Introducing the Inaugural St. Michael’s Residents’ Health ...€¦ · Introducing the Inaugural...

Introducing the Inaugural St. Michael’s Residents’ Health Services Panel

August 2016

“We hope to contribute a great deal over the course of our term as members of the Residents’ Health Services Panel, and this report is our first step.”

Toronto Central Local Health Integration Network

Members listen to a presentation about the panel process.

3Introducing the Inaugural St. Michael’s Residents’ Health Services Panel 3

A Letter from the President and CEO

The neighbourhoods surrounding St. Michael’s Hospital have always been diverse — from Rosedale to the Waterfront, Yonge Street to Regent Park, we provide care for a diverse group of people, including some of the city’s most vulnerable.

Our local residents have a wealth of expertise to share about their needs and experiences. They are newcomers to the country and well-established families, individuals living in poverty and middle-class families, seniors and youth. There are individuals who lead healthy lives as well as those who are critically ill or marginalized through issues such as mental health, social exclusion, or other challenges that may impact their heath.

We know that the journey to improve care requires us to engage with resi-dents in a meaningful way and going beyond traditional focus groups and patient surveys. At St. Michael’s, we want to give our community the opportu-nity to work and learn with us to improve our health system.

Our Residents’ Health Services Panel is an opportunity to do exactly that. The panel reflects the rich diversity of our community and uses the members’ collective experiences to bring a fresh and informed perspective to the health system challenges we are working to address. I am truly inspired by, and thankful for, their commitment, engagement, collaboration and thoughtful debate throughout their first four meetings. I am excited to share their inaugu-ral report with you.

This report was written by the panelists themselves, as local residents who have come together to represent central-east Toronto and advise on improve-ments to local health services in our community.

I believe that the principles they’ve developed as local residents will be a use-ful guide in our efforts to improve care for our entire urban community. The pri-orities they’ve defined present opportunities for service providers to collaborate across sectors and with government to improve the health of our city. We will continue to listen carefully to the panel’s guidance, to take action on their advice when it is within our ability to do so, and to work with our partners to bring to life the vision of the health system that they are pointing us towards.

Thank you to each of the panelists, and the many others who volunteered but were not selected. We look forward to your continued guidance.

Sincerely,

Robert HowardPresident and CEO, St. Michael’s Hospital

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Table of Contents

1. What You Need to Know About the Residents’ Health Services Panel .............7

2. Meet the Members of the Panel........................................................................11

3. Understanding the Civic Lottery ......................................................................19

4. Principles and Priorities for Improving Local Health Services: the Panel’s Inaugural Report .............................................................................21

Guiding Principles for Providing Comprehensive Care for St. Michael’s Entire Urban Community .........................................................22

Priorities for Providing Comprehensive Care for St. Michael’s Entire Urban Community .........................................................25

5. About the Panel’s First Four Meetings .............................................................33

Christopher Biri (Regent Park / Moss Park) presents and discusses values he would like to see inform the panel’s work.


1. What You Need to Know About the St. Michael’s Residents’ Health Services Panel

The St. Michael’s Residents’ Health Services Panel is a new initiative of St. Michael’s Hospital. In February 2016, 14,500 randomly selected households in central-east Toronto received a letter in the mail from the hospital’s CEO, Dr. Robert Howard, asking them to advise the hospital over the course of eight meetings on how best to improve health services for its entire urban community. More than 370 residents responded, and 28 were randomly selected so that together they represent the demographics of those living in St. Michael’s diverse local geography.

Two months into its one-year term, the panel had completed the first phase of its work: learning about the health system and the needs of local residents, and reaching consensus about the guiding principles and most urgent priorities for improving local health services. The panel will continue to meet for the rest of 2016 to advise St. Michael’s on how to ensure specific initiatives ultimately lead to improvements in the local health system.

The 28 members of the St. Michael’s Residents’ Health Services Panel are Toronto residents without any special training in medicine, health-care, administration or public policy. While some residents were frequent users of health services at St. Michael’s, others had never been through the hospital’s doors. As you will see from reading their biographies in Section 2, however, all panelists were committed to helping improve the health-care system and each offers an important perspective concerning the needs of local communities. Collectively, they bring a wealth of knowledge about the health system experience of local residents, and a commitment to helping health-care organizations focus their attention where it is needed most.

HOW MEMBERS WERE SELECTED

In February 2016, 14,500 randomly chosen central-east Toronto households were sent a letter from St. Michael’s Hospital’s CEO inviting them to volunteer for the panel. Letters and invitations were also distributed through service agencies throughout the local geography. More than 300 residents of central-east Toronto put their name forward, and the panel’s 28 members were selected randomly from amongst those volunteers. Members were selected using a civic lottery, a process developed in Toronto that has now been used more than 25 times to convene citizen panels across the country. The selection process achieves broad representation by ensuring

8Introducing the Inaugural St. Michael’s Residents’ Health Services Panel

a proportionate number of the panel members are appointed to the panel based on their age, gender, household tenure, patient status, visible minority and indigenous status. You can learn more about this selection process in Section 3. The members of the panel will meet for a total of eight sessions over the course of 12 months and will cumulatively contribute 38 hours of public service to their local health system.

THE PURPOSE OF THE ST. MICHAEL’S RESIDENTS’ HEALTH SERVICES PANEL

St. Michael’s has served central-east Toronto since 1892 and from the outset has focused on providing quality care to some of the city’s sickest patients, including those who experienced poverty, were marginalized, or otherwise disadvantaged.

In its newest strategic plan, published in 2015, St. Michael’s renewed its longstanding commitment to the critically ill and to disadvantaged popu-lations. St. Michael’s also adopted a new strategic priority: comprehensive care for its entire urban community — a diverse area experiencing unprec-edented growth and change. The St. Michael’s Residents’ Health Service Panel was created in partnership with the Toronto Central Local Health Integration Network to give residents of central-east Toronto the opportu-nity to provide representative and informed advice to St. Michael’s about how it could best achieve this strategic priority.

Although this engagement of local residents is a new endeavour for St. Michael’s, it complements other mechanisms of patient, family, and public engagement: three well-established community advisory panels that each focus on a specific marginalized population, and the newly established Patient and Family Advisory Committee, which focuses on recent recipients of hospital care.

Members of the Residents’ Health Services Panel have been asked to learn about the local health-care system, the hospital, the demographics of the local community, and then to work on behalf of the entire community to shape the hospital’s efforts to improve local health services.

