Board of Directors DRAFT Agenda July 2011 · 2015-04-09 · Board of Directors- June 22, 2011 CEO...

201 Queens Avenue, Suite 700 London, ON N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll Free: 1 866 294-5446 www.southwestlhin.on.ca

Board of Directors’ Meeting Wednesday, July 20, 2011

South West LHIN Board Room

2:00 pm to 4:00 pm

AGENDA Item Agenda Item Lead Decision/

Information Time

1. Call to order Chair 2:00-2:05

2. Declaration of Conflict of Interest Chair 2:05-2:10

3. Approval of Agenda Chair Decision 2:10-2:15

4. 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8

Consent Agenda Items Approval of Minutes: Board Committee-June 8, 2011 Board of Directors- June 22, 2011

CEO 2011/12 Quarter 1 Compliance Report Chair 2011/12 Quarter 1 Compliance Report 2011/12 LHIN Quarter 1 Operational Year-to-Date Report Comprehensive Mental Health & Addictions Strategy London Emergency Departments/Urgent Care Centre External Review – Implementation Overview Aging at Home Investments Update Senior Leadership Report M Barrett/M Brintnell/ K Gillis/L Johnson/ G Lanteigne/ J White

Chair M Barrett Chair M Barrett M Barrett M Barrett/ M Brintnell M Brintnell Leadership

Decision Decision Decision Information Information Information Information Information

2:15-2:20

5. 5.1 5.2

Agenda Items for Decision/Information 2011/12 Wait Times Strategy Allocation Access to Care Update (Standing Item)

M Brintnell M Barrett

Information Information

2:20-2:35 2:35-2:40

6. Board Chair Report

Chair 2:40-3:00

7. Closed Session Chair Decision 3:00-4:00

8. Date and Location of Next Meeting September 28, 2011- 2:00 pm to 5:00 pm, Board Room Hanover District Hospital, 90-7th Avenue, Hanover

Chair

9. Adjournment

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1

201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll-free: 1 866 294-5446 www.southwestlhin.on.ca

Agenda Item 4.2 CEO Certificate of Compliance

To: The Directors of the South West Local Health Integration Network Date: 2011/12, 1st Quarter, April 1, 2011 to June 30, 2011 In my capacity as Chief Executive Officer of the South West Local Health Integration Network (the “LHIN’), I hereby certify that to the best of my knowledge and except as set out in the attached schedule, as of the above date:

1. Salaries & Benefits: The LHIN has met all of its obligations in respect of the payment of all employee salaries and wages (both regular and overtime), vacation pay, holiday pay, termination pay, severance pay, bonuses and benefits.

2. Income Tax: All income tax source deductions for (i) employees; (ii) those directors who have requested source deductions; and (iii) payments made to persons who are not Canadian residents (if any), have been deducted, withheld and remitted within the respective times required by the Income Tax Act, Canada and the Income Tax Act, Ontario as appropriate.

3. Employer Health Tax: All employer health taxes have been deducted and remitted within the time required by the Employer Health Tax Act (Ontario).

4. Employment Insurance: All employment insurance premiums have been deducted and remitted within the time required by the Employment Insurance Act, (Canada).

5. Environmental Protection Act: The LHIN has at all times handled any hazardous substances in compliance with the Environmental Protection Act and all other applicable laws, approvals or authorizations.

6. Financial Statements: The financial statements of the LHIN, as at their respective dates of preparation were (i) accurate and complete in all material respects, (ii) prepared in accordance with generally accepted accounting principles and the public sector accounting Board principles as appropriate.

7. Insurance: All insurance policies remain in full force and effect. The LHIN is not in default with respect to any provisions contained in any insurance policy and has not failed to give any notice or present any claim under any insurance policy in a timely manner.

8. Administrative Actions, Orders and Litigation: There is no order, action, suit or proceeding, at law or in equity pending, or threatened against, or affecting, the LHIN or its business or assets.

9. Oaths of Allegiance to the Crown & Oaths of Office. Two Oaths required under the Public Service Act of Ontario (PSAO), are outstanding.

10. Quarterly Reports: Quarterly Reports, due to date, have been submitted on time and all information contained there, and on other filings, is true and correct in all material respects. . All applicable and material governmental and non-governmental reporting/filing requirements have been met.

2


11. Internal Controls: Sufficient internal controls are in place to identify, monitor and mitigate LHIN operational, compliance and financial reporting risks. All significant internal control weaknesses identified during this period have been addressed to the satisfaction of LHIN management and the LHIN Board Finance and/or Audit Committees; or approved plans are in place to address them.

12. Health & Safety: The Health and Safety Committee of the LHIN has not identified any, nor made any recommendation for the monitoring or improvement of, workplace situations relating to health and safety that remain outstanding.

13. Compliance with Applicable Law, Directives and Policies: All business undertaken by the LHIN in this reporting period has been conducted in compliance, in all material respects, with all applicable laws of Canada and the Province of Ontario, including the Local Health System Integration Act (LHSIA), and with the Memorandum of Understanding (MOU), the Ministry LHIN Performance Agreement (MLPA) and all applicable Ontario Public Service (OPS) Directives and Ministry of Health and Long-Term Care (MOHLTC) Policies and Protocols (including Transfer Payment Accountability, Procurement Directives, Travel, Meal & Hospitality Expenses Directive and Perquisites Directive.

14. Occurrences of Fraud: I am not aware of any occurrences of fraud in the operation of the South West LHIN.

15. Extensions to Contracts: There have been no extensions to any contracts that occurred after the implementation of the new guidelines for the Procurement Directive, dated April, 2011.

I have reviewed, or caused to be reviewed, such files, books, records and accounts of the LHIN and have made, or caused to be made, such enquiries of the financial, accounting and other personnel of the LHIN as I have determined were necessary for the purposes of this certificate. Dated this 30th day of June, 2011 Michael Barrett, Chief Executive Officer

3


SCHEDULE A

EXCEPTIONS: FOR PERIOD: April 1, 2011 to June 30, 2011 Oaths of Allegiance to the Crown & Oaths of Office. Oaths of Allegiance to the Crown & Oaths of Office are in the process of being completed for two staff. All Oaths are to be completed by July 31, 2011.

