Helping to Shape a Local Model of Care – North East Local Health Integration Network (LHIN)

Helping to Shape a Local Model of Care

August 3, 2017 — For close to a year, this physician has been meeting with patients and providers, working to develop a plan to better coordinate care for people living in rural areas of Northeastern Ontario. For her work with Rural Health Hubs (RHH), Dr. Janet McLeod has been named the North East Local Health Integration Network’s (NE LHIN) Healthy Change Champion.

“Dr. McLeod has a history of putting patients first,” said Kate Fyfe, Interim CEO, NE LHIN. “She is passionate about the Rural Health Hub project and the patients who will benefit from improved care coordination. She truly deserves to be recognized as a Healthy Change Champion.”
A primary care physician for three decades, Dr. McLeod spent 20 of those years working in medical clinics and hospitals in a rural setting. She believes primary care is the foundation of the health care system, especially in rural medicine, where primary care providers are generalists.

“The Rural Health Hub concept is an opportunity to strengthen and enhance the primary care model, so that patients in a geographic area can access the care and services they need through their primary care organization,” said McLeod. “Where opportunities and resources exist, primary care could provide a point of system navigation and care planning for patients.”

Seamless transitions, assistance with referrals, follow-up with specialists are what Rural Health Hubs are about. This past August, both North Shore Health Network and Espanola Regional Hospital and Health Centre were announced by Premier Wynne as two of the early adopters of the Rural Health Hub pilot sites in Ontario. Supported by the NE LHIN, hospitals in these areas received funding to work with different health and community sectors to identify local health care needs and gaps – and develop a plan to improve care.

“Collaborating and communicating as a team, forming partnerships, working collectively to either bring services to the community or make better use of the ones that exist makes more sense than being organized in separate silos. Ultimately, if we, as a system, work well together, the patients we serve have a smoother journey through the health care system,” said Dr. McLeod.

Dr. McLeod is helping to advise and consult on the RHH pilot project, but this push to improve care coordination has been a team effort. She said it could not be done without the support of the NE LHIN, the hard work of the local teams of health service providers and patient representatives who oversee and plan, and people like Project Lead, Mary Ellen Luukkonen.

“Dr. McLeod believes that patients are better served in a primary care model that provides wrap around services that not only provide the patient with better care but take the burden of navigating the system away from the patient and more appropriately place the accountability with service providers who are working together to improve the patient experience,” said Luukkonen. “Having Dr. McLeod involved in the RHH pilot project has brought an ‘on the ground’ approach to system improvement.”

Dr. McLeod has been involved in other patient-centred, primary care initiatives in the past – but she has never worked on anything of this magnitude. The RHH project in the North East continues to engage patients and assess health service providers. Work teams have now been created across both hubs to address any gaps and identify priorities that could be accomplished before the end of the project in March 2018.

Aside from her role as a primary care physician, Dr. McLeod has taught several medicine-related programs. For many years, she was also a national examiner for the College of Family Physician’s certification exam in Family Practice.

Dr. McLeod moved to St. Joseph Island in 1997 to practice medicine and develop a small family-run commercial maple syrup operation and hobby farm. She continues to live and work there today.

Frequently Asked Questions:

  • How many Rural Health Hubs pilot sites has the province funded? Five early adopter sites have been funded. The North East and North West LHINs both have two sites and the Central East LHIN has one site.
  • What is the difference between a Health Link and a Rural Health Hub? A Health Link is designed to foster collaboration between health and social service providers to better coordinate care for medically complex patients – those with multiple health conditions who see a large number of providers – by working with them to develop individual coordinated care plans. A Rural Health Hub is designed to improve coordination of care for all people in a given area by bringing all the health care providers together through enhanced partnerships and to provide patients with ready access to a comprehensive list of health care services.
  • Can a Rural Health Hub and Health Link operate in the same area or overlap? Yes. Both are working to improve the coordination of care across the continuum of both local health and social service providers – Health Links are focused on medically complex individuals and Rural Health Hubs on all residents’ needs.
  • Will every Rural Health Hub be structured the same? No. As the Multi-Sector Rural Health Hub Advisory Committee, led by the Ontario Medical Association and the Ontario Hospital Association, explained: “Each rural health hub will be locally defined and tailored to the community. A rural health hub is flexible, not one size fits all, is innovative, based on local needs and provides coordinated access to care.”

Background Information – Healthy Change Champion Award:

  • Who is Eligible? North East LHIN health service providers, employees and volunteers of providers, as well as, health care leaders, community leaders, and other Northerners who are contributing to building a stronger health care system in the North East.
  • What kind of work does the NE LHIN Healthy Change Champion recognize? Those who are transforming the health care system so that it becomes more patient/client-focused, integrated, and easier to access. These are people or organizations who are reaching out to others in the course of their work to improve the system. Their work may be small or large in scope, but it’s significant in that it is making a difference in people’s lives.
  • Who can nominate? Any Northerner can suggest a Healthy Change Champion. We just ask that you tell us in one or two paragraphs why you believe the person or organization deserves this recognition. Send your nomination to or 555 Oak Street East, Third Floor, North Bay, ON, P1B 8E3.
  • How are they picked? Nominees are reviewed by our senior team. Consideration is also given to individuals and organizations advancing the care for special population groups within the North East LHIN including seniors, Aboriginal/First Nations/Métis, and Francophones.


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