WHAT THE PANEL HAS ACCOMPLISHED SO FAR

Over the past two months, panel members each dedicated 22 hours of their time to learning and working together. They have heard from some of Toronto’s foremost health system experts about the way Ontario’s health system is structured, the operations of St. Michael’s Hospital, and the current demographics and health needs of central-east Toronto. They have hosted a public roundtable meeting to learn from other local residents about the needs and priorities of their community. And they have engaged in a series of facilitated discussions to identify six guiding principles and 15 priorities that they believe should guide St. Michael’s efforts to improve comprehensive care for our entire urban community.


WHAT’S NEXT FOR THE PANEL

The Residents’ Health Services Panel will meet four more times over the course of 2016. At each of these meetings, panelists will learn about initiatives St. Michael’s and its partners are developing to improve local health services. They will then work together to advise the hospital on how to ensure that these proposed initiatives reflect the needs of local residents and ultimately lead to improvements in local health care. They will use their diverse perspectives and experiences, as well as what they’ve learned about the health system and St. Michael’s role in it, to provide advice that reflects the priorities of residents and takes into account the current realities faced by the hospital and the community. At the end of this inaugural term, the Residents’ Health Services Panel will be evaluated, and a renewed panel will be formed to continue advising the hospital in the years ahead.

Leo Warner (South Riverdale) listens to a fellow panelist’s remarks during a presentation of their work.

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2. Meet the Members of the St. Michael’s Residents’ Health Services Panel

The 28 volunteers of the St. Michael’s Residents’ Health Servic-es Panel broadly match the demographic profile of central-east Toronto and the catchment area of St. Michael’s Hospital. Read about each of them on the following pages, in their own words.

Adam Lenskyj, Moss Park. I was born in Austria and later immigrated to Australia as a refugee. I moved to Canada in 1966 and have lived in St. Michael’s catchment area on and off since arriving here. Since retiring, I have become an active volunteer with St Michael’s Volunteer Services and the Out of the Cold program. I am also a patient of St. Mike’s family practice unit and have received care in many other departments, such as the Kidney Care centre, the Cardiac Arrhythmia Service, the Eye Clinic, the Emergency Department, and the Diabetes Clinic. While I have received excellent care from St Michael’s several of my neighbours and friends have had concerns with the care they received there. In particular, they have felt St Michael’s has rushed their discharge process resulting in uncertain and confusing after-care plans. I volunteered for the panel to represent these concerns and work with St Michael’s to ensure they are isolated cases.

Ana Sinha, North St. James Town. I came to Canada in 2005 as an international student. I originally lived in London, Ontario before I moved to Toronto in 2010 and fell in love with this multicultural city. Over the last six years, I've worked in various financial institutions, and currently work for Canada’s oldest insurance company. For the past five years, I have also been volunteering at the Canadian Breast Cancer Foundation. I come from a family of medical professionals, starting with my great-grandfather, who was a doctor. Even though I am not a doctor (and don’t work in anything related to health care), I find health care extremely interesting and I am passionate about bridging the gap between services offered and access to those services for the residents of Toronto. I am very excited to be a member of this panel because I feel like I can be a voice for other Torontonians, helping to represent their interests and concerns.

Andrew Kunitskiy, Church-Yonge Corridor. I’m an art school graduate. I was born in Moscow, Russia and moved to Canada in 2009. For the first three years, I lived in Vancouver and then relocated to Toronto three years ago. I moved to the area near St Michael’s less than a year ago and enjoy this part of the city because it has a diverse population and is very centrally located. When I got the brown envelope in the mail asking to participate in St. Michael’s Residents’ Health Services Panel I got


excited, I always wondered who exactly was being consulted in social research like this and was surprised to get a phone call saying I had been selected for this one. I hope that my experience of living in different cities can really help this panel to bring the health-care system in central-east Toronto to the next level!

Bebe Szerelmes, North St. James Town. I’m from the Philippines and moved to Toronto nine years and nine months ago (to be exact!). In 2013 I joined Asian Community AIDS Services (ACAS) as part-time trans-outreach staff member. My main role is to provide sexual health information and distribute safer sex materials to venues and events that are frequented by Asian trans women. Being a part of this panel is both an honour and a responsibility. In my own little way, I hope to be a productive public servant.

Chris Biri, Regent Park/Moss Park. As a revenue management analyst for the Regional Municipality of York in Transportation Services and a new member of the Regent Park community, I have an interest in how health-care services are developed. I want to be a part of ensuring that patients everywhere have access to the resources they need; when they need them. I have an interest in LGBTQ issues and currently am the co-chair of CUPE 905's LGBTQ Committee, working to identify diversity issues within the workplace and aiding to adopt various guidelines and policies to close the gap on all diversity issues within our organization. My goal as a member of this panel is to present a fresh perspective and provide whatever insight that I can offer.

Chantal Forest, Regent Park/Moss Park. Not available.

Elizabeth Kowpak, Regent Park/Moss Park. I grew up in Streetsville, Mississauga, and after finishing my undergraduate degree I moved to Toronto six years ago. I am a senior brand manager, and have always worked in the food industry. I am thrilled to have the opportunity to work with a team of people, both health-care professionals and community volunteers, to help optimize the way health-care works in central-east Toronto.

Fook Loy (Eddie) Ng, Regent Park/Moss Park. I was born in Malaysia and moved to Toronto in 1988. I have lived in several different neighbourhoods and currently call the Regent Park area home. I enjoy my neighbourhood and do a lot of volunteer work in the area. I have previously been an outpatient of St. Michael’s clinic department. While at the hospital, I had to wait for over two hours before receiving care. This experience motivated me to volunteer for the St. Michael’s panel. I hope to share my experience and see the hospital improve care for other patients.

Greg McLean, Church-Yonge Corridor. I was born in Burlington but moved to Bangkok, Thailand, as a kid and went to high school there. I returned to Canada for university and am in my fourth year of undergrad at the

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University of Toronto, studying finance and economics. Living abroad has made travelling a passion and goal for my life. I am interested in health-care provision, outcomes and policy, so am glad to volunteer for this panel to help St. Michael’s shape its health services in the community.

