Association of Ontario Health Centres
Annual Report 2012-2013
VISION The best possible health and wellbeing for everyone living in Ontario: • 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 participant 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 social determinants of health. • to advocate for eliminating systemic barriers to health and to champion health equity. • 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.
Association of Ontario Health Centres Report 12-13 TABLE OF CONT ENT S 1
Message from the President
Health Equity, Healthy Public Policy and the Elimination of Systemic Barriers
Promoting Quality Primary Healthcare
Comprehensive, Integrated, Coordinated Services
Supporting Member Centres
Community Primary Healthcare Research and Evaluation
A Strengthened AOHC
AOHC Board of Directors
This report is also available in French upon request.
President’s Message: Strengthening our core, extending our reach Last year the Association of Ontario Health Centres (AOHC) developed a new vision statement: the best possible health and wellbeing for everyone. This bold declaration signalled AOHC’s intention to significantly extend our reach and to advocate in the best interest of everyone living in Ontario, not just on behalf of our member centres and those they serve. Our commitment to this vision holds especially true in supporting those who face barriers accessing services or who are vulnerable to poor health. To move closer to this vision we built a three year plan with six strategic directions. As you review this report on the first foundational year of this plan, you’ll see we’ve made significant progress. We are advocating for healthier public policies and a stronger and more connected primary healthcare system. We have been at the policy table with the provincial government, the LHINs and an array of stakeholders. We are gathering momentum on a wide range of advocacy initiatives, capacity building, research and evaluation, and information management systems to better equip, continuously extend the reach of our members and improve the quality of services they deliver. We have also been building relationships to strengthen the support we can give to our members.
• More equitable funding for AHACs • Deployment of a single shared Electronic Medical Record • Playing a leadership role at the Ontario Primary Care Council– a collaboration of primary care associations in Ontario Driving our success is the strong unity of purpose that we share with our member centres. We share a strong belief that the highest attainable standard of health is a fundamental human right. Health is not just something you access at a medical clinic; it is a complete state of physical, mental, social and spiritual wellbeing. These values lie at our core. A strong core can’t be taken for granted. To fortify it we laid out our principles in a new Health Equity Charter and a new Model of Health and Wellbeing. These remind us that community is central to everything we do. They guide our work and affirm that we are part of a larger struggle for equity, social justice and a future where everyone can access the services they need for complete health and wellbeing.
Major achievements in this area include:
In closing, let me offer many thanks to all the staff and board members at our member centres who have contributed their ideas, energy and enthusiasm to our shared endeavor this year. Thanks also to the dedicated staff at AOHC. Read on to learn more about the action packed journey we’ve been on this year and where we intend to travel in coming months.
• Giving thousands more people access to Community Health Centres (CHCs) and Aboriginal Health Access Centres (AHACs) through the biggest capital investment made by the provincial government at any one time
Jocelyne Maxwell AOHC President
Strategic Plan for 2012/2013 AOHC’s Strategic Plan for 2012-2013 identified six key goals, listed in the following table. 1. 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. 2. QUALITY PRIMARY HEALTHCARE Champion equitable people— and community-centred primary healthcare that fulfills its mandate as the foundation of the healthcare system. 3. COMPREHENSIVE, INTEGRATED, COORDINATED SERVICES Promote comprehensive, integrated, coordinated health and social services.
4. SUPPORTING MEMBER CENTRES
Support member centres to build capacity to continuously improve the quality and efficiency of their services. 5. COMMUNITY PRIMARY HEALTHCARE RESEARCH AND EVALUATION
Lead and participate in data-driven, evidenced-informed research and evaluation initiatives to document and assess the impact of communitygoverned primary care. 6. A STRENGTHENED AOHC
AOHC will ensure it is sufficiently resourced, aligned with partners and positioned in the larger health and political environment to be an effective leader in community-governed primary healthcare in Ontario.
Advancing Health Equity, Healthy Public Policy and the Elimination of Systemic Barriers to Health A new Health Equity Charter The drive to advance health equity is one AOHCâ€™s most important cross cutting values. It shapes everything we say and do. With the adoption of a new Health Equity Charter at our June 2012 Annual General Meeting, AOHC and its member centres have signaled an intent to adopt a highly proactive and assertive approach in improving equal access to health. The charter is anchored in the understanding that many health problems are not just medical or biological; they are caused by social conditions that affect access to resources and power. Access to resources and power are often constrained by poverty, racism, sexism, homophobia, transphobia, ageism, ableism, and other forms of exclusion that are interconnected. In our own practices, the Charter commits us to identify, name and confront inequity through a wide range of practices, principles and policies. And in our work within the broader community it also maps out a range of activities to ensure the promotion of health equity is deeply embedded in health system transformation and public policy initiatives.
