In the Spring of 2015, the critical shortage of physicians serving the Kenora area was addressed in a deputation to Kenora City Council entitled Kenora Health Care – A Growing Industry Sector: The Importance of Physician Recruitment and Retention, Community Vision and Collaboration (A Physician Perspective). The presentation focused on five key areas:
In response, the City spearheaded the creation of the Kenora Area Health Care Working Group in September 2015. At that time, the group included representatives from the City of Kenora, Lake of the Woods Development Commission, Lake of the Woods District Hospital, Waasegiizhig Nanaandawe’iyewigamig, Kenora Chiefs’ Advisory, Northwestern Health Unit, family physicians, and members of the community. The working group identified three key issues: (1) physician recruitment and retention; (2) cross border access to care between Ontario and Manitoba; and (3) the need for a long-term collective vision for health care in the Kenora area.
In less than a year, the working group completed a needs assessment, raised funds from committed stakeholders, and hired a healthcare professional recruiter. In less than two years, the working group made progress on the cross-border issue, identified the replacement of aging hospital infrastructure as an additional key priority in support of both successful patient care and physician recruitment, and secured funding begin a formal planning process.
Political leadership comprised of Grand Council Treaty#3 Ogichidaa, the Mayors of the City of Kenora and the Township of Sioux Narrows/Nestor Falls, Chief Lorraine Cobiness on behalf of the Kenora Area First Nation Chiefs, and the President of the Kenora Métis Council assembled in the roundhouse at Wauzhushk Onigum First Nation to sign a resolution agreeing to work together in partnership to develop an All Nations health care system, including construction of an All Nations hospital and campus, with the express purpose of improving health outcomes for all people of the region it serves through a healthcare service model built on a partnership between First Nations, Métis, and non-First Nations governments and providing an improved healthcare system that reflects the specific needs and costs of the north.
The signatories to this document now wish to work together to grow and evolve the working group to create the All Nations Health Partners, a coalition of leaders in Indigenous and mainstream health services in the Kenora Region, and of other stakeholders, through this collaborative decision-making framework agreement.
A pictorial of the initial All Nations Health Partners model is set out below:
For value received, the Team Members agree as follows:
|VALUE||APPLICATION IN CONTEXT|
|Honesty||Speak openly and truthfully always.|
|Truth||Focus on facts; be prepared to accept information you may not want to hear.|
|Respect||Everyone has value, and should be treated with respect. Being on time, listening, and speaking humbly, and respecting personal boundaries are all ways in which respect is demonstrated.|
|Bravery||Take risks; move toward your vision despite fears and unknowns. Have the courage to engage in sensitive or difficult conversations.|
|Love||Love describes the good life – minobimaadiziwin. It is given and received through life, earth, people, choices and opinions.|
|Humility||No one person or community is more important than another; we are all equal. Everyone has a voice, and all contributions have value. We all have gifts as well as limitations.|
|Wisdom||We constantly learn by listening, hearing, and applying what we learn – especially from our elders – in a never-ending process.|
“ANHP” means the All Nations Health Partners, which is formed by the Team Members, and created to fulfill the Shared Objective and to act as the ANHP-OHT.
“ANHP Council” means the council described in Section 10 and Schedule 10.
“ANHP-OHT” means the All Nations Health Partners – Ontario Health Team.
“Business Day” means any working day, Monday to Friday, excluding statutory holidays observed in Ontario.
“Confidential Information” means information of a Team Member that by its nature is confidential and proprietary information but does not include information that: (1) was known to or received by the receiving Team Member before its receipt from the disclosing Team Member (unless acquired on a confidential basis); (2) was public knowledge at the time received by the receiving Team Member or later became public knowledge through no fault of the receiving Team Member; or (3) was independently developed by a Team Member without reference to the Confidential Information previously disclosed by a Team Member.
“Effective Date” means ●, 2021.
“Framework” means this Collaborative Decision-Making Framework, including its Schedules, as amended from time to time.