1


Agenda Item 4.3

DECLARATION OF COMPLIANCE To: The Honourable Deb Matthews,

Minister of Health & Long-Term Care From: Jeff Low, Board Chair

South West Local Health Integration Network (the “LHIN”) Date: July 20, 2011 Re: 2011/12, Quarter 1, April 1, 2011 to June 30, 2011 (the “Applicable Period”) The Board has authorized me by resolution dated July 20, 2011 to declare to you as follows:

Upon due enquiry of the Chief Executive Officer and other appropriate LHIN officers, and subject to any exceptions identified on Schedule A, to the best of the Board’s knowledge and belief, the LHIN has;

1. fulfilled, its obligations under the Memorandum of Understanding and the

Ministry LHIN Performance Agreement (MLPA) in effect during the Applicable Period; and

2. without limiting the generality of the foregoing, complied with the provisions of

the government directives applicable to it including the Procurement Directive and the Travel, Meal & Hospitality Expenses Directive.

during the Applicable Period.

Jeff Low, Board Chair

2


SCHEDULE A South West LHIN Declaration of Compliance

For the Applicable Period: 2011/12, Quarter 1, April 1, 2011 to June 30, 2011

1. MEMORANDUM OF UNDERSTANDING

no known exceptions

2. Ministry LHIN Performance Agreement

no known exceptions

SOUTH WEST Report on LHIN Operations -- 2011/12 Q1 ($ to the $Dollar) Note: Amounts are provided for illustrative purpose.

(A) (B) (C=A+B) (D) (E) (F=E/D) (G=D+E) (H) (I) (J=I/D) (K) (L=K/D) (M) (N=M/D) (O=G+I+K+M) (P=O-C) (Q) (R)

April & May Actual

June Estimate

% Estimate / Actual

Total% to Revised

Allocation

July, Aug and Sept Estimate

% to Revised Allocation

Oct, Nov and Dec Estimate


Jan, Feb and Mar Estimate


Forecast Year-end vs Revised Allocation (note 1)Required if (note 2 and 3): 1) F is < 40% OR > 60%, or

2) H, J, L, N is < 15% OR > 35% Allocation 5,153,420 - 5,153,420 858,910 429,451 50% 1,288,361 25.00% 1,288,353 25% 1,288,353 25% 1,288,353 25% 5,153,420 0 Salaries & Wages Salaries & Wages 3,091,820 3,091,820 488,362 257,652 53% 746,013 24.13% 772,955 25.00% 772,955 25.00% 799,897 25.87% 3,091,820 - Subtotal (Salaries & Wages) 3,091,820 - 3,091,820 488,362 257,652 53% 746,013 24.13% 772,955 25.00% 772,955 300.00% 799,897 107.22% 3,091,820 - Employee Benefits HOOPP 278,260 278,260 44,042 23,188 53% 67,230 24.16% 69,565 25.00% 69,565 25.00% 71,900 25.84% 278,260 - Other Benefits 278,260 278,260 76,763 23,188 30% 99,951 35.92% 69,565 25.00% 69,565 25.00% 39,179 14.08% 278,260 - Subtotal (Employee Benefits) 556,520 - 556,520 120,805 46,377 83% 167,182 30.04% 139,130 139,130 111,078 556,520 - Transport & CommunicationStaff Travel 51,000 51,000 10,221 4,250 42% 14,471 28.37% 12,750 25.00% 12,750 25.00% 11,029 21.63% 51,000 - Governance Travel 27,625 27,625 3,868 2,302 60% 6,170 22.34% 6,906 25.00% 6,906 25.00% 7,642 27.66% 27,625 - Communications 47,600 47,600 26,724 3,967 15% 30,691 64.48% 5,636 11.84% 5,636 11.84% 5,637 11.84% 47,600 - Other T & C - 0% - 0% 0% 0% 0% - - Subtotal (Transport & Communication)

126,225 - 126,225 40,813 10,519 116% 51,332 40.67% 25,292 20.04% 25,292 20.04% 24,309 19.26% 126,225 -

ServicesAccommodation 289,340 289,340 47,766 24,112 50% 71,878 24.84% 72,335 25.00% 72,335 25.00% 72,792 25.16% 289,340 - Advertising - - - 0% - 0% - 0% - 0% - 0% - - Banking 600 600 41 50 122% 91 15.18% 150 25.00% 150 25.00% 209 34.82% 600 - Consulting Fees 176,929 176,929 31,524 14,744 47% 46,268 26.15% 44,232 25.00% 44,232 25.00% 42,196 23.85% 176,929 - Equipment Rentals 38,000 38,000 3,218 3,167 98% 6,385 16.80% 9,500 25.00% 9,500 25.00% 12,615 33.20% 38,000 - Insurance 22,000 22,000 16,474 1,535 9% 18,009 81.86% 1,535 6.98% 1,535 6.98% 921 4.19% 22,000 - LSSO Shared Costs 360,000 360,000 59,915 30,000 50% 89,915 24.98% 90,000 25.00% 90,000 25.00% 90,085 25.02% 360,000 - LHIN Collaborative 50,000 50,000 50,000 0% 50,000 100.00% 0.00% - 0.00% 0.00% 50,000 - Other Meeting Expenses 19,000 19,000 5,100 1,583 31% 6,684 35.18% 4,750 25.00% 4,750 25.00% 2,816 14.82% 19,000 - Board Chair's Per Diem expenses 42,000 42,000 4,900 3,500 71% 8,400 20.00% 10,500 25.00% 10,500 25.00% 12,600 30.00% 42,000 - Other Board Members' Per Diem expenses

40,465 40,465 300 3,372 1124% 3,672 9.07% 10,116 25.00% 10,116 25.00% 16,560 40.93% 40,465 -

Other Governance Costs 37,720 37,720 862 3,143 365% 4,005 10.62% 9,430 25.00% 9,430 25.00% 14,855 39.38% 37,720 -

LHIN Operations Sub-category

Base Allocation

In-Year Adjustments

Revised Allocation

Forecast Year-end Position

Variance (note 1)

Explanation of VarianceQ1 Estimated Quarter-end Q2 Forecast Q3 Forecast Q4 Forecast

