Thursday, 29 October 2015

Concerns Raised with Pre-Capital Submission

In 2012, the Muskoka Algonquin Healthcare (MAHC) Board of Directors set a strategic objective to develop a long-range facilities and clinical services plan. The planning goal was to ensure that MAHC could continue to sustain and deliver the very best health care to Muskoka residents in the years ahead. After two years of careful data gathering and analysis involving many stakeholders and following significant community engagement, the Board unanimously endorsed the One Hospital model, centrally located for the year 2030 and beyond.

Our Pre-Capital Submission was submitted to the North Simcoe Muskoka Local Health Integration Network for review on August 7, 2015. Through the month of September we worked collaboratively with staff at the LHIN to revise the Part A to incorporate their input and feedback based on their analysis of the projected demand on two North Simcoe Muskoka regional programs: Complex Continuing Care and Acute Integrated Stroke Rehab. Part A of the Pre-Capital Submission is our future plan for programs and services that MAHC will provide in the next 5, 10 and 20 years planning horizons. The Part A was revised to incorporate changes to the bed projections for the future and is posted on MAHC’s website.

On October 26, the LHIN Board of Directors endorsed Part A and directed the LHIN to facilitate further engagement between MAHC and the local municipalities to support enhanced awareness and endorsement for the proposed health service delivery model (one hospital) in the future. This engagement will be facilitated by LHIN Board Chair Robert Morton in the next two months and will involve representatives from MAHC and the local mayors and the District of Muskoka. We know that community support for the proposed future model is important to moving any potential capital redevelopment project through the Ministry of Health and Long-Term Care’s process. We are optimistic that these sessions with our elected officials will help them better understand the rationale for the Board-approved future direction to pursue one hospital and garner their support and the support of our communities at large.

At the same time, some of the area municipalities have raised concerns about the approach we used for our Community Information Sessions, as well as access to service in the future, the evaluation criteria utilized, and land use planning legislation and policies. I felt the need to address these concerns in my blog and explain our position.

Community Engagement
MAHC wanted an engagement approach with our community that would facilitate meaningful conversations, feedback and interaction with those directly involved in the planning such as the consultants, architects, Board members, physicians, committee members and administration. To that end, directly following the formal presentation, community attendees were encouraged to move through a variety of information posters and to stations set up for each of the models under consideration where they could engage one-on-one with the planning team members. Having directly participated at one of the stations and by observing the activity in the room, there was clearly a richness and depth to the conversations that wouldn’t have been possible using the standard microphone in the centre of the room approach where people line up to pose their questions or make their observations. This approach was validated by the very positive feedback we received from many community members with respect to the information shared, the format in which it was presented, and their access to those directly involved in the project. We were able to directly involve more people through this approach.

The Board has acknowledged that access to services was one of the most common concerns raised within the 350 pieces of written feedback and other feedback that was received. The Board has made a strong commitment to being an active partner in local transportation initiatives and health integration efforts like the Muskoka Health Link and the Health Hubs to help improve access to care. In addition, there are several initiatives occurring municipally that will help improve access to all areas of Muskoka. Both the Towns of Bracebridge and Huntsville are working on their own transit strategies and the District of Muskoka has identified transit and the Highway 11 Corridor Bus system as a strategic priority. With these important initiatives underway and by working together as partners, MAHC is confident that transportation access can be improved not only for access to health care but for access to all services that Muskoka has to offer.  

Travel Times
Access to health care is more than just travel times. One of the primary considerations in MAHC’s planning work was to ensure the preferred model was one that would be sustainable for future generations, thus preserving current services. Sustainability and access to services was a risk to some of the models considered because those models did not allow for critical mass and efficiencies. Not achieving critical mass and efficiencies of some services currently available at one, or both sites, risks the availability of these services locally in the future, which could reduce access to care.

Evaluation Criteria
The criteria developed to assess the various models under consideration were based on several factors including Ministry criteria, advice from planning consultants, feedback from the working groups and an analysis by the Ad-Hoc Steering Committee that guided this work. The intent of the criteria was to provide decision-makers with an objective tool to compare and contrast the various options. It included several different categories, one of which was community support and perspective. The criteria helped eliminate some of the unfavourable redevelopment options early in the process that had the least support, such as the Ambulatory/Acute model initially considered. True to our commitment to a transparent and open process, the criteria that would be used to evaluate the models was broadly shared throughout the planning process and public information sessions.

Land Use Planning
Our knowledge and expertise is in health care service planning, not in land use planning and as a result we understood the importance of working closely with our Municipal and District partners. To that end, MAHC met with representatives of the District of Muskoka on several occasions. These meetings included the District Chair, the Commissioner of Engineering and Public Works, the Commissioner of Community Services, the Commissioner of Planning and Economic Development, the Commissioner of Finance and Corporate Services, the Chief Administrative Officer, and other District planning staff and engineers. The District of Muskoka and Emergency Medical Services team assisted with mapping and modeling and was consulted regarding the potential impact of one hospital. Generally, it was acknowledged that a single site model located somewhere between the two existing sites would pose challenges, but no initial deal breakers were identified in our meetings. It would be preferable that any services required for one hospital could build upon existing investments in infrastructure, such as water and sewer services. Preliminary costing by the District in their September 2015 report supports the fact that there is capacity in the system to do so.

I would be remiss if I didn’t remind my blog readers that there are many steps and years in the process before redevelopment approval is granted by the Ministry of Health and Long-Term Care. We need to be united in our attempt to build an accessible, innovative, and technologically advanced hospital that will provide safe, high-quality health care that our communities deserve and need in this highly competitive environment where limited capital dollars are available. We are committed to working with our municipal leaders and our communities to move this plan forward for Muskoka. The opportunity for us to come together to build the very best in hospital care is not only exciting, but a guarantee of health care locally for generations to come.