2024-2027 Strategic Plan

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The NOHT-ÉSON’s strategic plan culminates a collaborative and inclusive process that reflects our community’s diverse voices and perspectives. Over the past months, we engaged extensively with community groups, health and social care partners, and individuals with lived experiences, ensuring that our priorities for the next three years truly represent Niagara residents.

Central to our development process was the involvement of Patient/Client and Family/Caregiver (PCFC) advisors, whose insights helped shape a plan that prioritizes the needs of those directly impacted by the health and social care system. By working closely with interested and affected parties from across various sectors, particularly the health and social services sectors, the NOHT-ÉSON and its partners identified strengths, challenges, and opportunities, resulting in a comprehensive strategy grounded in evidence and community-driven insights.

Our data-driven approach allowed us to analyze community health trends and workforce challenges, guiding us to focus on equity and addressing disparities, particularly among Indigenous, Francophone, and equity-deserving populations. This plan sets a clear roadmap for 2024-2027, aligning with provincial health mandates while remaining adaptable to emerging challenges and community feedback.

Through this process, we have strengthened partnerships across Niagara, fostering a unified health and social care community committed to better outcomes. Trust and transparency have been foundational to our efforts, ensuring accountability as we move forward together. We invite you to explore our strategic plan and join us in our commitment to enhancing health care for all in Niagara.

Below are six pillars that make up the priorities of the NOHT-ÉSON’s strategic plan. Check back often, as updates on our progress toward achieving our goals and objectives are being shared here.

Of course, we welcome input from Niagara residents, people with lived experience who have accessed health or social care in the region, and interested and affected parties. Do you have feedback or have a question regarding the health and social care system? Visit our Contact Us page or, better yet, help the NOHT-ÉSON and its partners enhance health and social care in Niagara and get involved here.

Indigenous HealthHealth and Social Care NavigationInclusive Health and Social CarePrimary Care for AllBuilding Our WorkforceStrengthening Trust

GOAL

TO ENSURE THAT OUR HEALTH AND SOCIAL CARE SERVICES REFLECT INDIGENOUS VALUES, PRIORITIZE INDIGENOUS VOICES IN DECISION-MAKING, AND INTEGRATE COMMUNITY PERSPECTIVES INTO ALL LEVELS OF PLANNING.

Health and social care services must prioritize Indigenous Peoples, focusing on their needs, rights, values, and aspirations. It is of the utmost importance to ensure that Indigenous Peoples have timely access to the care they choose through practices grounded in identity-affirming approaches and cultural humility. The NOHT-ÉSON has made it a priority to build and strengthen trusting relationships with Indigenous Peoples in Niagara.

OBJECTIVES

  1. Ensure that people are the first priority in all aspects of health and social care services. Strive for optimal fulfillment of Indigenous individuals’ needs, aspirations, and rights, placing their well-being at the forefront of decision-making and resource allocation.
  2. Enhance cultural competency, practices, and policies within health and social care services to reduce the risk of mistreatment and premature death among Indigenous Peoples.
  3. Redirect funds to prioritize optimal care that aligns with Indigenous values and preferences, ensuring that services are tailored to the unique needs and inherent rights of Indigenous Peoples.
  4. Foster partnerships with Indigenous communities, organizations, and leaders to actively involve them in decision-making processes, strategic planning, and service delivery. Conduct community outreach and education initiatives to enhance understanding of disparities and promote culturally-sensitive care.
  5. Develop integrated health, social and community services that address the holistic needs of Indigenous Peoples, considering factors such as cultural traditions, language, and spirituality. Ensure that services are accessible, responsive, and respectful of Indigenous identities and experiences. This may involve the creation of new agents.
  6. Acknowledge the paramount importance of Indigenous data sovereignty across all phases of data collection, utilization, storage, and interpretation. Commit to supporting Indigenous Peoples and communities in asserting control over their data, ensuring that data practices honour Indigenous rights, knowledge systems, and self-determination. Ensure that asserting control over data does not impede Indigenous participation in health and social care programs and services.

GOAL

TO BUILD AND SUSTAIN AN INTEGRATED SYSTEM THAT PROVIDES SEAMLESS CARE, SERVICES AND SUPPORTS.

The NOHT-ÉSON will develop a coordinated approach to care that brings together health, social, and community service providers to collaborate on the design and delivery of services for patients with specific clinical issues and chronic conditions. Integrated care means a high degree of collaboration and communication between service providers so that patients can transition through and navigate the system with ease.

OBJECTIVES

  1. Further develop and implement integrated clinical care pathways, inclusive of social and community services, for priority populations, with a focus on transitions and service navigation.
  2. Improve shared access to patient- and client-level information and care plans by all providers involved in a person’s circle of care, including the patient, while ensuring accuracy of information, and respecting the principles of ownership, control, access, and possession.

