1 Central East Local Health Integration Network CEO Report to the Board September 26, 2012 Table of Contents Transformational Leadership ............................................................................. 2 Service and System Integration......................................................................... 4 Mental Health and Addictions ............................................................................ 6 Integrations ....................................................................................................... 7 Aboriginal Services ........................................................................................... 9 IHSP Strategic Aims ........................................................................................ 10 Enablers – eHealth.......................................................................................... 17 Community Engagement ................................................................................. 22 Operations ...................................................................................................... 24 Appendices ..................................................................................................... 26
Transcript
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Central East Local Health Integration Network CEO Report to the Board
September 26, 2012
Table of Contents
Transformational Leadership ............................................................................. 2 Service and System Integration ......................................................................... 4 Mental Health and Addictions ............................................................................ 6 Integrations ....................................................................................................... 7 Aboriginal Services ........................................................................................... 9 IHSP Strategic Aims ........................................................................................ 10 Enablers – eHealth .......................................................................................... 17 Community Engagement ................................................................................. 22 Operations ...................................................................................................... 24 Appendices ..................................................................................................... 26
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Central East Local Health Integration Network CEO Report to the Board
September 26, 2012 The following is a compilation of some of the major activities/events undertaken during the month of September in support of the Central East LHIN’s Strategic Directions;
a) Transformational Leadership, b) Quality and Safety, c) Service and System Integration, and d) Fiscal Responsibility.
Transformational Leadership: The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Service and System Integration/Quality and Safety: The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Fiscal Responsibility: The LHIN organization will maintain a primary focus on quality as a driver for cost-effectiveness and measure cost efficiency against our strategic priorities. The Central East LHIN is working towards achievement of the Strategic Aims of the 2010-2013 IHSP; 1. Save a Million Hours of Time Patients Spend in the Emergency Departments by 2013; and 2. Reduce the Impact of Vascular Disease by 10% by 2013 (2010-2013 IHSP).
Transformational Leadership The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Central East LHIN Doctor Talks: The Central East LHIN’s Primary Care Physician Leads Dr. Robert Drury and Dr. Christopher Jyu are working with the LHIN staff and in partnership with the Ontario Medical Association (OMA) to plan the first ever Doc Talks, a series of physician led OTN-supported webinars being held July through October of this year. This Continuing Medical Education (CME) accredited Doc Talks series will provide primary care physicians in Central East with an opportunity to share their expertise and inform the development of the Central East LHIN’s next Integrated Health Service Plan (IHSP). To date, four of five priority topic sessions have taken place:
July 30 – Mental Health and Addictions;
August 13 – Frail Seniors;
August 27 – Diabetes and Vascular Health; and
September 10 – Palliative and End of Life Care.
The most recent Palliative and End of Life Care session included physician facilitator Dr. Christopher Jyu, panelists Dr. Howard Burke and Dr. Rahim Abdulhussein and special guest Dr. Samir Sinha, Seniors Care
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Strategy Lead for the Ministry of Health and Long-Term Care. Physician panelists provided two very rich patient stories that sparked robust discussion and participant contribution. The final Primary Care Doc Talks session will be held on October 15. This session will be moderated by Dr. Robert Drury and Dr. Christopher Jyu, with panelists Dr. Paul Caulford and Dr. Don Harterre. Primary Care LHIN Lead update: The Primary Care Working Group (PCWG) is working with the Central East LHIN Primary Care Leads – Dr. Robert Drury and Dr. Christopher Jyu in the redesign of their Terms of Reference to reflect new provincial primary care priorities and improve the ability of the Working Group to provide informed advice to the LHIN. The PCWG hopes to ratify its updated Terms of Reference by November. Current work of the Primary Care Leads has focused on developing the networks and contacts needed across the LHIN to advance both LHIN and provincial primary care level priorities. 2013-2016 Integrated Health Services Plan (IHSP) Strategic Aims: The Central East LHIN's Integrated Health Service Plan 2013-16 will provide a blueprint for change for the local health care system outlining shared priorities, strategies and proposed outcomes. The document will also form the basis of accountability agreements with all Central East LHIN health service providers. The IHSP is a strategic document which will be used to guide the activities of the Central East LHIN and its stakeholders over the next three years from 2013 to 2016. The development of the IHSP’s strategic aims is well underway. A project charter and a project plan have been created. The Triple Aim Framework of improving the health of the population, enhancing the patient experience and reducing, or at least controlling, the per capita cost of care continues to be used as a foundation to craft strategy. A provincial environmental scan has been completed based on 2006 and 2011 census data. Decision Support and the team leads from System Design and Implementation will prepare a focused and detailed analysis throughout August to support the preparation of the 2013-2016 strategic aims. To ensure that the strategic aims have the greatest possible impact, the IHSP will focus on:
1) Mental Health and Addictions, 2) Diabetes and Vascular Health, 3) Frail Seniors; and 4) Palliative and End of Life Care
The IHSP is being developed in partnership with health care providers and the broader community. The “Doc Talks” series will provide primary care physicians in Central East with an opportunity to share their expertise and inform the development of the IHSP. To develop the strategic aims, SDI team members are working closely with a variety of advisory bodies including: the Mental Health & Addictions Network, the Vascular Health Coalition, the Regional Specialized Geriatric Services entity and the Central East Hospice Palliative Care Network. Aboriginal Circles and the French Language Health Planning Entity # 4. Meetings are to be held with the e-Health Steering Committee to get their input on how e-Health initiatives can support the Central East LHIN’s strategy. The experiences of the general population will be included in the IHSP via an online survey that is to be posted later this month. The core elements of the IHSP will be presented at the next board meeting. Upon Board approval, a broad community engagement process will begin. Further engagement includes dialogue with the local Municipal Councils and the Governance Advisory Councils. LHIN staff will garner feedback on the draft strategic aims from a large number of planning partners such as the Health Professionals Advisory Committee and health service providers. A hospital roadshow will be initiated to engage patients and their families as well, with a draft of the IHSP to be presented to the Central East LHIN Board for approval at the November Board meeting. It will be submitted to the Ministry of Health and Long-term Care on November 30, 2012 for their review and comment.
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Service and System Integration
The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Stocktake Report: The Stocktake report is the unified report of all LHIN activities and performance to the Ministry of Health and Long-Term Care. It is collaboratively completed by representatives of all LHIN portfolios to communicate our strategies and plans. The Stocktake report includes indicators related to the following initiatives and agreements:
Ministry LHIN Performance Agreement (MLPA)
Pay-for-Results (P4R)
Nurse Practitioner Supporting Teams Averting Transfer (NPSTAT)
Community Care Access Centre (CCAC) Wait Times
Mental Health and Addictions
Excellent Care for All Act (ECFAA)
The Summer Cycle Stocktake report template was published by the Ministry of Health and Long-Term Care on August 14 and the completed report was submitted to MOHLTC on August 28. On October 3, representatives of the Central East LHIN will meet with Assistant Deputy Minister, Catherine Brown, to discuss LHIN performance. Key messages for this meeting include the following:
Percentage Alternative Level of Care (% ALC) days remained above the provincial target in Q4 11/12 for all LHINs. Compared to Q3 11/12 where the majority of LHINs saw an increase, except for Central East who had the largest decrease of 4.7% - the most improved LHIN across the Province in Q4. The Central East LHIN’s % ALC days sits at 13.03%, still well above the Provincial target of 9.46%.
For Admitted Emergency Department Length of Stay (ED-LOS), Central East wait times decreased from 48 hours in Q4 11/12 to 33.7 hours in Q1 12/13. While Central East performance is below its MLPA target, it still remains above the provincial interim target of 25 hours.
For Non-Admitted High Acuity ED-LOS, Central East is below the LHIN target (7 hours) and the provincial target (8 hours).
Time to Inpatient Bed has seen an overall improvement of 9.7 hours over baseline (35.2 hours). Of particular note, Rouge Valley Ajax Pickering saw a decrease of 19 hours while Ross Memorial Hospital decreased by 27.6 hours over last quarter.