Other Governance Costs 37,720 37,720 862 3,143 365% 4,005 10.62% 9,430 25.00% 9,430 25.00% 14,855 39.38% 37,720 Printing and Translation 39,000 39,000 1,636 3,250 199% 4,886 12.53% 9,750 25.00% 9,750 25.00% 14,614 37.47% 39,000 - Staff Development 65,500 65,500 9,999 5,458 55% 15,457 23.60% 16,375 25.00% 16,375 25.00% 17,293 26.40% 65,500 - Other Services 150,301 150,301 10,926 12,525 115% 23,451 15.60% 37,575 25.00% 37,575 25.00% 51,699 34.40% 150,301 - Subtotal (Services) 1,330,855 - 1,330,855 242,662 106,440 2336% 349,102 26.23% 316,249 23.76% 316,249 23.76% 349,256 26.24% 1,330,855 - Supplies & EquipmentIT Equipment - 0% - 0% 0% 0% 0% - - Office Supplies & Purchased Equipment

48,000 48,000 11,683 4,000 34% 15,683 32.67% 12,000 25.00% 12,000 25.00% 8,317 17.33% 48,000 -

Other S & E - 0% - 0% 0% 0% 0% - - Subtotal (Supplies & Equipment) 48,000 - 48,000 11,683 4,000 34% 15,683 32.67% 12,000 25.00% 12,000 25.00% 8,317 17.33% 48,000 - Minor Capital Assets Purchased - 0% - 0% 0% 0% 0% - - Subtotal (Minor Capital Assets Purchased)

- - - - - 0% - 0% 0% 0% - 0% - -

TOTAL BUDGET for 2009-10 5,153,420 - 5,153,420 904,325 424,987 47% 1,329,311 25.79% 1,265,626 1212.61% 1,265,626 387.68% 1,292,857 407.18% 5,153,420 - Prior Year Balance - 0% - 0% 0% 0% 0% - - Prior Year Recovery - 0% - 0% 0% 0% 0% - -

Net 2009-10 Operational Position 5,153,420 - 5,153,420 904,325 424,987 47% 1,329,311 25.79% 1,265,626 24.56% 1,265,626 24.56% 1,292,857 25.09% 5,153,420 - The LHIN has incurred $129,880.13 in eHealth expenses

with no offsetting revenue Non-Operational Funding (if applicable)

- - 0% 0% 0% 0% - - Aboriginal Community Engagement 35,000 35,000 5,840 2,916 50% 8,756 25% 8,748 25% 8,748 25% 8,748 25% 35,000 0 French Language Health Services 106,000 106,000 17,670 8,833 50% 26,503 25% 26,499 25% 26,499 25% 26,499 25% 106,000 0 French Planning Entities - - 0% - 0% 0% 0% 0% - - LHIN Collaborative - - 0% - 0% 0% 0% 0% - -

0% - 0% 0% 0% 0% - - 0% - 0% 0% 0% 0% - - 0% - 0% 0% 0% 0% - -

- 0% - 0% 0% 0% 0% - - Total Non-Operational Funding 141,000 - 141,000 23,510 11,749 50% 35,260 25.01% 35,247 25.00% 35,247 25.00% 35,247 25.00% 141,001 1

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Report to the Board of Directors Comprehensive Mental Health and Addictions Strategy

Meeting Date:

July 20, 2011

Submitted By:

Kelly Gillis, Senior Director, Planning, Integration & Community EngagementPatty Chapman, Planning and Integration Lead Christina Janson, Planning and Integration Specialist

Submitted To:

Board of Directors Board Committee

Purpose: Information Decision

Purpose To provide the South West LHIN Board of Directors with a brief summary of the new long-term Comprehensive Mental Health and Addictions Strategy: Open Minds, Healthy Minds which includes a focus on children and youth in the first three years. Background On June 22, 2011, the Ontario government released a Comprehensive Mental Health and Addictions Strategy: Open Minds, Healthy Minds – the government’s plan to enhance mental health across the lifespan, from childhood to old age, and to provide the integrated services and supports that Ontarians need if they experience a mental illness or addiction, creating a more coordinated and responsive mental health system. The Comprehensive Mental Health and Addictions Strategy responds to many of the recommendations in the final reports from the all-party Select Committee (released August 2010) and the Minister’s own Advisory Group on Mental Health and Addictions (released October 2010). The government’s vision is that every Ontarian enjoys good mental health and well-being and Ontarians with mild to complex mental illness and addictions recover and participate in welcoming, supportive communities. The strategy has four goals: 1. Improve mental health and well-being for all Ontarians

Ontarians are happier, more resilient and more likely to succeed in school, work and life when they are able to cope with stress and manage the ups and downs in life. Programs will be available for all ages to help Ontarians develop the skills they need early in life to improve their mental well-being and to lead healthier lives.

Agenda Item 4.5

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2. Create healthy, resilient, inclusive communities We will help build inclusive, supportive communities. All Ontarians deserve access to the basic elements of a safe and healthy life – education, employment, income and housing – as well as opportunities to participate in meaningful ways in their community. Healthy communities help create a sense of belonging, which leads to better mental health.

3. Identify mental health and addiction problems early and intervene

Acting early – at the first signs of mental illness or problematic substance use and gambling – can have a profound effect. It can help prevent addictions from taking over, and for those with a mental illness, it can shorten the journey to recovery.

To intervene early, we must be able to identify and reach out to people with problems, wherever they are: in school, at work, in their doctor’s office or in the justice system. This is particularly important for children and youth as symptoms of mental illness often first occur during childhood and adolescence.

4. Provide timely, high quality, integrated, person-directed health and human services

Ontarians with a mental illness and/or addictions need timely access to health and social services that meet their needs. These services should be integrated so people have easy access to the right mix of supports. Better coordination across health and other human services – such as housing, income support, employment and the justice system – will lead to better mental health.

