Outcomes

Hamilton is no ordinary place. It’s one of Canada’s ten largest cities. It has an aging population – the number of older adults doubling in the next two decades. Mental health concerns and social isolation impact members of our communities regardless of age or social status. Suicide is the number one cause of death for people under 45.

It has an acute care system that is over capacity. In the past year, there was a five-year high in the number of “code zeros” - no ambulances available for 911 calls, and hospitals’ medical surgical beds regularly operate above 110% capacity. Demands are increasing; the trajectory unsustainable.

In parallel, youth wellness indicators show concerning trends. Youth need successful paths to adulthood. 40 years ago, the manufacturing industry was thriving. Hamiltonians could leave high school and make an income that could support a family - an option not readily available today.

Hamilton’s Vision: To be the best place to raise a child and age successfully. It was based on consultations with more than 55,000 residents; as part of the Smart Cities Challenge consultations key themes emerged: health, poverty and access to services.  Issues that are clearly connected.

A goal to become “Canada’s most connected community” –means changing the way public services are delivered across the city using technology to integrate health, community, education and social services in one fluid system.

It means breaking down barriers that existed in a paper-based world by building digital bridges between the programs and service providers across the city. It means developing repeatable models, scaling them up with smart technology, and connecting them in a way that is replicable across the country. It is public service delivery reimagined to improve health and wellness of the community.

It’s not about technology alone. It’s about using technology to enhance connectivity between people and places. This really is no ordinary place. It’s Hamilton –big enough to make meaningful change, small enough all of our major institutions already collaborate and are committed to moving the community forward together.

Hamilton is home to a life sciences cluster with major education, health delivery and research institutions such as St. Joseph’s Healthcare, Hamilton Health Sciences, McMaster University and Mohawk College. A unique environment, it brings together diverse expertise for ground breaking innovation and delivery, collaborating directly with local start-ups and global business leaders such as IBM Canada, also based here.

Millions of dollars of research investment has resulted in a cluster of highly specialized world leading health institutions. McMaster is unique in Canada for its depth and breadth of research and collaboration focused on older adults, such as the McMaster Institute for Research in Aging (MIRA), including the Labarge Centre for Mobility in Aging, enabling researchers to study mobility from broad perspectives, from social isolation to transportation and the built environment to physical mobility and nutrition. McMaster is also home to the Canadian Longitudinal Study on Aging – a 20 year study of 50,000 Canadians between the ages of 45 and 85, collecting data on the health and social aspects of their lives.

Hamilton is home to a large number of successful services, programs and pilots but a recurring issue is residents don’t know what they are and how to access them. To assist people, a series of different navigator roles have been established but they too have difficulty keeping track of all the program offerings.

Our recent consultations reaffirmed community priorities, highlighting the need for a community that focuses both on prevention to keep residents on the right path and interventions for those who are at-risk or experiencing poor outcomes. An inter-generational approach is needed.

To achieve these priorities we will connect the community in a new way – using people, places and technology to make it smart, responsive and resilient. We will impact the health and wellness of our residents by putting them at the centre of service delivery. Success means focusing on four key areas:

Outcome: A Virtual Navigator for Hamilton – “Hey Hamilton” – to reduce the amount of time people spend searching for common community information as residents or service providers.

Where can I …? How do I …? Where can I find …?

In most major sectors the way one engages, gathers information and obtains services has changed. For example, the ways in which clients interact with banks or retail in a digital world is very different than when residents try to access public services in their community. This can change.

By replicating what’s common practice in other industries, with proven technology, Hamilton will deliver a new way of accessing services and programs in the city – a leading edge public service navigator that connects municipal, education, health care, community and social services, providing users with easy access to information via the web or mobile devices. It would also be capable of communicating in multiple languages.

This will be underpinned by a smart city platform to enable data sharing between the institutions to enhance opportunities for service delivery.

Success will be measured by number of users, number of services accessed and user feedback. Data insights will be used to inform system transformation,  an iterative approach.