Central East LHIN met all of its Surgical and Diagnostic wait times for Q1 12/13. Home First: Planning for a modified roll-out to Ontario Shores Centre for Mental Health Sciences (OSCMHS) has begun. The Central East Community Care Access Centre (CECCAC) and OSCMHS staff have met to map out the “as is” process in the hospital and are working together to determine the “to be” business processes. The roll out process will be initiated in September. Regional Specialized Geriatric Services Entity: The Central East Regional Specialized Geriatrics Services (CE RSGS) Governance Authority (GA) will be submitting their initial high-level content for the next Integrated Health Service Plan (IHSP) to be followed by a more detailed operational plan that will be included in the 2013 Annual Business Plan.
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Behavioural Supports Ontario (BSO) Program: During August, activity in the Behavioural Supports Ontario (BSO) program in Central East LHIN focused on the development of cluster-based BSO Implementation Teams. These teams are comprised of members from each of the Integrated Care Team partners – Long-Term Care Home (LTCH) staff from Early Adopter LTCHs; nurse practitioners from NPSTAT (Nurse Practitioners Supporting Teams Averting Transfers); psycho-geriatric resource consultants (PRCs); and hospital-based geriatric mental health outreach team staff. The implementation teams held initial meetings in August and quickly completed a number of deliverables with support from the Central East LHIN BSO staff members. This included preparing Terms of Reference, identifying and confirming a chairperson and the membership, updating the implementation action plan with a number of activities and creating strategies for engaging Phase 2 LTCHs – homes that are implementing BSO but are not one of the 13 Early Adopter homes. The teams drafted a blueprint for Phase 2 homes to follow in implementing BSO. By request, as an early adopter LHIN, Central East LHIN staff participated in the design of the qualitative information gathering process being conducted by the Hay Group consulting firm as part of the formal evaluation of the BSO. In August, it was confirmed that Health Quality Ontario (HQO) and the Central East LHIN Behavioural Supports Ontario (BSO) project would be co-hosting a joint Residents First/BSO quality improvement training workshop for developing Improvement Facilitators in November. The BSO Education Committee confirmed the 2012/13 training schedule for three of the BSO-related courses (PIECES, UFIRST, Montessori) and also Quality Improvement. The schedule includes 25 sessions and will accommodate 835 attendees. Assisted Living Services for High Risk Seniors: The Assisted Living Services for High Risk Seniors (ALS-HRS) program offered by Community Care Durham (CCD) is currently serving a total of seventy eight clients in the Oshawa and Whitby Hubs. As of August 10, 2012, the CCD program is at full capacity and having to place clients on a waitlist. The VON Assisted Living Services program is serving a total of ninety seven clients in the North Durham, Scarborough, Peterborough and Lakefield Hubs. Staff have been receiving notes of appreciation from clients, caregivers and family members for providing timely care, scheduled/unscheduled supports and visits.
Geriatric Assessment and Intervention Network Clinics (GAIN): With the new Regional Manager for GAIN well established in her position, there is significant activity underway. A planning day for the four GAIN teams has been scheduled for November 30. This will be an opportunity for all disciplines to collaborate on continuing education and quality improvement. A survey is being distributed amongst primary care providers to better understand how GAIN and primary care can work better together.
GAIN Nurse Practitioners met in August and commenced work on a template for dictation, a role description and an orientation package for new NPs (also applicable to other disciplines). These tools will assist to clarify roles, improve efficiency of some of the administrative tasks carried out by NPs and help newcomers to GAIN to integrate effectively. These tools will be adaptable to other disciplines and meetings will be held with other groups to follow a similar process. Work has been underway on a generic referral process flow chart and this document has now been approved by the Operations Committee for inclusion in the GAIN procedure manual. Efforts will continue in identifying opportunities to develop standard processes to support the teams.
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At the suggestion of the teams, a common GAIN poster is being explored that can be used in conjunction with other posters, or as a stand- alone to describe GAIN services to a variety of audiences. The intention will be to professionally produce four posters (one per team) that will assist teams with their own efforts to share information about GAIN
GAIN team members have also been invited to join a research exercise exploring the experience of seniors with a geriatric assessment and intervention process. Through this study the impact of GAIN recommendations on the lives of our patients and the barriers to following through with recommendations will be explored. Several new team members were welcomed recently. The Peterborough GAIN team welcomes Lorene Racher, CCAC Case Manager and the Lakeridge Health GAIN team welcomes Andrea Dion, Physiotherapist and Mary Ellen Henderson, CCAC Case Manager. Tamra Laughlin, Program Director, CE-CCAC joins the Operations, Performance and Sustainability (OPS) Committee, replacing Laszlo Cifra. Laszlo has played an important role in the visioning and start-up of GAIN. Laszlo was thanked for his wisdom and knowledge over the past few years of GAIN team development.
Mental Health and Addictions Ontario Common Assessment of Need: A “wrap-up” meeting is scheduled for October 18 with CCIM staff, the Central East LHIN and members of the Ontario Common Assessment of Need (OCAN) steering committee. The purpose of the meeting is to conclude the implementation project, review the results and discuss sustainability options going forward. Discontinuation of OxyContin: The delisting and discontinuation of the drug OxyContin remains as an issue of great concern to the Ministry of Health and Long Term Care and to the LHINs. There have been few systemic pressures noted in Southern Ontario. OTN equipment has been purchased; a steering committee has been struck of LHIN Senior Directors and staff along with staff from the MOHLTC and Ontario Telemedicine Network. The distribution of equipment has been based on the criteria and strategy developed for the province by the Steering Committee. The first wave of OTN distribution has occurred, with the Pinewood Centre receiving one Clinical Unit. Central East LHIN staff worked with OTN to submit a list of suggested sites for the second wave of distribution. These sites were not approved due to the level of need assessed according to the assessment matrix. The matrix included factors such as waitlists for service, requests for service and service numbers. There simply was no data supporting additional OTN capacity related to the OxyContin issue in the Central East LHIN at this time. These sites may be reassessed in the future, depending on any changes in the approved sites. Although many LHINs, including Central East, have noted pressures in many First Nations communities, this equipment cannot be allocated without a commitment on the part of the Federal Government to cover additional costs. This commitment has not been made as of yet, so some machines have been set aside pending the conclusion of the negotiations between the provincial and federal levels of government. It is our understanding that a provincial panel on OxyContin and opiate use have produced and submitted a report to the Minister, which is yet to be publicly released. Based on the recommendations contained in this report, the Ministry has directed all of the LHINs to target a specific portion of the expected 4% community increase and assign this to substance abuse services related to opiate use. These are to be ancillary services such as case management and other supports and are to be targeted to opioid treatment response and programs for pregnant and parenting women with addictions. The Ministry arrived at the LHIN amounts based on per capita funding. Central East LHIN staff are currently working with our Integrated Substance Abuse Providers to plan these services.
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The LHIN is continuing to submit bi-weekly reports regarding the status of the OxyContin issue in accordance with Ministry protocols. Central East LHIN staff have been communicating with health service providers to canvas for any new pressures being faced as a result, on a regular basis. Scarborough Addictions Expansion: Pinewood is now well underway with their plans for the Scarborough Addictions System expansion, which will include a plan for Substance Abuse Withdrawal, Opioid Treatment Response and programs for pregnant and parenting women with addictions. A more detailed report will be provided next month. Assertive Community Treatment Team (ACTT) Value Stream Mapping: A business case is expected from the Durham ACTT Network and Ontario Shores regarding their plan to move forward with implementing the aims which were developed as a result of the Value Stream Mapping event that was held in March 2012. This work will be done under the auspices of the Transitions in Care Committee. Central East LHIN Hospital to Home – ED Avoidance Coalition Steering Committee: Hospital to Home or “H2H” is an embedded Emergency Department Team that builds on the model established by the “ED Avoidance Coalition” (2009). There are two teams – one in the Durham Cluster and one in the Northeast Cluster. The Durham team is embedded in the Emergency Department at Lakeridge Health Oshawa, and consists of six case management positions allocated to the Community Treatment Order Program (CMHA-Durham), the Pinewood/Destiny Centre (Lakeridge Health) and the Community Crisis Team, (Durham Mental Health Services). The purpose of the team is to connect with an Emergency Department patient with Mental Health and/or Substance Abuse issues and work with them to avoid subsequent visits. The Northeast Team is located at Peterborough Regional Health Centre and Ross Memorial Hospital, where a Case Manager is embedded in the Emergency Department. There were not sufficient funds to provide the entire range of services which could extend to substance abuse case management and/or Community Treatement Order case management. The ‘Hospital to Home Project’ has reported a robust level of activity at all three sites. The next meeting of this group will take place on September 21, 2012. Commencing on April 1, 2012 data was collected and may now be entered into the newly developed project scorecard. Nurses in Schools: There has been further communication from the Ministry of Health and Long-Term Care regarding the specific practice elements of the program. The CECCAC held a further planning meeting with all stakeholders on September 5. Exploring Opportunities to Serve People living with Acquired Brain Injury (ABI) and Mobility related Disabilities Meeting: A meeting was held on September 10, and focussed on opportunities for improvement at a systems level. Members of this group have been meeting with cross-sectoral and long-term care partners to explore the issue of younger adults with ABI being housed in long-term care homes. Central East LHIN staff have been kept apprised of the ongoing discussions.
