The objective of the Citizens’ Reference Panel was to help the South East Local Health Integration Network (SE LHIN) set priorities by drawing upon recommendations from a panel comprised of residents of South East Ontario.
Problems and Purpose
The South East Local Health Integration Network – from here onwards referred to as SE LHIN – is one of 14 networks established by the province of Ontario in order to plan, manage, and fund the health care system at the local and regional levels. As part of the Engage 2009 Program, a citizens' reference panel was used, bringing together 36 randomly selected citizens who were first informed on healthcare delivery in Ontario; following that, they were asked to provide feedback to guide direction and funding priorities for the region’s health system. As part of this panel, the citizens met for three Saturdays in February and March 2009, coming to consensus-based recommendations. Many of the submitted recommendations were implemented.
The Citizens’ Reference Panel served two purposes. First, it was intended to provide public input on the use of health services to South East LHIN. Second, it demonstrated the LHIN’s commitment to community engagement in the region which it believes is essential to improve the health system.
Background History and Context
The South East region extends from Brighton on the west to Prescott and Cardinal on the east, north to Perth and Smith Falls, and back to Bancroft. In 2009, the South East Local Health Integration Network (LHIN) received a mandate from the Ontario government to engage the local citizens about their healthcare. Consequently, the South East LHIN undertook a 4-phase series of events called Engage 2009 - of which the 3rd Phase was the creation of a Citizens' Reference Panel to guide future direction and funding in the SH LHIN.
Ontario's Local Health Integration Network
When Local Health Integration Networks (LHINs) were established in Ontario in 2005, they were given a mandate to engage the residents and health service providers in their communities. Community engagement is a core function for LHINs, and every three years, the LHIN must create an Integrated Health Service Plan—a roadmap for priorities and actions for the LHIN for the next three-year period. Across Ontario, there are 14 LHINs. The South East LHIN is one of these networks and was one of the first ones to be created. It is responsible for the administration and integration of the health care system for the 480,000 residents with an annual budget of $870 million.
SE LHIN created the first Integrated Health Services Plan (IHSP) in 2006. During the second IHSP, SE LHIN chose to include the citizens of the South East region during the decision making process, for the first time allowing them to make recommendations that would ultimately help guide the new Integrated Health Services Plan for 2009.
Organizing, Supporting, and Funding Entities
The South East Local Health Integration Network, established by the province in 2005 to administrate public healthcare in that region of the province, supported this citizens' reference panel. MASS LBP operated as contractor for the South East Local Health Integration Network (SE LHIN), creating and facilitating the public engagement process.
Participant Recruitment and Selection
The citizens who participated as part of Engage 2009 were randomly selected through a Civic Lottery process. To select the panelists, 5,000 letters were sent to randomly selected households asking them if they wanted to participate for three Saturday's in February and March. Out of the 5,000 households that received letters, over 250 of them responded, from which 36 citizens were selected for the Panel. Participants represented all age, gender, and geographic profiles of the region. Each panelist represented approximately 13,700 South East residents. The first 'learning' phase of the Panel involved guest lectures from experts on the Ontario health care system.
Methods and Tools Used
This initiative used the civic lottery and citizens' reference panel methodologies characteristic of other participatory events, in this case designed by MASS LBP. The process also included a non-traditional town hall meeting which employed thematic dialogue tables to facilitate small group discussion.
What Went On: Process, Interaction, and Participation
Deliberation between the 36 panelists was a 3-stage process: Learning, Discussion, and Reccommendations. The Panel consisted of three intensive weekends in February and March. South East Ontario residents were engaged to provide their views on what could be improved regarding local health care services. Recommendations came as a result of three challenging days of learning and deliberation.
On Day One, the Panel heard from a range of experts (including experts from the Local Health Integrated Network). This stage was called the learning phase and was designed to give the panelists a solid base of information on the subject of LHINs, ensuring the following discussions and deliberations were well-informed.
On Day Two, the Panelists participated in an activity that illustrated the range of services which fall under the LHIN's administration, and their locations.
Panelists were also assigned readings as "homework" to ensure they could participate fully in each discussion topic. Panelists offered feedback on the appropriateness and usefulness of each of the assigned reading doccuments.
In the second phase, discussions were facilitated through a number of methods:
a) With the first day’s learning phase complete, the thirty-six panelists divided into five groups for roundtable conversations about their past experiences with the health care system. They also shared their initial thoughts on what they thought should be priorities for the LHIN. With the assistance of facilitators, each group reviewed the homework assignment provided in advance to all panelists. Each member was asked to speak to three people about their concerns for the health care system. These accounts helped the panelists understand the many issues at stake. Next, they were challenged to think thematically and translate the stories they shared into a series of priorities which the health system could address.
