CEO REPORT OCTOBER 28, 2008 - Apache Solr · CEO Report Page 5 October 28, 2008 • Improving...

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CEO REPORT OCTOBER 28, 2008

Standing Items: • Ministry of Health and Long-Term Care Incremental Funding Allocations to Central LHIN • Strategic Priorities 2008-10 • Board Follow-up • 2008/09 Business Plan • Compliance Declaration • IHSP Action Plan • Quarterly Report Submissions • Quarterly Budget Updates

CEO Report Page 2 October 28, 2008


TABLE OF CONTENT

1.0 MINISTRY OF HEALTH AND LONG-TERM CARE....................................................................................... 4 1.1 Assessment of 2008 Ministry-LHIN Accountability Agreement Target Process (Appendix 1.1) ............................. 4 1.2 General Surgery Wait Times (Appendix 1.2) ............................................................................................................ 4 1.3 New Agreement with Doctors – October 18, 2008 (Appendix 1.3)........................................................................... 4 1.4 Ontario Integrates eHealth Activities Under One Agency (Appendix 1.4)................................................................ 5 1.5 Public Reporting of Clostridium Difficile Associated Disease (Appendix 1.5)......................................................... 5 1.6 Infrastructure Ontario / The Humber River Regional Hospital Project Joint News Release (Appendix 1.6) ............ 5 1.7 Incremental Funding Summary for Central LHIN (Appendix 1.7)............................................................................ 6 1.8 Transfer of Vaughan Community Health Centre (Appendix 1.8).............................................................................. 6 1.9 Vaughan Community Health Centre-Annualized Base Funding (Appendix 1.9) ...................................................... 6 1.10 Health Based Allocation Model – Communiqué (Appendix 1.10) ............................................................................ 6 1.11 Ministry-LHIN Accountability Agreement Status Report – Developmental Indicators (Appendix 1.11)................. 6 1.12 e-Referrals (Appendix 1.12) ...................................................................................................................................... 6 1.13 Urgent Priorities Fund (Appendix 1.13) .................................................................................................................... 7 1.14 Nursing Graduate Guarantee (NGG) (Appendix 1.14) .............................................................................................. 7 2.0 LEGISLATION ....................................................................................................................................................... 7 3.0 LHIN-WIDE............................................................................................................................................................. 7 3.1 Multi-Sectoral Service Accountability Agreement .................................................................................................... 7 4.0 CENTRAL LHIN..................................................................................................................................................... 8 4.1 Strategic Priorities 2008/09........................................................................................................................................ 8

4.1.1 Quality (Appendix 4.1.1)............................................................................................................................. 8 4.1.2 Aging at Home 2008/09 Project Update (Appendix 4.1.2) .......................................................................... 8

4.2 Board Follow-up – Board of Directors – September 28, 2008 .................................................................................. 9 4.2.1 2008/09 Emergency Department Pay for Performance............................................................................... 9 4.2.2 Aging at Home 2009/10 Strategy Timeline for Decision Milestone ............................................................ 9 4.2.3 2008/09 Community Agency Budgets .......................................................................................................... 9 4.2.5 Draft Integration Strategy ........................................................................................................................... 9

4.3 2008/09 Business Plan (Appendix 4.3)...................................................................................................................... 9 4.4 Hospital Service Accountability Agreements - Schedule B....................................................................................... 9 4.5 Compliance Declaration (Appendix 4.5) ................................................................................................................... 9 4.6 IHSP Action Plan (Appendix 4.6).............................................................................................................................. 9 4.7 2nd Quarter 2008/09 Budget Update (Appendix 4.7) ................................................................................................. 9 4.8 2nd Quarter Report Submission (Appendix 4.8) ....................................................................................................... 10 4.9 Multi-Year Risk Report ........................................................................................................................................... 10 4.10 Organizational Review............................................................................................................................................. 10 4.11 Feasibility Study for Data Centre Consolidation Central LHIN Hospitals - Agreement in Principle (Appendix 4.11)

................................................................................................................................................................................. 10 4.12 Physician Engagement Workshop ........................................................................................................................... 10 4.13 Ophthalmology Services within Central LHIN........................................................................................................ 11 4.13.1 Planning for the Future of Ophthalmology Services within Central LHIN ............................................................. 11 4.13.2 Voluntary Integration Proposal – York Central Hospital /Southlake Regional Health Centre -Transfer of Cataract

Surgery (Appendix 4.13.2 a-h) ................................................................................................................................ 11 4.14 Community Engagement Activities and Themes..................................................................................................... 11 4.15 Diversity and Inclusion Update (Appendix 4.15) .................................................................................................... 13

4.15.1 Community of Practice .............................................................................................................................. 13 4.15.2 Diversity Data Profile ............................................................................................................................... 13 4.15.3 Communication.......................................................................................................................................... 13 4.15.4 Health Equity Policy and Plan .................................................................................................................. 13

4.16 Child Health Network .............................................................................................................................................. 14


4.17 Health Service Needs Assessment and Gap Analysis.............................................................................................. 14 4.18 Hospice Palliative Care Network............................................................................................................................. 14 4.19 Urgent Priority 2007/2008 and 2008/2009 Investment and Project Progress Report ............................................. 14 4.20 Communications (Appendix 4.20)........................................................................................................................... 14 4.21 Central LHIN Website Metrics (Appendix 4.21)..................................................................................................... 15 4.22 Vaughan Community Health Centre – Assignment................................................................................................. 15 4.23 Central LHIN Health Professional Advisory Committee ........................................................................................ 15 5.0 HEALTH SERVICE PROVIDER ....................................................................................................................... 15 5.1 Stevenson Memorial Hospital - Cash Advance........................................................................................................ 15 6.0 OTHER UPDATES ............................................................................................................................................... 15 6.1 Hospital Service Accountability Agreement Update - Joint LHIN/OHA Service Accountability Agreement Task

Force – October 2, 2008 (Appendix 6.1) ................................................................................................................ 15 6.2 2008 Special Report of the Office of the Auditor General of Ontario on the Prevention, and Control of Hospital

Acquired Infections (Appendix 6.2) ........................................................................................................................ 16



1.0 MINISTRY OF HEALTH AND LONG-TERM CARE 1.1 Assessment of 2008 Ministry-LHIN Accountability Agreement Target Process (Appendix 1.1) A memo dated October 16, 2008 was received from Carrie Hayward, Director, LHIN Liaison Branch regarding the Assessment of 2008 MLAA Target Setting Process. In order to build on the Ministry-LHIN Accountability Agreement target setting process from 2008, the LHIN Liaison Branch committed to providing to the LHINs an assessment of the 2008 process. The Ministry and LHINs together and through the joint Ministry-LHIN Agreement Development Team will keep the assessment in mind when developing the process and tools for target setting in 2009. A slide deck is attached. 1.2 General Surgery Wait Times (Appendix 1.2) October 17, 2008, the government announced that it is setting the most aggressive General Surgery Wait Times Targets in Canada as part of an expansion of its Wait Time Strategy. General surgery targets are being set for procedures such as gall bladder removal, hernia repairs, anorectal and some intestinal surgeries. Targets are also being set for orthopaedic and ophthalmic surgeries. Targets for each surgery are set in four categories, ranging from urgent to elective surgery. Where urgent surgery is required, targets are less than 24 hours for general and ophthalmic surgeries and one week for orthopaedic surgery. For all three surgery groups, cases of mild or occasional symptoms and elective surgeries, targets range from 12 to 26 weeks. Through the province’s Local Health Integration Networks (LHINs), Ontario is investing $11.64 million this year for an additional 8,240 general surgery procedures such as gallbladder removal, hernia repairs and intestinal surgeries. Central LHIN’s 2008/09 General Surgery Wait Times Allocation is as follows:

Central Number of Surgeries

1,102

Funding Allocation

2008/09 $1,448,700

Once funding confirmation is received from the Ministry, a proposed Ministry funding allocation will be brought to the Board for approval. 1.3 New Agreement with Doctors – October 18, 2008 (Appendix 1.3) On October 18, 2008, the government reached a new agreement with the Ontario Medical Association that includes a shared commitment to help 500,000 Ontarians without a family physician find one. The commitment is the driving force behind a new program called Health Care Connect that will connect patients with family health care providers who are taking on new patients. Health care professionals in each of the 14 Local Health Integration Networks will connect people with appropriate health care providers in their community. The program will be launched in February, 2009. Other key components of the agreement ratified by Ontario Medical Association members on October 18 include:

• Reducing congestion in hospital emergency rooms • Providing funding for 500 nurses to join group practices • Helping patients who have chronic diseases – such as diabetes – better manage their condition and reduce their

need for emergency health services • Ensuring Ontario remains the jurisdiction of choice for future physicians with a new program that will defer

interest on medical resident debt


• Improving access to community mental health services provided by physicians 1.4 Ontario Integrates eHealth Activities Under One Agency (Appendix 1.4) On September 29, 2008, the government announced the appointment of Dr. Alan Hudson as Chair of eHealth Ontario, a restructured agency responsible for all aspects of e-health in Ontario including creating an electronic health record for all Ontarians. eHealth Ontario will bring together the Ministry of Health and Long-Term Care’s e-Health Program and the province’s Smart Systems for Health Agency (SSHA) under one banner. Three key e-health priorities have been identified for the next few years including a Diabetes Registry, an e-health portal to centralize health information on an easily accessible web site, and e-prescribing which will eliminate hand written prescriptions and reduce medication errors. Dr. Hudson - who is leading the government's efforts to reduce wait times in emergency rooms and for key procedures – will chair the Board of Directors for eHealth Ontario, which will have individuals from the broader health, business and information technology sectors. The ultimate goal of the e-health strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system. Also named as board members are the following:

• J. David Livingston, President and CEO of Infrastructure Ontario; • Matthew Anderson, CEO of the Toronto Central Local Health Integration Network (LHIN); • Heather Sherrard, Vice President of clinical services at the University of Ottawa Heart Institute; and • Ken Deane, Assistant Deputy Minister, Health System Accountability and Performance Division, MOHLTC.

1.5 Public Reporting of Clostridium Difficile Associated Disease (Appendix 1.5) Mandatory public reporting of C. difficile rates began on September 26, 2008, for the first time ever in Ontario. Rates must be posted on the websites of all Ontario hospitals and the Ministry of Health and Long-Term Care’s public site at: http://www.health.gov.on.ca/patient_safety/index.html. Public reporting enables hospitals to monitor C. difficile rates in their facilities so that the most appropriate infection control measures and highest possible standards of patient safety can be put in place. Numbers for August 2008 show that there were 319 cases of C. difficile associated disease found among the 228 hospital sites in Ontario. The provincial C. difficile rate was 0.39 per 1,000 patient days. The Ontario Agency for Health Protection and Promotion is also working with the Institute for Safe Medication Practices Canada and infectious disease expert Dr. Allison McGeer to support hospitals in the most effective use of antibiotics. This work is important because prolonged exposure to certain classes of antibiotics presents a real risk for C. difficile associated disease to emerge. Ontario is also boosting patient safety measures by creating infection control resource teams, and funding 66 more infection prevention and control practitioners in hospitals and local health units. 1.6 Infrastructure Ontario / The Humber River Regional Hospital Project Joint News Release (Appendix 1.6) On September 25, 2008, Infrastructure Ontario and the Humber River Regional Hospital issued a joint news release announcing the selection of HOK Architects Corporation to work on Humber River Regional Hospital’s new facility. Humber River Regional Hospital’s new facility will be a new state-of-the-art hospital for acute care, constructed at Keele Street and Wilson Avenue in Toronto. The new facility will offer a comprehensive range of services to support inpatient and outpatient programs.

http://www.health.gov.on.ca/patient_safety/index.html


Highlights of the new hospital include:

• Expanded emergency services; • Increased specialized outpatient services; • Modern, high-tech diagnostic equipment for better patient diagnosis and treatment; • Updated infectious disease containment systems to monitor and prevent a broad range of infections.

Infrastructure Ontario and the Ministry of Health and Long-Term Care will work with Humber River Regional Hospital on the new hospital, which will remain publicly owned, publicly controlled and publicly accountable. Infrastructure Ontario is a Crown corporation dedicated to managing some of the province's larger and more complex infrastructure renewal projects – ensuring they are built on time and on budget. 1.7 Incremental Funding Summary for Central LHIN (Appendix 1.7) A summary of Incremental Funding for Central LHIN is included in the appendices. This list will be updated on a monthly basis and included in the CEO Report. 1.8 Transfer of Vaughan Community Health Centre (Appendix 1.8) In a letter dated October 6, 2008 to the Vaughan Community Health Centre, Carrie Hayward, Director, LHIN Liaison Branch confirmed the transfer of the Vaughan Community Health Centre to Central LHIN effective October 1, 2008. 1.9 Vaughan Community Health Centre-Annualized Base Funding (Appendix 1.9) In a letter dated October 6, 2008, the Minister confirmed $2,591,511 in annualized base funding for the Central LHIN under the Community Health Care Centre Expansion Plan transition to LHINs for the Vaughan Community Health Centre. In a letter dated October 6, 2008, Ken Deane, Assistant Deputy Minister, Health System Accountability provided the administrative details regarding this funding. The Ministry approved $2,591,511 in annualized base funding for the Vaughan Community Health Centre. For fiscal 2008-09 only, funding will be $1,034,880 for partial year. Copies of the letters are included in the appendices. 1.10 Health Based Allocation Model – Communiqué (Appendix 1.10) Over the last three years, the Ministry of Health and Long-Term Care has been involved in the development of a new management and allocation tool: The Health-Based Allocation Model (HBAM). Now that the first components of this made-in-Ontario model are nearing the implementation stage, the Ministry is introducing the first edition of the HBAM Advisory Committee Communiqué. This one-page newsletter will be issued by the newly formed HBAM Advisory Committee on a bi-monthly basis. The Communiqué will inform health care stakeholders of the current status of the Committee's work and of upcoming HBAM-related issues under review. Since this joint Ministry/LHIN committee has been tasked with providing recommendation on all aspects of the HBAM model, this Communiqué will act as the primary source of HBAM information for all health related sectors. 1.11 Ministry-LHIN Accountability Agreement Status Report – Developmental Indicators (Appendix 1.11) As per Schedule 10, Section 2 (c) of the Ministry-LHIN Accountability Agreement, Carrie Hayward provided a status report on the developmental indicators, prepared by Health Analytics Branch. The Summary Status Report was marked confidential and is not appended to this report. 1.12 e-Referrals (Appendix 1.12) A letter from Assistant Deputy Ministers John McKinley and Gail Paech was received on September 22, 2008 regarding e-Referrals. During the past few years, significant efforts have been made to enable the broader health sector with new tools to deliver better care for Ontarians. Among those that have been under consideration is the concept of “e-referrals”. The e-Health program has led the development of a provincial e-Referral Strategy, which is intended to guide future development


of the provincial e-Referral model which will address architecture, data standards and interoperability issues. The e-Health Program has initiated an e-Referral Project, and will be organizing a Steering Committee to provide the necessary consultative support for the collaborative process which will be required to develop the model. 1.13 Urgent Priorities Fund (Appendix 1.13) In a letter dated October 10, 2008, Leela Prasaud, Manager, GTA Unit, LHIN Liaison Branch notified the Central LHIN that the Community Back Office Integration proposal for the 2008/09 Urgent Priorities Fund met the eligibility criteria. Payment process is expected to start in October, 2008. Staff will notify the respective health service providers and advise them that their proposal will be processed for payment shortly. 1.14 Nursing Graduate Guarantee (NGG) (Appendix 1.14) This innovative program is the first of its kind in the world and was created to improve the experience that nurses have in the beginning of their careers. The Nursing Graduate Guarantee includes the opportunity for every new graduate to work full-time after graduation. The Ontario government has funded 17 Demonstration Projects. These programs disseminate information and best practices in order to help employers take the necessary steps to improve planning and to make the best use of the nursing human resources that are available. For more information on the Demonstration Project you can visit www.healthforceontario.ca. 2.0 LEGISLATION There are no updates to report. 3.0 LHIN-WIDE 3.1 Multi-Sectoral Service Accountability Agreement The Multi-Sector Service Accountability Agreement Template has been distributed to the LHINs for Board approval by the end of November 2008. The template was developed through a consultative process led by the LHINs in conjunction with representatives from the Community Support Services, Mental Health and Addictions, Community Health Centres and Community Care Access Centre Sectors. The template was developed by the M-SAA Steering Committee and tabled with the sector specific groups for review and consultation. Four Sector specific teams have been established to carry out the consultation process over the summer months. Consultation Teams will be providing suggestions and questions to the M-SAA Steering Committee. The Steering Committee in turn will be reviewing the suggestions, making revisions to the template agreement and schedules, providing feedback to the various sectors. It is the responsibility of the M-SAA Steering Committee to ensure that the structure and content of the new M-SAA template agreement is consistent with the Local Health Services Integration Act (LHSIA) and the Ministry-LHIN Accountability Agreements (MLAA).