Reducing health disparities This year we laid the ground work to advancing the health and wellbeing for specific populations who face barriers accessing the services they need. Working with like-minded organizations we advocated for the reversal of detrimental federal cuts to health care for refugees and continued to call for an end to the three-month wait period for OHIP coverage for new immigrants. These efforts helped a number of CHCs secure increased funding to meet the health needs of non-insured people in their communities. Since income status is one of the central determinants of health we also put a special focus on breaking down barriers to good health for individuals and families with low-incomes. Working with Ontarioâ€™s anti-poverty movement, AOHC called on the 3
Province to allow low income people to “earn more, keep more, and have benefits restored” through an increase to the minimum wage and social assistance rates, rule changes for people on social assistance, and an increase to the Ontario Child Benefit. Oral health also plays a critical role in physical health and so a large portion of our advocacy work this year was focused on raising awareness about the need to improve public dental programs for children and expand access to oral health services for low income adults. In partnership with the Ontario Oral Health Alliance, our campaign resulted in over 50,000 Ontarians signing oral health postcards, dozens of meetings with MPPs, and province-wide media.
Setting the stage for Community Health and Wellbeing systems Over the longer term, AOHC believes one of the best ways to advance health equity and break down barriers to good health is to transform Ontario’s fragmented sickness care system into a Community Health and Wellbeing system. Throughout 2012-2013 we began laying the foundation for a multi-pronged, multi-year approach to achieve this shift. Consultations are underway with a wide range of potential partners who share our vision. And, thanks to a substantial grant from the Ontario Trillium Foundation (OTF), we partnered with the Canadian Index of Wellbeing (CIW) which holds great promise to provide the conceptual framework for the shift we envision.
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. The OTF grant will enable AOHC and member centres to explore and demonstrate how the CIW can be used in program and service development, accountability, public communications and local partnership development; and to further promote the CIW as a measurement for progress in community health and wellbeing and building resilient communities.
The CIW has been under development for over a decade and has become one of the world’s leading initiatives to measure societal progress. By analyzing eight domains, the index goes beyond economic indicators and measures 4
Promoting Quality Primary HealthCare Recommendations and commitments to drive positive change All experts agree an effective healthcare system is built on the foundation of a high performing primary care system. This past year highlighted much discussion and debate on how to improve primary care. AOHC offered a significant contribution to the dialogue with the release of a discussion paper called: An Emerging Primary Care Strategy for Ontario. The paper proposed ten principles to guide a primary care strategy for Ontario. In particular, it committed AOHC member centres to move forward with initiatives that will increase and improve access,
maximize the effectiveness of interprofessional teams and forge better connections to other parts of the health and social service system. Both our recommendations for primary care transformation, as well as the commitments we’ve made to support primary care transformation, were presented to the Ministry of Health and Long-term Care (MOHLTC) and the Local Health Integration Network (LHIN) strategy council.
Identifying where expanded access to CHCs and AHACs is most urgently needed A growing body of evidence demonstrates that expanding access to CHCs and AHACs improves population health and advances health equity. However, as things now stand, only a very small proportion of the provinces’ population can access these services. To support the LHINs and the MOHLTC in making decisions about where to invest in increased access, AOHC released a demographic study that identifies which parts of the province have the most significant service gaps. Funded by the MOHLTC agency ECHO, and conducted by Steps to Equity, the study found that many communities with large populations and multiple barriers to primary health care have little or no access to CHCs and AHACs. The study went on to pinpoint areas of greatest 5
need. This coming year AOHC will be using the study in multiple forums to identify where to prioritize expanding access to CHCs and AHACs.
Minister Deb Matthews meets clients from various CHCs at Queen’s Park during Community Health Week
Supporting Member Centres As our membership grows, we continue to help bring primary healthcare, health promotion and a community development approach to communities all over Ontario. The AOHC membership currently is made up of a total of 75 CHCs, 7 Nurse Practioner Led Clinics (NPLCs), 15 Community Family Health Teams (CFHTs) and 10 AHACs.
Comprehensive, Integrated, Coordinated Services Community Health Ontario In creating a more comprehensive, integrated and coordinated health system, AOHC intends to lead by example. For this reason we helped form Community Health Ontario, a strategic partnership that also includes the Ontario Community Support Association (OCSA) and the Ontario Federation of Community Mental Health and Addictions Programs/Addictions Ontario (OFCMHAP/AO). This past year the partnership is moving forward with Healthy Community Collaborations (HCC) , a project funded by the Ontario Trillium Foundation. The project aims to support the community health sectors in their integration initiatives while staying true to our values.
Hospital report manager The delivery of comprehensive, coordinated services depends on member centres being electronically connected with other parts of the health system. For this reason AOHC has been developing hospital reporting systems.
solution is being successfully piloted at the Shkagamik-Kwe AHAC and the Central East LHIN and the Timely Discharge Information System (TDIS) has been successfully implemented for most of the CHCs in that LHIN.