The government will also develop performance measures for publicly reporting wait times, client experiences and health outcomes. As part of the long-term strategy, the Ministry of Children and Youth Services, Ministry of Health and Long Term Care and Ministry of Education announced the focus will be on children and youth in the first three years. Over 50,000 Ontario kids and their families will now have quicker and easier access to the right mental health supports, when and where they need them, starting this summer. Investments will grow to $93 million a year by 2013-14. Supports for kids target three priority areas:

1. Provide fast access to high-quality service 2. Identify and intervene in kids’ mental health needs early 3. Helping vulnerable kids with unique needs

Key Investments for children and youth include: Placing mental health workers and nurses with mental health expertise in schools – benefitting over

9,000 kids – and giving educators, social workers and other professionals tools and training to identify mental health issues early on.

Providing more services such as short-term therapy and crisis intervention in community agencies to help 13,000 more kids and reduce wait lists.

Expanding telepsychiatry (video counseling) services to rural, remote and underserved communities to provide more kids with consultations with child psychiatrists.

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Providing culturally appropriate services to 4,000 more Aboriginal kids by hiring new Aboriginal mental health workers.

Keeping 2,300 youth out of the justice system by adding more mental health court workers who can refer them, instead, to community-based services, such as clinical counseling.

Helping more than 16,000 youth transitioning from secondary to post-secondary school by adding more mental health workers on campuses in colleges and universities.

Alignment to Provincial Priorities The Comprehensive Mental Health and Addictions Strategy aligns with several government priorities: Complements the Poverty Reduction Strategy – improving the opportunity for Ontario’s kids

Supports the Excellent Care for All Act – bringing evidence and patient focus to decision making

Complements Ontario’s Policy Framework for Child and Youth Mental Health – child and youth mental health is a key determinant of overall health and well-being

Supports student achievement - improving the graduation rate of Ontario’s students

Supports reduced wait times and family health care – improving access through measurement and innovation

Supports stimulating and growing the economy –Intervention at the right time in the right way stimulates and grows the economy – by getting Ontarians at their best.

The LHINs’ Role The LHINs are important health care partners that are responsible for ensuring integrated health care delivery at the local level. The LHINs’ role includes assessing the health needs of the community and planning for better use of resources. The aim of the government’s Comprehensive Mental Health and Addictions Strategy is to improve mental health and well-being for all Ontarians. It will take a person-centred approach to enhancing and improving mental health and addictions services and collaboration across the system. To ensure local responsiveness, LHINs will need to play an integral role in planning and fostering connections among service providers Additional information regarding the strategy, including the full report, can be found at the following web-link: http://www.health.gov.on.ca/en/news/release/2011/jun/nr_20110622_1.aspx

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Report to the Board of Directors London Emergency Departments/Urgent Care Centre External

Review Final Report – Implementation Overview

Meeting Date:

July 20, 2011

Submitted By: Michael Barrett, Chief Executive Officer Mark Brintnell, Senior Director, Performance, Contract and Accountability

Submitted To:

Board of Directors


Background The South West LHIN Board of Directors received the Final Report dated June 2011 from Dr. Kevin Smith, President and CEO, St. Joseph’s Health System in Hamilton, on his review of the state of clinical coverage for the City of London Emergency Departments and Urgent Care Centre. The report identified fifteen recommendations in the areas of access, coverage, communications, and longer term strategies. Certain recommendations are the responsibility of individual organizations, while others involve a partnership to address the recommendation. The South West LHIN was identified to monitor the implementation of the recommendations and to have a follow-up assessment completed within 6 and 12 months to ensure action has been taken on those recommendations with shorter timelines and progress is being achieved on those recommendations with a longer-term focus. Current Status The London hospitals appointed a city-wide leadership group (administration and clinical) to oversee implementation efforts in response to the recommendations. A number of actions have already been undertaken including the introduction of Nurse Practitioners as part of the clinical model at the Urgent Care Centre to assist with the manpower challenge, posting of open shifts through Health Force Ontario, opening of additional beds at London Health Sciences Centre (LHSC) to create greater access, continuation of recruitment to fill open positions, and enhancements to existing communication channels to better meet internal and external needs. The LHIN and LHSC have initiated work to launch the Home First initiative in September with the goal of improving patient flow and ensuring people receive timely quality care in the appropriate setting. The Ministry of Health and Long-Term Care is aware of the recommendations requiring their attention and discussions continue on how these will move forward. The LHIN will be meeting with the London hospitals on a monthly basis to review progress against the recommendations and discuss any associated risks as they arise. An implementation tracking tool has been introduced to facilitate communications and track progress against each recommendation. Next Steps A more detailed implementation status report will be provided to the LHIN Board at the September meeting to coincide with the implementation timeline for several of the recommendations.

Agenda Item 4.6

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Agenda Item 4.7 Report to Board

Aging at Home Investments Update

Meeting Date: July 20, 2011 Submitted by: Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Mark Brintnell, Senior Director, Performance, Contract and Accountability Submitted to: Board of Directors Board Committee

Purpose: Information Only Discussion/Feedback Decision Purpose To provide an update on the status of the Aging at Home investments in the South West LHIN and to inform upcoming decisions related to previously approved Aging at Home (AAH) funding allocations.

Background The AAH strategy was designed to work towards matching the needs of seniors and their caregivers with the appropriate local services and avoiding the unnecessary loss of independence due to premature admission to long-term care homes or hospitals. The AAH strategy is of critical importance, both for its potential to improve the lives of Ontario seniors by supporting them to live independently and healthy in their homes, and also because it will help ensure the sustainability of the overall health system. The South West LHIN received the following AAH funds over 3 years:

2008/09 (Year 1) – $7M 2009/10 (Year 2) – $17.4M (increase of $10.4M) 2010/11 (Year 3) – $27.5M (increase of $10.1M)

In Years 1 and 2 of the South West LHIN AAH Strategy, 27 projects were approved for funding. In 2010/11, quarterly performance reports were monitored by LHIN staff to understand if projects were achieving their performance indicators and milestones in addition to reporting financial activity. In its third year, the aim of the AAH program evolved from its original inception. The Ministry of Health and Long-Term Care moved the focus of the program from one which was intended to keep seniors living independently in their own homes to a program which aims to reduce the number of Alternate

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Level of Care (ALC) patients in hospitals. The evolution of the program was intended to assist in addressing the significant pressures facing hospitals with patient flow, capacity and emergency department wait times. The following five projects were funded through AAH in Year 3. Funding was flowed at various times in 2010/11 with many of the projects ramping up towards year end. Enhancement of Services and Supports for Aboriginal Seniors Behavioural Support System for Older Persons with Behavioural Challenges (BSS Project) System of Care for High Risk Seniors who live in their own Homes (High Risk Senior Pilot

Project) Quality & Process Improvement Program South West Self Management Strategy (Chronic Disease Prevention and Management Peer

Support, Caregiver Support and Self-Management Tools)

Performance reporting is just now being submitted by the Year 3 projects. A final report of the High Risk Seniors Pilot Project (October 2010 – March 2011) was finalized in May, 2011 that showed significant learnings related to improving the transition from hospital, inpatient and emergency department, to home for seniors living with increased risk.