Integrations Community Health Services Integration Strategy: The purpose of the project is to implement a facilitated integration process to achieve the ‘Community First Strategic Aim’ in each of the Durham, Scarborough and Northeast Service Clusters. The project will result in the identification of a preferred community health services integration model for each service cluster.
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Strategic Aim: Design and implement a cluster-based service delivery model for Community Support Services and Community Health Centre agencies by 2015 through integration of front-line services, back office functions, leadership and/or governance to:
• improve client access to high-quality services, • create readiness for future health system transformation and, • make the best use of the public’s investment.
Durham Cluster Process The facilitated integration process is continuing with the Integration Planning Team (IPT) meeting weekly. In the months of August and early-September, the Durham Community Health Services (CHS) planning activities were focused on community stakeholder engagement and the identification of emerging integration opportunities. A governor liaison check in meeting was held on August 20 at Sunrise Seniors Place as an opportunity to gather feedback from the Board representatives on the work of the IPT. Feedback from all key stakeholders has been collated and is being reviewed by the IPT which will guide the ongoing discussions for the next few meetings. Next steps include preparing the recommendations for emerging integration options which will be discussed at the next Governors’ check in meeting on October 25. Integration Planning Process in Haliburton County Local organizations providing health care to the residents of Haliburton County are working together to improve access and ensure that their organizations are ready to meet the needs of a changing population by becoming part of a Central East LHIN Integration Planning Team (IPT). The work being done by the Haliburton County IPT is part of the broader Community Health Services Integration Strategy approved by the Central East LHIN Board in February 2012. On August 10, a meeting of the Governors Liaison group, chaired by Margaret Risk, was held to inform governors of the status of the project, to share next steps and to solicit feedback to ensure all parties were moving in the same direction. There are additional meetings slated for September, October and January. The IPT has been working diligently at completing documentation of current service profiles by organization and developing two surveys – one for organization clients/community members and another for organization staff, volunteers and Board members. Staff from the Central East LHIN will be presenting to the Haliburton County Council on September 26. Canadian Mental Health Association (CMHA) – Northeast Cluster Integration: Central East LHIN staff are continuing to follow the Northeast CMHA Cluster Integration. The Joint Governance Group is continuing to meet on a bi-weekly basis in accordance with the approved Integration Plan, to date, the integration schedule is on track, and the process continues to move forward. Central East Hospice Palliative Care Network Steering Committee: The steering committee continues to be engaged in discussions regarding the Hospice Palliative Care Priority, as part of the Integrated Health Services Plan, including dialogue surrounding the draft aim: “Increasing the number of people who receive hospice palliative care in the community and die at home, by choice, by 10% by 2016.” Additionally, the Network has reviewed its Terms of Reference to support current realities and priorities such as clearly outlining the Network’s accountability to the LHIN, the Central East LHIN’s 2013-2016 IHSP, and the Ministry’s Declaration of Partnership document. The Network has also revised its Expression of Interest for membership, which has been distributed to the broader community. There are three (3) vacant positions to be
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filled. Applications are due by the end of September. Eric Hong’s term as Network Chair is complete. Linda Sunderland will now succeed to this position. Palliative Education: The Central East LHIN’s System Design and Implementation and System Finance and Performance Management sections are working together to support the roll of funding letters for palliative education and consulting services to designated health service providers. The CEHPCN Steering Committee and Education Working Group will continue to discuss options for ongoing administrative support, automated registration, website reorganization and program evaluation. The LHIN continues to work towards redesigning service delivery and support for physician palliative education. This includes redesigning and improving physician education offerings; aligning Palliative Pain and Symptom Management Consultant (PPSMC) resources with growing Community Palliative Care Nurse Practitioner Program (CPNP) and reinstating palliative education offerings. A second meeting has been organized to discuss next steps for physician education with a broader group. Objectives include:
To discuss current and future state palliative care physician education in the Central East LHIN.
To provide a forum for feedback on future palliative care needs and capacity building for the region.
To review and identify coordinated opportunities with the Cancer Care Ontario initiative.
To highlight the Community Palliative Care Nurse Practitioner Program. Community Palliative Nurse Practitioner Program: In mid-August, LHINs received a formal briefing note from the MOHLTC confirming the allocation of NP palliative care positions to enhance palliative care, facilitate care connection across sectors and promote continuity of care for complex high risk individuals. This funding will help support the Community Palliative NP program expansion across the LHIN as initially set out in the project plan and associated project status reports. The LHIN and CCAC will continue to discuss expectations regarding communication and program reporting.
Aboriginal Services Central East LHIN First Nations Health Advisory Circle: Central East LHIN staff are working to firm up dates for both the Central East LHIN First Nations Health Advisory Circle and the Annual Joint Health Advisory Circle meetings.
Central East LHIN Métis, Inuit and Non-Status Circle: The next meeting of the Central East LHIN Métis, Non-Status Health Advisory Circle is scheduled for September 19, 2012, a report on the discussions will come forward in next month’s CEO report.
Aboriginal Workers in the Schools: Central East LHIN staff have a meeting scheduled for September to discuss this program with representatives of the Ministry of Children and Youth Services (MCYS). The program is being offered across the Central East MCYS region. On August 28, a joint teleconference was held with the Mental Health and Addiction Leads from the North Simcoe Muskoka, Central and Central East LHINs to discuss joint communication strategies in working together with other ministries involved in the implementation of the province’s mental health strategy. The other ministry area boundaries include all three (3) of our LHINs. It was decided that the staff leads would request to meet with representatives of these other ministries to share information and develop common work
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plans on a quarterly basis. This request to meet will be extended after each of the three (3) LHINs involved have completed their individual meetings with MCYS staff.
French Language Services Francophone community engagement: Francophone focus groups are on track for IHSP engagement. A stakeholder engagement group has been successfully organized in Scarborough with approximately 20 Francophones, Francophone leads and members of the Francophone Community from the Scarborough area. Two other focus groups are scheduled to meet in early-September in Peterborough and Durham region. In order to facilitate an active offer to Francophones on the IHSP engagement, the English survey has been adapted in French and posted on the Central East LHIN website. Surveys in French are currently being received and French Language Services staff will facilitate the translation process to ensure that all Francophone feedback is received by the planning team. Active offer strategy through the Central East LHIN website – Web Alerts: Each time the Central East LHIN launches a web alert to the website subscribers, an active offer of French goes along with the message to direct all interested recipients to the French Language Services Coordinator for information en Français. Staff will be keeping up with the new information posted to the website to assist any Francophone stakeholders with questions going forward, translations have included information released regarding Behavioural Supports Ontario updates, Community Health Services Integration strategy updates and the Get Connected with Care page. Staff have been working through several presentations to translate and share with Francophone stakeholders which speak to Central East LHIN activities. The listing includes Health Equity Impact Assessment considerations for French Language Services, IHSP 2013-16 Doc talk releases, and a Central East LHIN overview for Francophones.