Heather Roberts, South Riverdale. I have lived in Toronto most of my life. For almost 30 years I have been an educator teaching in inner-city schools. Many families I have worked with are new to Canada and have difficulty negotiating our health-care system. As well, several close members of my family (including my son) have had serious health issues and have needed intensive and extended health-care. My husband and I are getting older and have concerns with the care we will be able to access as our health needs change. I want to be involved in discussions as to how we can make health care services in the downtown core as accessible and comprehensive as possible to take care of the diverse needs of our community.

Jennifer Parney, Rosedale-Moore Park. I grew up in Mississauga and have lived and worked in Toronto for the last 25 years. I work in the investment business but I have a master’s degree in urban and regional planning and have always had an interest in community planning. I thought this project would be a good way for me to get involved in that again and to learn more about issues in health care. I have family and friends who have experienced great care at St. Michael’s and I am happy to be working with the hospital to help them explore ways to serve their community even better.

Keith Wong, Church-Yonge Corridor. I grew up in Hong Kong and received my university education in Australia. After working for a few years in international banking, I moved to Canada in the late 1980s. I have been living in Toronto ever since. In the last decades, I have worked in accountancy and non-profit management, and actively volunteered about racial minority and LGBT advocacy issues. At present, I am engaged in part-time consultancy on organizational development and training for non-profit and community organizations. I enjoy photography, cooking and running.

Leila Bautista, Church-Yonge Corridor. I'm a market research specialist currently working as an account manager. I've lived in the same area in Toronto for almost three years, after moving here following university. As a market researcher, voicing public opinion is close to my heart. I graduated with a double degree in economics and political science, and health care is an area where both financial and social interests tend to clash the most. I also worked as an analyst in the medical device industry – that sparked my interest in the health-care field. In addition, I have been diagnosed with major depressive disorder and have had extensive interactions with our health-care system. I'd like to take my personal experiences and extrapolate to macro issues that will benefit the entire St Michael's community. I also enjoy athletics: I'm a former varsity swimmer, currently taking part in triathlons, rock climbing, yoga and various intramural sports.



Leo Warner, South Riverdale. I’m originally from Bassetere, St. Kitts, and immigrated to Canada 35 years ago. I lived in Saint John, New Brunswick for a short time before relocating to Toronto, which I now call home. I work in the financial services industry and have worked in a variety of roles across a number of disciplines (operations, people management, human resources, business analysis, project management, learning and development), leveraging my education, experience and corporate knowledge. My first volunteer experience was with the 2015 Pan Am/Parapan Am Games as deputy venue transportation manager at the Athletes’ Village, where I managed volunteers and worked with a variety of teams to ensure a successful operation and wonderful experience for the athletes. Being on this panel is another opportunity to give back to my community and provide advice on health care, which is a concern for all.

Marina Zub, North St. James Town. I was born in Omsk city, Russia. I graduated from Omsk State University with a bachelor's degree in history. My graduation project was researching Sweden's social-economical model of the 20th century and the development of social welfare. During my years as a student, I was an active student who established volunteer organizations and participated in many events and efforts. My connections with Russian opposition parties led to my emigration from my country. I lived for a year in the U.S. and for six months in Mexico. Now I'm a student at George Brown College. I'm passionate about cooking, creating recipes and nutrition. I'm married, and I have two adorable guinea pigs.

Mohammad Hossain, Regent Park. I was born and brought up in Bangladesh. I immigrated to Canada in 2002 and work as an IT professional. I worked in a graphic design firm in Toronto for 10 years. Now, I am doing business with a multi-level marketing company. I am looking forward to continuing the work we’ve started together as members of the St. Michael's Residents’ Health Services Panel.

Myra Reisler, Rosedale-Moore Park. I was born and raised in North Toronto, as the oldest of four kids. After completing undergraduate studies in Halifax, I returned to Toronto, where a junior role in public relations grew into a career in corporate communications in the financial services industry. My family (husband and two young daughters) now call central-east Toronto our home. I look forward to discussing the future of health care on behalf of my little girls.

Nelson Fraute, North St. James Town. I'm from Venezuela, and moved to Toronto eight years ago. I have a background in the environmental field, and I've worked for five years now as a contractor. I joined the Residents’ Health Services Panel because I think health care is very interesting, and I would like to learn more about it.

Pat Munroe, Waterfront - Toronto Island. I was born in British Guyana, in South America, in a marginalized community. I immigrated to Toronto

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36 years ago. I am fortunate and consider Canada to be one of the greatest countries in the world. My educational background consists of human resources management, training and development, and coaching. I held management roles in health care, then in housing development. My extended family and I have used the services at St. Michael’s over the past 35 years. The staff and volunteers at St. Michael’s are remarkable. My passion is working with people. I feel it’s time for me to give back to health care in my community, especially to St. Michael’s. I volunteered to be a member of this panel to provide feedback about how to improve the current system and to be a voice for all residents who want to improve the structure of health care in the future.

Scott Roose, Moss Park. I’ve lived in the Greater Toronto Area for 15 years, though I’m originally from Chatham, Ontario. I have worked as a sous chef with a major hotel chain, in food services in the health sector, and most recently as a private caterer. I stopped working in 2010 to better deal with severe depression triggered by the death of my partner of seven years to HIV. I joined the panel to bring to light the difficulties I have faced in navigating the confusing social assistance and social support network.

Sharie Dewar, Rosedale-Moore Park. I am a retired math teacher from Alberta. I moved to Toronto in 2011 to be with my grandchildren.

Simon Noel, Church-Yonge Corridor. I was born and raised in Toronto. I went to study in the U.S. at Arizona State University where I received a bachelors of science in Global Business and Leadership with a minor in Communications and where I was a member of Phi Theta Kappa Honors Society. I am currently studying Business Analysis at the University Toronto. I have always found it inspiring and fulfilling serving the Toronto community. Health and striving to be healthy is something that plays a major part in quality of life for all Torontonians. I joined the panel because it enables us panel members to bring awareness to the needs of our community to decision-makers.

Stefany Pierce, South Riverdale. Originally I'm from the Ottawa Valley but I've lived in Toronto for 28 years. I'm a specialist in delivery management with 15 years experience in the advertising industry. For the last two years I've worked for a large Canadian company in their publishing and media divisions. I work with process design and change management so this seemed like a good opportunity to be helpful to my community and see how a different sector rolls out new services. I'm also the parent of a young child who is growing up in the St. Michael's neighbourhood and has used some of St. Michael's services, so I have a vested interest in potential improvements.