By the end of the activity, the panelists established thirty-four ideas, each of which might help improve the health services that citizens receive. The day concluded with a plenary session where each group shared their favourite ideas and began to cluster them with the ideas presented at other tables. As more ideas were presented, overarching themes emerged.
b) Panelists were instructed to read partions of the Integrated Health Services Plans (IHSP) as "Homework". On Day 2, Panelists discussed this doccument, expressing frustration with the doccument's lack of context and vagueness. With the help of a facilitator, the Panelists created a list of ideas for a new set of IHSP priorities, and eventually identifying four overarching themes for new IHSP priorities.
c) On Day 2, members of the public who were not selected as panelists were invited into the space for a "Citizen's Town Hall". The space was opened up and over 100 members of the public joined, at over 20 round-tables. Each table was facilitated by a member of the Ctizens' Reference Panel. This Town Hall session was opened with a short presentation to provide a brief overview of the LHIN and its work from multiple perspectives. Discussion at each table persisted for an hour, and the outcome at each table was a series of short-term and long-term objectives for the LHIN.
d) On March 7, 2009, the Panel along with the South East LHIN and others held a public town hall meeting in Kingston, Ontario. The process also included a Citizens' "Town Hall" meeting in Kingston, Ontario which allowed for participation from the broader public (those not selected to be on the panel). Over 100 citizens attended the Town Hall meeting which subverted the typical Town Hall style; the room was set up into multiple tables where citizens could discuss their views on the SE LHIN services with others. These discussions were facilitated by panelists.
The meeting focused on the phenomenon of “family doctors cherry picking patients”. The relevant questions asked were why this phenomenon occurs and what it says about the healthcare system. Then possible solutions were discussed. One solution particularly discussed was rebooting the whole system to better the needs of nurse practitioners and physician assistants.
In the final phase, the panel produced a series of recommendations for the South East LHIN. South East LHIN took these recommendations into consideration and included some of them in the next 3-year action plan.
a) From public events and through deliberation, the panelists sorted and synthesized dozens of ideas and suggestions finally reaching 6 overarching themes:
- Increase collaboration among health service providers
- Address community-specific health issues
- Proactive leadership from the LHIN
- Seamless access to care that is appropriate and respectful to the individual patient
- Bolster Primary Care
- Strengthen Community Support Systems
Taking these 6 overarching themes into account, SE LHIN toured the region, holding open houses for the public to join the conversation about what can better the health care system.
When everything was done, the Citizens Reference Panel agreed upon fifteen interrelated recommendations:
- Provide Community Support
- Focus on Primary Care
- Increase Collaboration
- Target Patient Groups
- Encourage Personal Accountability
- Develop E-Health
- Provide Seamless Access to Care
- Focus on Prevention
- Patient-Centred Health
- Advance Systems Accountability
- Improve Communications and Clarity in Health Documentation
- Develop a Directory of Services
- Environmental Consciousness
- Regional Research and Education
- Install a LHIN Ombudsman
Influence, Outcomes, and Effects
The recommendations that the panel came up with were presented by the LHIN at a series of public meetings held in April and May 2009.
Many of the recommendations found their way into being included into the South East Local Health Integrated Network’s 3-year plan called Integrated Health Service Plan II (IHSP II).
Another outcome of the recommendations was that it led to changes in the Community Care Access Center (CCAC) leadership and the implementing of an overall, ongoing, improvement plan that has yielded positive early results.
Analysis and Lessons Learned
Panelists found that being a part of this experience was very helpful in understanding their health care system.
Want to contribute an analysis of this initiative? Help us complete this section!
 MASS LBP. (n.d.). Engage 2009: Report on the deliberations of the South East Local Health Integration Network’s Citizens’ Reference Panel on Health System Planning and Integration. https://www.dropbox.com/s/a7b3shfgy3zysiy/02.SELHIN.pdf?dl=1 [pdf]
 MASS LBP. http://masslbp.com/celebrate25 [BROKEN LINK]
Update: similar information can be found at SouthEast LHIN (2010/11-2012/13). Integrated Health Services Plan Local Health Future State IHSP2. https://collections.ola.org/mon/23009/295210.pdf
 http://crptownhall.eventbrite.ca/ [DEAD LINK]
Update: similar information can be found at SouthEast LHIN (n.d.). About Us. http://www.southeastlhin.on.ca/AboutUs.aspx
 SouthEast LHIN (2010/11-2012/13). Integrated Health Services Plan Local Health Future State IHSP2. http://www.southeastlhin.on.ca/~/media/sites/se/UploadedFiles/IHSP/IHSP-...
 http://www.southeastlhin.on.ca/en/GoalsandAchievements/Planning/IHSP.aspx [DEAD LINK]
Update: similar information can be found at RELEASE: Public comments welcome on draft health system plan for the South East [pdf]