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Five RNAO members lend expertise to LHINs RNAO congratulates the following members who have been appointed to the LHINs board: • Gwen Dubois-Wing, CEO (North West) • Patricia Mandy. CEO (Hamilton Niagara Haldimand Brant) • Kim Stasiak, Member, (Hamilton Niagara Haldimand Brant) • Georgina Thompson, Chair (South East) • Jean Trimnell, CEO (North Simcoe Muskoka) For a complete list, visit www.health.gov.on.ca/transformation reform. “Anything that helps to create a more seamless, navigable and accessible system is a good thing,” she says, adding that one key point still needs clarification.“My main concern is that if competitive bidding is introduced by LHINs as it was through the Community Care Access Centres (CCACs), it could mean the expansion of private, for-profit health care.We have to remember that LHINs are merely a tool, and we are all responsible for how they’re used. As nurses, we need to be vigilant at this early stage to ensure LHINs evolve to strengthen Medicare.” Paech acknowledges the concern and is clear that competitive bidding is not planned. As noted by CCARH and others, there has been too little evaluation of the country’s many RHAs to provide conclusive lessons for Ontario, but six prescriptive points emerge as key to achieving vital regionalized health care. First, a stable, transparent and accountable government-LHIN relationship is key. Government must support contentious or unpopular decisions at the local level to avoid the politicization of the process, especially since LHIN boards consist of political appointees. Stasiak is hopeful about the potential for greater accountability in the new system.“The new accountability agreements will ensure that the services offered by 16 July/August 2005 the providers under the LHIN are maintained, with good patient outcomes. This will mean that public dollars are being utilized properly to provide essential services.” Lewis says it also helps to measure and report on performance at the seams of the system. “For example, how well hospitals hand off care to the community, or how easy it is for people to figure out where to go for service, etc. More practically, there has to be accountability for achieving the main objectives of the LHINs instead of merely rhetorical declarations of intent.” Second, a needs-based funding model is essential to align resources to needs. Many provinces are already working on this, but only British Columbia, Alberta and Saskatchewan have adopted a needsbased funding formula. Lewis argues that needs-based funding is critical, but no formula is perfect. “Everyone needs to understand what the rules are and why certain decisions have been made.” Needs-based funding relies on objective factors such as population base, the specific health needs of the district, and patient traffic across regions. The third prerequisite calls for the need to foster a culture of innovation in health care.As Paech says:“We need to move from working competitively to working collaboratively.We also need to think of what is best for the system rather than our own particular agency, hospital, or little patch of health care. Incentives encouraging innovation will be key but are yet to be worked out.” Thompson is already confident the new system will result in new ways of working together.“LHINs will create an opportunity that doesn’t exist now for different health providers to work as a team, to plan and coordinate local health services with one common group of patients in mind,”she says. Mandy emphasizes that LHINS will also increase the efficiency and responsiveness of the system because of less duplication and a new focus on providing coordinated care. Setting up new, more responsive regional health-care networks requires improved information management. For the newly appointed LHINs members to do an effective job, health information has to be accessible, timely and up-to-date. One of Canada’s foremost health-care analysts and University of Toronto professor Colleen Flood emphasizes what she thinks is another key to a successful transition to regionalized health care: that physician services and drug budgets be brought under RHA or LHIN control. She writes: “Who can manage effectively without control of all the significant levers?” So far, no province has had the political will to make this move. Finally, Lewis says LHINs must be free to experiment.“LHINs need to have the flexibility to experiment and even to fail on occasion, as long as they are accountable for performance and are willing to admit mistakes and correct them. Governments have a tendency to micromanage funding and set expectations for volumes of services and While Ontario’s LHINs are still a work-inprogress, some newly appointed RNs see the overall policy direction as a very positive step. processes of care rather than outcomes.” Although it’s not yet clear what regionalization might mean for RNs, Lewis’s early appraisal of what Ontario can expect from regional reforms best sums up the imperfect truth:“The aims are laudable, but it remains to be seen if the means are sufficient to achieve these ends. Ontario has the country’s most fragmented health-care system. Given the political realities of health care in Ontario, it may well be that LHINs constitute the best step forward at this time. But it’s probably optimistic to anticipate dramatic improvements in coordination, efficiency, and redistribution of resources to improve health care any time soon.” RN ANILA SUNNAK IS A FREELANCE WRITER IN TORONTO.
RN Beth Hamer, lead of the best practice consult group at Penatanguishene Mental Health Centre (PMHC), knew RNAO’s crisis intervention best practice guideline (BPG) would make a big difference in the lives of her patients. That’s because many of them have already been diagnosed with a mental illness,live and function well in the community, but come to the centre overwhelmed by situational crises such as losing their apartment, the break-up of a relationship, or the death of a friend or family member.Mental illness can be exacerbated by such crises, but Hamer says the guideline may help patients get their lives back. With a $12,000 grant through RNAO’s Advanced Clinical/Practice Fellowships for Nurses, and a matching grant from the health centre, Hamer implemented the crisis intervention guideline on PMHC’s admissions assessment unit. With support from three staff nurses on the unit, she approached the admissions staff with plans to implement the guideline. Hamer admits to some initial front-line resistance. “Staff nurses have a tremendous amount of work already,” she says. “They worry this is just another thing (to do)… and (wonder), will it be utilized?” Securing the support and buy-in of staff is not the only challenge facing nurses who bring guidelines into the workplace. The adoption of accessible and user-friendly technological devices that aid in the application of BPGs – things like Personal Digital Assistants (PDA) – is another challenge, as is the vital need to increase awareness among nurses and administrators of the importance of BPGs, and the opportunities they afford. Hamer helped raise awareness when she by Jill Shaw BPGs: to bedside From Boardroom RNs across Ontario and around the world share success stories and offer inspiration to nurses confronting the challenge of best practice implementation. Delegates from the U.K., Australia and the Netherlands visited RNAO in late May to discuss ways of identifying, critiquing and influencing international trends in BPG development, implementation and evaluation. Pictured (L to R): (front row) Irmajean Bajnok, Director, RNAO Centre for Professional Nursing Excellence; Margaret Harrison, Associate Professor, Queen’s University; RNAO Executive Director Doris Grinspun; (back row) William Gray, Research and Development Fellow, Quality Improvement Programme, Royal College of Nursing Institute, UK; Heather McConnell, BPG Program Manager; Tazim Virani, Director, BPG Program; Josephine Santos, BPG Program Coordinator; Bernice West, Research Director, Robert Gordon University, UK; Rick Wiechula, Director of Operations, The Joanna Briggs Institute, Australia; Barbara Davies, Associate Professor, University of Ottawa; Kirsten Krull- Naraj, VP, Patient Care Services and Chief Nursing Officer, Royal Victoria Hospital; Stephanie Lappan-Gracon, BPG Champions Network; Herry In Den Bosch, Project Manager, LEVV The Netherlands Centre for Excellence in Nursing; and Jane Schouten, BPG Program Coordinator. Registered Nurse Journal 17
Page 1: Exhibit unearths nursing’s past
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Page 8 and 9: y Jill Shaw Nursing inthenews R N A
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