Central East LHIN Visibility in the GTA Francophone Community: Central East LHIN visibility is increasing in the GTA Francophone Community through the FLS staff involvement in francophone networking, including gathering and networking of Francophone physicians and health professionals in Toronto and participation in Francophone Committees on Mental Health at CAMH in August. Francophone Stakeholders of Scarborough and Durham regions have been mapped; currently FLS staff have developed contact listings for key stakeholders.
IHSP Strategic Aims Save a Million Hours of Time Spent in the Emergency Room Department Emergency Department Pay for Results (P4R) Program: As discussed at the August Central East LHIN Board meeting, the Pay-for-Results (P4R) funding allocations were recently released by the Ministry of Health and Long-term Care. The P4R program has changed significantly for 2012-2013, the fifth year of the program. Many of the changes recommended by LHIN Emergency Department (ED) Physician Leads and Performance Leads were incorporated into the new methodology. The program has been simplified with a variety of funding streams (fixed, short-stay unit, physician initial assessment and variable) rolled into one. A total of $93 million will be provided provincially this year to 74
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hospitals/sites. Funding allocations for each LHIN are now based on individual hospitals’ relative performance, amongst the 74 participants, in the same five indicators as previous years:
I. Emergency Department (ED) Length of Stay (LOS) for admitted patients; II. Emergency Department (ED) Length of Stay (LOS) for non-admitted complex patients;
III. Emergency Department (ED) Length of Stay (LOS) for non-admitted minor patients; IV. Time to Physician Initial Assessment (PIA); and V. Time to Inpatient Bed.
Both current performance and improvements in performance over time are taken into account so that hospitals that are already high performers are rewarded. The Central East LHIN’s allocation is $10,294,392. While the methodology provides a basis for how each hospital/site performed, LHINs may choose to allocate funds based on their discretion and respective system pressures. At the August board meeting, funding for the following shared projects were approved in principle. The intent is to take this funding “off the top” of the $10.2M allocation.
Project Provisional Funding Allocation - August
Final Funding Allocation - September
Emergency Department (ED) Conference $5,000 $5,000
Small Hospital: Campbellford Memorial Hospital (CMH)
$125,000 $83,400
Small Hospital: Haliburton Highland Health Services (HHHS)
$125,000 $125,000
Short-stay Unit at Rouge Valley Health System (RVHS) 5 of 10 beds
$733,500 $733,500
Bed Utilization Project $1,014,000 $1,055,400
Total $2,002,500 $2,002,300
Percentage (%) of Central East LHIN Allocation 19% 19%
Funding for Individual Hospitals $8,291,892 $8,292,092
A meeting was held with senior staff from each of the 11 participating hospital sites on August 23. While additional detail and discussion is required on the Bed Utilization Project, hospitals generally felt these were acceptable expenditures. Because funding is being provided late in the year, Campbellford Memorial Hospital delayed the start of their project, and therefore only required $83 400 for fiscal year 12/13. The remaining funding has been reallocated to the Bed Utilization Project, for a total of $1,055, 400, as this is a significant undertaking. For the remaining $8.2M, provisional allocations by hospital were made based on replicating a similar distribution pattern as was used for the original $10.2M, recognizing each site’s performance and contribution. Support was expressed for this methodology. On August 23, 44 proposals from the six Central East LHIN P4R participating hospitals were reviewed, with representatives from all hospitals participating. Many of the projects focus on establishing or continuing Emergency Department initiatives that improve patient flow, such as a transfer nurses, nurse navigators, porters, and crisis workers.
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Quality improvement initiatives that leverage LEAN methodology were also commonly proposed. Others added physician hours or are improving human resources practices in an effort to retain nurses. Rouge Valley Health System (RVHS) requested use of a significant portion of their allocation to cover the remaining cost of operating their 10 bed short-stay unit as this has contributed greatly to improving their performance. Discussions of these projects led to some revisions of proposals. On August 31, the 2012-13 P4R Action Plan having been reviewed and approved by the Central East LHIN CEO as per delegation by the Board at its August meeting was submitted to the Ministry of Health and Long-Term Care. The following tables outline projects by site that were included in the Action Plan:
Campbellford Memorial Hospital Proposed Funding
Nurse Practitioner in the ED & Rapid Assessment Area (RAA) $83,400
Total $83,400
Haliburton Highland Health Services Proposed Funding
Transfer Nurse $125,000
Total $125,000
Peterborough Regional Health Centre Proposed Funding
Bed Management and Surge Planning $200,000
Enhanced Physician coverage to decrease Physician Initial Assessment time. $210,800
Decrease ED consultation time (Hospitalist) study and process improvement event $100,000
ED Flow Navigator Position $174,600
Enhanced Physiotherapy Coverage $70,000
Surviving Sepsis Campaign Bundle & EDD and Green Zone/Blue Sustainability Plans. $113,200
Recruitment & Retention Strategy: Staff development $100,000
Expanding medication Reconciliation $270,000
Electronic Incident Reporting System $30,000
PRHC Total $1,268,600
ED Conference Shared Project $5,000
Total $1,273,600
Scarborough Hospital Proposed Funding
Birchmount Campus
Shared Care - Mental Health Crisis Team and ED $223,600
EMS Offload and Transfer of Care Wait Time Reduction $24,000
General Campus
Nurse Navigator and PIA Reduction Strategy $164,100
ED Nursing Recruitment & Retention $83,600
Inpatient Capacity – Improving Bed Flow and Corporate Discharge Processes $645,500
ED Electronic Triage (TSH EDM Triage System) $128,900
Mental Health and Addictions Care for Seniors in ED $90,000
ED-DI Wait Time Reduction Quality Engineering Process Improvement $278,000
Transport Tracking System $180,000
Total $1,817,700
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Reducing the Impact of Vascular Disease by 10% (save 10,000 patient hospital days) by 2013 Ontario Integrated Vascular Health Blueprint: Over the past several months, the founding members of the Ontario Vascular Health Coalition (the Cardiac Care Network of Ontario, the Heart and Stroke Foundation and the Ontario Stroke Network) have been working together with a multidisciplinary team of health care providers, patients and administrators to develop an integrated vascular health strategy for Ontario. The objective of the strategy is to develop new ways of addressing the province's growing vascular-related chronic disease burden. The culmination of their efforts has been the development of a Blueprint for Vascular Health released in August 2012. Mario Tino has agreed to serve as Chair of the Implementation Steering Committee for the Vascular Blueprint. The next phase of work will include recruitment of Steering Committee Members to activate the Vascular Blueprint, this work is underway and the Committee is expected to assemble within the next few weeks.
Lakeridge Health Oshawa Proposed Funding
Rapid Assessment Zone $488,000
Physician Process Improvement and Coverage Initiative -Oshawa $172,800
Lakeridge Health Bowmanville
Physician Process Improvement and Coverage Initiative -Bowmanville $265,200
Lakeridge Health Bowmanville &
Lakeridge Health Oshawa
Emergency Care Navigators $418,000
Cardiac Assessment Zone $374,400
Total $1,718,400
Ross Memorial Hospital Proposed Funding
Patient Navigator $127,000
3rd Physician See and Treat $150,000
Physician Assistant $71,400
Social Worker $35,000
Admission Nurse $77,200
ISTAT Troponin $60,000
Best medication History $35,900
LEAN Event ED RAZ Unit $20,000
Surge Activities $105,000
Admissions After Hours $150,000
ED Lock Down $29,300
Total $860,800 Northumberland Hills Hospital Proposed Projects
The Blueprint is focused on targeted changes in four (4) domains: 1. Population health and promotion of healthy public policy. The Vascular Health Coalition will work
with partners on initiatives that promote vascular health. 2. Understand and support the individual and family through the vascular health journey. All
provincial and regional activities will include perspectives of patients and families. 3. Improve the quality and access to a continuum of services. The Coalition will support activities to
offer primary care providers tools to enhance best practices, communication and patient monitoring; promote a shared/collaborative model of care and; develop and disseminate tools to improve communications among patients and providers.