“Participants” means those entities that are parties to a Project Agreement but that are not Team Members.
“PFEAC” means the Patients, Families, and Elders Advisory Council, as described in Section 13.
“Project” means a collaboration on specific strategies, initiatives, programs, and/or services, as described in this Framework.
“Project Agreement” means any agreement executed by the participating Team Members and, where applicable, Participants, that sets out the details about a specific Project.
“PSAC” means the Primary Care and Specialist Care Advisory Council, as described in Section 15.
“Seven Sacred Teachings” means the teachings described in Section 6.
“Shared Objective” means the development and implementation of a collective vision for health care in the Kenora area, which includes the establishment of a new and innovative fully integrated health service delivery model, through and outside of the ANHP-OHT, that encompasses holistic care for everyone and that will better meet the needs of all people living in the Kenora area, focusing on three main initiatives: (a) recruitment and retention of physicians and other health care professionals; (b) cross-border access to services in Manitoba; and (c) construction of a new All Nations hospital and health care campus supported by a comprehensive, innovative healthcare system.
“Team Members” means the organizations that have signed this Framework.
“THAC” means the Traditional Healers Advisory Council, as described in Section 14.
|ANHP Council – Terms of Reference|
|Capitalized terms used throughout these Terms of Reference have the meaning given to them in the ANHP Decision-Making Framework to which these Terms of Reference are a Schedule.|
|Mandate||The ANHP Council’s role is to plan, design, implement, and oversee initiatives in pursuit of the Shared Objective.
The ANHP-OHT is part of the work of the ANHP.
The ANHP Council’s responsibilities include to:
Planning and Priorities
|Committees and Working Groups||The ANHP Council may strike committees and working groups to move specific issues forward as they arise. Membership on committees and working groups shall be determined by the issue at hand with the approval of the ANHP Council, and shall continue until the issue has been addressed unless otherwise determined.|
|Membership||The ANHP Council shall consist of:
|Selecting and Changing Membership||The PFEAC, THAC, or the PSAC may replace its member(s) on the ANHP Council or appoint a temporary alternative at its own discretion on reasonable notice to the ANHP Council provided the process followed is acceptable to the ANHP Council. The ANHP Council, by a majority vote, may require the PFEAC, THAC, or the PSAC to replace its ANHP Council member where that member is not acting in accordance with the Seven Sacred Teachings and in pursuit of the Shared Objectives. The replacement member shall be selected through a process approved by the ANHP Council.|
|Co-Chairs||The ANHP Council shall have two Co-Chairs. Co-Chairs must reflect the Indigenous/non-Indigenous partnership. KCA will appoint one Co-Chair to reflect the Indigenous partnership. The ANHP Council members will elect the other Co-Chair reflecting the non-Indigenous partnership by a simple majority vote. The Co-Chairs’ terms will be two years and the terms will be staggered. The Co-Chairs may be re-appointed or re-elected for additional two-year terms. The Co-Chairs shall share the meeting chair responsibilities. Both Co-Chairs participate in deliberations and decision-making of the ANHP Council. The Co-Chairs shall be key contacts and spokespersons for the ANHP Council.|
|Meetings||A regular schedule of meeting dates will be established, and may be amended from time to time. Meeting locations may rotate among the various Team Members. Meetings will be held at the call of a Co-Chair or of nine ANHP Council members. The acting Co-Chair may determine the meeting procedures. Agendas will be sent in advance and indicate if decisions are known to be required. Meetings may be in person or by any available technology. Guests may attend a meeting upon consent of a majority of the ANHP Council members participating in the meeting. In addition, based on the focus of individual agenda items, there may be times when additional individuals will be invited to participate in meeting discussions. Permission should be sought from the Co-Chairs.|
|Quorum||Quorum will be a majority plus one of the members, present in person or electronically.