A presentation was given to the South West LHIN Board Committee on May 11, 2011. Specific system enhancements were noted that included:

CCAC intensive case managers in both hospital and community were essential to successfully transitioning individuals with very complex needs back home. Intensive case management must begin early in the admission process (within 24-48 hours) with frequent contact to instill confidence in returning home and to engage partners to provide the level of supports necessary.

The supports for daily living service through Cheshire London provided access to personal support and homemaking services on a 24 hour basis, 7 days per week, in the client’s home through scheduled and “on-call” visits of frequent and short duration. This service made the difference between completing a long term care home application or admission and many clients decided to stay at home once they were introduced to the service.

A timely visit(s) by the CCAC nurse practitioner following discharge addressed the medical stability of the client in their home, and through their full scope of practice provided a better focused plan of care to prevent readmission to hospital. The nurse practitioner was able to access the hospital database including a list of medications to enable medication reconciliation, education and management in the home.

Continuing the funding previously provided to the CCAC and Cheshire for the High Risk Seniors pilot will assist with ensuring community capacity as the home first philosophy is initially implemented in London.

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Aging at Home Next Steps The South West LHIN AAH team is confident that the existing AAH programs have impacted the three performance domains across the continuum of care that include “prevention & promotion”, “acute” and “recovery & maintenance”. Each program is delivering the services that were intended and for some, the potential exists to spread to other geographical areas of the LHIN (e.g. Falls Prevention), or even to other LHINs (e.g. Community Stroke Rehab).

1. Provincial Aging at Home Final Report: The Ministry of Health and Long Term Care and the 14 LHINs have agreed to summarize the results of the Aging at Home strategy. The South West LHIN has provided executive, financial and initiative summaries that capture the results of the South West LHIN projects. This information will be rolled up provincially. The LHINs will have an opportunity to review and validate the draft provincial report before it is finalized sometime in July.

2. Continued monitoring of quarterly reports: The existing AAH projects will continue to report quarterly to the LHIN for the next fiscal year at which time we will evaluate the need for and adjustments to initiatives and supplemental reporting.

To support communication efforts, a one page profile of each of the AAH projects will be posted on the South West LHIN website in July.

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Report to the Board of Directors Senior Leadership Report

Meeting Date:

July 20, 2011

Submitted By:

Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Mark Brintnell, Senior Director, Performance, Contract and Accountability Glenn Lanteigne, Chief Information Officer and eHealth Lead Julie White, Director, Communications and Customer Service Lisa Johnson, Manager of Corporate Services

Submitted To:

Board of Directors Board Committee

Purpose: Information Decision Strategic Items French Language Health Planning Entity The Erie St. Clair (ESC) and South West LHINs signed their first accountability agreement with our French Language Health Planning Entity on March 11, 2011. Since that time, we have established our Liaison Committee which includes senior leadership from the 3 organizations and the ESC and South West LHIN French Language Coordinators. Kelly Gillis and Suzy Doucet-Simard are the South West LHIN participants on the Liaison Committee. The Liaison Committee has now met on two occasions and has confirmed its terms of reference and finalized its first joint work plan for 2011/12. The agreed upon objectives identified in the joint work plan are to:

1. Describe how each partner will work with each other and the roles and responsibilities of each partner, and develop an accountability framework;

2. Actively seek opportunities to improve access to services in French for priority populations, including people with mental health and addiction issues, people living with a chronic disease, in particular diabetes, and seniors and adults with complex needs; and

3. Develop a mutual community engagement framework that defines the roles of each partner. It is anticipated that the Joint Liaison Committee will meet every two months for the next year and then quarterly thereafter. Operational Items Health Service Provider Q4 Reports Health Service Providers were required to submit their 2010/11 quarter 4 reports by June 30, 2011. LHIN staff is working to review and assess the information contained within all reports and follow up with providers that have yet to submit or seek points of clarification or justification on the results received. The full package of information will come forward to the LHIN Board at its next meeting in September.

Agenda Item 4.8

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Communications Media relations The total number of media stories tracked by the communications department (were posted online) was 13 in the month of June, down 4 from May. Four of the stories were related to the South West LHIN Board’s community engagement event in Ingersoll on June 22nd. In addition to promotional media coverage prior to the event, the LHIN also ran advertisements in Oxford area newspapers. Three media releases were issued in June – the first was on June 8, announcing the appointment of Dr. Jon Dreyer as the Emergency Department Lead for the South West LHIN. On June 22, the LHIN issued a news release about the final report of the External Review of London’s Emergency Departments and Urgent Care Centre, as well as posted the report to the website. Finally, on June 30, the LHIN issued a media release regarding the $3.25 million investment in local priorities. Website & social media During the month of June there were 5,366 visits to the South West LHIN website, up 1,349 from May. A total of 13,322 pages were viewed by 3,564 unique visitors. The average time they spent on the site was 2 minutes and 06 seconds. One hundred and twenty-five people viewed the website on mobile devices (47 on iPhone, 45 on iPad and 24 on Blackberry among others). Just over 40% of visits were direct traffic to the website, while 31.7% came from search engines and 28% from referring sites (500 from the lhins.on.ca page alone.) Among the top pages viewed were careers (36%), about our LHIN (12%) and the Board meetings page (4.37%). At the end of June, we had 960 MyPage subscribers – 26 more than in the previous month. MyPage subscribers are people who select to have new South West LHIN website content sent directly to their inbox. On June 30, there were 138 fans of the South West LHIN Facebook page – up two from May and 109 of our fans are active users. There were 9 new posts by the LHIN during the month and 3,249 post views. On June 30, there were 1,376 followers of the @SouthWestLHIN account on Twitter (84 more than the previous month) and it had amassed 3,618 tweets – 369 during the month of June. We use #SWLHIN to track our Board meeting and engagement tweets, #LHIN to identify generic LHIN tweets and have started using #access2care tweets provincially to identify some of the provincial LHIN messaging. In June, there were six new videos posted to the South West LHIN You Tube page – they included the video from the Kincardine Council presentation, an update to the eShift video that debuted at the Quality Symposium, coverage from the June 22nd Oxford County engagement (in two segments), Jessica’s story from the June 22 event and a tour of the new north tower at LHSC with area Members of Provincial Parliament