Steve Gold, Regent Park. I’m a life-long Torontoian, having been born and raised in North York. I moved to Regent Park seven years ago. For the past eight years, I’ve worked at UPS in courier delivery. I volunteered


for the Residents’ Health Services Panel because I was interested in giving back to my community. I was also interested to learn more about the health-care system.

Teodora Reyes, South Riverdale. I've lived in the same neighbourhood in Toronto for 46 years. I'm a retired nurse. I like working with people, because most learning happens through people. I'm a single mom with two children, and three grandchildren. I volunteered for this panel because my community was very good to me when I was a single parent, and I'd like to give back in some way. I also volunteered because I want to improve the health services in our community and country. If St. Michael's is doing well, other places can use St. Michael’s as a model for improved health services. I am an active member of my community. I volunteer in my church and have my own business from home.

Xiaojia (Cathy) Dong, North St. James Town. I was born in China and moved to Canada several years ago. I now live in downtown Toronto. I'm currently working on a master’s of Mechanical Engineering at Ryerson University. I believe the public’s health and our health-care system is one of our most important social issues. Even though our government offers people free health care, I think we still have a lot to do to make the public health system better and serve people better for both their physical and mental health. I volunteered for the Residents’ Health Services Panel because I wish to contribute some of my efforts to help people, to hopefully reduce their pain, so they can recover more quickly.

Zane Magnus, Waterfront Communities-The Island. I’ve lived in Toronto and the GTA for nearly all of my life, spending a lot of that time downtown. I’ve worked downtown for the last five years at a digital service company. I am passionate about the role that digital tools can play in service industries, how they can make peoples’ lives easier and more convenient. I joined the panel because I haven’t had much interaction with hospitals during the second half of my life and I’m interested to learn how they’ve changed, what challenges they’re currently facing as local health care continues to modernize and to participate in providing solutions that address those challenges and make the most of new opportunities.

One member of the Residents’ Health Services Panel had to withdraw from participating due to unforeseen circumstances.

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TRUENORTH

20 KILOMETERS

Male 13Female 14

18 to 29 years old 630 to 44 years old 945 to 64 years old 865+ years old 4

Aboriginal 1Visible Minority 10 All Else 16

History 6with HospitalNo History 21with Hospital

Own Home 11Rent Home 11Other 5

The civic lottery package: outer envelope, return envelope, letter, frequently asked questions and response card

St. Michael’s Hospital Residents’ Health Services Panel, 392a King Street East, Toronto, ON, M5A 1K9

(Important message enclosed)

SMH_OE

Only 1 in every 5 households have been randomly selected to receive this invitationWe need your help to rethink health services in central Toronto

DeadlineFebruary 29 Respond Today


Sanjay Smith #2-143 York View Dr Toronto, ON M5A 1D3

What is a Residents’ Health Services Panel? A Residents’ Health Services Panel is a group of residents invited to learn, discuss, and provide advice to health system leaders about how to improve health services in their local area. Twenty-eight randomly selected residents will be appointed to the panel for one year. The panel will develop its input as a group and will work to reflect the perspectives and concerns of all local residents.

Why is the Residents’ Health Services Panel being created?Right now, St. Michael’s Hospital is working with local partners to improve the design of local health care services in central Toronto. Hospitals have an important role to play in helping to modernize care provided at home and in the community, improve access to well-coordinated health care, and increase the health of local residents. St. Michael’s goal is to see that your local health services become better coordinated and more integrated. This could include, for example, making it easier to access specialists and medical tests outside of the hospital. The result for patients could be shorter wait times or easier transitions from one health care provider to another. To do this, St. Michael’s needs residents to help identify the most important gaps in local health services, and recommend ways we can address them. The Residents’ Health Services Panel is unlike a focus group or townhall meeting because the members of the panel will spend a significant amount of time learning about the health system, contributing their perspective, and reaching consensus with other members of the panel on their most promising recommendations.

Could this mean my family doctor might change or become a part of St. Michael’s Hospital?No. St. Michael’s efforts will not affect your relationship with your family doctor. Nor will you be obliged to receive health services from St. Michael’s Hospital or its Family Health Teams. If, however, you don’t have a family doctor or nurse practitioner in the local area, we want to make it easier for you to access one.

Could this mean that, if I receive care from another health care organization, I will be asked to switch to St. Michael’s?No. Central Toronto residents will continue to receive care from different health care providers, whether they are in your neighbourhood or in another part of the city. However, St. Michael’s is working to coordinate more frequently with different doctors, nurses, and organizations in the local area. This way we can make sure that together we are serving the needs of all residents.

Do I need to be a current or former St. Michael’s patient to participate?No. All residents of central Toronto are encouraged to volunteer. St. Michael’s Hospital is hosting this panel to help inform its health care services in central Toronto. St. Michael’s has partnered on this initiative with the Toronto Central Local Health Integration Network, the provincial agency responsible for funding and evaluating health services in this area. You do not need to be a current or former St. Michael’s patient to participate.

Do I need to be a Catholic to participate?No. St. Michael’s Hospital welcomes people of all faiths and exists to serve the health needs of Ontarians as one of Canada’s top teaching and research hospitals. All local residents, regardless of their personal beliefs, should feel welcome and comfortable obtaining health services at St. Michael’s Hospital and serving on our Residents’ Health Services Panel.

What is the Toronto Central Local Health Integration Network?The Toronto Central Local Health Integration Network is an agency of the Province of Ontario with responsibility for funding and evaluating the provision of health services in central Toronto. For more information about the TC LHIN, please visit: www.torontocentrallhin.on.ca

What will members of the Residents’ Health Services Panel do?Members of the panel are responsible for representing the perspectives of all local residents. Working together, they will help St. Michael’s understand the most important health care issues for residents of central Toronto, and then contribute to the design of new health services for local residents. During the first two meetings, members of the panel will meet with senior hospital staff, as well as other experts, to learn about health care in central Toronto. During the third and fourth meetings, members will work in small groups to identify the health care priorities that you believe are most important for central Toronto. During meetings six through eight, St. Michael’s staff will present proposals for improving health services —like new specialized clinics or better patient records— and ask panelists to offer guidance. St. Michael’s will use the panel’s advice to help improve health services in central Toronto.