The LHINs will be completing M-SAAs with approximately 1500 HSPs during the 08/09 fiscal year for implementation April 1, 2009. The timelines are as follows: June – August 29 Sector Team Consultation with input back to Steering Committee Schedules and Guidelines

Working Group completes its tasks September Steering Committee considers suggestions from the Consultation Teams and Schedules and

Guidelines Working Group

http://www.healthforceontario.ca/

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Sept. 30 Community Annual Plan Submission Plan Guidelines out to the field Sept-Oct Education sessions for Health Service Providers will be led by LHINs Sept. 30 Feedback to the Sector Teams on the template agreement and schedules Nov. 30 LHIN Boards Approval of SAA Template Nov. 14 Completed Community Annual Planning Submissions due to LHINS* Dec 31 Template and Schedules sent out to LHINs to begin the individual negotiation process on the

schedules Jan.– Mar. LHINs finalize Service Accountability Agreements with service providers *This timeline, established by the Joint Ministry/LHIN Steering Committee, is being extended by the Central LHIN to November 30. Multi-Sector Service Accountability Agreement Template will be brought forward for Board approval in November. 4.0 CENTRAL LHIN 4.1 Strategic Priorities 2008/09 4.1.1 Quality (Appendix 4.1.1) The Central LHIN Board has indicated “Quality”, is one of its strategic priorities over the next few years. Over the next three to four months, a quality scoping exercise will be undertaken, to define a quality agenda for Central LHIN. The scoping initiative will identify a strategic framework for quality, identify targeted areas of focus (within quality/performance improvement), and propose a high level implementation plan. A draft work plan has been developed for this Central LHIN Quality Scoping Initiative. The work plan will include activities to engage the LHIN Board, health service providers, provincial stakeholders and subject matter experts. It is anticipated that a proposal - defining the quality agenda and a near term implementation plan - will be presented to the Central LHIN Board early in 2009. Please see draft work plan at appendix 4.1.1. 4.1.2 Aging at Home 2008/09 Project Update (Appendix 4.1.2) Aging at Home 2009/10 Proposal Evaluation In response to our call for proposals initiated in August 2008, a total of 67 proposals were received equating to a total funding request of $44,665,880. The proposal evaluation process was supported by the Seniors Advisory Network on October 7, 2008. Please see Appendix 4.1.2 for more information on the process and timelines for RFP selection. 2009/10 Detail Plan for Aging at Home - Update To date we have not received the template or innovation criteria to be used for the 2009/10 Detail Plan submission to the Ministry of Health and Long Term Care which is due December 15, 2008. Aging at Home Projects and CCAC Waitlist Approval of the Central CCAC budget for 2008/2009 includes implementation of service delays (waitlists) for personal support and therapy services. As a result, Aging at Home initiatives that rely on either of these services will be impacted. We will be working closely with the CCAC to better understand this impact and work toward potential solutions when considering 2009/10 recommendations for year one projects. Newly Created Central LHIN Health Impact Assessment Tool The Ministry have been delayed in deploying their Health Impact Assessment Tool however Central LHIN is interested in harnessing their work to date for Aging at Home purposes. The draft tool created by the Ministry will be used to create one for the Central LHIN. The Central LHIN tool is not yet developed, but will be created with the assistance of the Diversity and Inclusion Advisory Group.


Transportation Update Transportation services to seniors are currently provided by stand-alone organizations with different processes and we believe there are opportunities to increase capacity, efficiency, quality and access in Central LHIN. We will be hosting a planning day for Central LHIN transportation services which will include participants from healthcare sector as well as public transportation providers (e.g. municipal providers, taxi services, ambulance services etc). Findings from this event will be presented to the Board for potential development in 2009/10. 4.2 Board Follow-up – Board of Directors – September 28, 2008 4.2.1 2008/09 Emergency Department Pay for Performance The Emergency Department Reporting System (EDRS) is now operational. The information collected by EDRS will be reviewed by staff and included in the monthly Project Management Office (PMO) report. 4.2.2 Aging at Home 2009/10 Strategy Timeline for Decision Milestone The Aging at Home 2009/10 Strategy Timeline for Decision Milestones update is included the IHSP Action Plan (see Appendix 4.1.6). 4.2.3 2008/09 Community Agency Budgets A proposed approach on dealing with the 61 Community Agency Accountability Agreements that are due on March 31, 2009 will be tabled at the November Board meeting. The approach will highlight, among other things, the issues dealing with options for assessing community wait-times and revised performance corridors. 4.2.4 My Friends’ Place Update in the IHSP Action Plan. 4.2.5 Draft Integration Strategy Update in the IHSP Action Plan. 4.3 2008/09 Business Plan (Appendix 4.3) An updated Business Plan is included in the appendices. 4.4 Hospital Service Accountability Agreements - Schedule B Updates on Schedule B of the Hospital Service Accountability Agreements will be reported on a quarterly basis in the CEO Report. 4.5 Compliance Declaration (Appendix 4.5) The Compliance Declaration for October 2008 is included in the appendices. 4.6 IHSP Action Plan (Appendix 4.6) The 2008/09 IHSP Action Plan dated October 28, 2008 is included in the appendices. 4.7 2nd Quarter 2008/09 Budget Update (Appendix 4.7) The Central LHIN Operations spending is on track at just over 50% of budget at September 30, 2008. All categories of expenditures are proceeding as expected. It is anticipated that there will be no surplus or deficit at year-end.


4.8 2nd Quarter Report Submission (Appendix 4.8) The second quarter report was completed and submitted to the Ministry of Health and Long-Term Care on September 29, 2008. The report provides a status update on Central LHIN performance, financial forecast, risks, and an update on Integration activity, among other matters. The full submission has been posted on the Central LHIN Board Update. 4.9 Multi-Year Risk Report The Multi-Year Risk report is a requirement of the Annual Service Plan submission. Central LHIN submitted the Multi-Year Risk report to the Ministry on September 30, 2008. 4.10 Organizational Review The Central LHIN is embarking on an organizational review, with the objective of ensuring our structure, roles and responsibilities are appropriately designed to enable us to achieve our mandate. As part of this initiative we are examining the aspects of our organization design that act as enablers or as barriers to effective operations and successful achievement of our goals, objectives and desired outcomes. The review is expected to be completed by the end of December; implementation will proceed in the new year. 4.11 Feasibility Study for Data Centre Consolidation Central LHIN Hospitals - Agreement in Principle

(Appendix 4.11) In a memo dated September 29, 2008 Central LHIN Hospital CEOs were advised of the need for a feasibility study for data centre consolidation for hospitals. As implementation of the Ministry of Health and Long-Term Care e-Health strategy is moving forward, the need to assess the readiness and capacity of hospitals to undertake these initiatives is significant. One component of a readiness assessment is to examine current data centre capacity for growth, expansion and business continuity. Consolidation will provide significant benefits:

• Accelerated deployment of provincial and regional e-Health initiatives • Implementation of business continuance for critical applications • Implementation of best practice data centre technologies and processes to reduce the technical risk to hospital

applications • Leveraging economies of scale to: improve service; minimize operating risk; reduce operating costs and reduce or

eliminate investment costs. The scope of the feasibility study will examine the viability of consolidating the data centres from York Central Hospital, Humber River Regional Hospital, Southlake Regional Health Centre, North York General Hospital and Markham Stouffville Hospital. A copy of the memo is included in the appendices. 4.12 Physician Engagement Workshop A Central LHIN/Ontario Medical Association joint physician engagement workshop is scheduled on October 29, 2008. Key objectives of the workshop include: • Discuss the interdependencies among physicians, patients and the Central LHIN • Provide an opportunity for physicians to learn about the role and current engagement framework of the Central LHIN • Discuss the principles, processes and actions that will ensure an effective partnership between physicians and the LHIN • Provide opportunities for physicians to network with colleagues from other parts of the Central LHIN The planning of this workshop has been undertaken by a committee comprised of physicians from within our LHIN, Ontario Medical Association representative and LHIN staff member.


The workshop will meet the accreditation criteria of the College of Family Physicians of Canada, hence physician attendees will receive Continuing Medical Education Credits.

4.13 Ophthalmology Services within Central LHIN 4.13.1 Planning for the Future of Ophthalmology Services within Central LHIN An Ophthalmology Work Group with representation from Central LHIN’s acute hospitals and clinicians has been collaborating to develop recommendations for options for the future of ophthalmology service delivery in Central LHIN. The Work Group has leveraged the findings from an earlier report from the Central LHIN Wait Times group that proposed consideration of the consolidation of cataract surgeries to two centres within Central LHIN, as part of a North-South Collaborative. The Work Group has established two task teams:

a) Governance/Administration Team that is developing a governance and leadership model and addressing administrative matters such as financial impacts, human resources impacts and medical staff credentialing associated with the proposed clinical care model.

b) Clinical Care Model Team that is developing the clinical care model and identifying the scope of services.

In September 2008, both Task Teams provided an interim progress report to the Work Group. The Work Group and Task Teams will continue their planning work which is anticipated to result in the development of recommendations and a business plan for ophthalmology service configuration in Central LHIN. The recommendations and plan will be presented to the hospitals and LHIN staff leadership within the current fiscal year. 4.13.2 Voluntary Integration Proposal – York Central Hospital /Southlake Regional Health Centre -

Transfer of Cataract Surgery (Appendix 4.13.2 a-h) On September 11, 2008, a voluntary integration pre-proposal was received from York Central Hospital and Southlake Regional Health Centre proposing a transfer of York Central Hospital’s base cataract surgery volumes, with associated funding, to the Southlake Regional Health Centre Eye Centre. Formal notice was received on October 7, 2008 in the form of a joint letter and attached board motions, from York Central Hospital and Southlake Regional Health Centre to the Central LHIN CEO. The following are included as appendices:

a) Memo to Acute Hospital CEOs– February 6, 2008 b) Central LHIN News Release – March 11, 2008 c) Letter from Southlake Regional Health Centre and York Central Hospital and Board motions – October 1, 2008 d) Central LHIN Acknowledgement Letter to Southlake Regional Health Centre and York Central Hospital –

October 9, 2008 e) Letters from Town of Richmond Hill Council – September 26, 2008; October 1, 2008 f) Central LHIN Letter to Richmond Hill Town Council – October 2, 2008 g) Letter from Town of Richmond Hill Council – October 20, 2008 h) Ophthalmology Work Group Terms of Reference

4.14 Community Engagement Activities and Themes Significant engagement was conducted over the past several months. In addition to traditional LHIN sessions, the use of community leaders and health service providers to assist the LHIN with outreach has enabled the LHIN to reach more broadly into the community. Common themes heard in engagement sessions include the challenges faced by residents regarding adequate transportation for seniors, those who are marginalized and those in rural areas. The inequity of services available was also a common theme, particularly primary care and home care, particularly in the northern areas of the LHIN. Gaps in services for people


of all ages who require mental health services are significant and the need to work collaboratively with other sectors to address these gaps was identified. Engagement for several initiatives has been undertaken and specific themes are presented below. Aging at Home: With the assistance of Community Leaders and our health services providers, more than 58 sessions with more than 1100 seniors and caregivers were conducted as part of the Aging at Home community engagement input to the year two planning process. 1) Consultation with Seniors and Caregivers Community Support Service providers conducted structured sessions with 712 seniors and caregivers on the supports for seniors to live independently in the community. The top needs to assist seniors to remain in their own home, that were identified, include: • Transportation – The shortage of transportation services and the lack of a coordinated system of transportation remains

a top issue in the LHIN • Assistance with personal care and that home care hours are inadequate • Home maintenance, including housekeeping, lawn care and garbage removal were rated very important to maintaining

independence • Caregiver support, especially adult day programs and respite • Caregiver education in safety and accident prevention is an important factor for senior’s caregivers and access to

education programs needs to be addressed. Community leaders held 28 sessions with 212 diverse participants representing Pakistani, North African, Portuguese, Japanese, Chinese, Hindi, Punjabi, Korean and South Asian communities. Input was also received through providers of services to Italian, Jewish, Russian and Chinese seniors. Topics explored with seniors and caregivers included the issues related to caring for seniors from diverse cultures living in the community. Themes heard: • Language was indicated as a barrier to accessing services. While there is a willingness to accept help in some cultures,

there is a preference to receive care from immediate family members in Asian and South Asian cultures. • If services are to be provided by others, they are preferred to be provided by those who understand their language and

culture. • There is a need to address equitable access for those in rural areas. Three Alzheimer Societies held focus groups with 30 participants and 112 interviews with caregivers about caring for people with dementia in the community and the supports seniors and their caregivers need. The most significant challenges for caregivers included the nature of the illness, safety, hygiene, abuse and physical and emotional stress of caregiver, navigation of the system, education and training, insufficient hours of care and respite. Caregiver relief was a major theme including the need to increase the availability for night care services. Socialization, at home monitoring, and physical activity were significant gaps for seniors with dementia from the caregiver perspective. Issues regarding the need for health professionals to increase their understanding of the disease and listen more effectively to the caregiver were heard. Hospice and palliative care providers met with 50 clients and caregivers to discuss challenges faced to support a palliative care senior at home. Themes include the lack of palliative professionals, including physicians, to support people at home, assistance with personal care, challenges in navigating the system and the lack of information and support groups for palliative care. 2) Consultation with Health Service Providers Supportive housing providers were consulted around the services needed most. In York Region, the biggest issues are related to rent subsidy and challenges associated with the conversion of units. In Toronto, the homemaker program identified gaps in transportation to medical appointments, nutritional issues, financial and socialization issues. Legislative restrictions make it challenging to be creative in how care is provided.


