Do you like a good riddle? Can you name a major part of Ontario’s health-care system:
- For which seven government ministries, and multiple branches in the health ministry, have some responsibility?
- On which well over $1 billion a year is spent, with less than half of that coming from the health ministry? (Much of the rest is paid for through auto insurance or workers’ compensation.)
- To which only 10-30 per cent of eligible patients in one major patient population are being referred, despite substantial evidence of efficacy?
It’s rehabilitation. If ever there was a sector of health care that needed a strong voice and a solid policy base, this is it.
That was certainly on the mind of the province’s Health Services Restructuring Commission, when it recommended a network of providers and planners to “manage the seams,” to borrow a phrase used by the Provincial Rehabilitation Reference Group.
The Greater Toronto Area (GTA) Rehabilitation Network was thus born in 1998 as an association of organizations involved in the planning and provision of rehab services. Its 43 member organizations represent institutional and community-based providers, academia, and other planning, coordinating and advisory organizations. It does not provide direct service to clients.
The Network is funded through membership dues and governed by a council of representatives of the membership. All member organizations signed five-year participation agreements. A secretariat of 3.5 full-time-equivalent staff supports the work of groups of volunteers.
An integrated rehab system is at the core of the Network’s vision. Its mission is to provide a forum for collaboration, communication and consensus-building, and to coordinate service, promote equitable access, address gaps, reduce duplication, increase research and education, and measure overall performance.
The ultimate goal of the Network’s activities is improved client outcomes and high levels of satisfaction among clients, their caregivers/families, rehab providers, and funding bodies. That is expected to result from a number of systemic improvements:
- Coordinating mechanisms – Increased linkages among rehab stakeholders at policy, administrative, planning and service-delivery levels.
- Access to services – Increased availability of types of care (filling gaps), timeliness and flexibility (responsiveness to client/family needs)
- Quality of care – Coordination across the continuum of care (less fragmentation and smoother transitions between levels of care), adoption of best practices, increased consistency of care.
- Efficiency – Appropriate service duration, improved cost control.
- Relevant and accurate information – Improved availability and use of patient-linked data, and making it easier to be evidence-based at the practice level.
- Communication – A higher profile for rehab, to promote recognition of its role in the restoration and maintenance of health and in overall quality of life to maximize human potential.
- Policy – Improved government receptiveness to recommendations, and their translation into public policy.
In its start-up phase, the Network focused on building relationships and linkages as well as gathering information to feed into priority setting. Several reports were issued, a communications program was launched, and commitment to the organization began to grow.
In the second phase, desire is growing for results that clients will recognize, and several initiatives are under way:
- A pilot project funded by the health ministry is working on a “seamless model of care” for people with an acquired brain injury (ABI) and multiple sclerosis.
- A “Needs Assessment and Plan for Integrated Stroke Rehabilitation in the GTA,” also funded by the health ministry through the Heart and Stroke Foundation of Ontario (HSFO), has been prepared for implementation.
- A standard template and lexicon for stating admissions criteria to rehab programs is being developed, with plans to make it available on the Internet.
- A third annual clinical education and research day is being planned to promote best practices in the clinical, operational, policy and planning spheres.
- Groups are examining: informatics needs, such as maximizing benefits from the Canadian Institute for Health Information’s new national rehab reporting system; a more coordinated model for musculoskeletal rehab (e.g. fractures and hip/knee replacement), the largest rehab program; and waiting-list issues. A sister network for ABI rehab has already established a centralized referral system and database that may serve as a model for other rehab populations.
- An advisory role to the health ministry is being developed.
The Network’s operating plan and other information are available at www.gtarehabnetwork.ca.
A strategic approach is helping the Network to tackle its ambitious agenda:
- Consensus-building – Member organizations are grouped into clusters with representation on the governing body. Currently, more than 80 people are at work on eight committees formed around the Network’s priorities in the operating plan. An annual CEO breakfast has enjoyed almost full attendance.
- Stable funding and infrastructure – All member organizations committed to five years’ participation and funding, and the secretariat supports the volunteers who make up the committees.
- Integration and dissemination of best practices – Besides the annual conference, an inventory of research projects has been compiled, researchers have been actively engaged in Network activities, and pilot/demonstration projects are being designed.
- Communication – An annual plan guides the communication program’s development, supporting transparency, accountability and teamwork in the Network’s activities. More than 2,000 individuals can be contacted using the Network’s database, and a members’ section of the Internet site is coming on line.
- Partnerships – The Network has links to complementary initiatives at the provincial and national levels (e.g. Ontario Hospital Association, HSFO, associations for specific rehab populations). All district health councils in the GTA, the regional geriatric program and the health ministry are ex officio members.
- Evaluation – A “logic model” to support program evaluation for Network activities has been adopted and will serve several purposes: internal and external accountability; performance measurement; and a framework for setting objectives of Network activities.
Expectations of the Network are running high, because the need is real. Through the Network, these high hopes are being channeled into concerted action. Whether the “patient” is an individual or the health-care system, the member organizations know not to underestimate the value of a well-designed program of rehab.