If a member is not able to attend, the member may (but is not required to):
|Decisions||Unless otherwise specified in a decision-making framework adopted by unanimous approval of the ANHP Council, decisions will be made by consensus. Consensus means that each member is prepared to support the decision or, if applicable, recommend it to their governing body or organization, even if they do not agree with the decision/recommendation. If consensus cannot be reached, the ANHP Council shall resort to the dispute resolution provisions of the Framework. The ANHP Council may, by unanimous approval of the ANHP Council members, adopt a decision-making framework that identifies types of decisions where a majority vote or other specified percentage is sufficient to bind all ANHP Council members.|
|Minutes||ANHP Council meetings shall be documented through minutes that record issues discussed, key discussion points, decisions made, and actions to be taken. Discussion during meetings shall be open, frank, and free-flowing, and while contents of minutes will be shared, they will not include attribution of individual contributions made by ANHP Council members.|
|Fund Manager||The ANHP Council shall, by a majority vote, select a Team Member to be a “Fund Manager” (for a term to be agreed) to, as directed by the ANHP Council, receive, manage, distribute, and keep accurate accounts of, pooled resources, including funding earmarked for the ANHP-OHT. The Fund Manager will submit financial reports to the ANHP Council on a quarterly basis and retain financial records for at least seven years.|
|Information Sharing||The ANHP Council shall develop a protocol for how information is shared with Team Members and their respective boards and councils, the PFEAC, the THAC, the PSAC, committees, and working groups. Key messages will be communicated to the Team Members through the ANHP Council following each meeting.|
|Confidentiality||The ANHP Council members shall respect the confidentiality of information received by, and discussions of, the ANHP Council. ANHP Council members shall share information in accordance with the protocol adopted by the ANHP Council from time to time. ANHP Council members and all members of committees and working groups shall each sign an acknowledgement confirming their agreement to respect the confidentiality of information received in their capacity as a member of the ANHP Council or one of its committees or working groups, as applicable, and to adhere to these Terms of Reference and any protocols, policies, or procedures adopted by the ANHP Council from time to time.|
|Conflicts of Interest||ANHP Council members represent the broad interests of the communities being served. They are expected to bring the knowledge gained from their experiences, occupations, beliefs, and cultural perspectives. The best interests of the ANHP Council’s work may occasionally differ with the interests of an ANHP Council member, either individually or with an organization they may represent. In resolving competing interests, members should act to make the health system better. Conflicts of interest should be disclosed where they exist.|
|Policies||The ANHP Council may adopt policies, protocols, and procedures to support the work of the ANHP Council and its committees and working groups.|
|Accountability and Reporting||Each Team Member will delegate a scope of authority to its respective ANHP Council member. Each member must act within their own delegated scope of authority, and must report, and be accountable, to their own board of directors or governing body.|
|Amendment||These Terms of Reference shall be reviewed annually be the ANHP Council and may be amended only with the written agreement of the Team Members.|
[To be developed.]
Project Principles and Requirements.
Where appropriate, each Project (and, if applicable, Project Agreement) will set out:
OCAP® Principles. Given the importance and need to recognize Indigenous community rights and interests in their information, additional information sharing considerations are required to ensure Indigenous data and information governance principles such as the First Nations Principles of OCAP® (ownership, control, access, and possession) are adhered to. OCAP® ensures that First Nations own their information and respects the fact that they are stewards of their information. It also reflects First Nations commitments to use and share information in a way that maximizes the benefit to a community, while minimizing harm. The Team Members aim to work with First Nations, Métis, and urban Indigenous partners to incorporate OCAP® and relevant Métis data governance principles across ANHP’s data and information collection, use, and disclosure practices. This approach also aligns with the foundational relationships and commitment to reconciliation across all members of the ANHP and Indigenous leadership and organizations.
Information Sharing. Team Members will engage in ongoing communications and provide information to each other, and to the ANHP Council, and their committees and working groups to achieve the Shared Objective.