In the summer of 2022, several community support providers, Happy in my Home – Community Care Support Services of Niagara, Niagara Health, the Alzheimer Society of Niagara Region, and the NOHT-ÉSON launched the Let’s Go Home program. This initiative was designed to help seniors transition from the emergency department to their homes by offering essential community support such as meal services, transportation, homemaking, and respite care. The primary goal of LEGHO is to reduce hospital admissions among individuals aged 65 and older who have non-acute or non-medical concerns or are living with dementia.

Approximately 275 seniors visited Niagara’s emergency departments each year with non-urgent or non-clinical issues, highlighting the need for programs like LEGHO. Officially launched in late January 2023, LEGHO alleviates pressure on emergency departments while ensuring that seniors receive the care and assistance they need in their communities.

LEGHO First Link Care Navigators, employed by Happy in my Home – Community Support Services of Niagara and the Alzheimer Society of Niagara Region, play a crucial role in the program, working closely with hospital discharge staff at Niagara Health’s emergency departments in Welland, St. Catharines, and Niagara Falls. The navigators identify eligible patients and their families, connecting them with appropriate community supports, dementia-specific services, and respite care. The services offered through LEGHO are time-limited and provided free of charge for up to six consecutive weeks, with the option for eligible individuals to access the program a second time within a year.

Since its launch, LEGHO has made significant strides in supporting seniors in Niagara. From January 2023 onward, the program has received 342 referrals and served 226 individuals. The services provided have been substantial, including 777 hours of homemaking, the distribution of 16,067 meals, the arrangement of 74 rides to medical appointments, the conduct of 780 wellness checks, the facilitation of 780 navigation visits, and the delivery of 697 hours of respite care. These milestones demonstrate the program’s effectiveness in meeting the needs of seniors and their families.

As the program continues to grow, LEGHO remains committed to enhancing the quality of life for seniors in Niagara by providing them with the support they need to live safely and comfortably in their own homes. Its innovative approach to community care exemplifies the power of collaboration in addressing the complex needs of an aging population.

GOAL

TO ENSURE OUR HEALTH AND SOCIAL CARE SYSTEM EMBRACES AND RESPECTS EVERYONE IN OUR COMMUNITY THROUGH SAFE AND INCLUSIVE SERVICES. THIS IS ABSOLUTE.

We will ensure that all Niagara residents have easy access to safe, respectful, and excellent care regardless of race, ethnicity, disability, gender identity, socioeconomic status, preferred language, or other factors. The ultimate goal is attainment of the highest possible level of health for all people in Niagara, where everyone has a fair and just opportunity to attain optimal health.

OBJECTIVES

  1. Improve access to and experience with the health care system for Francophone populations.
  2. Improve access to and experience with the health care system for other equity-deserving populations.

GOAL

TO ENSURE THAT EVERY PERSON IN OUR ATTRIBUTED POPULATION HAS TIMELY AND EQUITABLE ACCESS TO PRIMARY HEALTH CARE SERVICES.

All Niagara residents must have quick and easy access to a family doctor or other primary care provider/team. Primary care serves as the patient’s entry point into the health care system, and it is central to a person’s health and well-being. Primary care addresses a majority of personal health care needs, in partnership with patients, in the context of family and community. The NOHT-ÉSON is endeavouring to increase the number of practitioners and build upon team-based primary care in Niagara, and to increase access to the providers already working in Niagara.

OBJECTIVES

  1. Support efforts to increase the number of practitioners and team-based primary health care providers in the NOHT-ÉSON catchment area.
  2. Support efforts to increase the number of equity-deserving people attached to/accessing primary care (e.g. physicians, nurse practitioners, PAs, RPNs, pharmacists, and health care teams).

Efforts are underway to connect thousands of people in the Niagara region who don’t have regular access to primary care services, like a family doctor or nurse practitioner, with the right health care providers.

With the help of several NOHT-ÉSON partners, this initiative focuses on areas of Niagara where many people are without a regular doctor or nurse practitioner. The plan also includes services like mental health and addictions support.

In February 2024, the NOHT-ÉSON received $2.1 million from the Ministry of Health to help launch this initiative. Bridges Community Health Centre is leading the effort, along with partners like the Centre de santé communautaire Hamilton/Niagara, Niagara Falls Community Health Centre, Niagara Medical Group Family Health Team, Niagara North Family Health Team, Quest Community Health Centre, REACH Niagara, and the Alzheimer Society of Niagara Region. Collectively, the organizations offer services across the region from Fort Erie in the south to St. Catharines in the north.

Since the funding was received, the group has hired seven nurse practitioners and seven other allied health professionals, including social workers. The aim is to connect between 5,800 and 7,200 people to team-based care or other services, like physiotherapy and mental health supports, across the region.