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eHealth connecting South Western Ontario (cSWO) The Provincial Treasury Board/Management Board of Cabinet approved the cSWO project funding submitted by eHealth Ontario. The cSWO Steering Committee continues to meet to move forward with forming the governance structure and further defining the funding details. The overarching goal of the c-SWO project is to implement a robust, scalable, reusable, standards-based platform for integrated data exchange, called a “Regional Integration”. This will include regional cornerstone initiatives, integration with provincial assets as they become available, and foundation initiatives. The foundation initiatives are “quick wins” intended to support the near-term progress of sub-regional integration while accelerating adoption and clinical value for the entire region. The regional cornerstone initiatives are the major building blocks of the regional and provincial integrated Electronic Health Record (iEHR), will deliver adoption in the later stages of the project. The Initiatives are as follows;

Regional Cornerstone

Initiatives:

Foundation Initiatives: Provincial Asset Integration

1. c-SWO regional Clinical Data Repository (CDR)

2. c-SWO regional Web Portal 3. c-SWO regional Health

Information Access Layer (HIAL)

1. SPIRE Expansion Project 2. Clinical Viewer Project 3. Clinical Tool Adoption Project 4. ClinicalConnect Expansion

Project

1. Adoption of provincial assets determined in priority by eHealth Ontario and confirmed in the Planning Phase – ie. OLIS

Diabetes Registry (DR) In support of Ontario Diabetes Strategy, eHealth Ontario is implementing a Diabetes Registry and Portal, built upon a chronic disease management system. It will focus on diabetes and identify patients with the disease and assist primary care providers in offering best practices in diabetes care. As an Early Adoptor LHIN for the Diabetes Registry (the Champlain LHIN is the other one), the South West LHIN recommended 12 Primary Care Sites plus 4 related Diabetes Education Programs (DEPs) to take part in the Limited Production Release (LPR) of the Diabetes Registry. eHealth Ontario selected 6 of these Primary Care Sites. Information letters have been sent to these sites, as well as the 6 sites not selected for implementation at this time. Kick off meetings have been scheduled for the LPR sites for early July; these will be followed up by a series of meetings, leading to implementation in October 2011. The majority of the work required to implement the LPR phase will be performed by the vendor CGI and eHealth Ontario. The South West LHIN has requested to shadow this process to gain the knowledge and skills required to take the lead for implementation & adoption activities associated with the General Availability phase The South West LHIN project team has been meeting with eHealth Ontario’s Implementation & Adoption (I&A) team to discuss the General Availability phase where the remaining 750 primary care physicians in the South West LHIN will be offered the system. Tentatively, implementation for this phase will begin in January 2012. eHealth Ontario also wishes to leverage regional leadership demonstrated by the South

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West LHIN. Via an agreement to be negotiated, they would like the South West LHIN to take responsibility for implementation of the DR in LHINS 1, 3 and 4. South West Physician Interface to Regional EMR (SPIRE) The SPIRE project provides a secure electronic interface between hospitals’ Electronic Patient Records (EPR) and participating regional physicians’ offices, allowing radiology reports, lab results and notes to be delivered electronically instead of by fax. The SPIRE expansion proposal is in the final stages of signoff with the eHealth Ontario senior team. eHealth Ontario has directed us to begin high level planning so as not to lose momentum in the project timelines. Planning sessions with OntarioMD and LHIN 1 (Erie St. Clair) will begin the week of July 4th. Once we have the full approval we will begin the detailed planning sessions. Consumer eHealth Innovation Workshop On Thursday, June 30th, the South West LHIN brought technology vendors together with health service providers, physicians and others interested in emerging eHealth solutions at The University of Western Ontario’s Research Park Convergence Centre to learn about computer applications that affect consumers; this was the first in a series of five sessions to address various eHealth topics. This wasn’t just another Vendor Friday: The session featured the opportunity to learn about the latest developments in personal health records, patient monitoring, consumer navigation of the health care system, and mobile technologies. As well, the session explored how these and other tools support the South West LHIN’s eHealth Strategic Plan and address real issues affecting health care professionals in southwestern Ontario. Vendors presenting included Microsoft, TELUS, Thehealthline, Sensory Technologies, Sykes, Patientway, OTN and CareLink Advantage. Staffing Announcements Cathy Goetz-Perry joined the South West LHIN team on Monday, July 4th as a Planning and Integration Lead. Cathy’s portfolio will focus on Chronic Disease Prevention and Management. Cathy brings to the LHIN extensive experience and expertise in chronic disease prevention and management, patient self-management, self-management support and health promotion. Cathy has attained her Masters of Nursing and most recently completed her Ph.D. from the Faculty of Health Services School of Nursing - McMaster University focusing on chronic disease prevention and management in primary health care (PHC) and held a CIHR strategic fellowship in PHC. Many of you will recognize Cathy from her previous work for South West LHIN with the Aboriginal Primary Health Care Strategy and more recently as Project Lead on the Aboriginal Aging at Home Project. Cathy also worked as Director Research and Evaluation for VON Canada’s Chronic Disease projects, as Executive Director for VON – Grey Bruce, VP Patient Care Services at Louise Marshall Hospital in Mount Forest and as a Project Consultant with OHA Hospital Employee Relation Services. As part of Cathy’s portfolio, she will be the LHIN Planning and Integration geographic lead for the Grey Bruce area. Please join us in welcoming Cathy to the LHIN. Carol Mulder joined the South West LHIN team as the new Alternate Level of Care Lead (“ALC Lead”) on July 11th. The primary focus of this one year contract position will be to coordinate and align various initiatives and actions aimed at improving ALC in order to achieve stated goals and reach confirmed performance targets. Carol brings almost 20 years of experience in healthcare to the role of ALC Lead.