Transparency and Disclosure. If a Team Member becomes aware of an issue that might materially impact its, or another Team Member’s, ability to perform its obligations under this Framework or a Project or Project Agreement, it will promptly notify the ANHP Council of the fact or circumstance and its anticipated impact so that the Team Members, through the ANHP Council may consider how to assess and mitigate the impact on the Shared Objective.
Privacy. In some instances, Team Members will share personal health information with one another for the purposes of providing health services, and coordinating its provision, in accordance with applicable laws. Team Members will enter into a data sharing agreement in respect of sharing personal health information for all other purposes.
Confidentiality. Team Members will not disclose any Confidential Information of other Team Members to a third party, except: (a) with written consent of the relevant Team Member; (b) to the extent that disclosure is necessary to meet applicable laws or governmental or regulatory authority directives or other requirements; or (c) as permitted under the terms of this Framework.
Loss or Compromise of Confidentiality. If a Team Member discovers any loss or compromise of the Confidential Information of another Team Member, it will notify the Team Member promptly and cooperate with it to mitigate the loss or compromise. Upon request, each Team Member will return or destroy all Confidential Information of the relevant Team Member that it is not required to retain by applicable laws or other requirement. Any loss or compromise of personal health information will be addressed in accordance with applicable laws and any data sharing agreement entered into between and/or among the Team Members.
Public Notices and Media Releases. All notices to third parties and all other publicity concerning this Framework or the ANHP or ANHP-OHT, will be planned, co-ordinated, and approved by the ANHP Council, and no Team Member will act unilaterally in this regard without the prior approval of the Team Members through the ANHP Council, except where required to do so by applicable laws or governmental or regulatory authority requirements. The spokespersons for the ANHP will be such member or members of the ANHP Council as determined by the ANHP Council from time to time.
Independent Contractors. The relationship between and among the Team Members under this Framework is that of independent contractors. This Framework is not intended to create a partnership, agency, or employment relationship between or among the Team Members. No Team Member will have the power or authority to bind another Team Member or to assume or create any obligation or responsibility, expressed or implied, on another Team Members’ behalf or in its name, nor will it hold itself out to any third party as a partner, agent, or employee of another Team Member. Each Team Member will be responsible and liable for its own employees, agents, and subcontractors, unless otherwise agreed to in a Project Agreement.
Notices. Where, in this Framework, a Team Member must give or make any notice or other communication, it will be in writing and is effective if delivered personally or sent by electronic means addressed to the intended Team Member at the address set out in Schedule 28. Notice or communication will be deemed received one Business Day after delivery or sending. The address of a Team Member may be changed by notice as provided in this paragraph.
Entire Agreement. With respect to its subject matter, this Framework contains the entire understanding of the Team Members and supersedes all previous understandings and agreements, written or oral, between and among the Team Members.
Amendment/Waiver. This Framework may be amended by mutual written agreement. If a change in law or a directive from a governmental or regulatory authority requires a change to this Framework, the Team Members will work cooperatively to amend it. No waiver of any provision of this Framework is binding unless it is in writing and signed by the Team Member entitled to grant the waiver.
Assignment. No Team Member may assign its rights or obligations under this Framework without the written consent of the other Team Members. This Framework enures to the benefit of and binds the Team Members and their respective successors and permitted assigns. A Team Member may assign this Framework without consent pursuant to an integration order of the Minister of Health.
Severability. Each provision of this Framework is distinct and severable. Any declaration by a court of competent jurisdiction of the invalidity or unenforceability of any provision will not affect the validity or enforceability of any other provision.
Counterparts. This Framework may be executed in counterparts and delivered electronically.
Survival. Paragraphs 18 and 26 and Schedule 18 survive a Team Member’s withdrawal or expulsion from or termination of this Framework.
Governing Law. This Framework is governed by, and interpreted and enforced in accordance with, the laws of the Province of Ontario and the laws of Canada applicable in the Province of Ontario.