Health services integration in a small Ontario community

Varouj Eskedjian

In January 2013, I took on the role of President and CEO at Haliburton Highlands Health Services (HHHS). While the transition into the CEO role has had its expected growing pains, the adjustment to the position has been more challenging by virtue of its location in a small rural community in the Province and because of integration initiatives that have resulted in the restructuring of the organization. Lessons learned through the past several years of transformation will assist in HHHS’ achievement of the vision to become Leaders in Innovative Rural Health Care and enable the organization to develop as a rural health hub.


Living and working within a hospital/health care organization in a small community has tremendous benefits, as well as some burdens. Small and rural communities cherish their health service providers, support them financially and through volunteering efforts, and appreciate their importance from both a health and economic perspective. In Haliburton County, HHHS is the second-largest employer and one of the community’s most cherished institutions. The per capita level of support to the HHHS Foundation and two Auxiliaries are higher than that of larger communities in Ontario. As CEO, I am mindful of the relative importance of health services in the community and constantly need to take this into consideration in leading HHHS, managing organizational issues and in contemplating any organizational changes. As well, I have become fully aware of the dynamics of living and working in a small community which affords minimal anonymity and confidentiality of what goes on in the organization.

Upon my arrival in Haliburton County, HHHS was thrown into a Central East LHIN-directed community health services integration planning exercise with other community health agencies in the County and larger health care providers in the adjacent City of Kawartha Lakes. The Final Integration Plan called for the transfer of community services from the smaller agencies to HHHS to become the sole LHIN-funded health services organization in the County. This recommendation reflected the strongly held position that local governance and management of health services was paramount to governors of HHHS and the other County-based community health agencies.


The outcome of the Haliburton County/City of Kawartha Lakes integration planning process was the development of HHHS as a more fully integrated health services delivery organization providing the majority of the continuum of healthcare for the community. On October 1, 2014, following the integration and transfer of community services, HHHS launched a Community Support Services Division that includes: supportive housing, adult day programs, foot care coordination, a community hospice program and a wide array of community support services, including meals-on-wheels, social recreation and congregate dining, transportation services, friendly visiting and security checks, Home First and Home at Last, and falls prevention. Because of HHHS integration achievements, in January 2015 the Central East LHIN also approved an investment of more than $1.1 million for a specialized comprehensive geriatric community team, a palliative care community team and assisted living services for high-risk seniors. The community services division now complements the Hospital Division that includes two emergency departments in Minden and Haliburton and a small acute care unit at the Haliburton site, the Long-Term Care Division that includes two long-term care homes operating 92 beds in total (62 beds at Hyland Crest in Minden and 30 beds at Highland Wood in Haliburton), and the community mental health program based out of Minden.

The restructuring of HHHS as a result of the “vertical” integration with community providers was only part of recent organizational changes. The other significant effort over the past three years has been the development of a joint venture/preferred partner relationship with Ross Memorial Hospital (RMH) in the City of Kawartha Lakes. While there was significant local opposition throughout the integration planning process for a potential merger of HHHS and Ross Memorial, the Board of Directors of HHHS was fully supportive of the strategic alliance with RMH. The “horizontal” integration between the two hospital organizations has resulted in a number of joint leadership positions, harmonization of telephone systems and shared information technology (IT), joint leadership training, and fee-for-service arrangements for the provision of central processing/sterilization services, laboratory services, pharmacy services and procurement services. The quality, service, expertise and efficiency gains for HHHS through the joint venture have been endorsed by the Board because they have not come at the price of the organization’s independence. However, the closer relationship with Ross Memorial Hospital has had a mixed reception from HHHS staff and physicians.


There are a number of lessons learned from the Haliburton County integration experience over the past several years that can be applied to other small and rural communities in the Province contemplating restructuring into rural health hubs through integrations with community partners. In the HHHS experience, while there has been an appreciation of the quality and access gains for the organization and the community resulting from organizational integration and the joint venture with RMH, these changes have caused anxiety among staff who perceive potential job losses as a result of all the restructuring. Not surprisingly, this anxiety has also spilled over into the community, raised concern about the impact on services and become larger issues to be managed. In hindsight, a sound change management strategy, including ongoing communication with the Board, management, staff, physicians, volunteers and the community could have potentially minimized concerns and garnered greater buy-in from internal and external stakeholders.

The integration experiences at HHHS, including for me as CEO, are important because as Ontario’s health services landscape changes, further organizational transformation is anticipated. Similarly, as many small and rural hospitals/health care organizations look to become health hubs to meet current and future service pressures, HHHS can be a model to emulate given similarities to other communities across Ontario.