As part of this initiative, mobile geriatric cognitive assessments are being done across the region by the Alzheimer Society of Niagara Region. This will help people living with dementia receive an earlier diagnosis and quicker access to the right services and supports. The partners also plan to hold PAP test and vaccine clinics for people who might not have access to this level of health care.

GOAL

TO BUILD AND SUPPORT A STRONG, HEALTHY, AND DIVERSE WORKFORCE TO MEET THE NEEDS OF OUR ATTRIBUTED POPULATION.

Canada is facing a significant health human resource crisis in many disciplines across the continuum of care, and Niagara is no exception. Health worker shortages may lead to increased wait times and service closures, and may seriously constrain the achievement of health goals. The NOHT-ÉSON will employ a collaborative approach to workforce planning in Niagara. The network seeks to increase recruitment and retention efforts of health workers, and to develop strategies to improve provider satisfaction and experience.

OBJECTIVES

  1. Develop and support system strategies to increase recruitment and retention rates in Niagara.
  2. Develop and support system strategies to improve provider experience and satisfaction.

The Niagara region is facing a critical shortage of health care professionals, particularly family physicians. This shortage has led to longer wait times, increased reliance on emergency services, and overall poorer health outcomes for the population. Currently, Niagara has a deficit of 90 family doctors, with the capacity to serve only 67% of its residents. With plans to grow the population by over 125,000 by 2041, the region urgently needs to recruit 30 new doctors each year for the next decade to meet the increasing demand.

To tackle this issue, the NOHT-ÉSON sought financial support from the Ministry of Health through Ontario Health’s Models of Care Innovation Fund, which supports innovative projects that optimize health human resources (HHR). The network’s proposal, Building Physician and HHR Capacity in Niagara, was submitted in August 2023 and proposed building a dedicated team focused on recruiting health care professionals, particularly family physicians and physician assistants. The team was to create and implement strategies to attract doctors, including those trained internationally, and ensure they were well-integrated into the community. Additionally, the proposal called for a grant program to incentivize doctors to hire physician assistants, helping to alleviate the workload and improve patient care. Part of the funding received would have covered 50% of the salary for newly hired physician assistants for one year.

The plan included hiring four new temporary positions: a Manager of Physician Recruitment, a Primary Care Advisor, a Human Resource Advisor, and a Resource Coordinator. The team was to work collaboratively to recruit health care professionals, address clinic space shortages, and support the integration of internationally-trained professionals into the local workforce.

The project aimed to significantly increase the number of physicians recruited to Niagara, with a goal of boosting candidate leads, site visits, and new physician hires by 50% annually.

The NOHT-ÉSON is awaiting approval of its proposal from the Ministry of Health and Ontario Health at the time of the 2023-2024 annual report’s publication.

Since the COVID-19 pandemic, many areas in Canada, including the Niagara region, have been dealing with shortages of health care workers. This shortage makes it difficult for health organizations to provide timely and high-quality care, sometimes forcing them to cut back or eliminate services altogether. The Niagara region is no different.

One major issue in Niagara is the need for clear information about where these shortages are and how severe they might be. The NOHT-ÉSON created the Health Human Resources Working Group (HHRWG) to address this problem. The working group’s primary goal is to better understand the local situation and find solutions that work for Niagara.

One of the HHRWG’s primary objectives is to build a strong, healthy, and diverse workforce to meet the needs of the community. This goal is part of the NOHT-ÉSON’s new strategic plan, launching in late 2024.

The NOHT-ÉSON also aims to increase the number of health practitioners and team-based care providers. Additionally, the HHRWG is working to improve recruitment and retention rates in Niagara and develop strategies to enhance job satisfaction for health care providers.

Members of the NOHT-ÉSON’s Planning Table were invited to join the HHRWG. The group also reached out to representatives from outside the NOHT-ÉSON, including municipal and regional officials.

The HHRWG is co-led by Jill Croteau, Physician Recruitment Specialist with the Niagara Region, who is also responsible for the creation and implementation of SOPRA (see Opening Message), and Dr. Jeff Remington, Founding Physician at Niagara South Family Medicine.

The group held its first meeting in March 2024 and has already begun its work.

One of the group’s first tasks was creating a survey in collaboration with the Workforce Collective, a Niagara-based non-profit organization that focuses on workforce challenges. This survey, launched in mid-June and sent to NOHT-ÉSON partners, aims to identify hard-to-fill roles, vacancy rates, and the human resource strategies used by different organizations. The results will be analyzed by a research assistant from Brock University, under the supervision of Dr. Kathryn Halverson, Assistant Professor from the Department of Nursing in the Faculty of Applied Health Sciences.

The HHRWG is also meeting with different organizations to understand their perspectives. They have already met with groups that work with internationally-trained health professionals and are discussing a marketing strategy to highlight Niagara’s learning, employment, and recreational opportunities.