Emergency services leaders were consulted to understand the issue of emergency department use by seniors. While it was felt that visits to emergency by seniors were appropriate, it was agreed that there should be some investigation of the urgent care model as some seniors may benefit from using this type of setting. Health Service Providers: A community engagement survey was emailed to all Central LHIN health service providers. The response rate was just over 50% and the survey indicated that all providers were involved in some level of community engagement in many languages for a variety of reasons. Results will be presented to the Community Engagement Framework Hospital Task Group later this fall. Aboriginal: A session was held on Georgina Island as part of the Service Needs and Gaps Analysis. Themes articulated included transportation barriers, the lack of services, particularly primary care providers and homecare, the need for addiction and mental health treatment, access to diabetes education and the poor nutrition of residents. There were also concerns about the difficulty in accessing training for providers. The LHIN also met with Nin Os Kom Tim, an Aboriginal organization in Newmarket who advised about the challenges faced by urban Aboriginal in accessing Aboriginal and mainstream health services. The organization has agreed in principle to participate in a GTA meeting that is currently being discussed. Francophone: The French-speaking community participated in Aging at Home engagement sessions as well as Service Needs and Gaps Analysis sessions. Major themes from this community include the lack of services available in French; the difficulty in recruiting health service professionals who speak French; the need for Supportive Housing and adult day programs for seniors who speak French. 4.15 Diversity and Inclusion Update (Appendix 4.15) The Diversity and Inclusion Advisory Group has agreed upon working definitions of equitable access, equitable outcomes, health equity, health inequities, cultural competence, diversity and inclusion. 4.15.1 Community of Practice Initial meetings of the 25-member Community of Practice focused on ensuring the goal and objectives (identifying gaps to accessing inclusive healthcare, and creating tools to fill the gaps) were clearly understood by all, and that the key areas earlier identified as priorities (newcomer services, community health education, service provider training) were still agreed upon. The Community of Practice is planning an intensive diversity training session to enhance their knowledge of diversity, inclusion and equity in order to be better equipped to complete their work. Review of promising Diversity and Inclusion practices within Central LHIN is underway. Mina Singh, a member of York University’s faculty of Nursing, will be the lead on evaluating the entire project. In keeping with the community of practice model, both the research and evaluation components will be participatory in nature. 4.15.2 Diversity Data Profile A work group has been meeting to understand the data requirements of the Advisory Group so that members can provide informed advice based on a good understanding of the diversity in the LHIN. Data from the Service Needs and Gaps Assessment will establish a baseline for a population profile of the Central LHIN. Data will include many aspects of diversity including ethnicity, immigration, family structure, mother tongue, country of birth and other differences. 4.15.3 Communication A communication plan has been developed that mirrors the Diversity and Inclusion work plan. An area of the Central LHIN website will include content on the work of the group. A collaboration tool on a secure area of the site has been made available for members of the Advisory Group to share information.

4.15.4 Health Equity Policy and Plan A project charter has been developed and work will begin on implementing this initiative once funding approval is received from the Ministry. Individuals from provider organizations have been identified as members of the Health Equity Plan Task Group which will be initiated next month.


4.16 Child Health Network A meeting between Central LHIN, the Child Health Network for the Greater Toronto Area, and Central LHIN Hospitals that are members of the Child Health Network for the Greater Toronto Area was held on September 17, 2008. The various directors, Obstetrics Chiefs, and Pediatric Chiefs from Markham Stouffville, North York General, Southlake, and York Central Hospitals were in attendance. The Child Health Network presented an analysis of the maternal newborn population of Central LHIN based on the Niday Perinatal Database. The Network discussed with the member hospitals next steps and how they can assist with the development and implementation of the Provincial Pediatric and Newborn Plan. 4.17 Health Service Needs Assessment and Gap Analysis The Health Service Needs Assessment and Gap Analysis is beginning to define different needs and gaps among the seven planning areas. The consultants have now met extensively with providers across the LHIN to discuss the data with respect to both the domains and the planning areas. The data illustrates that the seven planning areas vary considerably in population characteristics and that their health service requirements over the next 10 years will also vary. This is beginning to be the emerging story of our LHIN and it now has a sound basis of data and findings to support it. A community survey, carried out in October, provided supplementary information for the project through consulting with residents of Central LHIN regarding access to care, continuity of care and the continuum of care. The survey used existing questions from the Canadian Community Health Survey and other validated survey instruments in addition to being informed by members of the Diversity and Inclusion Data Workgroup. Results from the community survey will be incorporated into the Service Needs Assessment and Gap Analysis report. 4.18 Hospice Palliative Care Network On October 7, 2008 the Central LHIN Hospice Palliative Care Network hosted a conference focused on education and integration. Conference highlights included a plenary session on Dyspnea Management (difficulty breathing), and workshops on multi-disciplinary teams, empowering clients to cope with breathlessness, common assessment tools, residential hospice planning, energy conservation in symptom management, and guiding families through the terminal time. Approximately 100 people attended the conference, including nurses, personal support workers, physicians, volunteers, and health service administrators. Of the evaluations received, 98% rated the conference as good or excellent. This is the third conference that the Network has hosted in two years. 4.19 Urgent Priority 2007/2008 and 2008/2009 Investment and Project Progress Report A project management report for Central LHIN Urgent Priority Funding is being developed. The report will include a compilation of investments by priority portfolio (e.g., Seniors, ER.) and by sector (e.g., acute, CCAC, etc.). Also included is a status/progress report tracking deliverables. The full project management report will be tabled for information at the November Board meeting. 4.20 Communications (Appendix 4.20) Central LHIN has recently garnered media coverage in two regional newspapers. The Alliston Herald reported that the Service Needs and Gap Analysis project was holding a community engagement session and participants were invited. The Richmond Hill Liberal (and other York Region Media Group newspapers) reported that a proposal was developed by York Central Hospital to centralize cataract surgery. The paper has published three stories, one containing erroneous information about a decision being made by the Central LHIN Board. After a discussion with the reporter/newspaper, the information was clarified in a subsequent story. Other communication items include:

• The posting of the revised 2008-2009 Ministry-LHIN Accountability Agreement and Annual Service Plan is complete and online

• Staff are working to develop a Diversity and Inclusion online collaboration site through the Central LHIN website as well as a diversity and inclusion webpage

• Health Check-In: Is a one-page snap-shot of initiatives at Central LHIN. The second issue has been developed and distributed to MPPs, media, ministry officials and LHIN peers. It has been well received by MPPs, ministry and LHINs. It is also available online.


• Incident Management Working Group - has been developed to facilitate a standardization process for issues. Group includes representatives from all Central LHIN hospitals and CCAC as well as the team lead from the newly established Incident Management Unit at the Ministry and the LHIN Liaison Branch. The first meeting scheduled on October 29, 2008.

• Highlighting Aging at Home Year 1 initiatives on Central LHIN website.

The September and October issues of Health Check-In are included in the appendices. 4.21 Central LHIN Website Metrics (Appendix 4.21) The metrics for the Central LHIN’s website traffic volume and site reach are summarized in the appendices. News stories receive positive and consistent attention from visitors. These metrics suggest that our site is a reliable source for information among visitors. Communication staff continues to receive requests from health service providers and the general public to guide them through the registration of MyPage so that they can automatically receive notifications. 4.22 Vaughan Community Health Centre – Assignment Effective October 1, 2008, the Ministry assigned Vaughan Community Health Centre’s Accountability Agreement to the Central LHIN. A copy of the letter from the Director, LHIN Liaison Branch, dated October 6, 2008 is included in the appendices under Appendix 1.9.

As part of due diligence before accepting the assignment, Central LHIN staff met with Vaughan CHC who identified above average rents in comparison to the Ontario average. Based on the existing lease, Vaughan CHC determined a budget shortfall of $111,311 per annum. The Ministry has communicated to staff that they will provide an additional $75,000 in base funding.

4.23 Central LHIN Health Professional Advisory Committee The Central LHIN Health Professional Advisory Committee met on September 15, 2008. The Committee has identified a Chair, the name of the nominated member will be brought forward for recommendation by the CEO to the Central LHIN Board of Directors for approval. The minutes of June 16, 2008 were approved and are included in the appendices. 5.0 HEALTH SERVICE PROVIDER 5.1 Stevenson Memorial Hospital - Cash Advance Stevenson Memorial Hospital will be provided a cash advance of $655,775 from the March 31, 2009 payment. When the 2008-2010 Hospital Service Accountability Agreement between Stevenson Memorial Hospital and the Central LHIN is signed and the additional base increase is payable, the amount of the cash advance will be recovered. 6.0 OTHER UPDATES 6.1 Hospital Service Accountability Agreement Update - Joint LHIN/OHA Service Accountability Agreement

Task Force – October 2, 2008 (Appendix 6.1) The Joint LHIN/OHA HSAA Review Task Force (Task Force) will be reviewing and providing recommendations on the leading practices and processes of the 2008-10 Hospital Services Accountability Agreement (HSAA) negotiations. This Task Force was developed out of the 2008-10 template agreement negotiations between the Local Health Integration Networks (LHINs) and the Ontario Hospital Association (OHA). The Task Force, co-chaired by Sandra Hanmer, CEO, Waterloo Wellington LHIN and Tom Closson, President and CEO, OHA, has approved its Terms of Reference (ToR), membership and scope of work. The review of negotiations processes will focus on: HAPS planning, submission and review, communications, education, monitoring, and LHIN-hospital negotiations. This would include an examination of the following:


• Education/communications – This would include a review of the nature and adequacy of materials provided to

facilitate understanding of the new HSAA process, communications between hospitals and LHINs, as well as those provided by OHA and LHINs jointly.

• Negotiations Process – This aspect of the review would look at how hospitals were engaged in negotiations with their LHIN (e.g., type and extent of engagements), areas of the agreement that posed significant challenges for the parties, as well as use of the compliance framework set out in the Commitment to the Future of Medicare Act.

• HSAA Monitoring – This part of the review would assess the extent that HSAA processes are being utilized to monitor and move forward with scenarios where one party is not meeting a performance obligation.

The newsletter is included in the appendices. 6.2 2008 Special Report of the Office of the Auditor General of Ontario on the Prevention, and Control of

Hospital Acquired Infections (Appendix 6.2) On September 29, 2008, Auditor General Jim McCarter submitted a special report to the Speaker of the Ontario Legislature on the prevention and control of hospital-acquired infections. The report is posted on the Auditor General’s website at: http://www.auditor.on.ca/en/reports_en.htm. A copy of the news release is included in the appendices. “There are a number of areas where improvements are required,” McCarter said. “While the hospitals we visited and the Ministry of Health and Long-Term Care have implemented some good initiatives, there’s still a lot more to do.” Hospital-acquired infections are those, such as C. difficile, that a patient acquires while in the hospital being treated for some other condition and that can cause illness or even death. In the last few years, one Ontario hospital reported more than 75 deaths related to C. difficile and others have experienced significant outbreaks. Contributing factors can range from improper antibiotic use to inadequate hand hygiene among hospital workers to improper cleaning of patient rooms. The Standing Committee on Public Accounts will be reviewing the Special Report on October 29, 2008. Ministry of Health and Long-Term Care officials, LHIN CEOs and organizations visited by the Auditor General are invited to attend the meeting. Respectfully submitted,

Hy Eliasoph CEO

http://www.auditor.on.ca/en/reports_en.htm

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Appendix 1.1a

Assessing and Improving the MLAA Target Setting Process

LHIN Liaison Branch

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Appendix 1.1b

2

Context• As part of the refresh of the MLAA, the Ministry and LHINs:

• Negotiated targets for the 5 non-wait time priority indicators, and• Updated targets for the wait time priority indicators.

• The setting of LHIN targets took into consideration the provincial target, resources, overall volumes and funding, local factors, levels of service, historical trends, and other considerations that could impact the indicator.

• Targets:• Create confidence within the system by demonstrating progress in

the performance of these indicators, • Indicate movement towards the provincial target, and • Take into consideration both Ministry and LHIN priorities

• LLB consulted both internally and with LHIN Sr Directors for suggestions on how to improve and build on the 2008 target setting process

3

Target Setting ProcessTarget Setting Process

• The Local Health System Performance Reference Group developed a target-setting template, approved by the ADT, for each LHIN to submit to LLB by April 30 (Appendix 1)

• LHINs were provided a decision tree to assist with completion of the template and historical data for all the MLAA performance indicators to inform LHIN target proposals (Appendix 2)

• The completed templates were used as a starting point by the Ministry in its discussions with LHINs when developing targets

• The Ministry consulted with Dr. Alan Hudson, Lead, Ontario’s Wait Times Strategy, on the wait times indicators and Dr. Kevin Smith, Lead on ALC days, on the ALC and Wait Times to LTC homes indicators.

• During the month of May, LLB and Wait Times held face to face meetings with each LHIN to develop LHIN specific targets.

• Pre-meetings were held to help narrow the issues that required more discussion.

• In most instances, follow up meetings were required to finalize all the targets

4

Target Setting – What Worked

Both Ministry and LHINs agreed that:• Overall process worked well (target templates, pre-meetings and face-to-

face meetings)• The target setting templates completed by each LHIN provided a starting

point to inform Ministry analysis and the target setting meetings • Face to face meetings at the LHIN facilitated open communication for

LHINs, LLB and other MOH staff to discuss issues • Pre-meetings between the Ministry with each LHIN in the majority of cases

narrowed the issues for discussion at meetings and allowed meeting time to be used effectively

• Follow up discussion and exchange of completed templates/information in advance of meetings allowed all parties to focus on the outstanding items for discussion

• Break-out sessions during the meeting (occurred at some meetings) allowed LHIN and MOH staff to review its approach prior to presenting it to the table

5

Target Setting – Suggested Improvements Identified by Ministry and LHINs• Timeliness and consistency of data utilized by the Ministry and LHINs at

meetings (setting targets using data that is from 2 quarters back)• Compact timelines (suggest build in to workplan additional time for each

item): • 3-4 weeks for LHINs to complete target setting template• 1 week for MOHLTC analysis and internal consultation/discussion/

approval of proposed targets • 14 pre-meetings and meetings within 3 weeks

• Further understanding is required on how the LHIN and the Ministry derived its suggested targets

• Sharing of information well in advance of meeting is required to provide both the Ministry and the LHIN the opportunity to review and analyze the information, and to prepare for the meeting

• Many LHINs expressed a need for more provider specific results for the MLAA indicators to inform their target setting proposals

• Improved understanding of performance corridors in order to provide greater flexibility to develop targets

• In a few instances, 3 hours was not sufficient to have a complete discussion on all issues

6

Target Setting – Suggested Improvements Identified by LHINs• Assumption that trends showing improvement would continue is not always

the case and need to take into account environmental impacts, possible flat lining, etc., in setting of future targets

• For some cases, cause and effect relationship requires more logistical techniques (X does not always effect Y, at times, need to consider, X1, X2, etc. when analyzing how it will effect Y - cannot just say “X’ amount of investment will allow for “Y” improvement)

• Process needs to allow for a strategic discussion about all indicator/targets together:• Cannot improve on all targets the same (eg – 10% improvement for all

targets or for the same indicator for all LHINs).• Need to take into consideration how shifting of resources to impact an

indicator positively may have a negative impact on another (need to balance resources and expectations)

• Need to identify when improvement is no longer possible or feasible especially when other indicators require improvement – need a balance

• There are IHSP priorities competing with Ministry priorities

7

Target Setting – Suggested Improvements Identified by LHINs Continued• The Local Health System Performance Reference Group (responsible for

recommending indicators for the MLAA) should include LHIN Sr Directors to ensure LHIN strategic considerations are taken into consideration by the group’s recommendations

• Consult with experts (ie CCN, CIHI, ICES, etc.)• Ensure that both Ministry and LHINs are privy to the same information at

the discussion (at times, MOH staff are aware of forthcoming funding announcements that LHINs are not)

• LHIN carry out common analysis together prior to meeting with MOHLTC to develop targets

• When setting targets, should be aggressive with LHINs not performing well on specific indicators, and not aggressive where performance is already at or close to the provincial target.

• Where targets are being set by government priorities and there is no room for changing the target, then it should be communicated to the LHIN, and time should not be spent discussing the target

8

Appendix 1: Target setting template

LHIN Proposed Targets

08/09 09/10

2008/09 2009/10

90th percentile wait times for Cancer Surgery90th percentile wait times for Cardiac BY-Pass Procedures

90th percentile wait times for Cataract Surgery90th percentile wait times for Hip Replacement Surgery90th percentile wait times for Knee Replacement Surgery90th percentile wait times for Diagnostic MRI Scan90th percentile wait times for Diagnostic CT ScanReadmission Rates for Acute Myocardial InfarctionPercentage of Alternate Level of Care DaysRate of Emergency Department Visits that Could be Managed ElsewhereHospitalization Rate for Ambulatory Care Sensitive ConditionsMedian Wait Time to Long-Term Care Home Placement

Indicator

Specificy rationale for proposed targets. May include local factors, environmental factors, funding for specific services, LHIN priorities. Attach additional documents if required.