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Her work has focused on the use of existing data to improve the quality of healthcare. Most recently, she was on faculty at the University of the West Indies in Barbados, teaching graduate and undergraduate students in medicine and public health. Prior to that, she maintained an active consulting practice in healthcare information management. Carol has good relationships with many local providers and has worked with several other community and teaching hospitals, public health organizations and governmental bodies. She is comfortable with healthcare data of all kinds, the good, bad AND the ugly and actually enjoys helping coax it into useful and usable information for decision-making. She is glad to be back home in Canada and looking forward to working with new colleagues and old friends in the South West LHIN.

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Report to the Board of Directors 2011/12 Wait Time Strategy Allocation Plan

Meeting Date:

July 20, 2011

Submitted By: Mark Brintnell, Senior Director, Performance, Contract and Accountability

Submitted To:

Board of Directors


Suggested Motion THAT the South West Local Health Integration Network Board of Directors approves the allocation of $13,165,000 in one-time funding for key services, general surgery and paediatric surgery as outlined in the South West LHIN 2011/12 Wait Time Strategy Allocation Plan. Background The Ontario Wait Time Strategy (WTS) was created in 2005/06 to supplement hospital base programs and drive wait times down to provincial targets (or lower) for selected procedures and service areas in order to improve access. The WTS covers key services (cancer surgery, cardiac procedures, cataract surgery, hip and knee replacement, MRI and CT scans), general surgeries, paediatric surgeries, and time spent in emergency rooms. A wait time is the amount of time you have to wait for your surgery or exam and is measured from the time your surgery or exam is booked until the time you receive it. Wait times are typically reported as the point at which nearly all patients (90%) have completed surgery or have had their exam. Today, only hospitals that get Ontario government funding to provide extra procedures have to report wait times. Wait times are a symptom of a broader problem: managing how patients get access to care. The South West LHIN is accountable for wait time targets for key services (general and paediatric surgery are not included) of the Ontario WTS through our Ministry-LHIN Performance Agreement (MLPA). The MLPA proposed targets for 2011/12 (appendix A) have recently been negotiated and will come forward to the LHIN Board as part of the approval phase of the MLPA. Hospitals have a base volume that is supported through their base allocation. Strathroy Middlesex General Hospital is the exception pertaining to the hip and knee program. WTS incremental volumes (one-time funding) are determined each year. The provincial Access to Care Wait Times area of the Ministry of Health and Long-Term Care considers capacity information from LHINs and makes LHIN-level decisions based on wait time performance, capacity and geographic allocation. Note: cancer surgery incremental allocations are determined by Cancer Care Ontario and cardiac procedures are determined through the provincial priority programs process and not by the LHINs. Wait time performance is the main factor which does result in a redistribution of volume between procedure areas across the province. For example, the South West LHIN is receiving a slightly higher allocation for hip and knee and CT hours but a lower allocation for cataracts and MRI hours compared to last year. This is a great example of how the overall allocation may be stable but the procedure areas shift. Hospitals may plan for a certain allocation but the actual volumes cannot be assumed.

Agenda Item 5.1

Page 2 of 2

Current Status For 2011/12, the South West LHIN received a total funding allocation of $12,356,000 for key services, $588,900 for general surgery and $220,100 for paediatric surgery. All investments are for incremental (i.e. one-time) volumes/hours only. In comparison to the 2010/11 allocations, the South West LHIN is targeted to receive a similar allocation for key services, a 23.9% lower allocation for general surgery, and a similar allocation for paediatric surgery. Although the dollar value for key services is similar to last year, the individual procedure volumes have changed as follows:

- cataracts: 18% lower - hip and knee: 12.5% higher - CT hours: 30% higher and MRI hours: 13.5% lower

The LHIN is working with the MOHLTC to utilize unallocated new MRI funding from the two new MRIs (London and Stratford) coming on-line in 11/12 Q3 to off-set the lower WTS allocation. The South West LHIN used the following allocation principles and approach to determine the local hospital-level allocation plan:

Allocation Factors: 1. Driving forward the goal of the WTS to reduce wait times, enhance access and improve

patient satisfaction. 2. Focus on process and outcome performance improvement. 3. Care closer to home and local access points.

Allocation Steps:

1. Hospital capacity surveys were used by the LHIN to determine what capacity and need exists across the LHIN and within each hospital site.

2. Access to Care and Wait Times (MOHLTC) identified LHIN-level allocations based on capacity survey results from across the province, wait time performance against established provincial targets, and access based on geographical distribution.

3. The South West LHIN used our LHIN-level allocation, hospital base program size, current wait time performance and established targets, and geographical points of access as factors in distributing service area volume across hospital sites in the LHIN.

In keeping with past practice the proposed hospital-level allocation plan was shared with our hospital partners to ensure they were aware of the preliminary allocations in order to prepare accordingly. The hospitals are all aware the plan is draft and subject to change until final approval letters are issued. Next Steps The LHIN will be completing an in-year reallocation process as required. The purpose of the in-year reallocation step is to ensure all approved volumes are delivered within the fiscal period. If for some reason a hospital is unable to complete its total incremental allocation (following completion of its base volume), another hospital will be identified to deliver the volume and a reallocation will occur. The South West LHIN worked with each WTS hospital to set wait time targets for key services within the 2011/12 Hospital Service Accountability Agreement Amending Agreement. The South West LHIN will be monitoring progress against these targets as part of our regular performance management process. Attached: Appendix A – South West LHIN 2011/12 WTS Performance Indicators and Targets Appendix B – 2011/12 WTS Allocation Plan

