Q & A with Paul Huras The CEO of one of Ontario’s 14 Local Health Integration Networks says it’s time to focus on system leadership.

Ontario’s Local Health Integration Networks (LHINs) have been called the ‘air traffic controllers’ of the healthcare industry. Can you describe your mandate?

In the Southeast LHIN, which I oversee, we have accountability agreements with 120 different organizations. While we don’t run these organizations, we are responsible for managing the entire system. Our specific mandate has six components to it: local health system planning; efforts to integrate the system by bringing organizations together to work cooperatively; funding the organizations (we allocate CAD$ 1.1 billion per year to our 120 members); accountability (we hold every organization accountable for the funding they receive through performance metrics that are publicly reported); and lastly, we’re responsible for engaging the public and other stakeholders to get input on how to improve the system and also to help everyone understand how it works.

Clearly, you are overseeing a highly-complex system. Talk a bit about the difference between system leadership and regular leadership.

Patients’ needs have changed dramatically in recent years. Today’s patient is typically older, more frail, and suffers from multiple chronic conditions that they will have for the rest of their life. These patients require components of care from a number of different organizations, and that has to be coordinated systemically.

In Ontario, we produce some extraordinary, world-class healthcare leaders, but their focus is (rightly) on their own organization and their board of directors. Their governance model ensures that those boards are holding people accountable for how the organization performs. For all of the money we spend on healthcare, patients should expect that the system as a whole is being coordinated efficiently — that care is focused on their individual needs, and that healthcare organizations in their region are working together to meet those needs. Clearly, this approach is very different from just worrying about someone from the time they arrive in your office until they walk out your door: today, we need to be concerned about the patient as they come in to an organization, ensuring that we are fully prepared and have the information from their last visit (possibly to a different organization), that we are aware of their future visits to other organizations, and that we’re considering the whole system of available care when dealing with them. Caregivers need to recognize that their role is simply one component of a patient’s care, and that they can best meet the patient’s needs by working within a true system of care.

It has been said that any healthcare system that focuses too much on treating disease is unsustainable. What does a more sustainable model look like?

A sustainable model has to be dynamic and able to flex with the changing needs of the population. As indicated, today’s patients need multiple types of care, so if we just focus on ‘building the strongest acute care (i.e. hospital) system in the world’ and don’t consider the other elements of the system — such as primary care, home care and community care — that is not a sustainable model. Acute care will always be an important aspect of healthcare, but if we want a sustainable system, we’ve got to make sure that all of the components work in collaboration

What we need is a system where hospitals are funded to do what they do best — and are not funded for things that could be done elsewhere. For instance, many hospitals do a lot of ambulatory care, primary care and other types of care that could be done in the community. It is much more expensive to provide care in a hospital environment, so if we’re trying to maximize the value of every dollar, we have to make sure that the money going to acute care facilities is for acute care.

You have repeatedly touched on the need for greater collaboration between all the elements of the system. Which tools work best to enable this?

We have found relationship-building and establishing credibility among providers to be very powerful. Strong relationships between providers — including people on the front lines — are critical. We need leaders and champions, but we also need doctors talking to doctors and getting the message out that things are different now, and we all have to focus more on the patient.

Patients aren’t saying to us, ‘You removed my appendix incorrectly’; what they’re saying is, ‘You make things so difficult for me! When I arrive at the next component of care, they have no clue I’m coming, or they don’t have my lab results, and I have to tell my story all over again’. People tell us that the quality of care they get from individual caregivers is fine, but when we ask them about the quality of care they get from the system itself, they say it’s very poor.

The LHINs are working to integrate the system from both a horizontal and a vertical perspective. Horizontal integration means, for instance, that the seven hospitals in our LHIN work together as a regional system of acute care, and that all of the addiction and mental health services in our region work together. But we also want to achieve vertical integration, where hospitals, primary care, long-term care and addiction and mental health providers all work together.

As indicated, another key focus for us is getting our organizations to recognize the importance of improving patient experiences and outcomes. It takes time, but once there is agreement and acceptance that we can achieve much more by working together, people start to look at how they can share resources and help each other out — with a shared focus of helping the patient.

How are new technologies affecting your work?

Whether it’s via tele-medicine or Skype, in most places, you can now have a consult done within a matter of minutes. We can also move patient information around and do lab work much more quickly than ever before. Most importantly, I’m not sure any of us really understands the impact that Consumer Genetics is going to have on healthcare: in the very near future, it will enable us to prescribe medicine that is precisely targeted for an individual patient’s needs — whether that be depression or chronic heart failure. There is amazing potential in this realm to completely redesign healthcare. 

How will you measure success for your LHIN?

The patient’s voice is going to become more and more important, so most of our measures of success will be around patient satisfaction. Simply put, we need to address the issues that patients feel are most important. Right now, they are telling us that the system doesn’t work, and we are getting a better idea of how it can work by listening to them and making adjustments, then listening again, and making further adjustments. It’s an iterative process.

Today’s healthcare leaders should be very proud of what they’re doing, but at the same time, they must recognize that it’s time to evolve to system leadership. This is why our work with the Rotman School is so important. The Advanced System Leadership Program that we have developed together is creating a healthcare culture that embraces system leadership.