Provincial Target

Current LHIN performance/baseline

if 2 > 1, can LHIN improve towards provincial target? Yes/No/Not Applicable (NA),

If 2 < or = 1, can LHIN improve on performance? Yes/No; Proceed to 5

Targets established in 07/08

9

Appendix 2: The target setting decision tree illustrates how the “provincial target” would be used in the target-setting process

Percent improvement ofcurrent performance

LHIN suggests local targets for negotiation

LHIN suggests target fornegotiation and provides

rational for decline in performance

Maintain current performance

yesno yesno

yesno

start

yesno

Forecasted performancebased on trends, expert opinion, LHIN strategies

and LHIN resources. Working towards

provincial benchmark.

Forecasted performancedecline and rationale based on trends, expert opinion,

LHIN strategies and LHIN resources. (why cannot continue to meet benchmark for the indicator).

Forecasted performancebased on trends, expert opinion,

LHIN strategiesand LHIN resources. Working

on improvement of current rate

Is the current LHIN rate better than the provincial target?

Is further improvement achievable given LHIN trend in addition to strategies and

resources available to the LHIN?

Is the provincial target achievable given LHIN trend and resources

available to LHIN?

Provincial target as LHIN target

Can the current rate be maintained?

NEWS Ministry of Health and Long-Term Care

WAIT TIME STRATEGY EXPANDS

McGuinty Government Sets Most Aggressive General Surgery Targets In Canada NEWS October 17, 2008

2008/nr-091 Ontario is setting the most aggressive wait time targets for general surgeries in Canada as part of an expansion of its successful Wait Time Strategy. General surgery targets are being set for procedures such as gall bladder removal, hernia repairs, anorectal and some intestinal surgeries. Targets are also being set for orthopaedic and ophthalmic surgeries. Targets for each surgery are set in four categories, ranging from urgent to elective surgery. Where urgent surgery is required, targets are less than 24 hours for general and ophthalmic surgeries and one week for orthopaedic surgery. For all three surgery groups, cases of mild or occasional symptoms and elective surgeries, targets range from 12 to 26 weeks. Current wait times are below the provincial target in all three areas. Ontario is also investing $11.64 million in funding for 8,240 additional general surgery procedures to help ensure that these times remain on target. Wait times are available by hospital at www.ontariowaittimes.com.

QUOTES “Our Wait Time Strategy is working – more Ontarians are getting the care they need sooner,” said David Caplan, Minister of Health and Long-Term Care. “That’s why we’re expanding our strategy so that wait times continue to decline.” “Ontario’s health care providers have risen to the wait time challenge over the past three years and I am confident we will see the same good results with general surgery,” said Dr. Alan Hudson, Provincial Lead – Wait Time Strategy. QUICK FACTS Wait time is defined as the time between when the surgery is ordered and when it is

performed. Ontario’s Wait Time Strategy has invested $1.1B to deliver 1.69M procedures since 2005. As per September 2008 data, wait times in the five key areas have been reduced:

Cataract surgery by 62.1 per cent, Hip and Knee replacements by 48.7 per cent and 53.4 per cent respectively, Cancer surgery by 9.9 per cent Angiography by 53.6 per cent, Angioplasty by 50 per cent, MRI and CT scans by 16.7 and 49.4 per cent respectively.

http://www.ontariowaittimes.com/

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Appendix 1.2a

LEARN MORE Find out more about wait times in your area and developments in the Wait Time Strategy. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)

Media Contacts: Steve Erwin, Minister’s Office, 416-326-3986 Andrew Morrison, Ministry of Health and Long-Term Care, 416-314-6197

ontario.ca/health-news Disponible en français

http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html

http://www.health.gov.on.ca/transformation/wait_times/providers/wt_news.html

BACKGROUNDER Ministry of Health and Long-Term Care

GENERAL SURGERY WAIT TIMES ALLOCATIONS

October 17, 2008

Through the province’s Local Health Integration Networks (LHINs), Ontario is investing $11.64 million this year for an additional 8,240 general surgery procedures such as gallbladder removal, hernia repairs and intestinal surgeries.

LHIN

NUMBER OF SURGERIES 2008/09 FUNDING

Erie St. Clair 732 $923,100 South West 429 $529,800Waterloo Wellington 794 $956,400Hamilton Niagara Haldimand Brant 435 $720,400 Central West 262 $360,500 Mississauga Halton 586 $724,400 Toronto Central 330 $913,200 Central 1,102 $1,448,700 Central East 1,213 $1,549,300 South East 294 $776,100 Champlain 1,477 $1,823,600 North Simcoe Muskoka 151 $234,400 North-East 163 $345,700 North-West 272 $330,600TOTAL 8,240 $11,636,200

For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)

Steve Erwin, Minister’s Office, 416-326-3986 Andrew Morrison, Ministry of Health and Long-Term Care, 416-314-6197


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Appendix 1.2b


GENERAL SURGERY WAIT TIME DATA

October 17, 2008 Ontario has expanded its Wait Time Strategy to include reporting of general surgery wait time information. Surgical wait times track the time between when the surgeon and patient agree to proceed with surgery and when it is performed. Wait times depend on the type of procedure and the patient’s situation. Ontario has developed wait times targets to give an idea of how long one might have to wait for a procedure. The most currently available information is available at www.ontariowaittimes.com. Procedure Group 90th

Percentile (days)

Anorectal Surgeries 130 Digestive System - Colorectal 132 Digestive System - Gallbladder (Cholecystectomy) 105 Digestive System - Small Intestines (Intestinal Surgeries)

128

Hernia - Abdominal Wall 128

General Surgery

Hernia - Groin 127 General Surgery (All Procedures) 127 For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)




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Appendix 1.2c


WAIT TIME TARGETS

October 17, 2008 Ontario is establishing the most aggressive wait time access targets for general, orthopaedic and ophthalmic surgeries in the country. Wait time access targets are the optimal length of time within which a patient should receive treatment. The targets are based on an assessment of the patient’s condition and urgency for care. These wait time targets were developed with the help of clinical experts. The Wait Time Information System incorporates these targets and priority classifications. GENERAL SURGERY TARGETS General surgery is described as surgical procedures performed to treat benign conditions of the digestive, endocrine and lymphatic system. These also include benign breast surgery and the removal of lumps, bumps and cysts. Priority Level

General Surgery Priority Descriptions Access Target

1 Immediate – emergency surgery required Within 24 hours

2

Constant, frequent or severe pain/symptoms (biological, psychological);

Significantly impacts ability to perform usual activities; High probability of disease progression with morbidity that might affect

function or life expectancy; Recurring unscheduled visits i.e. ED/primary care physician/surgeon

Within 4 weeks

3

Mild or occasional pain/symptoms (biological, psychological); Minimally or moderately impacts ability to perform usual activities; Low probability of disease progression with morbidity that might affect

function or life expectancy; Minimal unscheduled visits i.e. ED/primary care physician/surgeon

Within 12 weeks

4 Elective indication for surgery; Minimal risk of morbidity incurred by waiting Within 26 weeks

ORTHOPAEDIC SURGERY TARGETS Orthopaedic surgery is a surgical procedure performed to treat benign conditions of the musculoskeletal system, including bones, joints, muscles, tendons and ligaments. Priority Level Orthopaedic Surgery Priority Descriptions Access Target

1 Surgery is urgently required i.e. fractures, tendon/ligament injury, significant joint derangement Within 1 Week

2 Severe pain that actively affects role and independence; High probability of disease progression and morbidity affecting

function Within 6 Weeks

3 Moderate pain; Disability is a threat to role and independence; Disease progression is moderate

Within 12 Weeks

4 Minimal pain; disability does not threaten role and independence; Disease progression is minimal Within 26 Weeks

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Appendix 1.2d

OPHTHALMIC SURGERY TARGETS Ophthalmic surgery includes surgical procedure performed to treat benign conditions of the eye and surrounding bones and soft tissue. Specific access targets were created for cataract, corneal transplant, glaucoma and vitrectomy surgeries. All other ophthalmic surgeries use the below general ophthalmic surgery access targets. Priority Level General Ophthalmic Surgery Priority Descriptions Access Target

1 Immediate surgery required to preserve sight or prevent secondary damage Within 24 hours

2

Significantly impacts ability to perform usual activities; High probability of disease progression that might affect ocular

function or result in compromised surgical outcome; Constant, frequent or severe pain/symptoms (biological,

psychological)

Within 6 Weeks

3

Moderately impacts ability to perform usual activities; Moderate probability of disease progression that might affect ocular

function or result in compromised surgical outcome; Moderate or occasional pain/symptoms (biological, psychological)

Within 12 Weeks

4 Elective indication for surgery; Minimally impacts ability to perform usual activities; Minimal risk of morbidity incurred by waiting

Within 26 Weeks

OTHER OPHTHALMIC SURGERY TARGETS Priority Level Cataract Corneal Transplant Glaucoma Vitrectomy

1 Within 24 hours Within 24 hours Within 24 hours Within 24 hours 2 Within 6 weeks Within 4 weeks Within 2 weeks Within 1 week 3 Within 12 weeks Within 12 weeks Within 6 weeks Within 6 weeks 4 Within 26 weeks Within 26 weeks Within 16 weeks Within 12 weeks





NEW AGREEMENT WITH DOCTORS IMPROVES ACCESS TO CARE McGuinty Government And Doctors Will Work To Get A Family Doctor For 500,000

Ontarians

NEWS October 18, 20082008/nr-093

The McGuinty government has reached a new agreement with the Ontario Medical Association that includes a shared commitment to help 500,000 Ontarians without a family physician find one. The commitment is the driving force behind a new program called Health Care Connect that will connect patients with family health care providers who are taking on new patients. Health care professionals in each of the 14 Local Health Integration Networks will connect people with appropriate health care providers in their community. The program will be launched in February, 2009. Other key components of the agreement ratified by Ontario Medical Association members on October 18 include: Reducing congestion in hospital emergency rooms Providing funding for 500 nurses to join group practices Helping patients who have chronic diseases – such as diabetes – better manage their

condition and reduce their need for emergency health services Ensuring Ontario remains the jurisdiction of choice for future physicians with a new program

that will defer interest on medical resident debt Improving access to community mental health services provided by physicians

QUOTES “This new agreement reflects the common vision shared by our government and the province’s doctors on how to improve health care for all Ontarians,” said Health and Long-Term Care Minister David Caplan. “We expect significant progress to be made in the next few years in family health care becoming available to more Ontarians and hospital emergency departments becoming less crowded.” QUICK FACTS The agreement with the OMA will cover the period April 1, 2008 to March 31, 2012

LEARN MORE Find out more about the government’s priorities to improve Ontarians’ access to health care. Read about Family Health Teams in the province. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)



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Appendix 1.3


ONTARIO INTEGRATES E-HEALTH ACTIVITIES UNDER ONE AGENCY

McGuinty Government Appoints Dr. Alan Hudson As Chair of eHealth Ontario NEWS September 26, 2008

2008/nr-080 Ontario has appointed Dr. Alan Hudson as the Chair of eHealth Ontario, a restructured agency responsible for all aspects of e-health in Ontario including creating an electronic health record for all Ontarians. eHealth Ontario will bring together the Ministry of Health and Long-Term Care’s e-Health Program and the province’s Smart Systems for Health Agency (SSHA) under one banner. Three key e-health priorities have been identified for the next few years including a Diabetes Registry, an e-health portal to centralize health information on an easily accessible web site, and e-prescribing which will eliminate hand written prescriptions and reduce medication errors. Dr. Hudson - who is leading the government's efforts to reduce wait times in emergency rooms and for key procedures – will chair the Board of Directors for eHealth Ontario, which will have individuals from the broader health, business and information technology sectors. The ultimate goal of the e-health strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system. QUOTES “eHealth Ontario will enable us to transform Ontario’s health care system as we know it,” said David Caplan, Minister of Health and Long-Term Care. “With its broad mandate, eHealth Ontario will deliver a comprehensive, patient-focused, secure and private electronic system that will improve the way patients receive care.” “This is an exciting time for e-health in Ontario,” said Dr. Alan Hudson, Board Chair for eHealth Ontario. “Combining thought leaders from the Ministry and Long-Term Care and the broader health sector means we now have the expertise to make electronic health records a reality for the people of Ontario.” QUICK FACTS eHealth Ontario will work with the Office of the Information and Privacy

Commissioner/Ontario to ensure the protection of personal health information; The Ontario government created SSHA in 2003 to improve patient care through a variety of

initiatives, including network hosting and secure e-mail. The agency has created the foundation for many of the e-health activities underway today.


Alan Findlay, Minister’s Office, 416-327-4320 Mark Nesbitt, Ministry of Health and Long-Term Care, 416-314-6197


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Appendix 1.4a


MCGUINTY GOVERNMENT NAMES MEMBERS OF EHEALTH

ONTARIO BOARD

September 29, 2008 The McGuinty government named Dr. Alan Hudson, Lead of Access to Services/Wait Times with the Ministry of Health and Long-Term Care, as board chair of eHealth Ontario – a restructured agency responsible for all aspects of e-health in Ontario including creating an electronic health record for all Ontarians. Also named as board members are J. David Livingston, President and CEO of Infrastructure Ontario; Matthew Anderson, CEO of the Toronto Central Local Health Integration Network; Heather Sherrard, vice-president of clinical services at the University of Ottawa Heart Institute; and Ken Deane, Assistant Deputy Minister, Health System Accountability and Performance Division, Ministry of Health and Long-Term Care. Dr. Alan Hudson, Board Chair Dr. Alan Hudson is lead Access to Services/Wait Times for the Ministry of Health and Long-Term Care. As president and CEO of Cancer Care Ontario Dr. Hudson led the integration of 11 cancer centres with their host hospitals. Dr. Hudson is a former president and CEO of Toronto’s University Health Network. During that time, he led the integration of Princess Margaret Hospital with the Toronto Hospital, creating the University Health Network. Dr. Hudson also served as McCutcheon chair and surgeon-in-chief at Toronto Hospital from 1989-1991. From 1970 to 1989, he was a leading neurosurgeon at St. Michael’s Hospital in Toronto where he co-founded a laboratory which garnered an international reputation for innovation in neurosurgery research. J. David Livingston, Board Member As President and Chief Executive Officer of Infrastructure Ontario, J. David Livingston oversees the crown corporation responsible for executing large-scale public infrastructure projects for the Ontario government. Livingston has 30 years of financial industry experience, where he ultimately rose to executive vice-president of corporate development at TD Bank Financial Group. At Infrastructure Ontario he has created a team of private and public experts that use innovative tools to deliver complex projects on time and on budget.

Livingston obtained his B.Sc. from the University of Western Ontario in 1973 and his MBA from Queen’s University in 1976. He is a director of Ovarian Cancer Canada and The Children’s Aid Society of Toronto.

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Appendix 1.4b

Matthew Anderson, Board Member Matthew Anderson was appointed CEO of the Toronto Central Local Health Integration Network in the spring of 2008. Prior to his appointment, he led the development of Toronto Central LHIN’s e-Health Strategy. Anderson was formerly vice-president and chief information officer of the University Health Network. He has been recognized nationally as an exceptional Canadian leader who has made an outstanding difference in the advancement of eHealth. He also previously served as chief information officer of the North York Community Care Access Centre, St. John’s Rehabilitation Hospital, Toronto Community Care Access Centre, Toronto Rehabilitation Institute, University Health Network and West Park Healthcare Centre. Heather Sherrard, Board Member Heather Sherrard is vice-president of clinical services at the University of Ottawa Heart Institute where she is responsible for all aspects of care by clinical staff and operating budgets of $40 million. Sherrard has held a variety of clinical and administrative positions in the acute care hospital sector, most of which have been in the area of cardiovascular care. She has been involved with the University of Ottawa Heart Institute since 1998 first as a nursing coordinator, and then the director of nursing. Sherrard holds two joint appointments with the University of Ottawa and is actively involved in the education of Masters students in Nursing and Health Administration. She is a member of the editorial board of the Canadian Journal of Cardiovascular Nursing. She has worked on a number of provincial committees associated with the care of cardiac patients. She also provides consulting services to other provinces in the area of cardiac health services. Ken Deane, Board Member Ken Deane is Assistant Deputy Minister of the Health System Accountability and Performance Division at the Ministry of Health and Long-Term Care. Prior to this, he was chief operating officer of the London Health Sciences Centre and St. Joseph’s Health Care in London, Ontario. Deane has also served as president and CEO of St. Joseph’s Health Centre in Toronto, president and CEO of Hotel-Dieu Grace Hospital in Windsor, vice-president of finance and chief financial officer of Hamilton Health Sciences Centre, and executive vice-president and chief financial officer of Grand River Hospital in Kitchener. He has served on various boards, most recently on the board of directors of the Workplace Safety and Insurance Board where he was the chair of the human resources and compensation committee.

