Hospital to Home (H2H) Coordinator

Exceptional Care–Exceptional People

The Brant Community Healthcare System is a two site Community Hospital located in Brantford and Paris, Ontario.

• The Brantford General is an acute care hospital
• The Willett in Paris is an urgent care centre and transitional beds
  
  

By choosing to work at Brant Community Healthcare System (BCHS), you are joining an organization with more than 130 years of making a positive difference in the lives of the people we serve throughout our communities. We value Care, Accountability, Respect and Equity, and we are working together to build a healthier community!

Why Choose BCHS?

• Centralized Education Fund – opportunities for continuing education and staff development.
• Various schedules available (e.g. 4 on 5 off for full time nurses)
• HOOPP Pension Plan
• Predictable work locations
• Discounted onsite parking (no shuttles or waiting lists)
• Support 24/7 – you’re not on your own (managers on call, physicians, allied health, and support staff).
• Wellness matters – our Employee Assistance program is free and confidential to all employees and family members.
• Ongoing infection and prevention control measures, education, appropriate PPE and support available to all employees.
  
  

Position Summary

Reporting to the Director of Access & Flow, the BCHS Hospital to Home (H2H) Coordinator in collaboration with the patient, family/supports, physician, and members of the clinical team will support eligible patients for the Hospital to Home Program. The H2H Coordinator acts as the liaison between the hospital team, the home care service provider, and the primary care physician. The aim of the program is to transition medically stable patients who have restorative potential back home with a clear, comprehensive bundled care plan of professional and personal support services.

The H2H Coordinator practices in accordance with standards of professional practice and the BCHS corporate mission, vision and values providing program oversight and ensuring identified patients have a comprehensive eligibility assessment, and a high-quality patient and family-centered transition care plan prepared to enable the safe and effective delivery of care in the patient’s home environment.

Primary Responsibilities

• In collaboration with the interdisciplinary team, assess identified patients for program eligibility based on guiding inclusion criteria.
• Communicate with the patient/family and support team details related to program enrolment including eligibility, timelines, feasibility, risks, benefits.
• Engage the patient/family, physician, service provider, community partners to co-create a transitional care plan, based on the patients’ goals while reinforcing the purpose of the program, delivery model and expectations.
• Collaborate with system partners including Ontario Health atHome, Community Support Services, as well as, support transitions to self/family care
• Provide program leadership and case management to ensure the interventions are meeting the patients’ goals and expectations.
• Adhere to H2H Program specifications and standards, maintain and report program indicators, ensuring accountabilities and program sustainability.
  
  

Mandatory Qualifications

• Bachelor's degree in Nursing, Occupational Therapy, Physiotherapy, or Speech Language Pathology
• 5 years clinical experience in an acute care or rehabilitation healthcare setting
• 1 year case management, discharge planning, care coordination
  
  

Mandatory Competencies

• Excellent interpersonal, communication, organizational and time management skills
• In depth understanding of community resources and relevant stakeholders
• Demonstrated ability to develop and implement project plans
• Experience in stakeholder engagement and communication, with the ability to build and maintain relationships.
• Proven ability to manage multiple tasks and meet tight deadlines.
• Excellent written and oral communication skills, with the ability to present complex information clearly.
• Familiarity with industry best practices and trends in program management
• Experience with tools and methodologies for data collection, analysis, and reporting Strong analytical and data interpretation skills, with experience in using metrics to drive decision-making.
• Proficient with computer systems such as email, MS Word, MS Excel, MS PowerPoint, and other project management tools.
• Strong problem-solving skills and the ability to think critically and strategically.
• Demonstrated experience working with financial decision support systems, electronic health records, and administrative information systems.
• Safety (patient, worker & workplace) is a BCHS Corporate Priority. The successful applicant will demonstrate good stewardship in the identification, reporting and mitigation of unsafe acts or conditions.
  
  

Accommodation

The Brant Community Healthcare System (BCHS) is an equal opportunity employer, committed to employment equity and diversity in the workplace. We welcome applications from women, Indigenous persons, members of racialized groups, visible minorities, persons with disabilities, persons of all sexual orientation and persons of any gender identity or gender expression.

Brant Community Healthcare System is committed to creating an accessible and inclusive organization. We are committed to providing barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require Code-protected accommodation through any stage of the recruitment process, please make them known when contacted and we will work with you to meet your needs. Disability-related accommodation during the application process is available upon request.

To ensure there is equal opportunity during the recruitment and selection process, please contact your Recruiter to discuss accommodation.