Slide 1 - Ontario Long Term Care Association by gjjur4356


									     Elements of an Effective
   Innovation Strategy for Long
      Term Care in Ontario
 Findings and Recommendations
             The Conference Board of Canada

                 Tuesday, November 23, 2010
         Project Goals and Objectives
•   Provide an overview of the impact of
    demographic and resource trends on the
    capacity of Ontario‘s LTC sector to fulfill its
•   Identify ideas and strategies for harnessing
    the innovation potential of the sector to sustain
    and improve its own activities.
•   Provide options for LTC to play a leadership
    role in broader health system transformation.
          Methodology (July-Oct., 2010)
• Literature Review
• Key Informant Interviews
      o   30 interviews with key stakeholders, including OLTCA
          members, gov.‘t officials, academics, experts.
• Environmental Scan of Other Jurisdictions
      o   scan of issues, challenges, and innovations in other
          jurisdictions, both provincially and internationally.
• Analysis and Report
• Consultation and Validation
               High Level Findings
• LTC could significantly expand its contribution
  to the health/well-being of our aging population
  by playing a larger role in delivering health and
  end-of-life care.
• The success of Ont.‘s Aging at Home and
  Emergency Room/Alternative Level of Care
  strategies, in particular, will depend on the
  facilities, expertise, and other resources of LTC.
               High Level Findings
• LTC will need to innovate in order to improve
  quality of care, the productivity of its facilities,
  and further integrate with the health care system.
But …
• Overcoming internal and external barriers to
  innovation will require self-transformation by
  LTC and additional government support and
             LTC Trends and Challenges
• LTC cannot keep up with existing demand and likely
  will be unable to keep up with future demand unless
  changes are introduced.
• LTC will face both quantitative and qualitative changes
  in demand and resident population.
 o   Quantitative changes in demand:
      Based on current demand and population projections,
       by 2035—when boomers are 71-89 years old—there
       will be about 238,000 Ontarians in need of long-term
       care (versus 98,000 today).
       Projected Supply and Demand for LTC in
                   Ontario 2010-2035
          Number of Beds

                           150000                                                           Expected
                                                                                            Supply (1.5%
                           100000                                                           growth)

                            50000                                                           Expected
                                                                                            (current ratio)

Calculations based on data from Ministry of Finance, Ontario Population Projections Update (2010); and Ministry of
    Health and Long-Term Care, LTC Home Systems Report (April 2010).
           LTC Trends and Challenges
• Qualitative changes in demand:
 o   The healthcare needs of LTC residents (and
     potential residents) have increased, and will continue
     to increase due to demographics and policy changes.
 o   Dementia and other mental illnesses will be
     especially prominent challenges for LTC.
 o   Extrapolating from the latest data, the number of
     residents who may be suffering from a particular
     condition in 2015, 2025, and 2035 can be
    Prevalence of Dementia and Alzheimer’s Disease,
        Physical Problems and Other Diagnoses
                                                     Estimated Number of Residents with each Diagnosis

                                 Percentage of
                                                       2015               2025                 2035
Dementia/Alzheimer’s                   54             61909              84131               128435
Diabetes                               19             21798              29622                45221
Congestive Heart Failure               13             14334              19479                29737
Stroke                                 21             24168              32843                50139
Arthritis                              33             38300              52048                79457
Parkinson’s                             6              7146               9712                14826
Cancer                                  9             10637              14455                22067
Peripheral Vascular Disease             4              5275               7168                10943
Osteoporosis                           21             24196              32881                50196
Emphysema/COPD                         12             13609              18494                28233
Arteriosclerotic Heart Disease          9             10664              14492                22124
Source: Canadian Institute for Health Information, Continuing Care Reporting System 2007-08. Based on
    extrapolation of the expected demand for LTC.
                LTC Trends and Challenges
•     Other qualitative changes in demand:
      o   Many of the ‗new old‘ exhibit stronger preferences for
          independent living arrangements, greater autonomy, and
          choice in services than previous cohorts.
      o   The ethnic and linguistic profile of the aged is changing
          and giving rise to needs/preferences for homes and
          services that the current system is ill-equipped to meet.
             22.8 per cent of Ontario‘s population is comprised of
              individuals who identify themselves as a member of a
              visible minority (up from 19.1 per cent of the population
              in 2001 and 15.8 per cent in 1996).
           LTC Trends and Challenges
• The operation, planning, and costs of LTC sector
  are strongly affected by the Emergency Room—
  Alternative Levels of Care (ER/ALC) Strategy and
  Aging at Home Strategy.

• With both strategies, even if LTC population is
  quantitatively stable, cost of care and services per
  resident will likely increase.
           Challenges Meeting Challenges
• Meeting the demographic and policy challenges is/will
  be hampered by issues related to:
    Human resources (recruitment, retention, morale, skills staff).
       •   The ratio of persons aged 20-64 (i.e., the working age population)
           to the number of people aged 85 or older (i.e., those most likely to
           need LTC) is worsening:
             o    In 2009 the ratio was 19 to 1
             o    In 2035 the ratio will be 10 to 1.
    (Over)-regulation.
    Financing (struggling economy; shrinking tax base).
    Technology and facilities – ‗less than ideal‘ adoption rate.