Alan Findlay, Minister’s Office, 416-327-4320 Mark Nesbitt, Ministry of Health and Long-Term Care, 416-314-6197


NEWS Ministry of Health and LongTerm Care

IMPROVING PATIENT SAFETY IN HOSPITALS McGuinty Government Invests In Infection Control Measures

NEWS September 26, 2008 2008/nr077

Ontario is boosting patient safety measures by creating infection control resource teams, funding 66 more infection prevention and control practitioners in hospitals and local health units, and supporting more effective antibiotic usage.

The announcement comes as C. difficile rates are being publicly reported for the first time ever in Ontario. Rates must be posted on the websites of all Ontario hospitals and the Ministry of Health and LongTerm Care’s public website, creating an unprecedented level of transparency.

Public reporting will enable hospitals to monitor C. difficile rates in their facilities so that the most appropriate infection control measures and highest possible standards of patient safety can be put in place.

Numbers for August 2008 show that there were 319 cases of C. difficile associated disease found among the 228 hospital sites in Ontario. The provincial C. difficile rate was 0.39 per 1,000 patient days.

This is the first time hospitals have been required to publicly report, and it will take time to establish trends. C. difficile rates may vary seasonally.

The Ontario Agency for Health Protection and Promotion is also working with the Institute for Safe Medication Practices Canada and infectious disease expert Dr. Allison McGeer to support hospitals in the most effective use of antibiotics. This work is important because prolonged exposure to certain classes of antibiotics presents a real risk for C. difficile associated disease to emerge.

QUOTES

“We’re improving patient safety as part of our commitment to ensure the highest standards of care for hospital patients in Ontario,” said Health and LongTerm Care Minister David Caplan. “We’re taking the steps needed to more effectively control infectious diseases in hospitals.”

“The infection control initiatives announced today will help us to be prepared as new information becomes available on infection rates through the full reporting of C. difficile and the other patient safety indicators,” said Dr. Michael Baker, executive lead, Patient Safety, Ministry of Health and LongTerm Care.

“We are pleased to establish infection control resource teams that will work with the ministry, local public health units and hospitals to provide ontheground expertise that will help frontline health care workers deal effectively with infectious diseases,” said Dr. Vivek Goel, president and CEO of the Ontario Agency for Health Protection and Promotion.

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“Ontario's hospitals strongly support collecting and publicly reporting patient safety data that will contribute to the continuous improvement of health care in hospitals,” said Ontario Hospital Association Board Chair Mark Rochon. “This data, reported on a consistent, provincewide basis, will be an important element in our efforts to improve patient safety.”

“The Quality Healthcare Network welcomes the creation of infection control resource teams and the addition of more infection prevention and control practitioners on the ground. We believe these investments bring criticallyneeded resources to the front lines. It demonstrates the government’s commitment to improving patient safety in our hospitals," said Cynthia Majewski, executive director of the Quality Healthcare Network and Ontario lead for Safer Healthcare Now.

QUICK FACTS

§ In addition to today’s announcement, Ontario has previously funded 136 infection prevention and control practitioners (ICPs) in hospitals and another 180 infection control staff in public health units;

§ Altogether, Ontario has now provided funding for 166 hospital ICPs – one ICP for every 100 hospital beds. This represents the best ICP to hospital bed ratio in North America.

§ ICPs are health care professionals with specialized training and expertise in infection prevention and control;

§ Infection control resource teams (ICRTs) will provide rapid, onsite assistance during an infectious disease outbreak when the Chief Medical Officer of Health determines that a need exists;

§ ICRTs will be assembled, managed and deployed by the Ontario Agency for Health Protection and Promotion;

§ Good hand hygiene is the single most effective way to prevent the spread of infectious diseases like C. difficile.

LEARN MORE

Learn more about Ontario’s Patient Safety Initiative and hospital reporting

Learn more about Ontario’s hand hygiene initiative Just Clean Your Hands.

Read more about infection control resource teams, infection prevention and control practitioners, hospital design and infection control, reporting C. difficile in hospitals and C. difficile reporting in other jurisdictions

Read the announcement on the full public reporting of eight patient safety indicators.

For public inquiries call ServiceOntario, INFOline at 18665323161 (Tollfree in Ontario only)

Steve Erwin, Minister’s Office, 4163263986 Mark Nesbitt, Ministry of Health and LongTerm Care, 4163146197

ontario.ca/healthnews Disponible en français

http://www.ontario.ca/patientsafety

http://www.justcleanyourhands.ca/

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/infection_team_bg_01_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/gos_infection_prevention_fs_01_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/cdiff_reporting_bg_01_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/may/nr_20080528.html

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/infection_practitioners_bg_01_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/infection_practitioners_bg_01_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/cdad_reporting_fs_02_20080925.pdf

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/sep/cdad_reporting_fs_02_20080925.pdf


REPORTING C. DIFFICILE RATES IN HOSPITALS

September 26, 2008

Beginning today, Clostridium difficile associated disease (CDAD) rates of all hospitals are being published on the Ministry of Health and Long-Term Care’s public website. About this reporting tool Ontario is requiring all hospitals to monitor and report CDAD in their facilities so the most appropriate infection control measures can be put in place. Hospitals will use this information to ensure they’re maintaining the highest possible standards of patient safety. How to interpret CDAD data When interpreting the data it’s important to understand that many differences exist from hospital to hospital which could affect their case counts and CDAD rates. These include:

Size of the hospital; Complexity of the services offered; Type of patient population served; Number of people hospitalized for respiratory infection; Use of antibiotics; Percentage of patients age 65 or older in the hospital.

CDAD rates may also vary seasonally. An increase of infection rates in several facilities over the winter months is to be expected. Trends in CDAD rates will be posted on the Ministry of Health and Long-Term Care’s website when enough data is available. Fluctuations in rates across reporting periods are better interpreted when rates from different periods are taken into account. The data presented on the ministry website is best used to measure individual hospital performance over time. It can also be used to ask informed questions to hospital representatives about their infection prevention and control program. It’s not intended to be the only source of information for making decisions about hospital care nor is it information for generalizing about the overall quality of care provided by hospitals. How is the data presented? Data is presented in tables by hospital site. Included in the tables is data on the number of new hospital-acquired CDAD cases as well as the CDAD rate by month. The data presented on the ministry’s website has been confirmed by the hospitals and is also being reported on the hospitals’ websites.

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The rate is calculated by dividing the number of new cases observed at the hospital site by the number of patient days per reporting period, multiplied by 1000. Rates are expressed as cases per 1,000 patient days and exclude patients less than one year of age. This rate calculation allows the level of hospital activity to be taken into account, which may fluctuate over time and is different across hospitals. Hospitals are grouped by hospital type to facilitate more relevant comparisons. The hospital types are:

• Large Community; • Small Community; • Mental Health; • Acute Teaching; • Complex Continuing Care & Rehabilitation.

These hospital types take into consideration differences in hospital size and patient case mix, factors which can make a significant difference in average CDAD rates. For example, teaching hospitals generally serve more complex or sicker - and therefore more vulnerable - patients and could have a higher CDAD rate than the provincial average. The provincial CDAD rate is aggregated data, compiled from the data for all hospitals in Ontario. August 2008 data For the period covering August 2008, there were 319 cases of C. difficile associated disease found among the 228 hospital sites in Ontario. The provincial CDAD rate was 0.39 per 1,000 patient days. This is the first time hospitals have been required to report and it will take time to establish a trend. However, public reporting of C difficile represents a significant tool for hospitals to use to monitor their performance and determine what measures they need to take to strengthen infection prevention and control in their facilities. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)

Steve Erwin, Minister’s Office, 416-326-3986 Mark Nesbitt, Ministry of Health and Long-Term Care, 416-314-6197



HOSPITAL DESIGN AND INFECTION CONTROL

September 26, 2008

Ontario has developed leading edge guidelines for the construction of new hospitals to support the delivery of high quality health care services, and to improve their ability to prevent the spread of infectious diseases. These guidelines have been developed with input from national and international experts. The guidelines are part of a new set of standards the province has developed to improve the efficiency of the planning process, create greater consistency for high quality health care, and prevent the spread of infectious diseases in hospital settings. Together, they are called GOS (Generic Output Specifications). These new standards (GOS) will ensure that new hospitals in Ontario are better prepared to stop the spread of infectious diseases. They will have more square footage to accommodate separate entrances and exits for staff and visitors, and new configurations for clinical spaces so that contamination of hospital equipment is less likely to occur. The consultation process for GOS included multidisciplinary teams consisting of doctors, nurses, allied health professionals, technicians, health care design consultants and maintenance staff looking at international standards and global best practices. While GOS guidelines were developed based on current and evolving health care benchmarks, the guidelines will be updated regularly to reflect changing clinical practice, technology, and evidence based-practices from around the world. With respect to infection prevention and control, GOS includes recommendations for hand hygiene stations, airborne precaution rooms, HVAC (Heating Ventilation and Air Conditioning), spacing and storage, clean and soiled storage areas, and waste management. Examples include: One hand washing sink inside each in-patient room, adjacent to the entrance. The hand

washing sink in the room is in addition to the sink in the washroom; Hand washing sinks must be free standing and not inserted into or immediately adjacent to

a counter; Alcohol-based hand rub bottles shall be mounted on the external wall immediately adjacent

to the entrance to every in-patient room; Alcohol-based hand rub bottles shall be mounted adjacent to the bedside in all situations.




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Appendix 1.5c


INFECTION PREVENTION AND CONTROL PRACTITIONERS

September 26, 2008

An infection prevention and control practitioner (ICP) is a health care professional with specialized training and expertise in infection prevention and control. The ICP works with all hospital departments to prevent health care-associated infections. They also educate health care staff on infection prevention and control, conduct surveillance and provide expert consultation as needed. Following today’s announcement, the government has now provided funding for 166 hospital ICPs across the province since 2004/05, which is a total investment of over $13 million. Ontario has provided funding for one ICP for every 100 hospital beds. This is the best ratio in North America. Listed below is a chart showing the hospital ICP positions funded since 2004/05:

HOSPITAL NAME

Funding 04/08 Funding 08/09

Alexandra Hospital (Ingersoll) 0.5

Almonte General Hospital (Almonte) 0.5

Arnprior and District Memorial Hospital Corporation (Arnprior) 0.5

Atikokan General Hospital (Atikokan) 0.5

Baycrest Centre for Geriatric Care (Toronto) 1 0.5

Bloorview MacMillan Children's Centre (Toronto) 0.5

Bluewater Health (Sarnia) 2 0.5 Brant Community Health Care System (Brantford)

2 0.5

Bridgepoint Hospital (Toronto) 2.5 0.5

Brockville General Hospital 0.5

Cambridge Memorial Hospital (Cambridge) 1

Campbellford Memorial Hospital (Cambellford) 0.5

Centre for Addiction and Mental Health (Toronto) 3 0.5

Chatham Kent Health Alliance 2 Collingwood General and Marine Hospital (Collingwood) 0.5 Cornwall Community Hospital (Cornwall) 1

The Credit Valley Hospital (Mississauga) 2 0.5

Deep River and District Hospital (Deep River) 0.5

Dryden Regional Health Centre (Dryden) 0.5

Espanola General Hospital (Espanola) 0.5

Glengarry Memorial Hospital (Alexandria) 0.5

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Grand River Hospital Corporation (Kitchener) 2.5 0.5

Grey Bruce Health Services (Owen Sound ) 1

Groves Memorial Community Hospital (Fergus) 0.5

Guelph General Hospital (Guelph) 0.5

Headwaters Health Care Centre (Orangeville) 0.5

Haliburton Highlands Health Services Corporation (Haliburton) 0.5

Halton Healthcare Services Corporation (Oakville) 1.5 1

Hamilton Health Sciences Corporation (Hamilton) 2 1

Hanover and District Hospital (Hanover) 0.5

Homewood Health Centre (Guelph) 2 Hôpital General de Hawkesbury & District General Hospital Inc. (Hawkesbury) 0.5

Hôpital Montfort Hospital (Ottawa) 1

Hôpital Notre-Dame Hospital (Hearst) 0.5 Hôpital Regional de Sudbury Regional Hospital (Sudbury) 2 1

Hotel-Dieu Grace Hospital (Windsor) 2 Hotel Dieu Shaver Health & Rehabilitation Centre (St Catharines) 1

Humber River Regional Hospital (Toronto) 1 1

Muskoka - East Parry Sound (Huntsville / Bracebridge) 1 0.5 Huron Perth Hospital Alliance (Seaforth, Stratford, Clinton and St. Mary's) 1 0.5

Joseph Brant Memorial Hospital (Burlington) 2

Kingston General Hospital (Kingston) 1

Lady Dunn Health Centre (Wawa) 0.5

Lake of the Woods District Hospital (Kenora) 0.5

Lakeridge Health Corporation (Oshawa) 1 1

Leamington District Memorial Hospital (Leamington) 0.5

Listowel & Wingham Hospital Alliance (Listowel and Wingham) 0.5

London Health Sciences Centre (London ) 2 1

Manitoulin Health Centre (Little Current) 0.5

Markham Stouffville Hospital (Markham) 2

Mattawa General Hospital Inc. (Mattawa) 0.5

The McCausland Hospital (Terrace Bay) 0.5

MICS Group of Hospitals (Matheson, Iroquois Falls, Cochrane) 0.5 Strathroy Middlesex General Hospital (Strathroy - part of Middlesex Hospital Alliance) 0.5

Mount Sinai Hospital (Toronto) 1

Niagara Health System (Niagara Region) 4 1

Nipigon District Memorial Hospital (Nipigon) 0.5

Norfolk General Hospital (Simcoe) 1

North Bay General Hospital (North Bay) 1 1

North Simcoe Hospital Alliance (Huronia / Penetanguishene) 1

North Wellington Health Care Corporation (Mount Forest) 0.5

Northeast Mental Health Centre (Sudbury) 2

Northumberland Hills Hospital (Cobourg) 0.5 0.5

The Ottawa Hospital (Ottawa) 1

Orillia Soldiers' Memorial Hospital (Orillia) 2

Pembroke General Hospital Inc. (Pembroke) 1 0.5

Penetanguishene Mental Health (Penetanguishene) 1 0.5

Perth and Smiths Falls District Hospital (Smiths Falls) 0.5 Peterborough Regional Health Centre (Peterborough) 1

Providence Healthcare (Toronto) 1.5

Providence Continuing Care Centre (Kingston) 2 0.5

Queensway Carleton Hospital (Ottawa) 1 0.5

Quinte Healthcare Corporation (Belleville) 1.5 0.5

Red Lake Margaret Cochenour Memorial Hospital (Red Lake) 0.5

Renfrew Victoria Hospital (Renfrew) 0.5

Ross Memorial Hospital (Lindsay) 0.5 Rouge Valley Health System (Toronto) 1.5 0.5

Royal Ottawa Health Care Group (Ottawa) 2.5

The Royal Victoria Hospital of Barrie (Barrie) 1

Runnymede Healthcare Centre (Toronto) 1 The Salvation Army Toronto Grace Hospital (Toronto) 1