Frequently Asked QuestionsToronto Planning Review Panel

Please turn over Å


Frequently Asked QuestionsResidents’ Health Services Panel Toronto Central Local Health

Integration Network



Dear Toronto Resident, This letter is not a fundraising appeal. Instead, it is a special invitation to participate in an important planning process that will gradually change the way health services are provided to residents living in central Toronto.

Canadians care passionately about their health system, but rarely do we have the opportunity to help shape the services we receive. This letter helps to change that. It is your invitation to influence the funding and service priorities of the local health system you rely on.

Only one in five area households have been randomly selected to receive this invitation.

We are asking you to volunteer to become a member of our new Residents’ Health Services Panel. Whether you enjoy good health or frequently use local health services, we hope you will volunteer.

Right now, St. Michael’s Hospital is working with local partners to improve the design of local health care services in central Toronto. Hospitals have an important role to play in helping to modernize care provided at home and in the community, increase access to well-coordinated health care, and improve the wellbeing of local residents.

St. Michael’s goal is to see that your local health services become better coordinated and more integrated. This could include, for example, making it easier to access specialists and medical tests outside of hospital. The result for patients could be shorter wait times or easier transitions from one health care provider to another.

We are actively working with local physicians and other care providers to understand their needs. Importantly, we are also reaching out to local residents to better understand their priorities. The Residents’ Health Services Panel will ensure that the priorities of local residents are heard.

You don’t need to be a health expert or a former or current St. Michael’s patient to participate. Your perspective as a local resident is what matters most.

As one of 28 members of our new Residents’ Health Services Panel, you will have an unprecedented ‘backstage’ experience as you learn about our health care system and the changing needs of local residents. Over the course of eight meetings, you will work alongside other residents and senior hospital staff as you share your perspective and help us decide how to improve the health services available in central Toronto.

Please turn over Å

Return Address

Response required by:Monday, February 29, 2016

Registering online ensures your response is received by the deadline

www.smh-panel.ca

❏ YES, I would like to volunteer as a member of the Residents’ Health Services Panel

❏ I am unable to volunteer for the Panel, but wish to volunteer for other consultations about local health services

First name: Last name:

Gender: Male Female Other: Age: 18 – 29 30 – 44 45 – 64 65+

Primary Phone: – – Secondary Phone: – –

Email: Ca

ndid

ate

Resp

onse

Car

d

Office use

Please turn over Å

Sanjay Smith #2-143 York View Dr Toronto, ON M5A 1D3

DeadlineFebruary 29Respond Today


3. Understanding the Civic Lottery

The 28 members of the 2016 St. Michael’s Residents’ Health Services Panel were selected by civic lottery. A total of 14,500 invitations were sent to randomly selected addresses within St. Michael’s catchment area in early February 2016. The letter, sent by St. Michael’s Hospital CEO Dr. Robert Howard, invited recipients to volunteer a total of eight evenings and Saturdays over the course of one year to learn about the local health system, and to work with other residents to shape goals and designs of hospital initiatives meant to improve local health services. Letters were mailed across central-east Toronto, and also distributed through local service agencies.

Volunteers were asked to donate their time and insight as a public service to their local health system. All costs incurred (including child care, elder care, food, and travel expenses) were covered. Three hundred and two people volunteered to be part of the panel, while another 70 wrote to express their interest, but were unable to commit to attending all of the eight meetings. Those who were not able to attend were invited to register to be contacted for other opportunities to advise the hospital in the future.

From this set of 302 potential volunteers, 28 panelists were randomly selected in a draw which ensured gender parity, a geographic distribution throughout central-east Toronto, proportionate representation of visible minorities, and representation of owners, renters and residents of supportive housing. At least one Aboriginal member was also selected, and both former patients of St. Michael’s and those with no previous experience of the hospital were selected. The appropriate proportions were based on the most recent census data for central-east Toronto. Income, level of education and other similar factors were not considered. The civic lottery used here is a made-in-Toronto process used over 30 times nationwide to allow randomly selected groups of volunteers, selected for demographic diversity and representative of the population as a whole, to provide informed policy recommendations and advice to all levels of government.

Elizabeth Kowpak (Regent Park/Moss Park) presents the work of a small group of panelists’ renfinements for a section of the final report.

21Introducing the Inaugural St. Michael’s Residents’ Health Services Panel 2121Introducing the Inaugural St. Michael’s Residents’ Health Services Panel

4. Principles and Priorities for Improving Local Health Services: the Panel’s Inaugural Report

What follows is the inaugural report of the St. Michael’s Hospital Residents’ Health Services Panel. This report was drafted by members of the panel over the course of their first four meetings held in March and April, 2016. The report was subsequently circulated to each panel member for their input, revisions, and approval. This process was completed with the assistance of panel staff.

INTRODUCING OURSELVES: ST. MICHAEL’S RESIDENTS’ HEALTH SERVICES PANEL

We are a diverse, representative group of 28 residents who live in St. Michael’s catchment area. We are engaged ambassadors of our community who bring to St Michael’s fresh eyes, empathy, a passion for problem solving, and insights from our own experiences. We represent the diversity of central-east Toronto, as health service users, mental health survivors, parents, caregivers of our own parents, students, teachers, workers, managers, retirees, long-time residents, and newcomers to these neighbourhoods and to this country.

We were chosen from over 350 volunteers, who, like us, wanted to help make our community better. We stepped forward for many reasons. We wanted to learn about the health-care system and the challenges we face as a community. We wanted to meet new people and connect with others. We wanted to share our experiences of health care, both positive and negative. We wanted to experience a different way of working together as citizens to solve collective challenges. And ultimately, we wanted to make a difference in the way St. Michael’s provided care and improve the health system for ourselves, our families, our communities, and for future generations.

Over our first four meetings, we have learned a great deal from health system experts, from community members, and from each other.

We’ve learned about the incredible diversity of our neighbourhoods here in central-east Toronto, and the many different needs of its residents. We’ve tried to put ourselves in others’ shoes — to think about what works for those other residents as well as for ourselves. We’ve learned a lot about the passion, as well as the frustration, of health-care providers, who want to provide great care but face barriers to doing so. We’ve learned about how complicated the health-care system is, and also become more aware of all the different services that are available to residents here in central-east Toronto. And by working together, we’ve already learned a lot about how to communicate and collaborate more effectively and make tough decisions that are acceptable to everyone.