Chigamik CHC was selected as the pilot site for the provincial Hospital Report Manager. The organization will soon benefit by being able to receive patient hospital reports electronically. In addition, AOHC has been working to implement other regional hospital report integrations in the North East and North West LHINs. The Physician Office Integration (POI)
The Southwest Physician Office Interface to Regional EMR (SPIRE) System, designed to give community physicians electronic access to hospital electronic patient record reports, was completed for West Elgin and South East Grey CHCs. Other sites will be added to these regional solutions over the upcoming year.
Supporting Member Centres As our membership grows, we continue to help bring primary healthcare, health promotion and a community development approach to communities all over Ontario. The AOHC membership currently is made up of a total of 75 CHCs, 7 Nurse Practitioner Led Clinics (NPLCs), 15 Community Family Health Teams (CFHTs) and 10 AHACs.
Capital funding for CHCs and AHACs Thousands more people throughout Ontario will gain access to community-governed primary healthcare as a result of the provincial government announcing in early April that it will invest in 17 new capital projects, involving 12 CHCs and 4 AHACs throughout the province. This was the largest capital announcement ever for our sector.
More equitable AHAC funding
Minister Deb Matthews with seniors from Rexdale CHC during a capital project announcement in April at the Rexdale Community Hub
For many years, AOHC has been advocating for equalization of funding for AHACs with their sister CHCs. In October 2012 we achieved partial success. MOHLTC will now fund physician and nurse practitioner positions at the same rate as in CHCs. The ministry also moved forward with an increase in base funding by 1.5 per cent. This funding increase represents a small success for the AHACs. We continue to advocate for equalization of funding.
AHAC health promotion planning & evaluation project AOHC received funding to help support the development and implementation of a planning and evaluation framework for health promotion programming for the 10 AHACs. The evaluation framework will cover three programs: Smoke-Free Ontario, Health Eating Active Living and Diabetes Prevention.
Health equity This year, preliminary work began to make the case for an Ontario Centre for Excellence in Environmental Health Business. This project will assess the model and gaps in services in order to support those with chronic, environment-linked illnesses across the province. The AOHC LGBT Advisory Group also completed their first cross-member survey related to lesbian, gay, bisexual, and transgender (LGBT) community programs and services and looked at policies of member centres. The results will inform the development of a coming strategy to further LGBT health across our membership. 7
Quality Improvement initiatives This past year saw a time of great change in the health system with primary care leading much of the health system transformation. Person-centred quality improvement became the focus, driven by Ontario’s Action Plan for Health Care and the Excellent Care for All Act passed in 2010. Quality Improvement Plans (QIPs), a set of commitments and actions that assist each organization to meet its quality objective, became mandatory for all primary care models including: CHCs, AHACs, NPLCs, CFHTs and FHTs. Some of the highlights of AOHCs Quality Improvement activities in 2012 include: • A Quality Improvement Maturity Assessment of all AOHC member-centres • A Quality Improvement Planning Professional Learning Event (held in partnership with Health Quality Ontario) as the Quality Improvement Planning Templates were released by the MOHLTC. • Support to centres with their Quality Improvement Planning provided by AOHC • 100 percent of member centres completing Quality Improvement Plans • 48 CHCs, 9 AHACs, 7 NPLCs and 13 CFHTs attended the Effective Governance for Quality in primary care training
EMR deployment and other IMS achievements The Electronic Medical Record (EMR) project has transitioned 26 sites to Nightingale on Demand (NOD) and connected four sites to the Ontario Lab Information System (OLIS). Over the next two years, 86 member organizations will also transition to NOD. This will facilitate higherquality 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. A new dedicated version of the EMR was set up to ensure that the system’s performance remains responsive and can support the entire complement of users. As well, as a result of deploying a provincially certified EMR, neither the Hospital Report Manager (HRM) nor OLIS integration came with any additional fees for our members.
Other system integrations include receiving hospital reports electronically through regional eHealth systems such as the Southwest Physician Office Interface to Regional EMR (SPIRE) System, the Timely Discharge Information System (TDIS), and the Physician Office Integration (POI). The Information Management System (IMS) team also completed the Drug Profile Viewer (DVP) pilot where 20 sites were provided access to the system. In addition, the Ontario Healthcare Reporting Standards/ Management Information System was completed. This project developed reporting standards for Community Health Centres to ensure consistent and accurate financial and statistical reporting to the province.
Education and capacity work 2012 was the first year of our large-scale Information Management Systems (IMS) Strategy and that placed a great emphasis on change management in order to transition teams to the new system. This also highlighted the need to build awareness and ownership in the sector. To strengthen our knowledge-sharing communities of practice (sharing essential skills and good practices with our colleagues) a number of professional development sessions were designed and delivered. These included:
Rodney Burns, Chief Information Officer, speaks with data management and decision support staff during Knowledge Management professional development session.