4. Develop enablers and ensure efficient use of resources and assets. The Coalition will leverage existing resources to support the activities in related areas as well as monitor and report on the progress and achievements of these activities.
The Central East LHIN’s Vascular Health Coalition was consulted early on by the provincial team and will continue to be engaged as the Blueprint is implemented.
Carefirst Seniors: Carefirst was selected to develop and implement an ‘Ontario Needs Assessment’ for Chinese Ontarians living with Heart Disease. The project timeline has been extended to the end of September. To date, a total of five (5) focus groups have been set up including patients/caregivers who speak Mandarin and Chinese. Focus groups have also been initiated with representation from both health care providers including Personal Support Workers, nurses, settlement counsellors and a CCAC placement coordinator. Next steps include conducting a phone interview with health care providers, including a medical doctor, cardiologist, pharmacist and social worker. There will also be a phone interview conducted with patients and health care providers in five (5) non-GTA locations.
Supporting an Integrated Roll-out of the Ontario Diabetes Strategy Long Term Care Home Project: The Central East LHIN Diabetes Regional Coordinating Centre (DRCC) has identified residents of Long-Term Care facilities as a priority population for improved diabetes management. Because this population often has co-morbidities and are complex to manage, there is little research that addresses the best diabetes management for them. Due to lack of evidence, the Canadian Diabetes Association Best Practice Guidelines do not provide specific recommendations for diabetes management. Dr. Afshan Zahedy, Endocrinologist, has completed research regarding this population and has developed recommendations to improve the management of same. DRCC team and Dr. Zahedy are working together to develop a program for Long-Term Care facilities to improve the management of diabetes for residents anticipating outcomes of decreased transfers to Emergency Departments with a primary diagnosis of diabetes/hypoglycemia. A survey to assess the gaps in care for residents and to identify the learning needs for staff of Long-Term Care facilities is in development and will be conducted in September. Central East LHIN Complex Diabetes Care Centre: Development continues under the leadership of the CECCAC, Diabetes Regional Coordinating Centre (DRCC), TSH, PRHC and LH for the Central East LHIN Complex Diabetes Care Centre (CDCC) (one of six approved in province). The soft-launch (internal) phase of the Central East CDCC was successfully implemented on August 20, with the hard launch targeted for November 2012. Potential patient candidates have been referred to the CECCAC who will conduct eligibility/admission screening on all referred patients. CDCC patients have received appointments at LH, PRHC, and TSH. Other activities to date include the development of the Central East
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CDCC Logic Model, a Central East Communications Plan and tools which incorporate strategy and tactics to promote the program across the region which has been developed and includes all participating organizations (i.e. DRCC, CECCAC, LH, PRHC, and TSH). Process maps have been developed at the CECCAC and Central East CDCC program that highlight both soft and hard launch phase processes. The development of the regional manager’s position detailing the job description, posting, and recruitment are currently underway. Mandatory self-management training dates for CDCC providers have been set for September 14 and November 2 and the orientation for site inter-professional providers is in progress starting with the Nurse Practitioner, Social Worker and Registered Dieticians. All sites are receiving referrals from Diabetes Education Programs, who are then screened for eligibility/admission into CDCC as per the soft launch phase. Patients have been assessed at all CDCC sites. A team visited the North York General CDCC site to network and share experiences and practices which proved to be extremely valuable. Standardized Referral and Intake Process The Diabetes Regional Coordination Centre (DRCC) has formed a Steering Committee with representation from across the Central East region to plan for the implementation of a Centralized Diabetes Intake System. Stakeholders have also been invited to participate in the development of a common referral form to support this initiative. This initiative is being planned in close alignment with the Central East CDCC with a common target date for implementation and to facilitate optimal communications with stakeholders leading up to the implementation and throughout the transition period. DRCC is planning and will host a communication event for all the Diabetes Education Programs in the region in September. This event will provide an opportunity for stakeholders to learn and provide input into planning for both the CDCC and the Centralized Intake System. Diabetes Services Inventory and Database: The Living Well with Diabetes (purple book) diabetes services inventory that was completed in 2010 is currently being updated to support the development of a searchable database for stakeholders and the Centralized intake system. This inventory update and the development of the searchable database are expected to be completed by November 1.
Chronic Kidney Disease (CKD) / Renal System Development In 2010, the province created the Ontario Renal Network (ORN), organized to align to provincial LHIN boundaries. A Central East LHIN Advisory body comprised of medical and administrative leadership from the three (3) Regional Renal Programs: Peterborough and Area (PRHC), Durham (LH) and Scarborough (TSH) were established. The ORN Regional Director is Jay Wilson and the Clinical Lead is Dr. Andrew Steele. New Chronic Kidney Disease Provincial Funding Model: The three (3) regional renal programs and the Ontario Renal Network are preparing for implementation of the new quality-based funding procedures/rates. Information sessions were scheduled in July. The interim 2011/112 blended rate as determine by the Ontario Renal Network is $263. This will be revised and increased slightly in 2013 after factoring in the direct costs for laboratory and allied health. Lakeridge Health was slightly below the $263 mark and will receive a slight top up. The Scarborough Hospital and Peterborough Regional Health Centre were above the blended rate:
PRHC is completing an internal review to validate the volumes/funding history that the Ontario Renal Network used. PRHC and satellites at Northumberland Hills and Ross Memorial have started discussing opportunities to create efficiencies. Year-end Reconciliation: The ORN will be making recoveries from each regional program as hospitals did not meet their allocated one-time incremental volumes based on the review of actual 2011/12 year-end data. Most substantial recoveries will be from TSH ($369K) and PRHC ($658K) where the LH recovery is under $5000. Areas where programs fell below target are:
The Scarborough Hospital: Pre-dialysis Clinic visits, Annualized Peritoneal Dialysis patients – this is a mature program with patient drop off due to death, peritonitis-membrane failure requiring change to Hemodialysis. There is slower growth starting new Peritoneal Dialysis patients which affects training day targets, Home Hemodialysis had a target short by 4 Home Hemodialysis patients.
Peterborough Regional Health: Home Hemodialysis rates grew as PRHC received funding for 14 new patients which ended up with only six patients. Technician hours of service were lower as well as a result of lower than projected volumes of Home Hemodialysis patients along with In-Hospital Peritoneal Dialysis exchanges.
Vascular Surgery Memorandum of Understanding (MOU): The MOU between Lakeridge Health and Peterborough Regional Health Centre is outstanding. The lack of an agreement has caused some challenges with repatriation of amputations back to Lakeridge Health. Peterborough Regional Health Centre has a backlog of patients waiting for transfer back to Lakeridge Health and will impact bed capacity at Peterborough Regional Health Centre. Improving vascular access for renal patients is tied into the larger vascular surgical agreement. Central East LHIN staff will continue to follow up on the status of the agreement. Scarborough Dialysis Patient Transportation working group: The working group to review the impact of changes to Toronto Transit Commission eligibility criteria is complete and a final report was submitted to the LHINs on August 3. Staff from the Toronto Central LHIN have been chairing the working group along with Jay Wilson, Central East LHIN Regional Renal Coordinator and staff from the Scarborough Regional Renal Dialysis program were active in the work group and its work. Recommendations have been provided with regard to: a) eligibility criteria for access to publicly-funded and subsidized transportation services for ambulatory clients requiring in-centre dialysis, b) establishing a process to handle current clients who do not meet the new criteria and assessment, c) determining principles for a transportation model with the metrics to assess adherence to these principles (i.e. standards of service) and lastly d) an assessment of the funds required to continue the services. Discrepancy remains, regarding WheelTrans’ patient volumes, between TTC reports and renal program survey data. A small working group has been struck to meet the objectives of implementing these key recommendations prior to implementation of the TTC policy change in December 2012 – the group will also attempt to better understand the discrepancy in reported patient volumes. Renal Program Human Resource Changes: Peterborough Regional Health Centre welcomed a new Program Director for Renal. Ms. Margot DaCosta has previously worked at Rouge Valley Health System, The Scarborough Hospital, and Humber in various portfolios. The interim Director, Trish Crawford will remain at Peterborough Regional Health Centre until January, supporting the implementation of the Complex Centre for Diabetes Care at the hospital. A new Vascular Access/ID coordinator will be recruited to assist.