Sault Area Hospital (Sault Ste Marie) 2.5 1

The Scarborough Hospital (Toronto) 1

Sensenbrenner Hospital (Kapuskasing) 0.5 0.5

SCO Health Service (Ottawa ) 2.5 0.5

Services de Sante de Chapleau Health Services (Chapleau) 0.5

Sioux Lookout Meno-Ya-Win Health Centre (Sioux Lookout) 0.5

South Bruce Grey Health Centre (Kincardine) 0.5

Southlake Regional Health Centre (Newmarket) 1

St. John's Rehabilitation Hospital (Toronto) 1

St. Joseph's Care Group (Thunder Bay) 2

St. Joseph's General Hospital (Elliot Lake) 0.5

St. Joseph's Health Care (London) 4

0.5

St. Joseph's Health Centre (Toronto) 1

St. Joseph's Heathcare (Hamilton) 2.5 1

St. Joseph's Health Centre (Guelph) 0.5

St. Mary's General Hospital (Kitchener) 1

St. Peter's Hospital (Hamilton) 1.5 0.5

St. Thomas-Elgin General Hospital (St Thomas) 0.5

Stevenson Memorial Hospital (Alliston) 0.5

Sunnybrook Health Sciences Centre (Toronto) 1 1

Temiskaming Hospital (New Liskeard) 1

Thunder Bay Regional Hospital (Thunder Bay) 2 1

Tillsonburg District Memorial Hospital (Tillsonburg) 0.5 Timmins and District Hospital (Timmins) 0.5

Toronto East General & Orthopaedic Hospital Inc. (Toronto) 2 0.5

Toronto Rehabilitation Institute ( Toronto) 3 0.5 Trillium Health Centre (Mississauga) 3 1

University Health Network (Toronto) 1

West Haldimand General Hospital (Hagersville) 0.5

West Lincoln Memorial Hospital (Grimsby) 0.5

The West Nipissing General Hospital (Sturgeon Falls) 0.5

West Park Healthcare Centre (Toronto) 1 0.5

Whitby Mental Health (Whitby) 2 0.5

William Osler Health Centre (Brampton) 1.5 1

Wilson Memorial General Hospital (Marathon) 0.5

Winchester District Memorial Hospital (Winchester) 0.5

Windsor Regional Hospital (Windsor) 2.5 1

Women's College Health Centre (Toronto) 1

York Central Hospital (Richmond Hill) 1 0.5

Total Allocation for 2004/2008

136 Total Allocation for 2008/2009 30 Total ICP Allocation between 2004/2005 - 2008/2009

166



News Release Communiqué

For Immediate Release September 25, 2008

ARCHITECTURAL FIRM CHOSEN FOR THE

HUMBER RIVER REGIONAL HOSPITAL PROJECT

TORONTO – The Humber River Regional Hospital project continues to move forward with the selection of HOK Architects Corporation to provide the planning, design and compliance aspects of the project. Humber River Regional Hospital’s new facility will be a new state-of-the-art hospital for acute care, constructed at Keele Street and Wilson Avenue in Toronto. The new facility will offer a comprehensive range of services to support inpatient and outpatient programs. Highlights of the new hospital include:

• Expanded emergency services; • Increased specialized outpatient services; • Modern, high-tech diagnostic equipment for better patient diagnosis and treatment; • Updated infectious disease containment systems to monitor and prevent a broad

range of infections. The compliance design team will develop the Site Master Plan and prepare key documents to form the guidelines and performance requirements that the successful building team must work with when preparing the overall design. “This is an important milestone for the community and for Humber River Regional Hospital,” said George Smitherman, Deputy Premier and Minister of Energy and Infrastructure. “With a commitment of more than $5 billion, we now have more than 100 new and existing hospitals in various stages of expansion and upgrade across Ontario, which represents the biggest investment in health care infrastructure in more than a generation.” “This is a clear sign of the government’s commitment to upgrade and modernize health care and is a positive step towards the redevelopment of this hospital,” said Monte Kwinter, MPP for York Centre. “This investment by the McGuinty government will further improve the health services provided to Ontarians.” The Humber River Regional Hospital project will proceed under Infrastructure Ontario’s Design Build Finance Maintain model whereby risks associated with the design, construction, financing and maintenance are transferred to the private sector. “We’re very pleased that our project has progressed to where we can announce our planning, design and compliance team,” said Dr. Rueben Devlin, President and CEO of Humber River Regional Hospital. “They will help us design the best possible medical

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Appendix 1.6

facility for our patients, and part of their work will be to lead consultations with our community on the services they want to see at this great new hospital.” Infrastructure Ontario and the Ministry of Health and Long-Term Care will work with Humber River Regional Hospital on the new hospital, which will remain publicly owned, publicly controlled and publicly accountable. Infrastructure Ontario is a Crown corporation dedicated to managing some of the province's larger and more complex infrastructure renewal projects – ensuring they are built on time and on budget. Visit www.infrastructureontario.ca for more information. - 30 - Contacts Amy Tang Jennifer Sclisizzi Minister’s Office Infrastructure Ontario Ministry of Energy and Infrastructure 416-325-7409 416-327-6747 Gerard Power Humber River Regional Hospital 416-243-4448 Disponible en français

http://www.infrastructureontario.ca/

Updated October 21, 2008

Investment Programs Purpose of Investment Amount in 2008-09 Amount in 2009-10 Amount in 2010-11

LHIN Urgent Priorities Fund Provide the LHINs with funding to address local priorities based on their IHSPs $3,609,369 $3,609,369 $3,609,369

Aging at Home StrategyTo tailor a range of support services to meet the needs of seniors so that they may live independently in their own homes.

$13,527,801 $33,618,398 $59,375,263

Post Construction Operating PlanTo Provide operating dollars to cover the costs of the new or expanded programs and services, as well as the additional space and equipment amertization

$3,689,900 $3,689,900 $3,689,900

CCAC - Home care - Homemaking Increase in the service maximums for home care personal support and homemaking services. $3,404,100 $6,808,300 $10,779,800

HOSP - Hospital Growth Demands The base funding increase is for hospitals experiencing high growth to help sustain services $6,998,000 TBD TBD

Wait Time Strategy - ED Pay-for-Results

Enable the Central LHIN to reduce D Length-of-Stay and improve patient satisfaction at designated hospitals in the Central LHIN

$4,648,200 TBD TBD

Critical Care StrategyFunding provided to support hospitals in LHIN with the cost of educating and training nurses newly hired to work in CC unit.

$391,000 TBD TBD

Personal Support Workers Funding to support creation of 873 personal support workers province-wide in LTC Homes $2,208,288 TBD TBD

Stevenson Memorial HospitalTo help Stevenson Memorial Hospital to implement operational improvements and efficiencies recommended by the supervisor

$1,751,700 $950,700 $950,700

Total $40,228,358 $48,676,667 $78,405,032

In Year Incremental Funding - Central LHIN

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Appendix 1.7

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Appendix 1.8

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Appendix 1.9a

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Appendix 1.9b

Communiqué

Issue #1 - October 2008

HBAM Advisory Committee Established

The Ministry of Health and Long Term Care, in conjunction with Ontarios Local Health Integration Networks (LHINs), are pleased to announce the formation of the Health-Based Allocation Model (HBAM) Advisory Committee. The Committee is a permanent structure established to provide balanced, evidence-based recommendations on all aspects of the HBAM model. This 12-person committee, chaired by Assistant Deputy Minister John McKinley and Central LHIN CEO Hy Eliasoph, meets regularly and will act as a central forum of communication and issue resolution on HBAM design and implementation. It is also mandated to provide oversight and guidance to the two standing technical subcommittees on calibration and enhancement, and to oversee the creation of any future tasks groups. Update on Current Activities:

Technical Subcommittee Member Selection

One of the current priorities of the HBAM Advisory Committee is the equitable selection of members of the health service provider and LHIN communities to join the HBAM technical subcommittees. A framework for the review of candidates has been approved by the committee and the selection of members is underway.

HBAM vs. IPBA

The Committee has begun reviewing a comparison of the Health-Based Allocation Model (HBAM) and the Integrated Population-Based Allocation Model (IPBA) to understand the potential impact on hospitals as HBAM implementation moves forward.

Review of Casemix

In its upcoming meeting, the Committee will begin a review of the HBAM casemix methodology and how it compares to the new CIHI CMG+ methodology.

Harmonization of Hospital Funding

In an effort to ensure proper HBAM implementation, the HBAM Advisory Committee has identified harmonization of hospital funding as a key area to be explored in the coming year. Communication with Stakeholders: Toolkit & Data Access

The HBAM Advisory Committee is also exploring options for providing LHINs and Health Service Providers (HSPs) with appropriate access to HBAM information and results in line with their respective roles in the health system. The Committee is considering a multiple-phase plan with emphasis on short-term and long-term solutions.

Also, to increase understanding of the model amongst partners in Ontarios health care system, the Committee is overseeing the development of an HBAM Communication toolkit consisting of a background document, and both a general and technical Q & A.

The Committee will continue to provide updates on its work and decisions at regular intervals. For more information on the HBAM Advisory Committee please feel free to contact Cristina Perez, Director of the Investment Planning and Management Branch ([email protected] ). Sincerely, John McKinleyAssistant Deputy Minister Health System Information Management and Investment Division Ministry of Health and Long-Term Care

Hy EliasophCEO Central Local Health Integration Network

Ontario Ministry of Health and Long-Term Care & Local Health Integration Network Collaborative

HEALTH-BASED ALLOCATION MODEL

Advisory Committee

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Ministry of Health and Long-Term Care

Ministère de la Santé et des Soins de longue durée

Health System Accountability and Performance Division LHIN Liaison Branch 5th Floor, Hepburn Block 80 Grosvenor Street Toronto ON M7A 1R3

Division de la responsabilisation et de la performance du système de santé Direction de la liaison avec les RLISS Édifice Hepburn, 5e étage 80, rue Grosvenor Toronto ON M7A 1R3

Telephone : 416 314-1864 Facsimile : 416 326-0018

Téléphone : 416 314-1864 Télécopieur : 416 326-0018 HLTC2980IT-2008-2404

September 30, 2008 TO: LHIN CEOs and

LHIN Sr. Directors, Performance, Contract and Allocations FROM: Carrie Hayward, Director, LHIN Liaison Branch RE: Ministry-LHIN Accountability Agreements (MLAA) Status Report

on Developmental Indicators As per Schedule 10, Section 2 (c) of the MLAA, attached is a status report on the developmental indicators, prepared by Health Analytics Branch. If you have any questions, please contact Paul Lee at 416-314-5534 or [email protected]. (Original Signed By) Carrie Hayward c: Sten Ardal, Director, Health Analytics Branch Paul Lee, Manager, Short-Term Response Unit

mailto:[email protected]

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Appendix 1.11a

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Appendix 1.12

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Appendix 1.13

Central LHIN – DRAFT QUALITY WORKPLAN, v4

Draft Quality Workplan – October 21, 2008 Page 1 of 3

Work plan

Description Output Timeline

Project Organization / Information Gathering

• Draft Work plan • Project Scoping - Initial • Key Informant Interviews

• Inventory of HSP Quality Initiatives

• Inventory of Quality and System Frameworks

• Board Education Session #1 – U

of T, Ontario Health Quality Council

• Performance Indicator

Frameworks

• Inventory of Cross LHIN initiatives

• Stakeholder Focus Group Session #1

• Identification of Board Champion

• Retain Consultant

• Board Education Session #2

• CEO Report – Ongoing • Project Charter – draft • Compilation (framework) of Findings • Compilation (framework) of Initiatives

and Areas of Focus • Compilation (framework) of provincial,

system and local frameworks and indicator sets

• Definitions, Preliminary Identification of

Preferred Framework • Updated Compilation of Initiatives,

Frameworks and Indicator Sets • Preliminary Stakeholder Feedback

October-November October-January

Preliminary Analysis / Scenario Development

• Literature Review of Dimensions

• Scenario Analysis / Options • Framework Draft – Two-Three • Draft Critical Path • Stakeholder Focus Group Session

#2

• Review of Findings with Board – draft recommendations

• Précis of literature and relevant forward thinking scholarly focus

• Development of Quality/Performance Frameworks (2-3 drafts)

• Terms of Reference • Updated Stakeholder Feedback • Revise draft project charter

December Stakeholder Focus Group

Monitoring Framework • Process Plan to Develop Framework

• Process Plan to Implement Framework

• Draft longer-term work plan to meet agreed goals / fulfill strategic priority

January-February

Organizational and Stakeholder Impact

• Plan to address: Culture, Competency, Structure

• Incorporate into longer-term work plan • Draft resource budget

January-February

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Appendix 4.1.1



Work plan

Description Output Timeline

Quality Forumn • Draft Project and Stakeholder

Findings • Updated Stakeholder Feedback • Final Draft Charter

January-March Early February Quality Forumn

Project Charter • Final Draft Charter • Board Review and Approval March



Key Stakeholders 1. Ontario Health Quality Council 2. Quality Health Network 3. York University 4. Select Health Service Providers 5. Ministry of Health and Long-Term Care

Related Initiatives – to inform thinking

1. Balanced Scorecard 2. Outcome Map - Step One of Evaluation Framework 3. Integrated Health Service Plan – Redo 4. Service Needs Assessment and Gap Analysis

Resources

1. Consultant/ expertise for work plan implementation and project scoping/refinement and Quality Forumn 2. Staff support 3. Board Champion 4. Ad Hoc Stakeholder Focus Groups 5. Key Informants

Aging at Home2009/10 Request for Proposals

DRAFT Evaluation Process for 2009/10 Proposals

October 2008

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Appendix 4.1.2

Results from 2009/10 Call for Proposals• Requests for proposals were posted on August 15 2008 on the Central LHIN

website

• Proposals were due Friday September 26 by 4:00pm

• Received 67 proposals in total

• Total Funding Requested from all proposals was:

• Base funding $35,198,101

• One-time funding $7,588,773

• Total Request: $44,665,880

Draft RFP Review Process• Aging at Home 2009/10 RFP Review Process is an

interim solution designed to dovetail with the uniform processes being designed by the Central LHIN Project Management Office

• Evaluation scoring tool is a weighted scorecard customized to measure the unique criteria set for each Request for Proposal.

• Review exercise involves both external subject matter experts as well as Central LHIN staff

Review Groups:Proposal Review Committee (Step 1)

Reviews all 67 proposals using the Aging at Home weighted scorecard. The Review Committee ensures eligibility, examines service coordination & access, evaluates risk and cost/benefit of proposed program, identifies possible legislative or regulatory barriers, ensures health equity is enabled through all proposals and develops final rank for expert panel review. Consists of 6 participants which include subject matter experts and Central LHIN staff.

Expert Panel (Step 2)Reviews recommended proposals from the Review Committee to examine impacts to Health Human Resources, Diversity & Inclusion, E-Health agenda, opportunities for potential integration, performance and measurement feasibility as well as any impact to the Central CCAC. In addition, the expert panel review process will include the initiation of the Health Impact Assessment Tool to be completed by successful providers of proposals upon Board approval. Consists of 6 participants representing targeted subject matter expertise.

Aging at Home Steering Committee (Step 3)Reviews final recommendations from the Expert Panel in preparation for presentation of proposed projects for Board approval

Central LHIN Board (Step 4)Proposals presented to the board for approval in November 2008

*Evaluation Process endorsed by Seniors Advisory Network October 7, 2008

Next Steps• Evaluation by Review Committee to be completed by

October 17, 2008

• Review and potential project modification by expert panel to be completed by October 28, 2008

• Providers to be notified of project status October 31, 2008

• Aging at Home Steering Committee to develop recommendation to Central LHIN board for approval in November 2008

2008/09 Business Plan Status Report – October 28, 2008 MINISTRY/LHIN ACCOUNTABILITY AGREEMENT

08/09 Business Plan Status Report- Updated October 16, 2008 1 Note: Changes highlighted BOLD.