We hope to contribute a great deal over the course of our term as members of the Residents’ Health Services Panel. This report is our first step. We want to bring together diverse opinions into a coherent community voice, to provide thoughtful and tangible recommendations about what matters most to local residents and how to improve local health services provided, and to push the local health system to solve long-standing issues that people have come to accept when solutions are, in fact, possible. Ultimately, we want to offer a renewed sense of energy about the role St. Michael’s could play in helping to provide great care throughout the community, so that our local health system serves us all.


Guiding Principles for Providing Comprehensive Care to St. Michael’s Entire Urban CommunityAs the Residents’ Health Services Panel, we believe the following principles should guide how St. Michael’s works with its partners to improve local health services.

A SYSTEM DESIGN THAT STRENGTHENS ACCOUNTABILITY AND TRANSPARENCYSt. Michael’s should work to create a local health system that is designed for accountability and transparency. At a system level, this means that the quality of care is measured, that the quality measurements are known and accessible to the public, and that health system funders hold providers accountable for providing great care. At an individual level, it also means that patients have a health-care provider who is their advocate — that is, a provider who is accountable to the patient for ensuring they get the comprehensive care they need. That advocate needs the resources to fulfil the role, and patients need to know their advocate is there to help them.

A FOCUS ON PREVENTIONSt Michael’s should work to create a local health system that is prevention focused. For us, this means care and services are proactive, seeking to keep people healthy and follow up about issues, rather than just responding to crises. This requires strong connections to community agencies and businesses who can partner to promote better health, and ensuring health education information is accessible to all.

A HOLISTIC APPROACH TO HEALTH SERVICESSt. Michael’s should work to create a local health system that takes a holistic approach to health services. For us, this means that health services in our local area address the whole person, including their physical and mental health as well as their lifestyle and social circumstances. This requires health-care providers to know their patients and their patients’ social situations, and for the local system to offer a diversity of services that respond to each patient’s needs.

23Introducing the Inaugural St. Michael’s Residents’ Health Services Panel 2323Introducing the Inaugural St. Michael’s Residents’ Health Services Panel

PATIENT-FOCUSED INTERACTIONSSt. Michael’s should work to create a local health system where patient-focused interactions are the norm. Every interaction with a health-care provider includes a focus on the needs and priorities of the patient. Patients are treated as partners throughout their health- care journey. They are listened to and they feel heard, and have the opportunity to contribute towards their own care decisions.

A SEAMLESS EXPERIENCE OF CARESt. Michael’s should work to create a local health system where patients experience seamless care. For patients, a seamless experience means care in the local area is connected and of consistent quality across the complete spectrum of health and social services. This requires good coordination, and also that patient information flow freely and appropriately between patients and providers, between different providers, and between different organizations.

RESPECT FOR EACH PATIENT AND WHAT MAKES THEM UNIQUE St. Michael’s should work to create a local health system where each patient is respected, no matter how different they are from ‘the norm’. Respect means providing care that is equitable, though this does not mean treating everyone the same. Respect requires that providers recognize and appreciate that people have different needs and situations that will affect their health and treatment needs. Respect for patients involves providing care that responds to each patient’s individuality, including but not limited to their socioeconomic status, culture, language, gender, sexual orientation, and religion. It also requires that providers take responsibility for making sure their patients get access to the respectful and individualized care that they need, especially in circumstances where their own organization is not the one able to provide it.

Simon Noel (Church-Yonge Corridor) works in a small group of fellow panel members during a facilitated exercise.


Priorities for Providing Comprehensive Care to St. Michael’s Entire Urban Community

As the Residents’ Health Services Panel, we believe the following 15 priorities should be the focus of St. Michael’s efforts to improve local health services in partnership with the Ministry of Health and Long-Term Care, the Toronto Central Local Health Integration Network, and other local health and social service providers. The 15 priorities are grouped into five issue areas: the health of marginalized communities, patient-provider relationships; communication and co-operation between different health-care providers; community health services; and information and empowerment for patients navigating the system. Priorities are listed in no particular order.

INFORMATION AND EMPOWERMENT FOR PATIENTS NAVIGATING THE SYSTEMInformation about health and the health-care system is needed for patients to be engaged in their care and take on shared responsibility for their well-being. Empowering patients so they can be strong advocates for their care is also important, because if patients or their loved ones aren’t able or comfortable advocating for great and comprehensive care, we believe they may not end up getting the care they deserve.

Priority A: Create a one-stop shop (accessible in a variety of ways, including in person, phone and web-based options) where patients can find out about all health services available in the central-east region of Toronto. We’ve learned that there are actually many health services available in our area, but there is no clear resource for people to learn about what they are or how to access them. Information that is easily accessible and relevant to the local community empowers people to take responsibility for their health care and allows them to be a partner in their health care. Though other information services exist for larger areas, we do not believe they are effective, and it is difficult to find locally relevant information. Such a service should help people navigate within their local LHIN sub-region, which aligns with St. Michael’s catchment area. This service could also be customizable to an individual’s particular demographics, and could help people navigate health services by informing them about important opportunities and health-care milestones (e.g. the importance of getting a colonoscopy after age 50).


Priority B: Centralize and promote a service where patients can enlist an advocate or navigator if they are unable to navigate the system on their own or have been unable to resolve an issue that is preventing them from getting the health care they need.Not all patients have the ability to navigate our health-care system: some need help. Advocates and navigators can empower patients to access the care they need and enable patients be full partners in their health care. Helping patients access care they need works as a preventative measure — we believe helping patients access the services they need will ultimately save the system money. This service should not only focus on services offered by the hospital but should apply to all services available in the LHIN sub-region. Perhaps a partnership amongst patient relations or complaints departments at different organizations can take on this priority to avoid the duplication of services.

Priority C: Advertise the information and navigation systems described in Priority A and B to ensure the entire local community in the LHIN sub-region knows about the services.These two services —the one-stop information shop and the patient advocate and navigator service— will leverage existing resources, and make it easier and more efficient for patients to access appropriate care. But this will not work if no one knows that this service exists. Advertising widely is essential to ensure these services achieve their intended goals.


THE HEALTH OF MARGINALIZED COMMUNITIESImproving the health of marginalized communities matters for many reasons. We believe the health of the most marginalized affects the health of the whole community, not just those individuals. We believe we are a caring community that wants everyone to be healthy. We know that health is determined by things outside the health-care system, that unaddressed mental illness and addictions undermine health, and that many people cannot afford necessary health services. These three priorities point to the fundamentals of good health.