              Options for a
    Long Term Care Innovation Strategy
                Defining Innovation
• Innovation is a process through which
  economic or social value is extracted from
  knowledge through the generation,
  development, and implementation of ideas
  to produce new or significantly improved
  products, processes, and services.
                Defining Innovation
• Much innovation is incremental, not
• Innovation is not invention—new ideas or
  improved products, processes, and services
  need not be ‗new to the world‘, they need
  only be new to the sector, firm, or
  individual and create value to count as
              Why Innovate in LTC?

• Necessary to meet current and future trends
  and challenges in LTC and the health system
  generally—both quantitative and qualitative.
• Opportunities for the health system as a whole to
  contain costs by preparing LTC to handle higher
  acuity residents at lower cost (than acute care).
• Meet rising customer expectations.
              Why Innovate in LTC?
• Pursuit of innovation, efficiencies, and best
  practices can contribute to:
  • improved health and quality of life
    outcomes for residents;
  • improved staff morale, better
    recruitment/retention, better reputation; and
  • (where appropriate) higher profits.
              Why Innovate in LTC?
• On cost savings:
  o   Australia‘s Productivity Commission found
      that if all LTC facilities in that country ―were
      to operate on a notional best practice
      frontier‖ and ―improved economies of scale‖
      there could be efficiency gains of around $1.6
      billion [AUD].‖
   Innovation Orientations for LTC in Ontario
An LTC Innovation Strategy could be developed on three levels:

                       Internal Innovation

  Innovation Orientations for LTC in Ontario
                                               Internal Innovation
                                       • Innovation and best practice aimed at
                                         enhancing LTC providers‘ ability to
                                         deliver traditional services and care in
        Internal Innovation
                                         light of current and future challenges.
                                       • Each home/chain focused on improving
                                         processes/services in own facilities.

                        Integration    • Possibilities include accelerating
Collaboration                &           adoption of administrative and assistive
                                         technologies; changes in HR
                                         recruitment, retention, scheduling
                                         practices; research partnerships;
                                         outsourcing admin/financial work.
  Innovation Orientations for LTC in Ontario
                                             Sector-Wide Innovation
                                        • Innovation and best practice to enhance
                                          collaboration and cooperation in LTC
                                          sector to find ways to improve care and
         Internal Innovation              service delivery.
                                        • Focus on exploiting inter-firm
                                          opportunities and achieving economies
                                          of scale (without formal consolidation)
    Sector                                including sharing costs, joint initiatives.
Collaboration                 &
                       Transformation   • Supply chain innovations (e.g., shared
                                          purchasing); research collaboration and
                                          knowledge exchange; shared HR
                                          recruitment and training.
    Sector Collaboration: Teaching LTC Homes
•    Teaching Nursing Homes, Teaching LTC Homes show promise
     as sites for preparing a health workforce to care for older adults
     and providing a platform for research into better care.
•    United States:
     o   R.J. Wood Foundation Teaching Nursing Home Program (1982-87)
     o   National Institute on Aging Program (1981)
     o   Mixed results: good health and education outcomes; poor
         communication; lack of long-term funding
•    Norway:
     o   Norwegian Teaching Home Program (2004-present)
     o   Good early results: good health and education outcomes; good
         communication; permanent state funding
 Sector Collaboration: Teaching LTC Homes
• Teaching LTC Home success depends on:
     o   access to sufficient resources;
     o   good communication between LTC homes and
         academic partners; and
     o   design that benefits both LTC homes and
         academic researchers.

• May require collaboration between LTC homes to
  achieve scale.
  Innovation Orientations for LTC in Ontario
                                           Innovation for Integration
                                        • Innovation to better integrate LTC into
                                          the health system and identify new
                                          products/ services that LTC providers
         Internal Innovation
                                          could offer to support aged care
                                        • Focus on finding new ways to exploit
                                          firm and sector strengths/ expertise to
    Sector                                enhance health system performance.
                       Transformation   • Possibilities: expand respite care; adult
                                          day/night dementia care; education and
                                          support services for home-base care-
                                          givers; support for research on improving
                                          system interfaces and performance.
          Integration and Transformation:
                  Mini LTC School
• Mini Med Schools have emerged to satisfy public appetite for
  expert knowledge on health and wellness and are typically
  organized and run by health professionals with expertise in a
  given subject matter.
• Given existing expertise and experience, LTC providers could
  create Mini LTC Schools to help fill gaps in public knowledge
  and awareness related to aging and long term care.
• Some Mini LTC Schools could be focused on specific care
  issues for home-care providers, such as understanding dementia
  and approaches to organizing and assisting with ADLs.
    Preconditions for Effective Innovation

• The Conference Board has been studying
  innovation since 1990 at the national-, sector-, and
  firm-levels, including substantial research on
  innovation in the health sector.
• The research has revealed a number of
  preconditions for, as well as barriers to,
  innovation that are relevant to LTC and its
  stakeholders in Ontario.
    Preconditions for Effective Innovation
• Enhancing innovation performance requires:
1. A vision and strategy for innovation
  • Successful innovation requires vision for change;
    identification of priority areas; clear objectives; and
    selection of initiatives that can achieve objectives.