• Knowledge Management – Meeting and Exceeding Our Challenges • Leadership and Organizational Culture • Health Promotion and Community Development – Shifting the Focus of Community Initiatives and Personal Development Groups: Moving from Activities to Impact • Accessibility… Beyond Disability Project: Accessibility for Ontarians with Disabilities (AODA) training on the Customer Service Standards and the New Integrated Standards Regulation. • Changes to the Not-For-Profit Incorporations Act • Presenting a Trans-Health webinar in collaboration with Rainbow Health Ontario
Community Primary Healthcare Research and Evaluation Research and evaluation The Community Initiatives Tool (CI Tool) has been refined and stabilized. This tool allows centres to create, monitor and share community initiatives across the sector. It is successfully capturing community development programs and helping to share those across the membership. The CI Tool helps to add visibility to this important work. A second-generation version of the CI Tool is under active development and will include more robust reporting and added functionality.
Our new model of Health and Wellbeing Understanding how important it is for our member centres to constantly evolve and improve, AOHC facilitated a process to strengthen and refresh the language of the CHC model of care first developed in 2008. The model refresh process started with gathering client stories in order to fully understand how CHCs and AHACs positively influence people’s lives. These stories revealed the shared values and beliefs that are contributing to better health outcomes for people and communities. The main changes are: 1. Aboriginal Health Access Centres and Community Health Centres worked together to develop a shared Model of Health and Wellbeing 2. A set of cross-cutting values were identified and named below: • People and Community-Centred • Improved Quality • Health Equity and Social Justice • Community Vitality and Belonging 3. Anti-oppression and cultural safety was made more explicit 4. Efficiency and Accountability was made more explicit 5. Populations Needs-Based Planning was made more explicit
A Strengthened AOHC This year AOHC and the Ontario Federation of Community Mental Health and Addiction Programs/ Addictions Ontario (OFCMHAP/AO) merged their two respective group benefits plans to create the largest and most affordable of its kind in the province. The merger ensures better coverage for all employees and enhanced affordability. The plan is open to any not-for-profit organization that is offering health services, mental health and addictions programs or community supports. Additionally, as of April 1st, 2013 AOHC is now providing Healthcare of Ontario Pension Plan (HOOPP) for its staff.
Financial report 2012-13 AOHC has a solid financial picture, with total revenue in 2012-13 of $10.2 million. Revenue was earned from membership fees and fees for learning events including our annual conference, program learning groups, meeting registrations and educational workshops. We also received project funding from the Ministry of Health Promotion and the Ministry of Health and Long-Term Care that enabled key work to move forward on the Excellent Care for all Act Governance Training and Accessibility for Ontarians with Disabilities projects. Additional projects included Supporting AHACs in planning and evaluation and the Ontario Centre for Excellence in Environmental Health. Continuing this year as a highlight was our leadership of the Electronic Medical Records (EMR) and development projects, which received a total of $7.4 million from the Local Health Integration Networks and eHealth Ontario to support the CHC-AHAC information management strategy. The EMR project will support our members in implementing high-quality care and an ambitious qualityimprovement agenda. In 2012-13, AOHCâ€™s surplus totaled $29,000; this was a result of our 2012 conference. We have transferred these funds to our Reserve fund, which now has a balance of $104,383 and is allocated to our March 2018 reserve target, which is set at $250,000. In 2012-13, 93% of our core budget was allocated to meeting AOHCâ€™s six strategic priorities while 7% went towards governance, including board, committee and constituency meetings; the audit; the annual report; governance-related transition; board development and the annual general meeting. AOHC operates on a principle of fiscal transparency through the leadership of our Member organizations. AOHC is grateful for this participation and for the trust of our members. Thank you! Audited statements are available upon request.
AOHC BOARD OF DIRECTORS 2012-13 President Jocelyne Maxwell, Francophone Constituency Representative
Community Family Health Team Constituency Representative Mark Ferrari
Vice President Cate Melito, South and West Constituency Representative
Eastern Constituency Representative Robert Fletcher
Secretary Janet Bowes, Eastern Constituency Representative Treasurer Peter Szota, South Central Constituency Representative Aboriginal Constituency Representative Angela Recollet Central Constituency Stacey Papernick Sarah Hobbs-Blyth
Members at Large Arlington Dungy Adam Awad Almaz Reda Northern Constituency Representative Denis Constantineau South Central Constituency Representative Richard Gerson South West Constituency Representative Carole Cleave
Central East Constituency Representative Marina Hodson
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The AOHC annual report describes the association's goals, activities and outcomes from the fiscal year (April 1 2012 to March 31, 2013.)