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The Scarborough Hospital recently recruited a third vascular surgeon to support the program. Lakeridge Health welcomed Cindi Wheeler who recently completed a Nurse Practitioner program. Cindi has taken the Nurse Practitioner role at Lakeridge Health in combining the CCDC diabetes with the renal role. Central East LHIN Self-Management Program: The Central East Self-Management Program was invited to become the lead agency to coordinate all self-management “train-the-trainer” training across Ontario, including training leaders to train “Peer Leaders” who deliver consumer and caregiver self-management workshops, as well as training leaders to teach and support clinicians in integrating self-management practices into their care. Additional one-time funding of $339,625 was provided to the CECCAC to cover the costs to host the training in 2012-13. In total, seven week-long train-the-trainer courses are scheduled, with the goal to train up to 115 new Self-Management Trainers across the province. Four courses will be delivered to health care professional candidates to allow them to become “Choices & Changes” Faculty (facilitators) recognized by the Institute for Healthcare Communication – Canada; Choices and Changes “Faculty” train and support clinicians to integrate self-management into their practice. Three courses will train lay persons and health care workers to become “Master Trainers” in Stanford’s Chronic Disease Self-Management Program; Master Trainers train the Peer Leaders who lead the actual consumer and caregiver workshops. Each LHIN region will carefully select the candidates to represent their region in receiving training, as the training graduates will assume leadership roles in the delivery of self-management/self-management support workshops within their region. The CECCAC will manage all the training course logistics, travel, and overall administration. This request recognizes the CECCAC as a provincial leader in Self-Management. The success as a lead agency for provincial self-management training will undoubtedly lead to further leadership opportunities for the CECCAC provincially, in continuing to expand self-management programming as part of Ontario’s Chronic Disease Prevention and Management strategy.
Enablers – eHealth Information Management / Information Technology (IMIT) Advisory Committee: The IMIT committee continues to support the Central East Executive Committee (CEEC) in all matters related to eHealth strategy, information management, systems integration, and Information Technology (IT) infrastructure. Staff have presented a proposed plan to establish a common network between hospitals which will include a wide area network (WAN) with common security management. Work continues on a scan of current hospital IT strategic plans and the identification of integration and collaboration opportunities. Benefits of this proposal include the potential for reduced duplication, the establishment of common directives and the specialization and improved monitoring for shared projects as well as best practices from an IT perspective. Recommendations were brought forward to the CEEC on September 11 to proceed with a shared resource consisting of one to two specialized network and information security experts. CEEC requested a business case be developed prior to moving forward with the request future steps include canvassing the Chief Financial Officers (CFOs) group to discuss a funding allocation model.
eHealth Strategic Plan: The Central East LHIN has initiated the development of an eHealth Strategic Plan by building on the 2007 eHealth Strategic Plan and making revisions to address current and emerging needs and requirements in support of the LHIN IHSP and the provincial eHealth Ontario strategy. This revised plan should inform and
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enable the development of a GTA LHIN Cluster strategy. The Project Charter was approved by all six LHINs, including William Osler Health System as the Transfer Payment Agency and was signed-off by the Project Sponsor and Executive Sponsor. A current state assessment has been developed by Deloitte; meetings were scheduled with all LHIN eHealth Leads. A review of provincial initiatives has been completed, in addition to stakeholder consultations that included engagement with LHIN CEOs, health service provider CEOs, CIOs and IT Directors, as well as discussion with the Ontario Telemedicine Network and Cancer Care Ontario.
Community Care Information Management (CCIM): The CCIM project consists of supporting the implementation of the Human Resources Information System (HRIS) and the various Common Assessment tools (CAT) within the Central East LHIN. Two CCIM tools are being implemented that impact the Hospitals and CCAC sectors, namely the Ontario Common Assessment of Need (OCAN) and Integrated Assessment Record (IAR), which will allow hospitals to view all assessments by patient in a central repository and storage environment for OCAN and Resident Assessment Instrument-Mental Health (RAI-MH). CCIM is now beginning to work with the Central East LHIN community support service agencies to implement the interRAI preliminary screener, which will support the intake process and identify individuals for a comprehensive assessment as well as record basic information about individuals who do not go through the full assessment, see Appendix B. The Central East LHIN Community Support Services Common Assessment Project (CSS CAP) Steering Committee, with representation from the CSS sector and the CECCAC will be working on developing a Shared Assessment Framework/Model for the Central East region. The CSS CAP implementation is proceeding as per plan with the steering committee tracking issues as required:
cGTA – ConnectingGTA: ConnectingGTA is a project with the five (5) GTA LHINs structured to “integrate electronic patient information from across the care continuum, and make it available at the point-of-care, to improve the patient and clinician experience”. The ConnectingGTA project will allow 700 service providers to securely share patient health information across the five (5) GTA Local Health Integration Networks (LHINs). Currently, electronic health information is contained in silos within the system. Over time, all 700 service providers will be connected under one “electronic roof” – allowing patient information to move from one service provider to another within the system. Program activities will focus on populating the ConnectingGTA solution with clinical data and then providing clinicians, from across the care continuum, with viewing capabilities to use that data to improve patient care. The Steering Committee confirmed that the ConnectingGTA Back-End Solution procurement was now complete and that TELUS Health Solutions was selected as the successful vendor. See Appendix B. Resource Matching and Referral (RM&R): Provincially, efforts have been underway to determine how best to move forward with the implementation of an automated solution that will facilitate a consistent approach to the transitioning of patients amongst various levels of care. An information gathering meeting was hosted July 31
st by Toronto Central LHIN to inform a
recommendation to be presented to the LHIN CEOs at their next meeting of September 6th. In essence, the
recommendation is to participate in a single coordinated cluster approach to RM&R procurement and automation, aligning with the Provincial RM&R Cluster Principles and modifying existing RM&R assets as required by business requirements. The LHINs in Cluster 2 also committed to individually identify the order and timeline for the implementation of pathways. The Toronto Central LHIN will create and distribute a draft work plan.
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Fiscal Responsibility: Resource investments in the Central East LHIN will be fiscally responsible and prudent Funding and Allocations: 2012/13 Human Services and Justice Coordinating Committees – The Canadian Mental Health Association – Peterborough (CMHA-P) branch has received $28,000 in base funding in fiscal year 2012/13. This funding will be used to support the operating expenses of the four local Human Services and Justice Coordinating Committees (HSJCC’s) in the Northeast Cluster. These are located in the Peterborough HSJCC, the Northumberland HSJCC, the Haliburton HSJCC and the Kawartha Lakes HSJCC. These committees contribute to a successful continuum of opportunities to divert people from inappropriate uses of law enforcement and the judicial system. The allocation for each local HSJCC is $7,000. Quarterly Report Highlights – Ministry of Health and Long-Term Care (MOHLTC): The Q2 report is in the process of being completed. It is due to the MOHLTC by September 28 and includes additional information from what was submitted in Q1. The additional information required by the Ministry relate to:
1. An update on the progress of the Central East LHIN’s commitments, activities or initiatives outlined in its annual business plan (highlighting the key initiatives from its plan, important developments and their resulting impacts, and particular challenges that the Central East LHIN may be facing).
2. A progress update on any additional performance measures that are not included in the accountability agreement between the Ministry and the LHIN.
3. Major activities or initiatives undertaken by the Central East LHIN that was not included in its annual business plan.
4. Additional Integrated Health Service Plan (IHSP) priorities that the LHIN wishes to report on, an update on key negotiations, key cost drivers and any other important developments or initiatives within sectors.