MOHLTC\HSIMI\HA and HDFinal

May 13, 2011 1

Appendix A

Performance Indicator Provincial TargetSouth West LHIN 2007/08 Starting

Point

South West LHIN 2010/11 Annual

Performance Result

Ontario 2010/11 Annual

Performance Result

South West LHIN Most Recent Performance

Result

South West LHIN 2011/12 Proposed

Target

90th Percentile Wait Times for Cancer Surgery 84 days 104 93 60 104 80

90th Percentile Wait Times for Cardiac By-Pass Procedures 182 days 56 49 49 46 46

90th Percentile Wait Times for Cataract Surgery 182 days 213 93 123 99 85

90th Percentile Wait Times for Hip Replacement 182 days 310 186 181 221 178

90th Percentile Wait Times for Knee Replacement 182 days 369 198 197 209 182

90th Percentile Wait Times for Diagnostic MRI Scan 28 days 169 67 116 67 44

90th Percentile Wait Times for Diagnostic CT Scan 28 days 64 29 33 28 25

South West LHIN Performance Agreement - Wait Time Strategy Performance Indicators

Appendix B - 2011/12 Wait Time Strategy Allocations

Facility Number

HospitalBase

Cataract Volumes

Total Incremental

WTS Cataract Volumes Rate $750 (Tertiary

$625)

Most Recent Wait Time (90% days)

Base Hip and Knee

Volumes

Total Incremental

WTS Hip and Knee Volumes

(Primary) Rate $6,882

(Tertiary $8,930)

Total Incremental

WTS Hip and Knee

Volumes (Revision)

Rate $8,796 (Tertiary $10,776)

Total Incremental

WTS Hip and Knee Volumes

Most Recent Wait Time (90% days) Hip / Knee

Base CT Hours

Total Incremental

WTS CT Hours Rate $250


Base MRI Hours

Total Incremental

WTS MRI Hours Rate $260


684 INGERSOLL Alexandra Hospital 171 140 52

633 CLINTON Public Hospital 476 214 66

955OWEN SOUND Grey Bruce Health Services

1,881 144 93 529 204 6 210 113 / 153 2,470 136 17 2,080 4,040 77

936 LONDON Health Sciences Centre 968 290 10 300 250 / 268 17,199 875 55 8,320 6,300 52

714LONDON St. Joseph's Health Care, London

3,830 1,184 132 278 0 0 0 116 / 134 2,350 250 42 4,160 3,340 66

793ST THOMAS - Elgin General Hospital

154 20 0 20 111 / 91 2,500 96 25

813 STRATFORD General Hospital 466 consolidated

with Clinton 62 248 166 4 170 221 / 222 2,236 123 18

814STRATHROY Middlesex General Hospital

487 80 77 174 6 180 164 / 162 1,920 106 14

824TILLSONBURG District Memorial Hospital

167 45 90 tbc 100 tbc

946KINCARDINE South Bruce Grey Health Centre

2,210 127 12

890 WOODSTOCK General Hospital 819 90 51 120 40 1 41 211 / 222 2,223 120 12

8,297 1,897 2,297 894 27 33,108 1,933 14,560 13,680

Base Volume

One-Time Incremental

WTS Outpatient Volumes

Rate Base Volume



Rate Base Volume


WTS Inpatient Volumes



Total One-Time

Incremental WTS

Volumes

Inpatient RateOutpatient

RateBase Volume



Rate Base Volume





Total One-Time

Incremental WTS

Volumes

Inpatient Rate

Outpatient Rate

676 HANOVER and District Hospital 1 7 $654 36 17 $1,056 0 4 0 4 $6,619 $591 44 20 $1,110

955OWEN SOUND Grey Bruce Health Services

11 11 $654 201 65 $1,056 0 2 4 6 $6,619 $591 175 56 $1,110 tbc 2 6 8 $3,136 $1,348

813 STRATFORD General Hospital $1,056 248 23 $1,110 95 0 22 22 $3,136 $1,348

814STRATHROY Middlesex General Hospital

13 11 $654 99 33 $1,056 2 5 1 6 $6,619 $591 68 37 $1,110 31 6 7 13 $3,136 $1,348

824TILLSONBURG District Memorial Hospital

84 20 $1,056 6 4 0 4 $6,619 $591 72 2 $1,110 21 0 7 7 $3,136 $1,348

890 WOODSTOCK General Hospital 48 6 $654 131 3 $1,056 40 4 3 7 $3,136 $1,348

936 LONDON Health Sciences Centre 103 15 $839 491 25 $2,153

176 50 1,042 163 8 15 5 20 607 138 187 12 45 57SOUTH WEST LHIN TOTAL

Cholecystectomy Surgery Intestinal Surgery Groin (Inguinal) Hernia Repair Ventral Hernia Repair

Facility Number

Hospital

i) Cataract, Hip and Knee, MRI and CT Allocations

SOUTH WEST LHIN TOTAL

ii) General Surgery Allocations

Anorectal Surgery

Appendix B - 2011/12 Wait Time Strategy Allocations

Base Volume





Total One-Time

Incremental WTS

Volumes


RateBase Volume





Total One-Time

Incremental WTS

Volumes


RateBase Volume


WTS VolumesRate Base Volume





Total One-Time

Incremental WTS

Volumes

Inpatient Rate

Outpatient Rate

SOUTH WEST LHIN

676 HANOVER and District Hospital 7 0 1 1 $2,478 $1,063

936 LONDON Health Sciences Centre 349 15 85 100 $2,478 $1,422 223 35 $1,259 47 0 5 5 $3,167 $1,580

7 0 1 1 349 15 85 100 223 35 47 0 5 5

Base Volume





Total One-Time

Incremental WTS

Volumes


Rate

SOUTH WEST LHIN

936 LONDON Health Sciences Centre 29 0 5 5 $3,963 $1,781

29 0 5 5SOUTH WEST LHIN TOTAL

Hypospadias Repair

Ophthalmology Surgery

All Ophthalmology Surgery procedures (inclusive of Strabismus Repair)

All Dental procedures (inclusive of Extractions/Restorations)

Urology Surgery

iii) Paediatric Surgery Allocations

Facility Number

Hospital

SOUTH WEST LHIN TOTAL

Orchiopexy

Facility Number

Hospital

Extractions/Restorations only

Dental/Oral Surgery Urology Surgery

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