Outcome: Reduce the City’s 911 call rate increase of by a minimum of 1%, (from 5% annually to an increase of less than 4%) redirecting approximately 670 calls in the first year, avoiding Emergency Department (ED) visits and improving patient satisfaction.

Outcome: Building on Hamilton’s initial Remote Patient Monitoring (RPM) pilot success, we will target a 40% reduction in ED visits and 911 calls in identified high risk cohorts.

Today, the top 5% of patients consume 60% of acute care services. By using the smart city approach, we will reduce this and increase capacity in the acute system.

The approach is multi-fold. Focus on chronically ill and older adults that are the highest consumers of acute care resources.  Also, focus on older adults who are on a trajectory of becoming less mobile and at risk for social isolation, with a higher probability of consuming more resources in the future.  We will improve patient experience and enable people to age successfully in place.

Data tells us who high-risk patients are and why they access the system. We know some of the care they receive would be better delivered in the community or at home with the right support.

Our community paramedics’ remote monitoring pilot demonstrated that identifying at-risk patients and providing intervention at home provides a better patient experience while reducing pressure on the acute system.  We will smart-enable the program and scale it significantly by connecting the paramedics’ program with the McMaster SmartHome Team, using a suite of wearable and ambient sensors in the home, monitoring to improve outcomes individually as well as allow cross-sectional and longitudinal analysis.

Additionally, the Ontario Telemedicine Network (OTN), our provincial partner, has agreed to offer multiple digital tools and services in a combined effort for the first time, bringing a suite of virtual consultation, app-based programs and connectivity services to the Smart City program.

While supporting high users of acute services, this will also inform a broader understanding of what’s happening in the system through big data. Including identifying indicators of future high users with opportunities to proactively intervene to improve patient experience, reduce pressure on the system, and enable successful aging in the home.

Research shows that social isolation and loneliness also contribute to a decline in health and wellness. Loss of mobility and hearing are key contributing factors. Leveraging the work of MIRA, we will identify and develop tools that assist in understanding and preventing mobility decline in older adults. In parallel, we’ll expand McMaster LIVELab’s research on helping older adults with, for example hearing impairments, to use technology – not just hearing aids - to the fullest extent. Mitigating these isolating factors is expected to enhance social connectivity to reduce decline in health and wellness.

Collectively we will develop predictive models and deliver programs that enable prevention.

Outcome: Reduce our youth ‘Not in Employment, Education or Training’ (NEET) group by 30% to be in line with the federal average.

In Hamilton, 9.3% of youth are in the NEET category, compared to approximately 6% federally.

We know that education is a building block for success, but it doesn’t stand alone. Sense of belonging, purpose, and caring adults to mentor young people are also critical factors.

The Hamilton-Wentworth Catholic District School Board (HWCDSB) identified its applied-stream graduation rate as 70% and only 1̸3 of those students go on to post-secondary education.

A gap identified was access to digital tools that enable guidance/career counsellors and students to understand present-day career pathways and opportunities in a format that works for them and is easy to use.

Additionally, youth wellness indicators, such as self-harm, are showing concerning outcomes. We know we need to engage and connect them. The Youth Serving Agencies Network identified that 80% of over 1600 teenagers surveyed did not participate in any recreational programming. They weren’t aware of it, were too busy or not interested. In parallel, those same youth indicated their top interests were: a place to go, sports, music, and information on volunteering/jobs. While these programs/services  exist youth don’t know how to find them.

The Hey Hamilton navigator will be tailored to create a ‘one-stop-shop’ for youth, co-designed so it meets their needs.

Also, new digital community spaces will be created around the city via a series of mobile and leave behind units. This will provide access to common features such as public Wi-Fi, workshops and computer access. Aimed at increasing community well-being and connectivity, programming will be based on what the community wants, from interactive learning, access to services or simply a safe place to hang out.