Status Legend On-track slightly off-plan significantly off

Central LHIN 2008/09 Business Plan Status Report

October 28, 2008

PART A

MINISTRY/CLHIN ACCOUNTABILITY AGREEMENT

PART B

OTHER BUSINESS PLAN REQUIREMENTS

PART C

RISK MANAGEMENT REPORT

PART D

QUARTERLY MLAA PERFORMANCE REPORT

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Appendix 4.3




AA Schedule Pages Comments Status Schedule 1:General

3 Budget announcement and MLAA refresh underway.

Schedule 2: Community Engagement, Planning & Integration

4-5

Several IHSP priority activities underway through support of Urgent Priorities Funding, and Aboriginal engagement funding. The MOHLTC Strategic Plan has been delayed. No changes to the IHSP are planned for the refresh until six months following the release of the strategy as per the MLAA.

Schedule 3: Local Health System Management 6-11

Satisfactory progress to date. Some items finalized; other processes & tools under development. Discussions are on-going with hospitals projecting a deficit.

Schedule 4: Information Management Supports 11

Provincial Forum to be developed.

Schedule 5: Financial Management 11-15 CLHIN financial resources continue to be challenged. In

particular new capital requirements will be an issue.

Schedule 6: Financial Processing Protocols 15

CLHIN has fully complied, however, CLHIN resources continue to be challenged.

Schedule 7: Local Health System Compliance Protocols 15-16 A process has been established with the Performance Improvement and Compliance branch to notify CLHIN of any Long-Term Care sector non-compliance.

Schedule 8: Integrated Reporting 16-18 CLHIN in compliance

Schedule 10: Local Health System Performance 18 CLHIN in compliance

Schedule 11: e-Health 19-20 Activities on track. Part B: Other Business Plan Requirements

20-22 Requirements being met.

Part C: Risk Management Report 22 Several financial risks are emerging with the hospital sector. Part D: Quarterly MLAA Performance Report 22 MLAA scorecard and commentary will be provided

Jun/Sept/Dec/Mar




Schedule 1: General # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part C. Phase II for 2007-2008 1.1 Develop provisions to address and add to the Schedules in the following areas:

(a) Schedule 5: Financial Management, related to capital. (b) Schedule 7: Local Health System Compliance Protocols; (c) Schedule 9: Allocations (d) Schedule 10: Local Health System Performance, performance benchmarks, baselines, LHIN targets and performance corridors for the performance indicators as set out in Tables A, B and C of the Schedule.

Completed These schedules have been updated through the MLAA refresh. The MLAA refresh was submitted and approved by the Board at the June Board meeting. Minster-signed copies of the amended MLAA were received on August 7, 2008.

1.2 Develop provisions in a timely manner about elements of the financial management framework related to results-oriented planning, fiscal prudence and parameters for the treatment of surplus funds.

Ongoing Ministry is revising the draft proposal. It will be provided to the Board for input when available.

Part D. Annual Review Update 1.3 Review within 120 days of a budget announcement by the Government of Ontario:

Schedule 3: Local Health System Management Schedule 9: Allocations; and Schedule 10: Local Health System Performance

Completed Budget announced. The Ministry has provided schedules to Central LHIN staff.

1.4 Work together to complete, an evaluation of their effectiveness in carrying out the transition and devolution of authority contemplated by this agreement, and within 90 days of receiving the report, develop an action plan to address recommendations arising from the evaluation.

Ongoing Ministry presented interim findings on June 18, 2008. The report is being finalized.




Schedule 2: Community Engagement, Planning & Integration # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part B. Community Engagement Performance Obligations 2.1 N/A

Regularly review community engagement strategy and plan.

Ongoing

2.2 N/A Report on community engagement activities in the Annual Report.

Completed Submitted to Ministry on June 30th.

Part C: Planning Performance Obligations 2.3 Develop and update, as necessary, an Integrated Health System Planning Guide to

support the development of the Provincial Strategic Plan and the IHSP.

Completed-Further Updates/changes,

as required

The Integrated Health System Planning Guide refers to Ministry directions and criteria for consideration with projects. Work Plans have been developed for all IHSP implementation activities; terms of reference for each successor group has been approved by the Board. Several activities are underway with approval of the Board, and funding from the Urgent Priorities Fund. Aging at Home initiatives approved by the Board and Ministry are underway.

2.4 Released by the Ministry the Provincial Strategic Plan in Spring 2007. The new target date is Winter 2009

Agreement that a new 3 year IHSP (2009-10-2012-13) will be developed

Oct/09 The Ministry presented the draft Strategic Plan as part of the Annual service plan meeting on June 19 and 20. A joint working group is developing a new IHSP Roadmap.




2.5 Develop a process to review the functions of health systems planning Organizations, other than LHINs.

Provide to the MOHLTC: (i) Advice on the functions of health system planning organizations, other than LHINs; and (ii) Information on any significant proposed changes to its IHSP.

N/A Central LHIN is monitoring pandemic activities. No changes to the IHSP are planned prior to the re-do.

2.6 N/A Reflect the IHSP in the Annual Service Plan required under Schedule 5.

Completed Aug. 31

IHSP priorities are articulated in the Annual Service Plan.

2.7 N/A

Demonstrate progress on the implementation of IHSP priorities, and report in the LHINs Annual Report.

Completed 2006/07 Annual Report complete and submitted.

Part D: Integration Performance Obligations 2.8 Consult with the MOHLTC prior to issuing a decision to integrate or to stop the

integration under sections 26 or 27 of the Act and include a report on its integration activities in its Annual Report.

In place To date, four voluntary and one facilitated integration decision completed. One voluntary and one facilitated integration request will be submitted to the Board in October for consideration. A consultant is being sought to undertake a feasibility study for back-office integration in the community sector. Central LHIN completed a LHIN-wide effort to compile and document Integration Decisions.

Schedule 3: Local Health System Management

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part B: General Performance Obligations 3.1 N/A Make decisions about which services will be

provided including service volumes, performance requirements, and funding.

Nov 08 A Service Needs Assessment and Gap Analysis for Central LHIN is underway.




3.2 Provide the LHIN with, and develop as appropriate, those provincial standards (such as operational or service standards and policies, and program eligibility) that apply to health service providers, including providing the LHIN with relevant program manuals.

Require health service providers to provide services funded by the LHIN in accordance with applicable legislation, provincial policies, standards, operating manuals and service accountability.

In place The Central LHIN as a matter of course, provides health service providers with directives as in accordance with Ministry direction.

3.3 N/A Develop a plan to negotiate new service accountability agreements.

Mar 31/09 A plan for negotiating new service accountability agreements with community health service providers is in the final stages of development and will is being brought forward for Board approval in October.

3.4 N/A Negotiate in 2007/2008 with each hospital a service accountability agreement that will commence on April 1, 2008.

Dec/08 Four hospital agreements remain unsigned. (See Part C- Risk Management Report). Progress on volume/budget achievements are reviewed as part of Quarterly reporting by hospitals on WERS. Significant variation to performance expectations are reported as part of risks. Specific reporting for Schedule 9 (Central LHIN specific performance obligations) will be tracked quarterly and reported as part of the CEO report.




Part C: Sector Specific Performance Parameter Hospital Programs Funded Through Base Budgets and Provincial Resources

3.5 Notify LHIN of provincial/regional service delivery models that must be maintained.

Maintain funding and require hospitals that provide these services to maintain the volume or activity levels and scope of service delivery.

Completed Expectations have been defined in Hospital Service Accountability Agreements and are monitored on a regular basis.

3.6 Determine the Dedicated Funding Envelope for Permanent Cardiac Pacemaker Services

Use the Dedicated Funding Envelope and require hospitals delivering these services to provide volumes.

In place Expectations are communicated as part of funding letters and are monitored quarterly.

3.7 Determine, in consultation with the Central LHIN, the hospital-specific volumes for those hospitals providing Specialized Hospital Services until April 1, 2011.

Consult the the MOHLTC on any proposed service changes to Specialized Hospital Services which include the following: Trauma, Sexual Assault and Domestic Violence Treatment Centres, Provincial Regional Genetic Services, HIV Outpatient Clinics, Hemophiliac Ambulatory Clinics, Regional/District Stroke Centres, Cardiac Rehab Services, and Permanent Cardiac Pacemaker Services.

In place Ministry is consulted on issues arising.

Emergency Room-Provincial Strategies 3.8 Determine the Dedicated Funding

Envelope for Emergency Room Services

Use the Dedicated Funding Envelope and require hospitals delivering these services to achieve specific targets.

Completed Board approved ER pay-for-performance initiated by the Ministry.

Acute Care -Provincial Strategies 3.9 Determine strategic and operational

program policy (funding model and accountability framework).

Provide advice to the MOHLTC. Incorporate into Hospital Service Accountability Agreements.

In place

3.10 Both parties will establish a joint working group to review issues related to the management and transition of Specialized Hospital Service programs

A working group is being established.




Acute Sector- Cancer Programs 3.11 Support service delivery of cancer programs in hospitals in CLHIN. In place CLHIN Cancer Services

Steering Committee continues to meet to discuss service delivery issues.

Acute Sector- Wait Time Strategy 3.12 For Wait Time Strategy funded

services determine specifications, including providers, volumes, funding levels.

Incorporate service requirements for services funded under the Wait Time Strategy into service accountability agreements with providers.

Completed Wait time targets have been established and communicated to hospitals. Volumes have been incorporated into schedules forming part of hospital accountability agreements. Variance from targeted performance is reported in Part D.

3.13 Determine Wait Time Strategy specifications for cataracts, hip and knee and MRI/CT services but will not determine providers or allocations to providers.

Determine the providers for these services and allocations to providers as set out in the MOHLTC specifications.

Completed Included in the MLAA refresh. Submitted and approved by the Board at the June Board meeting. Minster-signed copies of the amended MLAA were received on August 7, 2008.

3.14

Both parties will work together in the 2008-2009 fiscal year to move from funding specific wait time procedures to broader classes of related services.

March/09 Central LHIN has received communication from the Ministry outlining incremental hospital volumes for general surgery. Pending receipt of finalized letters formal Board approval will be sought in November 2008..

Acute Sector- Critical Care Strategy 3.15 Both parties will select a critical care leader for the LHINs geographic area and determine

the critical care leader’s accountability requirements to the LHIN and MOHLTC.

Completed Dr. Donna McRitchie has been selected as critical care leader.




3.16 Consult with the LHIN and determine specifications. For 2008/09 review Critical Care Strategy to determine future directions.

Incorporate applicable specifications in service Accountability Agreements identified in the Critical Care Strategy.

Completed The strategy has been developed by the Ministry Critical Care Leads.

Long Term Care Homes-NOTE: The Financial Management Branch is aware of specific bed types and special funding arrangements and cash flows appropriately Long Term Care Homes - Convalescent Care Beds

3.17 Determine a Dedicated Funding Envelope. Consult with Central LHIN to determine which Long Term Care Home operators will provide the service and the number of beds to be funded.

Fund and incorporate into service agreements. Determine whether to fund operators outside of funding envelope using Central LHIN allocation.

Ongoing To be evaluated against Alternate Level of Care pressures and Aging at Home funding.

Long Term Care Homes - Total Funding per Diem 3.18 Determine per Diem rate. Project

unused funding as of September 30 each fiscal year by LTC home operators and reallocate a share of this funding to the Central LHIN in proportion to the number of LTC beds.

Fund per MOHLTC per Diem and require compliance with per Diem envelope spending.

Completed New 2008/09 Per Diem rates finalized by the Ministry and communicated to LTC homes.

Long Term Care Homes - Construction Cost Funding (CCF) 3.19 Determine the Construction Cost

Funding per Diem and which Long Term Care Homes will receive it.

Provide Construction Cost Funding per Diem to selected Long Term Care Homes and make recommendations re new Construction Cost Funding applications.

N/A Not applicable at this point.

Long Term Care Homes - Interim Beds 3.20 Determine number of interim beds

to be funded as of March 31, 2008 and consult with Central LHIN to determine operators of these beds.

Fund operators and incorporate conditions of funding into service agreements. Determine whether to fund operators outside of funding envelope using Central LHIN allocation.

Oct/08 The Central LHIN Board approved Urgent Priorities funding for 35 interim LTC beds (Sept/08). The proposal was sent to the Ministry on Sept. 29/08.




Long Term Care Homes - Beds in Abeyance 3.21 Approve beds in Abeyance

applications. Manage applications, make recommendations to MOHLTC, monitor need to re-open beds and as necessary restore them to operation.

Feb/09 No applications received. The Central LHIN is presently working with the Ministry to gather information under the new Ministry transitional bed initiative.

Long Term Care Homes - Short Stay (Respite) 3.22 Determine the minimum threshold

for occupancy for short stay beds.

Monitor short stay bed utilization of each Long Term Care Homes home operator. Take action as appropriate to improve the utilization of these beds. Have the ability to set threshold for occupancy higher than the minimum set by MOHLTC.

Feb/09 Developing a monitoring process with the Community Care Access Centre. However, utilization is generally very high.

Community Health Centres (CHCs) 3.23 Determine funding for services by

CHCs to uninsured persons. Approve sponsoring groups, enter into an agreement for CHC-specific services and determine initial funding for new CHCs

Use Dedicated Funding Envelope for services to uninsured persons for CHCs. Work with MOHLTC and sponsor groups in developing new CHCs.

Ongoing Dedicated funding is provided to agencies with specified expectations. Vaughan CHC was assumed by Central LHIN effective October 1, 2008.

Community Mental Health Vau 3.24 Determine and advise the LHIN of

the health service providers and the Dedicated Funding Envelope for specified programs and services.

Use the Dedicated Funding Envelopes as advised by the Ministry, to fund health service providers who provide identified services.

Ongoing Dedicated funding is provided to agencies with specified expectations.

Addictions 3.25 Determine the Dedicated Funding

Envelope for Problem Gambling Treatment and for pregnant women with addictions funding through the Early Childhood Development Initiative.

Use the Dedicated Funding Envelopes of which it is advised for specified services. Fund the provision by health service providers of withdrawal management and counselling and support services.

Ongoing

Dedicated funding is provided to agencies with specified expectations.




Community Care and Access Centres (CCACs) 3.26 Determine the Dedicated Funding

Envelopes for specified services. Use the Dedicated Funding Envelopes of which it is advised for specified services. Require the CCAC to achieve volumes determined by the MOHLTC for Acute Hospital Replacement Clients and End of Life Strategy.

Complete Requirements for achieving specified volumes were incorporated into the CCAC agreement in 2007-08 by the Ministry. The Board approved the CCAC’s 2008-09 budget at the September Board meeting. A funding letter was subsequently sent to the CCAC.

Schedule 4: Information Management Supports # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part B. Performance Obligations 4.1 Develop a Provincial Forum, for the purposes of identifying pertinent information

management topics and making recommendations to the MOHLTC. Coordinate communications with health service providers, and avoid duplicating data and information sources and holdings.

Ongoing The Ministry is the primary information source and the Central LHIN’s role is to supplement the Ministry.

4.2

N/A

Require health service providers to submit data and information (including financial) to the MOHLTC, Canadian Institute of Health Information, or other third party. Improve data quality and timelines as necessary.

In place Specific data reporting requirements have been communicated to health service providers.




Schedule 5: Financial Management # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part B. Performance Obligations Multi-Year Funding Targets

5.1 Provide multi-year funding targets Develop an Annual Service Plan within the multi-year targets that outlines a three-year spending plan for each of its Operating and Transfer Payment Budgets.

Completed

2009/2011 ASP is due for submission at Oct. 31/08.

5.2 Provide multi-year funding targets Advise each public hospital of its multi-year funding targets for Hospital Accountability Agreements.

Completed Funding targets for 2008-2010 Hospital Accountability Agreements communicated and incorporated into HAPS/H-SAA.

5.3 Provide multi-year funding targets Prepare a plan to implement multi-year funding targets for other health service providers.

March/09 A plan for negotiating new service accountability agreements with community health service providers based on planning targets is in the final stages of development and will be brought for Board approval in November.