2. Resources
  • Time, money, expertise.
  • Investment in R&D, equipment, and ICTs.
  • Investments to address barriers to innovation.
    Preconditions for Effective Innovation
3. Leadership
  • Leaders with the capacity to plan and implement strategies,
    motivate employees, allocate resources, and take informed
    risks are critical to innovation.

4. Human Capital
  • Human capital, as measured by educational achievement, is
    associated with an economy‘s (and a sector‘s) ability to
    undertake innovation.
  • A well-trained, skilled, and motivated workforce is
    necessary for successful innovation.
    Preconditions for Effective Innovation
5. Supportive Organizational Culture
  • Firms that are open and receptive to ideas and constructive
    criticism create environments more conducive to innovation.

6. Competition as Driver
  • Lack of competition reduces pressures on firms to adopt
    technologies, re-organize processes, and improve
  • Where firms face (1) sophisticated and demanding customers
    and (2) rivalry from other firms, they are driven to seek new
    and better (innovative) ways to satisfy customer demands
    and preferences.
     Preconditions for Effective Innovation
7. Networks, Alliances, Collaboration
  • Innovation in LTC requires collaboration and alignment with:
    o Education/research institutions that have strong,
      knowledgeable, and creative talent pools;
    o Health-care organizations and professionals who interact
      daily with patients, clients, and communities; and
    o Governments that design, implement, and enforce policies,
      standards, regulations, and incentives that encourage and
      reward innovation.
              Barriers to Innovation

• While having these preconditions in place
  greatly improves opportunities for
  successful innovation, there are other
  barriers to overcome…
               Barriers to Innovation
• We recently surveyed 222 leaders of Ontario-based
  public and private-sector organizations of varying sizes
  and sectors about innovation.
• Nearly 90 per cent indicated that innovation is
  somewhat or very important to their organization.
• But despite the recognized importance of innovation
  and a desire to do more, respondents identified a
  number of barriers to their ability to innovate and
  spend more on R&D…
  Barriers to Innovation Cited by SMEs and LEs
           Barriers to Innovation in LTC
• Our research suggests that some of these barriers are felt
  intensely in LTC:
      o   regulatory barriers;
      o   lack of time;
      o   lack of resources/incentives;
      o   lack of expertise;
      o   negative perceptions.

        Supporting Innovation in LTC:
             Recommendations for LTC
1. Develop an LTC Sector Innovation Strategy that
   identifies priorities for each ―orientation‖ and key initiatives
   to support those priorities, in consultation with LTC
   members, residents and families, and government.
2. Enhance the skills and morale of staff by improving
   working conditions, work loads, and providing training
3. Partner with experts and researchers to identify
   opportunities for innovation and best practice in care,
   administration, and services.
            Recommendations for LTC
4. Continue to improve communication with other key
   actors in aged care—including those in acute,
   continuing, and home care organizations—in order to
   address system interface challenges.
5. Continue to make efforts to improve perceptions of
   •   New initiatives—such as providing educational and
       support services to home caregivers—may serve to
       improve perceptions.
      Recommendations for Government
1. Review current funding mechanisms to ensure that
   the LTC sector has access to appropriate funds that
   would contribute to innovation.
      • Specifically? Depends on the content of the LTC
        strategy relating to innovation.

2. Plan for and fund health human resource
   development to meet current and future LTC HR
   needs—and especially to support innovation in LTC.
      • Fund one or more Teaching LTC Home pilot
      Recommendations for Government
3. Provide incentives and more resources to LTC
   providers to improve technology implementation and
   training (as building blocks for innovation and more).
      •   U.S. Patient Protection and Affordable Care Act
          includes a 4-year grant program (beginning in
          2011) to help offset purchase, implementation,
          and training costs for ICT in LTC facilities.
      Recommendations for Government
4. To facilitate the emergence of an innovation mindset
   rather than the current compliance mindset, review
   LTC regulatory regime and shift emphasis towards
   public accountability for outcomes.
      • The Ontario Health Quality Council‘s Residents
        First initiative—which emphasizes accountability
        for outcomes and collaborative, continuous
        improvement (rather than mere compliance with
        regulations)—could provide the foundation for a new
        approach to measuring success in LTC.
• LTC needs to change to sustain and grow.
• Health care needs LTC to play a bigger role.
• Innovation and productivity improvements in LTC
  are essential – for quality gain and cost
• Results: better care and cost savings for the
  increasingly resource-pressured health system.
• Key: Create an LTC Sector Innovation Strategy
       o   LTC leadership to attract government support.
               Contact Information
                   Michael Bloom, D. Phil.
           Organizational Effectiveness and Learning
               The Conference Board of Canada
                      613-526-3090 x229

                     Daniel Munro, Ph.D.
                  Senior Research Associate
           Organizational Effectiveness and Learning
               The Conference Board of Canada
                      613-526-3090 x348

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