Using a multi-partner model we will deliver a digitally enabled support network that makes information and services easy to access. This would be bolstered with immersive learning programs (which exist today on a small scale) to build stronger relationships in the community inter-generationally, support transitions between primary and secondary and demystify post-secondary school to expand horizons when determining a path forward.

We will dramatically scale the McMaster Children & Youth University and fully digitally it, rapidly accelerating their e-book development and their QUESTION-DISCOVER-CREATE model. They engage youth and their families, with McMaster students, in immersive, experiential and interactive learning that is co-designed. Building engaged empowered young citizens and students to build smart cities.

We will also deliver opportunities for residents who want a better way forward to go back to school and pursue post-secondary education, with or with a high school diploma, building on Mohawk’s College’s access strategy which delivers that now through community delivered learning.

Connecting the community means bringing institutions to them, such as Mohawk’s City School, which offers on the ground in-community programs that encourage people with multiple barriers to engage.

Improving connection to these programs upstream will improve Hamilton’s youth and at-risk population’s capacity, resiliency, and overall independence, which we know has a downstream impact of reducing stress on the health care system.

Through these combined initiatives we will reduce our percentage of NEET youth and improve the community overall. We recognize this will require a set of indicators to be monitored throughout the program, two example indicators are the HWCDSB’s commitment to increasing the applied stream graduation rate to 80% and increasing post-secondary school access to 50%.

Outcome: Using smart technology to accelerate outcomes of Hamilton’s Urban Indigenous Strategy.

Under the leadership of the Hamilton Executive Directors Aboriginal Coalition (HEDAC), this program will accelerate the achievement of outcomes desired by the Indigenous community and the outcomes of Hamilton’s Urban Indigenous Strategy.

The ability to easily find and access Indigenous services was identified as an opportunity to improve. The navigator will be customized to enable access to Indigenous services with the potential for it to speak/learn Indigenous languages to deliver broader offering (a model that when successful could be shared with other Indigenous communities).  

The Indigenous community in Hamilton also identified that strong grounding in culture and Indigenous identity is a critical success factor for Indigenous youth, led by HEDAC we will use smart technology as a tool that can support Indigenous youth developing connections to their culture, language(s), and teachings, helping enable success in education, health and well-being to increase resiliency through the development and delivery of Indigenous-led content.

More specifically, a digitally enabled approach, such as virtual and augmented reality and artificial intelligence, would enable Elders and knowledge keepers to capture and share information about culture and learning more broadly.  With people at the centre, using technology to enhance capacity, real-life teaching and experiences could be supported and supplemented by virtual models that could include topics such as language revitalization to teaching traditional dance. (McMaster’s LIVElab is already demonstrating success in virtual dance through the use of avatars.) Measurements would be defined as part of the process by the Indigenous community and in-line with the work of the Urban Indigenous Strategy

Another outcome would be to create Indigenous led content to build understanding among non-Indigenous residents to raise awareness in the community.

Summary

Hamilton will create an interactive connected community that is easy to navigate, where the programs and services needed are easily located and accessed, where user-experience is paramount as public service delivery is reimagined with people at the centre.

From a population perspective, there is an understanding of the impact artificial intelligence and big data will have when we can understand system usage, identify patterns and be more predictive and preventative to use data to inform system transformation.

In addition to the outcomes identified previously, the program will establish a benefits measurement framework to help fully understand the impact and monitor progress against the five-year goals. Leveraging work done in healthcare by Canada Health Infoway on the value of connecting health information, a similar model will be established to focus on demonstrating progress on both connecting services in Hamilton and measuring impact on health and wellness of residents.

The City has foundational work underway and partnerships are in place. Hamilton is a microcosm of Canada – rural, urban, suburban, an aging population, a need to increase the resiliency of youth, and a focus on health and wellness.

Hamilton is big enough to make a difference, small enough to make it happen. Investment in our “Little Big City” enables us to build on the resources, expertise and collaborative partnerships to benefit the country. The results of what is developed and tested here can be reliably replicated in large and small communities nation-wide.