Priority A: Increase access to essential health care, including medications, dental care, glasses, mental health care, as well as access to the information and transportation that allows people to access the care they need.Many in St. Michael’s catchment area do not have access to basic and necessary care and medicines because of financial barriers, as well as other barriers such as stigma about mental health and a lack of information about how to get access. Access to these essential services support health and well-being and we believe would lead to lower long-term health-care costs.

Priority B: Advocate for timely access to safe and sufficient housing We believe safe and sufficient housing is fundamental to health. We recognize that health care is not directly responsible for housing. However, we believe doctors, nurses, and other health-care workers can advocate on behalf of patients who are without healthy housing — helping them get needed repairs, or get prioritized on a waiting list, for example. As a research organization, St. Michael’s can gather the evidence about health and housing in the local area and use its voice to advocate to governments about the need for better housing.

Priority C: Improve access to healthy food.Without healthy food, it is difficult to stay healthy and get well. St. Michael’s should take a more active and creative role working with community partners to improve access to healthy foods for those who don’t have it and promote healthy eating habits. They should also advocate to governments about how healthy diets are an essential part of health care and encourage governments to take more action on this issue.


Nivedita Balachandran of Sherbourne Health Centre and Leah Crawford Seventh Generations Midwives talk about their work and answer the panel’s questions.


PATIENT-PROVIDER RELATIONSHIPSPatient-provider relationships matter because without trusting and respectful relationships, it is impossible to provide high-quality, personalized care in the right place at the right time. We believe these three priorities are the best way to improve patient provider relationships in central-east Toronto.

Priority A: Put in place a set of basic, locally-appropriate standards for engaging patients in care that include measures of good communication, appropriate turn-around times, timely follow-up, and opportunities to talk to providers other than appointments.These standards need to be developed with all stakeholders, including patients and providers, adopted widely, measured, and enforced when standards are not met. By setting clear expectations and enforcing consistent practices for communication, turn-around times, follow-up, and other basic elements of good patient-provider relationships, St. Michael’s and its partners can promote greater trust and partnership with patients. These kinds of basic standards and patient feedback mechanisms will help foster an environment where improvement in patient-provider relationships occurs.

Priority B: Promote better patient education through more informative appointments and through other learning opportunities.Health-care providers should be educators, not just prescribers and treaters of illness, providing tailored information to the patient’s personal situation. Health-care organizations should also provide health information in multiple formats (and languages) outside of appointments through, for example, workshops, info sessions, and pamphlets. Education is important because it leads to healthier behaviours and also ensures informed treatment choices. Personalized education from a provider also builds trust as a symbol of respect and empathy.

Priority C: Create better opportunities and incentives for providers to learn more about their patients’ lives by allowing sufficient time in appointments for longer conversations, organizing greater consistency of providers, and by capturing relevant information about patients’ lives in their records and passing that on from appointment to appointment.Non-medical information often isn’t valued in patient-provider interactions, and it isn’t regularly documented and shared from appointment to appointment. We believe this information is increasingly important to providing accurate, effective and efficient care. We also believe it helps ensure care is compassionate, personalized and trusted.


COMMUNICATION AND CO-OPERATION BETWEEN DIFFERENT CARE PROVIDERSCommunication and cooperation between different care providers matters because people access health care through a variety of organizations for a variety of needs. These different services need to be integrated and co-operating so that the whole system works together to address the full spectrum of needs for each patient. Having co-ordinated organizations ensures better health outcomes and improves the patient experience while reducing costs. Each organization has limitations, but the whole system, if well co-ordinated, can overcome them.

Priority A: Establish procedures to communicate with a patient's full circle of care (as defined by the patient), when they are admitted to the hospital, during their stay at St. Michael’s, and after they are discharged.Hospitals are not necessarily familiar with each patient’s history, priorities and needs, and each patient’s circle of care is unique. Involving their circle of care —including family doctors, social workers, family members, and friends— is important because it allows for better understanding of the patient's full health profile. This helps them to develop and implement a unique health plan during their stay, and to ensure appropriate supports are in place when they leave the hospital. This communication procedure should occur at admission, during stay and after discharge as part of follow-up care.

Priority B: Take a proactive role working with local service organizations to improve local access to medical specialists by identifying needs and sending specialists out to where the need is.Fast and appropriate health care from specialist doctors is an important unmet need, so better access to these physicians should help increase early diagnosis and treatment and ultimately decrease the community’s reliance on inpatient hospital care. Working with others to increase access to medical specialists will also improve co-ordination with community services, focus resources on community-identified needs, help educate patients about health-care resources, and help educate providers about the community.

Priority C: Create opportunities for St. Michael’s management, staff and care providers to build relationships with local health and social service organizations that open the door for two-way communication around how to network and serve the community collectively.We believe better co-operation would lead to service delivery efficiencies, ultimately saving money, time and effort. This requires relationship building and good communication between organizations and individuals. St. Michael’s is a pillar of the health-care community and has a responsibility to take a leadership role in unifying the local health and social services and building a shared sense of responsibility.


ACCESS TO COMMUNITY HEALTH SERVICESImproving access to health services in the community, by, for example, offering flexible service hours or addressing local service gaps that need to be filled, should lead to better continuity of care, decreased admissions and readmissions, reduced costs, and ultimately better patient outcomes. We believe St. Michael’s has an important role to play helping increase the community’s access to great health services available in community.

Priority A: Ensure all residents have better access to after-hours care and flexible service hours for primary care, community services, and mental health and addictions care.We believe more after-hours care needs to be provided. After-hours care and flexible hours for primary care, home care, community services, and mental health and addictions care is important especially for more marginalized communities, but also for the average, time-constrained Torontonian. We believe this can reduce emergency room wait times by providing other places for people to get the help they need, especially for mental health care. We also think it will help people get the care they need more quickly, which could reduce admissions and improve general health.

Priority B: Improve local access to home care by providing home care services that the Community Care Access Centre (CCAC) is not providing.We think better access to home care for local residents is an important priority, especially for those at risk of being re-admitted to the hospital or to a long-term care home. Patient experience, patient health, care transitions, and patient-provider relationships will all improve, while decreasing readmissions. We believe St. Michael’s should take a leadership role providing necessary home care that others are not.