5. Integration activities currently in progress at the Central East LHIN.
Web Enabled Reporting System (WERS)/Self Reporting Initiative (SRI) Update: WERS was closed to data submissions on June 30, 2012 and will remain available in read-only mode for access by all health service providers (HSPs). There will be no further changes or updates to WERS and the SRI is now the system for submissions. The planned ‘go live’ date for Q2 implementation of SRI is October 1. The system is currently being tested by Ministry and LHIN staff and HSP testing will occur in September. A training webinar was held for HSP and LHIN staff participating in the testing of the SRI system. Testers were shown how to register for access to SRI and how to access financial and statistical reports. The community financial reporting template remains similar to CATLite and any changes will be communicated within the next couple weeks. Answers to questions on how to utilize the system from a LHIN perspective will be communicated in future webinars or emails directed to the SRI support team. Future training via webinars will be available to all SRI users to provide a full understanding of the submissions process and features of the system. Training is scheduled for September 17 through September 28 with additional refresher courses in October. A detailed training schedule will be communicated to HSPs shortly. Hospital Service Accountability Agreement (2012/15 H-SAA): Based on the Central East LHIN Board decisions regarding the Quality-based Procedures (QbP) Allocation Model and 2013/14 allocations for cataracts as well as the remaining 2012/13 allocations for hips and knees and cataracts, the H-SAAs will be amended accordingly. Hospitals will have the opportunity for discussions with the LHIN, as required, to ensure that the performance targets are reasonable and appropriate.
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Long Term Care Homes Service Accountability Agreement (L-SAA): The Long-Term Care Homes Accountability Planning Submission (LAPS) working group met in late-August to discuss timelines and deliverables around producing the LAPS documentation and enabling the process for the 2013-16 L-SAA. LTCHs will be given 60 days’ advance notice of their LAPS submission deadline; this notice will be sent in early September. Attached is the second L-SAA Communiqué in a series to be developed by LHIN Collaborative (LHINC) as we move through this process. The first was released in July and was sent to all Central East LHIN homes in August. The second L-SAA Communiqué was released on September 10
th and will
be communicated to all LTCHs. See Appendix C. The LAPS timeline is aggressive to allow the homes and corporations adequate time to review agreements and negotiate performance targets with the LHINs. It is anticipated that a copy of the agreement will be ready for review in early January and that the Central East LHIN Board will be asked to approve the template prior to its release to the HSPs.
Multi-Sector Service Accountability Agreement (M-SAA): Work for the refresh of the 2013/14 Community Accountability Planning Submission (CAPS) for the final year of the 2011-14 M-SAA has begun. The tentative timelines are as follows:
2013-14 CAPS refresh available on SRI Dec. 15, 2012
Consultations on MSAA refresh indicators Dec 2012 – Jan 2013
Review & finalize CAPS / M-SAA refresh submission Dec 2012 – Jan 2013
HSP Board Approval of M-SAA refresh January 31, 2013
Year 3 of the current 2011-14 M-SAA comes into effect April. 1, 2013
2013-2016 L-SAA Timelines August 2012
• Legal prepares rough draft of 2013-16 L-SAA changes
• LAPS Working Group convenes and develops workplan
• L-SAA Steering Committee meeting
• First draft of indicators presented to Steering Committee
September 2012
• LAPS Working Group prepares draft of LAPS guidelines and schedules
• Working Group provides feedback on draft L-SAA and schedules
• L-SAA Steering Committee meeting to approve LAPS guidelines and indicators
• Letter of Notice of LAPS sent to the Long-Term Care Homes
• LAPS released; LAPS Education Sessions
October/November 2012
•LHIN/LTCH Education Sessions - negotiations and discussions begin
•LAPS due November 15, 2012
January - March 2013
•L-SAA Education Sessions
•Finalize negotiations and discussions
•L-SAAs executed March 31, 2013
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A refresh of Community Health Centre (CHC) performance indicators is also in progress. There are two new 2012/13 accountability indicators for which targets need to be negotiated: 1) Influenza vaccination and breast screening rates; and 2) Periodic health exam and vacancy (Nurse Practitioner and physician) rates. Multi-Sector Service Accountability Agreement Indicators Dashboard: The performance and finance teams have been actively reviewing and investigating any variances (of 10% or more) identified in the M-SAA dashboard to determine root cause and mitigation strategies. Highlights of the analysis in the Community Mental Health and Addictions Sector included:
Agency Issue Explanation
CMHA-Peterborough Individuals Served by Functional Centre (Utilization) - variance >10%
Issues with tracking admissions and discharges with new software - currently being resolved.
Durham Mental Health Services
Individuals Served by Functional Centre (Utilization) - variance >10%
Service activity was higher than anticipated and exceeded capacity. Program/data collection methods under review; will be resolved going forward
Group Sessions (# of sessions) variance +25%
Definition change is being clarified. Target will be revised & issue will be resolved going forward
Northumberland Hills Hospital-CMHA
Individuals Served by Functional Centre (Utilization) - variance >10%
Staffing issues resulted in a modified work schedule and lower volumes. Plan to be on track going forward
Rouge Valley Health System – CMHA/Ontario Shores Centre for Mental Health Sciences
100% variance for admin Reporting error which will be adjusted on the next report.
15% variance for total expenses (fund type 2)
Agency didn't include budget adjustments from additional funding. This will be adjusted on the next report.
All data has been entered into the Performance & Risk Management Database and will be escalated through the Provider Issue Escalation and the Enterprise Risk Management Process as appropriate. Issues related to data quality will be corrected and results reported in the Q2 dashboard to be presented in December (Q2 reports are due from agencies November 7th). Agencies with significant issues identified through the performance management process may be contacted for further discussion or negotiation for the current year as well as for the M-SAA refresh in the fall winter of 2012/13.
Central East Community Care Access Centre (CECCAC) Performance and Risks: The CECCAC is still aiming for a balanced budget position at the end of this fiscal year (March 31, 2013). The savings strategies will not substantively impact the Home First philosophy or be felt by the acute care sector. The continued attention to efficiencies is resulting in reduced service volumes in spite of increasing client numbers. In case the CCAC strategies do not project sufficient savings by October, further strategies must be reviewed and implemented to ensure reduction in the growth in clients served. This is in addition to the CECCAC implementing a number of mandated new programs and initiatives including mental health & addiction nurses in schools, rapid response nurses program, the nurse practitioner integrated palliative care program, Behavioural Supports Ontario and the Centre for Complex Diabetes Care (CCDC). Personal support hours have seen a modest reduction over the past two months. Some of this is related to Home First criteria changes made in late-February 2012. The remainder is related to ongoing case reviews. The impact of the modified Patient Safety Assessment Tool (PSAT) will not be seen until late-September.
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Nursing volumes are about 3,000 visits lower than June and can be attributed to the school program. No school visits are provided in July and August. The balance of the reduction is related to improvements in wound Lengths-of-Stay (LOS), focus on IVs and attention to “teach, reduce and discharge” for injections.
Orthopaedic Quality Scorecard (OQS): The Q4 2011/12 OQS was released in July. For the Central East LHIN, the average Length-of-Stay (LOS) was 3.8 days, which is below the provincial target of 4.4 days, and the proportion of patients discharged home was 83%, which met the provincial target of 90±9%. A meeting has been scheduled in early September to bring together the OQS Working Group and the Resource Matching and Referral (RM&R) committee that contributed to the rehabilitation mapping exercise in order to begin discussions on the regional orthopaedic plan led by the System Design & Implementation Unit. Wait Time Strategy Working Group (WTSWG): The Central East LHIN received the final 2012/13 Wait Time allocations from the MOHLTC in early September. The allocations based on the proposed volumes for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Hip and Knee revisions, General surgery and Paediatric surgery have all been approved by the LHIN Board (at the July and August Board meetings) and presented to the group. Clarification from the Ministry regarding inclusions/exclusions for QbPs was discussed: 1) Bipolar Hip Arthroplasty and Austin Moore’s Arthroplasty (hip replacement procedures with trauma/complication of treatment) are not included in this year’s QbPs for hip replacements; 2) bilateral hip and knee replacements are funded from the hospital base budgets for 2012/13; and 3) one-time additional funding on an interim basis will be received by the LHIN for bilateral cataract procedures. Concerns regarding the stringent criteria for the funding of high risk breast MRIs under the Ontario Breast Screening Program (OBSP) were brought forward since hospitals were well below their volume targets. These concerns will be brought forward to the Diagnostic Imaging (DI) Working Group for analysis and discussion. Hospital-Community Care Access Centre Financial Leadership Group (HCFLG): The template requested by the Central East Executive Committee (CEEC) was developed and an initial review was done by the HCFLG members in August. The template is intended as a risk mitigation exercise to investigate potential financial risks in the system over the next three years. It is not a planning exercise but rather, it is a high-level strategic overview, with the assumption that the hospitals start in a balanced position and assume a 0% increase for the next three years. The final results of the survey will be reviewed by the HCFLG at the September meeting. Quality-Based Procedure (QbP) Working Group (QBPWG): Based on demographic need within the Central East LHIN, the LHIN has prepared suggested hospital volume allocations for cataract, hip, and knee procedures for the second half of the fiscal year, to achieve volume optimization in the LHIN. A number of different methodologies were used to arrive at final numbers. The volume allocations and results of the survey will be shared with the QBPWG for discussion during the next meeting which was scheduled for September 12. The outcome of this meeting and applicable motions will be presented and recommended to the Board for approval at the Board Meeting on September 26.
