our health care system. This educational document defines insider terms and provides a range of factual information and background on current legislation and practices.

Peer Lead Learning This year, the AOHC IMS team introduced a new format for learning: peer-led learning sessions. This takes the form of volunteer Peer Leaders that are well acquainted with the EMR presenting webinars on specific topics. The first session took place in March on the topic of Medication Management and had over 60 participants. Building on this success, AOHC is working closely with these Peer Leaders to build a strong knowledge sharing program and more sessions are slated for this coming year.

Quality Improvement Initiatives Annual Quality Improvement Plans (QIPs) focus on a common quality agenda to improve access, integration and a person’s experience across the health system. QIPs also include commitments by centres to strengthen the quality of their services and programs. Some of the highlights of AOHC’s Quality Improvement capacity building activities in 2013-2014 include:

Community Primary Healthcare Research and Evaluation

• Effective Governance for Quality in Primary Care Workshops held in Hamilton, Sudbury, Mississauga, Toronto North and Toronto Downtown • Maximizing Information for Quality and Decision Support Annual Professional Learning Event • Supporting Clinical Best Practices in Interprofessional Teams Professional Learning Event • Annual Quality Improvement Planning Professional Learning Event • Quality Improvement Planning Six Month Check-in Calls • Advanced Access Webinar presented in November with Health Quality Ontario • 100 percent of member centres completing Quality Improvement Plans

Community Initiatives Tool (CI Tool) A second-generation version of the CI Tool that allows centres to capture community development programs and share these community initiatives across the membership is under active development. It will include more robust reporting. The CI Tool helps to add visibility to important work that is often difficult to report on.

Knowledge and Learning

Business Intelligence Reporting Tool (BIRT) Now available through BIRT are the Multi-Sector Accountability Agreement (MSAA) and Community Annual Planning Submission (CAPs) reports needed to fulfill LHIN reporting requirements. Users of BIRT can now create a LHIN report with a click of a button. To achieve this goal, a significant amount of data remediation was completed to ensure a high level of data quality at centres for accurate and up to date information.

AOHC knowledge and learning is grounded in the values and principles of the Model of Health & Wellbeing. This year AOHC facilitated professional development events, peer gatherings, workshops and webinars to build capacity and strengthen knowledge about evidence-based practices. A number of professional development sessions were designed and delivered. These included: 13

Annual Report 2013-14

AOHC Board of Directors 2013-14

A Strengthened AOHC AOHC is committed to fulfilling the vision of the best possible health & wellbeing for everyone. To build organizational capacity AOHC has been assessing and updating its information technology systems, including our public website. Going forward this year, we will also move to a high performing membership portal which will improve communications with our members and allow for more dynamic interaction.

Financial Report 2013-14 The financial health of AOHC remains strong with total assets of $5.6 million and total revenues of more than $11 million for the fiscal year ending March 31, 2014. AOHC continues to move towards the reserve target of $250,000 by March 2018. The revenue was earned primarily from four sources of income: eHealth funded Electronic Medical Records (EMR) project, IMS Fees for Program Operations & Development, Membership Fees and Projects Funded by Members, and Government and Other Funded Projects. Our leadership in EMR implementation continues this year with revenues totaling $6.4 million from eHealth Ontario. The EMR project now supports 58 centres that have gone live, with an additional 24 scheduled to implement this strategy in FY 2014-15.

Revenues and Expenditures

Our 2013 Primary Health Care Conference was successful in bringing more than 500 delegates together. The revenue generated from this and a number of other projects contributed $29,680 to the reserve fund. AOHC continues to operate on the principle of fiscal and operational transparency through the leadership of our member organizations. AOHC is honoured to have the opportunity to promote health and wellbeing in Ontario and is grateful for the support of our members. Audited statements are available upon request.

Annual Report 2013-14

Board Chair Cate Melito, South West Constituency Representative

Community Family Health Team Constituency Representative Marina Hodson

Vice-Chair Sarah Hobbs-Blyth, Central Constituency Representative

Eastern Constituency Representative Robert Fletcher

Secretary Janet Bowes, Eastern Constituency Representative

Francophone Constituency Representative Jocelyne Maxwell Northern Constituency Representative Denis Constantineau

Treasurer Peter Szota, South Central Constituency Representative

South Constituency Representative Richard Gerson

Aboriginal Constituency Representative Angela Recollet

South West Constituency Representative Bonnie Burke

Central Constituency Representative Stacey Papernick

Members at Large Arlington Dungy Cheryl Prescod Adam Awad Annual Report 2013-14

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