While the NOHT-ÉSON awaits an update on its recruitment proposal, there are positive developments happening in southern Ontario.

The physician deficit is exacerbated by the fact that only 400 family medicine graduates are produced yearly in Ontario, too few to meet the needs of the 2.2 million residents without a family doctor. The situation is expected to worsen with changes to the Family Medicine Residency program, which will extend from two to three years, creating a gap year with no new graduates in 2026.

Physician recruiters play a crucial role in addressing this shortage by acting as community ambassadors, tracking local clinic needs, and navigating the complex requirements for licensing and immigration. However, many areas in Southern Ontario lack dedicated recruiters, and those that do often have limited budgets for international recruitment efforts. To tackle this issue, the 15 Ontario Health Teams (OHTs) in Ontario Health West (OHW), along with 12 physician recruiters, are collaborating to form the Southern Ontario Physician Recruitment Alliance (SOPRA).

SOPRA, the brainchild of Niagara’s Physician Recruiter, Jill Croteau, aims to enhance the visibility of Southern Ontario on the international stage, making the region more attractive to physicians from abroad. By pooling resources and working together, recruiters can attend more international events, reach new markets, and share leads more effectively. This collaborative approach is expected to increase the number of physicians coming to the area, help distribute them more evenly across the region, and ultimately improve patient access to primary care.

SOPRA’s goals include raising awareness of opportunities in Southern Ontario, developing a shared client relations management platform to streamline recruitment efforts, and standardizing best practices for attracting international physicians.

In the short term, SOPRA hopes to generate more leads from outside Canada and improve data tracking of recruited physicians. Over time, the initiative aims to reduce physician shortages in Southern Ontario, leading to more equitable access to care, decreased reliance on emergency services, and better overall health outcomes for the region.

Seamless Care Optimizing the Patient Experience (SCOPE) Niagara is a transformative program designed to streamline health care by connecting family physicians and nurse practitioners with a dedicated nurse navigator to improve patient outcomes. The Niagara Health-led NOHT-ÉSON initiative is particularly valuable for primary care providers registered with SCOPE, offering them direct access to Niagara Health’s on-call specialists.

Since its inception in May 2022, the program has registered nearly 200 family physicians and nurse practitioners, who have collectively made almost 500 calls to the SCOPE service, seeking support across a wide range of medical needs. Over that time, the program has helped people avoid more than 1,200 unnecessary visits to the emergency department (ED) in Niagara.

In the 2023-24 fiscal year alone, SCOPE successfully diverted approximately 88% of unnecessary ED visits, highlighting its effectiveness in optimizing health care delivery and reducing strain on emergency services. These calls have addressed issues such as general internal medicine, diagnostic imaging, and kidney care, reflecting the program’s broad applicability and its ability to meet diverse health care needs.

SCOPE Niagara continues to evolve to meet the changing needs of the community. Recently, the program expanded its services to include mental health and palliative care pathways, broadening its reach and impact. As the program grows, it is exploring additional options to enhance its offerings, including expanding into orthopedic care and assistance for individuals dealing with addictions. These potential expansions reflect SCOPE’s commitment to addressing a wide range of health care needs and ensuring that patients receive the comprehensive care they deserve.

GOAL

TO BUILD AND SUSTAIN A CULTURE OF TRUST, TRANSPARENCY, AND ACCOUNTABILITY.

Aiming to improve the way organizations of the NOHT-ÉSON work together as a system, we will increase trust, transparency, and accountability in the Ontario Health Team space. The NOHT-ÉSON will endeavour to improve communications between partners, promoting respectful and open forums, for the ultimate benefit of patients. The network is also developing and implementing evaluation and reporting frameworks to monitor performance, hold ourselves accountable, and make improvements where necessary.

OBJECTIVES

  1. Following Ministry of Health and Ontario Health timelines, become a legal, not-for-profit corporation, while maintaining a consensus decision-making model.
  2. Create culturally safe forums and mechanisms for clear, respectful, and open communication among members, partners, collaborators, and staff.
  3. Establish clear expectations to ensure mutual accountability for performance, deliverables, and active participation.

Land Acknowledgment

We would like to begin by acknowledging that the land on which we gather is the traditional territory of the Haudenosaunee and Anishinaabeg. This territory is covered by the Upper Canada Treaties, is within the lands protected by the “Dish with One Spoon” wampum agreement and is directly adjacent to the Haldimand Treaty territory.

Today, this land continues to be the home of many Indigenous Peoples. Acknowledging ensures we reflect on our past and what changes can be made going forward to further the reconciliation process, and it reminds us that the great standard of living that we enjoy in Niagara is directly related to the resources and friendships of the Indigenous Peoples who make up this community.

Wampum Belt

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