Community Engagement Community Engagement is the foundation of all activity at the Central East LHIN. Being more responsive to local needs and opportunities requires ongoing dialogue and planning with those who use and deliver health services. Engagement with a wide range of stakeholders can be conducted at various levels including informing and educating; gathering input; consulting; involving and empowering. To assist us in tracking our Community
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Engagement activities, an ongoing Calendar of Events is kept up to date and shared weekly with staff. It documents all engagement activities with a wide range of stakeholders. Many of these events are also posted on the Central East LHIN website: www.centraleastlhin.on.ca/showcalender.aspx. Below are listings of recent activities that the Central East LHIN staff were involved with in August:
The Primary Care Community Engagement Events “Doc Talks” continued with a session on Frail Seniors on August 13, Diabetes and Vascular Health on August 27 and Palliative and End of Life Care on September 10. Hosted by the Central East LHIN Primary Care Leads, these OTN-supported discussions are designed to allow primary care providers and other health care providers to discuss issues related to the delivery of care in five key areas. An average of 40 people have been signed on to each session, participating either via OTN or via webcast. These sessions are also archived on the OTN website. The LHIN will continue to use this technology to engage with its stakeholders in a cost-effective and accessible manner. The final Doc Talks “The LHIN and Primary Care” will be held on October 15.
Karen O’Brien attended the Association of Municipalities of Ontario’s (AMO) annual conference from August 19-21. It was a good opportunity to engage many of the municipal leaders from within the Central East LHIN, as well as many of our 13 MPPs.
Website The Central East LHIN website continues to be a primary vehicle for both communication and engagement with
our stakeholders. From August 1 - 31, 2012 there were 8,235 visits made by 4,284 unique visitors. There were
24,304 pages viewed. As is noted every month, the Career page continues to have the greatest number of “hits”
and providers continue to request space on the page to post their job opportunities. An analysis of traffic spikes
shows that on August 13th, 477 people came to the website with 396 unique visitors clicking on the “Community
Health Services Integration Strategy Durham” page when new content was added alerting stakeholders that the
opportunity to complete a survey on possible integration opportunities to be considered by the Integration
Planning Team was now closed. (Please note that in July a similar spike happened when the survey
opportunity was first posted.) The next day a similar spike, 371 unique visitors, visited the Project Management
page when it was alerted with new content regarding upcoming educational opportunities.
The LHIN continues to use its website as a repository to ensure that information is shared freely and openly.
Throughout the summer and early fall this included posting an IHSP 2013-15 survey asking people about their
patient experiences, alerting health service providers to their opportunity to submit funding requests related to
Community Sector Investments and updating the Funding page showing the current and historical funding
allocations to our health service providers in total, by sector and by agency. The LHIN continues to receive
feedback from our stakeholders that they appreciate being able to access this depth of information from the
website.
Social Media
The LHIN continues to post new tweets to its Twitter Account @CentralEastLHIN to generate awareness of
LHIN initiatives and opportunities with our followers and those who “retweet” our “tweets.”
As of September 19, the Central East LHIN Twitter account has 332 followers, an increase of 41 followers since
August. We continue to attract interest from a variety of stakeholders including provincial associations, health
care providers, elected officials and their staff, media and the general public.
The LHIN is continuing to Live Tweet during our OTN-supported “Doc Talks” series and a number of our tweets
are being retweeted by our partners.
By using a combination of face to face events, web-based and paper based surveys, planning partner meetings,
webpostings, news releases and tweeting, the LHIN is continuing to affectively engage its stakeholders in the
development of an integrated, sustainable health care system.
We continue to encourage people to subscribe to the website and to follow us on Twitter in order to be alerted to new content and new information as it is posted. This will ensure our communities are informed, educated, can provide input, be involved and consulted on the work being done to create an integrated system of care that provides better care, better health and better value for money. Other Announcements: New Chair is appointed for North East LHIN: Well-respected Northern governance leader, Elaine Pitcher, has been appointed the new Chair of the North East LHIN. She has a strong background in health and previous appointments included serving five terms as chair of the Sault Area Hospital. North Simcoe Muskoka announces interim CEO: Ms. Jill Tettman has been appointed by the North Simcoe Muskoka Board as interim CEO. Ms. Tettmann was previously the Chief Operating Officer leading up to her most recent appointment and has been with the LHIN since January 2006. Ms. Tettmann held the positions of Senior Director, Health System Performance, Measurement and Integration and Senior Director, Planning, Integration and Community Engagement. Queen Elizabeth II Diamond Jubilee Medal to Rik Ganderton: CEO of Rouge Valley Health System (RVHS) was presented with the prestigious award this month by Scarborough-Guildwood MP John McKay, in recognition for his leadership at the hospital and for the notable improvements under Mr. Ganderton’s direction.
Operations
Finance: Financial reports for the annual audit review are in the process of being prepared as well as the monthly variance reports and the statement of financial activities to capture the expenditures from the budget halfway through the fiscal year. The consolidated second quarter report includes actual expenditures from Q1 and Q2 with a budget forecast for the remainder of this fiscal year. The report also includes spending from July through to September 2012 (Q2) and will be completed and submitted to the Ministry by the end of September. Expenses for the Board of Directors, CEOs and Senior Directors are required to be posted online on a quarterly basis, as per direction from the Ministry of Health and Long-Term Care. Expenses from Q1 were prepared for posting to support our commitment to being transparent and accountable. System updates: The LHINs Shared Services Office (LSSO), through the Toronto Central LHIN (TC LHIN), provides back-office supports for the 14 LHINs. The service contract for the existing payroll system is nearing expiration which has prompted the LSSO/TC LHIN to initiate the procurement and project implementation for the transfer of the payroll system to another contract provider. BDO Canada LLP was selected to support Microsoft Dynamics GP 2010 as the new system. A project team consisting of staff from the LSSO/TC LHIN, Mississauga Halton LHIN and Central East LHIN have been charged with the system design and implementation tasks, which are tracking on schedule. Parallel Testing for the payroll system was completed and the new system will be live starting in October.
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Central East LHIN is in the process of implementing a software upgrade of Contact Resources Management (CRM), which is a contact management tool on a Microsoft platform. The contract vendor, NetDexterity, was working with the LSSO to complete the software upgrade to CRM 11. Licenses have been confirmed and user roles have been assigned for all staff within the Central East LHIN. An implementation team consisting of Central East LHIN staff has been struck to manage the all-staff roll out and training for the utilization of this tool. CRM is presently being used as a tool for issues management and complaint tracking and the new roll-out will expand the usage to all staff as the main contact database for all health service providers, stakeholders and affiliated contacts with the Central East LHIN. Staffing Announcements: Blair Falotico, Program Assistant for System Finance Performance Management (SFPM) completed a contract at the Central East LHIN on August 31, we wish him well on all future endeavors.
Appreciation is to be extended to Ms. Kristen Lemay for the work done in the Communications department in the month of August. Kristen was instrumental in tabulating data received through a LHIN-wide survey focussed on the Durham cluster community health services integration project. Respectfully Submitted,
Deborah Hammons Chief Executive Officer Central East Local Health Integration Network