Priority C: Work to increase available mental health and addiction services and supports available to the local community.We believe mental health and addictions services and supports need to be increased in central-east Toronto. St. Michael’s Emergency Department provides care to people in mental health crisis — other services should serve these people’s needs. Marginalized communities should also have access to specialized services. St Michael’s should help ensure people know about and have access to the services they need, whether from St. Michael’s or from other organizations.

Members work together on draft priorities that will be included in the naugural report.


5. About the Panel’s First Four Meetings

In March and April of 2016, panel members each dedicated 22 hours to an intensive four-session program held over the course of two Saturdays and two weeknight evenings. This program was designed to meet three goals: to allow the panel to learn about the local health system, to understand the health needs and priorities of local residents, and to create a set of guiding principles and priorities to guide St. Michael’s efforts to improve the local health system.

Meeting OneOn March 9, 2016, the panel met for the first time at St. Michael’s Li Ka Shing Knowledge Institute. This first meeting functioned as an introduction to the hospital and the services it provided, as well as an opportunity for panel members to meet each other and hear details about the year ahead. Dr. Robert Howard, president and CEO of St. Michael’s Hospital, welcomed the new panelists, thanked them for donating their time to help the hospital understand the experiences and priorities of the central-east Toronto community, and expressed how much the hospital would be looking to the panel for guidance. Dr. Tom Parker, physician-in-chief at St. Michael’s then provided an overview of the history of the hospital and the evolution of the health system, described the challenges faced in the health system today as it strives to provide an ever-higher quality of care, and introduced the hospital’s current strategic planning priorities. He situated the work of the panel within one of the three strategic priorities, which is to provide comprehensive care to the entire urban community. Panelists then began their first of many facilitated conversations. Panelists worked in small groups to identify factors they considered the hallmark of great local health care — a foundation that would help orient their conversations in the meetings to come.

Meeting TwoThe panel held its first full-day meeting on Saturday, March 19. The main goal of this second day was to help the panel understand the elements of the local health system and expose the panel to the full diversity of health needs of central-east Toronto residents. The panelists began the day with a brief, facilitated conversation where they identified a list of important questions about the health system they wanted answered. Dr. Pauline Pariser, lead for the Toronto Mid-West Health Link, took the panel on what she called a ‘whirlwind tour’ of health care in Ontario that allowed the panel to understand how St. Michael’s Hospital fit into the broader context of medical care in Ontario. Dr. Pariser outlined how the health system is funded, introduced the panel to the Local Health Integration Networks


that are responsible for co-ordinating health services in each of Ontario’s 14 regions, described the various types of care and types of organizations, and explained how various health-care services in Ontario are paid for.

Dr. Pariser’s talk was followed by a presentation by Dr. Rick Glazier, researcher at the Centre for Urban Health Solutions at St. Michael’s Hospital. Dr. Glazier introduced the panel to the social determinants of health, and showed the panel a series of detailed maps that showed, in particular, how economic prosperity and health outcomes were clearly linked within central-east Toronto. After an extensive question-and-answer period, the panel broke into small groups to brainstorm preliminary principles they felt should guide St. Michael’s efforts to improve local health services in light of what they had learned so far.

In the afternoon, the panel turned its attention to understanding the diversity of health services offered in central-east Toronto. Four speakers from community health-care organizations provided an overview of their own organizations, as well as the gaps in health services and opportunities for improvement from the perspective of their clients. These speakers were: Bradley Harris from the Salvation Army; Leah Crawford from Seven Generations Midwives; Sheila Braidek from Regent Park Community Health Centre; and Nivedita Balachandran from Sherbourne Health Newcomer Health Team.

Before ending for the day, the panel once again broke off into small groups for a facilitated discussion where they brainstormed a list of important issues that residents of central-east Toronto face with local health-care services, informed by the new information learned over the course of the day.

Meeting Three: Community RoundtableOn March 29, the Residents’ Health Services Panel took on the role of facilitators and hosts for a public meeting open to all residents of central-east Toronto. Over 45 members of the public came to the meeting to learn about the panel’s work and offer their perspectives on the current state of health-care services offered in central-east Toronto, as well as opportunities for improvement. The goal of the public meeting was to help the members of the panel better understand, and consequently represent, the experiences and priorities of central-east Toronto’s residents in the health-care system. The meeting also offered members of the community the opportunity to understand the hospital’s efforts to improve health-care services in the area, and a chance for hospital staff to hear directly from community members.

At the meeting, Dr. Tom Parker provided a brief overview of the hospital’s history, current role in central-east Toronto, and ongoing work to improve health services available in the area. In order to ensure the panel’s deliberations were informed by the experiences of other local residents, the panelists hosted conversations at small tables where they asked community members what issues they thought needed solving in the local health system, as well as what solutions they thought the hospital might want to consider. Community members and panelists provided periodic report-


backs throughout the evening about common problems and innovative possible solutions.

Meeting FourThe full day session on Saturday, April 16 was a whirlwind of deliberating and refining of recommended principles and priorities. The task for the day was to recommend a set of guiding principles and concrete priorities for local health service improvement. These principles and priorities will inform the way that St. Michael’s hospital seeks to advance its strategic priority concerning comprehensive care for its entire urban community.

The day began with a discussion of what the panel members had learned at the community roundtable. Panel members identified a number of comments and priorities from community members that had surprised them, and a number of issues that they wanted to carry forward into their report. The facilitation team had sorted the indicators of excellent health care generated by the panel on Day One into six categories, and the panel’s first working session involved breaking into small groups, with each group working to define one of the six principles based on their previous indicators of excellent health care. These guiding principles are presented in the panel’s report, above.

In the afternoon, the panel circled back to the set of issues with health-care services that they had brainstormed during their second session, as well as those identified in the public roundtable. The issues had been organized into five issue areas by the facilitation team. Over the course of the afternoon, and using the three days of learning to guide them, panelists worked to select three priorities within each of these issue areas that they believed the hospital should prioritize as it seeks to improve local health care. Each working group shared its preliminary work with the broader group, asking for feedback and seeking to ensure that there was consensus about the 15 total priorities for the hospital. Using that feedback, groups drafted text that explained and justified the priorities they were recommending to the hospital. This text is presented in the panel’s report, above.

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Stefany Pierce (South Riverdale) works with fellow panelists to develop and refine priorities for the inaugural report.



August 2016

Introducing the Inaugural St. Michael’s Residents’ Health ...€¦ · Introducing the Inaugural...

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