Annual Balanced Budget Requirements 5.4 Jointly develop policies and plans to introduce and ensure compliance with annual balanced

budget provisions. Ongoing

Requirements for a balanced budget will be one of the key features of service accountability agreements with all sectors. A joint LHIN/Ministry Working Group is developing guidelines to monitor HSP financial status and intervention escalation to support the MOU regarding LHIN-Ministry roles in working with HSPs. Where Health Service Providers forecast reflect potential year-end




deficits, CLHIN staff will meet with the Senior Management of the agency to determine appropriate mitigation strategies.

5.5

N/A

Plan and achieve an annual balanced budget for its Operating and Transfer Payment Budgets and submit annual balanced budget forecasts to the MOHLTC as part of Annual Service Plan and include annual balanced budget provision in agreements with Health Service Providers.

In place

Central LHIN Operating Budget: Total Operating Budget has been assigned to Central LHIN. Spending against internal allocations monitored monthly. Transfer Payment Budget: CLHIN operates within its allocated transfer payment envelope.

In-Year and Year–End Reallocations 5.6

N/A

Provide Quarterly Reports the last day of each quarter. Report on the: LHIN Quarterly Forecast by Sector, including forecast of year-end position, planned in-year reallocations, and actual in-year reallocations; Risk Summary and related mitigation strategies; Performance Variance on indicators.

Last day of each

quarter (June 30/08 Sept 30/08 Dec 31/08 Mar 31/09)

Q2 finalized and submitted on Sep 30/08. Hospitals reported their performance on financial and clinical targets before the quarter-end. This information was incorporated into the quarterly reporting to the Ministry.

5.7 N/A

Submit Annual Report including: Community Engagement and Integration Activities; LHIN’s Audited Financial Statements; LHIN’s engagement with planning entities.

Completed Submitted on June 30, 2008.

Risk Management Framework 5.8 Develop LHIN Risk Management Tools

and Policies in accordance with Ontario Public Service Risk Management Framework (2001) and Risk Management Policy (2002).

Using MOHLTC Tools and Policies, report on identified risks and related mitigation strategies in Annual Service Plan and quarterly regular reports.

Jun 2008 Sept 2008 Dec 2008

The Q2 and ASP risk templates were submitted to the Ministry Sept. 29 and Sept. 30 respectively..

5.9 Develop a Chart of Accounts for LHINs that is operable between all LHINs and MOHLTC. Completed Chart of Accounts completed &

utilized effective April 1/2007.




Capital-General Provisions 5.10

Carry out capital planning in alignment with the Provincial Strategic Plan. N/A The Ministry released a Provincial Strategic Plan on June 19/08.

Capital Initiatives

5.11 Work together to enable the LHIN to provide advice about the consistency of a health service provider’s Capital Initiative review and approval processes.

The MOHLTC/Central LHIN Capital Working Group is developing a Provincial approach to aligning capital with operating. Central LHIN has proposed a coordinated approach to reviewing/planning capital projects among Central LHIN hospitals. The project is completed and we are awaiting a response from the Minister on the Vaughan Hospital Services Report. Central LHIN has met with the Ministry and Humber River Regional Hospital and Markham Stouffville Hospital, separately to review proposed capital plans, using the HBAM to assess inpatient bed projections.

Own-Funds Capital Projects 5.12 Enable the LHIN to provide advice about the consistency of a public hospital’s Own-Funds

Capital Project and devolve the review and approval process for Own-Funds Capital Projects from the MOHLTC to the LHIN, as appropriate.

Dec/08 The MOHLTC/LHIN Capital Working Group is developing a policy and guidelines on how Own Funds Capital will be managed by the LHINs and a process for LHIN engagement with Providers and provisions under the Public Hospitals Act.




Schedule 6: Financial Processing Protocols


Part B. Performance Obligations 6.1 Manage payment process for LHINs. Request payments to be made and adjustments

to payments to health service providers. In place Payments are up-to-date

6.2 Review and Approve potential

reallocations from LHINs. Monitor the financial information of health service providers, and direct the MOHLTC on potential reallocations and adjustments.

In place Reallocations to occur at every Q3.

6.3 Collect and provide forecast information to LHINs.

Provide expenditure forecasts in quarterly and year end reports. In place

Q2 submitted Sep 29/08.

Schedule 7: Local Health System Compliance Protocols


Part B. Performance Obligations 7.1 Work together to proactively assess and mitigate risks to the local health system that arise

or may arise from the MOHLTC’s activities. Jointly develop guidelines for the LHIN on conducting audits, inspections, and reviews of health service providers. Jointly develop protocols for the consultations and information exchanges between the LHIN and the MOHLTC.

Dec/08

The Ministry working group is finalizing a proposed draft for review. The workload implications are

Health Infrastructure Renewal Fund (HIRF) 5.13 Work together to enable the LHIN to begin approving Health Infrastructure Renewal Fund

projects starting in Fall 2007. Completed For 2007/08, the MOHLTC has

allocated Health Infrastructure Renewal Funds (HIRF) to each eligible hospital. Individual hospital proposals have been approved by the Central LHIN Board.

Post-Construction Operating Plan (PCOP) 5.14 Provide by June 30/07 guidelines for the

eligibility, approval and funding of projects using the PCOP funding

N/A Completed Information has been provided by MOHLTC. CLHIN feedback was sent and is completed.




unknown at present. Audits, inspections, and reviews to assess health service provider’s operational efficiencies will be performed as required; this may impact the Central LHIN internal resources.

7.2 Inform the LHIN as soon as reasonably possible of any non-compliance (either legislative or otherwise) by a long-term care home operator.

Inform the MOHLTC of any non-compliance by a health service provider with an assigned agreement, a service accountability agreement, or legislation, including program standards. Provide the results of any audit or review of a health service provider.

In place

A process has been established with the Performance Improvement and Compliance branch to notify CLHIN of any Long-Term Care sector non-compliance. The LHIN organizational structure is not designed to perform program management.

7.3 Beginning in 2008/09 both parties will develop guidelines for the Central LHIN on conducting audits, inspections and review of health service providers Dec/08

See 7.1 above.

7.4 Beginning in 2008/09 both parties will develop protocols for consultations and information

exchanges between the LHIN and the MOHLTC. TBD No specific activities identified. Awaiting Ministry’s guidance.

Schedule 8: Integrated Reporting


Part B. Performance Obligations Quarterly Regular and Consolidation Reports

8.3 Provide forms for quarterly Regular and Consolidation Reports by April 30 of each fiscal year.

Submit to the MOHLTC a Multi-year Consolidation Report, consistent with the draft Annual Service Plan, using the form provided by the MOHLTC.

Completed Submitted May 28, 2008

8.4 Collect and provide information for

Advertising Review Board annual fiscal report.

Provide expenditure details each year reporting Communications contracts Completed

Report sent May 28, 2008




8.5 Approved hospital allocations for the current fiscal year and funding targets for the next three years by June 30

N/A Completed

8.6 Provide data on performance indicators

(Schedule 10) as follows: May 15: 2007-08 Q3 (Table A & C) and 2007-08 Q4 (Table B) Aug 15: 2007-08 Q4 (Table A & C) and 2008-09 Q1 (Table B) Nov 15: 2008-09 Q1 (Table A & C) and 2008-09 Q2 (Table B) Feb 15 09: 2008-09 Q2 (Table A & C) and 2008-09 Q3 (Table B)

N/A N/A

The Central LHIN has received and used the information. No issues have been identified.

8.7 Provide report containing year-to-date

expenditures by June 8 First Quarter Report Completed

8.8 Provide report containing year-to-date

expenditures by September 7 Second Quarter Report Completed Submitted to Ministry Sep 30/08

8.9 Provide report containing year-to-date expenditures by December 7. Third Quarter Report Dec 31

Ministry to work with the Central LHIN to provide a forecast of year-end position.

8.10 Provide a form for the Reallocation Report by February 15.

Fourth Quarter Report (optional – if required) March 31/09

Year End Reports 8.11 Provide for each fiscal year the form for the

financial content of the Annual Report and the form for the Year-end Consolidation Report.

Submit to the MOHLTC the year-end consolidation report, for each fiscal year to which this Agreement applies. Completed Submitted May 28

8.12 Provide Annual Report requirements (non-

financial content) by February 15, 2008 and forms for Annual Report (financial content) by March 31, 2008

Submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements, which includes: i) The effectiveness of the LHIN’S community engagement strategy using the common assessment tool.

Complete




ii) Engagement with planning entities prescribed under the Act. iii) A report on the LHIN’s integration activities. iv) A report on the performance of the local health system on all performance indicators.

8.13 Provide by April 30 of each year, information for the preceding fiscal year on transfer payments to support the preparation of Year-end Reports.

N/A Completed

Annual Service 8.14 Provide the forms and information

requirements for Multi-year Consolidation Report component of the Annual Service Plan by August 31 of each fiscal year.

Submit to the MOHLTC a draft Annual Business Plan and multi-Year Consolidation Report using the forms provided by the MOHLTC. Aug 31/08

Sep 30/08 Oct 31/08

Management approved Business Cases were submitted to the Ministry of Health and Long-Term Care on August 29. An additional Business Case was developed and submitted for a total of 8. Multi-Year Risk Report was submitted on Sept. 30. A draft Annual Business Plan has been developed. Feedback to follow.

Schedule 10: Local Health System Performance


Part B. Performance Obligations General Obligations

10.1

Provide calculated results for the performance indicators and support performance information.

Achieve performance targets for the performance indicators in Schedule 10 of the MLAA and report quarterly on mitigation strategies and performance improvement plans for performance indicators.

Ministry Deadline (Sept 30/08 Dec 31/08 Mar 31/09)

Refer to Part D: Quarterly MLAA Performance Report.

10.2 Report on the performance of the local health

system on all performance indicators in the LHIN Annual Report.

Complete Submitted June 30, 2008.




Schedule 11: e-Health # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

Part B. Performance Obligations 11.1

Inform one another of significant issues or initiatives that contribute to or impact on provincial or local e-Health issues, strategies or work plans.

Ongoing The new Provincial E-Health Strategy and priority areas of investment has been released, along with the results of the LHIN E-Health Readiness Assessment

11.2 Provide the LHIN with provincial e-Health priorities and strategic directions and provide any updates.

Implement the approved LHIN e-Health strategy through its LHIN e-Health Work Plan and service accountability agreements with health service providers.

Nov/08 Drug Viewer expansion - 4 of 6 Hospitals scheduled for Wave 1, starting Dec 2007. Wait Time Information System WTIS expansion in progress Critical Care Information System CCIS implemented Emergency Department Reporting System EDRS in progress (Southlake Regional Hospital agreed to be a beta site)

11.3 Inform the LHIN of a provincia e-Health governance model that will be established to oversee the implementation of provincial e-Health priorities and strategic directions.

Develop and implement the e-Health governance model for the local health system to oversee the development and management of the LHIN e-Health Strategy.

Oct/08 Secure Board approval for continued operation of and support for the joint LHIN E-Health Council. The Council is continuing as approved by the Board. We are not commiting resources directly to the Joint Council, but, rather, jointly funding individuals working on behalf of the Council. In October, we will be coming forward to the Board with a proposal for a refreshed e-Health strategy, aligned with the new Provincial strategy and a deployment plan with a proposed budget allocation.




11.4 Review and approve the LHIN e-Health Strategy after it is submitted by the LHIN and provide a Dedicated Funding Envelope to the LHIN.

Submit to the MOHLTC a LHIN e-Health Strategy. Once approved by the MOHLTC, release approved LHIN e-Health Strategy and any updates to the public. Use the Dedicated Funding Envelope to provide funding.

Oct/08 Central LHIN E-Health Strategy is being reviewed to ensure alignment with the new Provincial Strategy. $275K funding secured for 2008/09 e-health activities Focus on the GTA Health Information Access Layer (HIAL) project is the next step in readiness. The GTA HIAL is an overlay across all hospital/clinical information systems that will enable us to transfer/share info as a part of the electronic health record - this way, each hospital can keep its existing system and still exchange information.

PART B – OTHER BUSINESS PLAN

Operations

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status 1.1 Arrange for an annual audit of the LHIN. Completed Central LHIN Audit completed

during the week of April 28/08.

1.2

Recruit LHIN staff.

As Required

2 contracts to cover maternity leaves. Project Coordinator PICE – until Sep/09 Consultant, Funding & Allocation-until Mar 31/09. This is a hybrid position assisting both Funding and Performance responsibilities.




1.3

Develop and Implement LHIN Transfer Payment Approval and Authorization Policy. April/07

Completed. Board Approved and communicated to Ministry in April

Accountability Requirements

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status 1.4 Procurement Report – required by Memorandum of

Understanding directives.

Sept 2008

LHIN Liaison Branch to determine process and forward to LHINs. Central LHIN has contacted LLB who confirmed work underway.

1.5 Information to be provided to Ontario Health Quality Council on request (required per Local Health System Information Act).

On Request

1.6 Auditors Report. Completed Board Approved May 27, 2008 1.7 Annual Freedom of Information Report - required

per Freedom of Information and Protection of Privacy Act.

Completed

Board/Governance Requirements

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status 1.8 Bylaw Review. Completed “By-law No. 1” and “By-law No.

2” was approved by the Central LHIN Board on September 25, 2007.

1.9 Perform an annual assessment of the effectiveness of the Board as a whole and on individual members using tools common to all LHINS.

Completed 2007/08 Annual Assessments were completed. Results were reviewed by the Board on August 6, 2008. Individual Board Member assessments were discussed at the Board Development Day on August 6, 2008.




A common tool for individual assessments has not been provided.

PART C – RISK MANAGEMENT REPORT

Risk Potential Impacts Mitigation Strategy Of the 10 hospitals, 4 remain unsigned. Unsigned agreements have been extended. 2 hospitals are being reviewed.

2 hospitals are in the final stages of signing.

PART D – QUARTERLY MLAA PERFORMANCE REPORT

The Ministry has been developing a LHIN dashboard to assist with quarterly performance reporting as per the MLAA. The scorecard has gone through various iterations and continues to evolve. Generally, the Ministry releases the dashboard to each LHIN a few weeks in advance of the quarterly report due date. The dashboard below was released in preparation for the Q2 report (due September 30, 2008). As seen below, all indicators are within acceptable limits and thus, no variance report was required for the Q2 report as it relates to performance.




(A) (B) (C) (D) (E) (F) (G)

Performance IndicatorIndicator

TypeProvincial

Target

LHIN Starting

Point

LHIN Performance

Target - 2008/09

Projected Performance

Target

Performance Corridor -

Higher Value

Performance Corridor - Lower

ValueActual

Performance

90th Percentile Wait Times for Cancer Surgery 1 Access 84 Days 55.00 51.00 54.00 59.40 48.60 53.00

90th Percentile Wait Times for Cardiac By-Pass Procedures 1 Access 182 Days 68.00 60.00 66.00 72.60 59.40 53.00

90th Percentile Wait Times for Cataract Surgery 1 Access 182 Days 110.00 110.00 110.00 121.00 99.00 78.00

90th Percentile Wait Times for Hip Replacement 1 Access 182 Days 183.00 182.00 182.75 201.03 164.48 162.00

90th Percentile Wait Times for Knee Replacement 1 Access 182 Days 217.00 195.00 211.50 232.65 190.35 169.00

90th Percentile Wait Times for Diagnostic MRI Scan 1 Access 28 Days 110.00 105.00 108.75 135.94 81.56 102.00

90th Percentile Wait Times for Diagnostic CT Scan 1 Access 28 Days 46.00 42.00 45.00 56.25 33.75 26.00

Hospitalization Rate for Ambulatory Care Sensitive Conditions (ACSC) 2 Integration290.76 per

100,000 210.00 210.00 210.00 231.00 189.00 203.42

Median Wait Time to Long-Term Care Home Placement -All Placements 3 Integration 50 Days 63.00 55.00 61.00 76.25 45.75 68.00

Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 3 Integration 9.46% 9.80 9.60 9.75 10.73 8.78 10.59

Rate of Emergency Department Visits that could be Managed Elsewhere 2 Integration11.79 per

1,000 9.47 9.40 9.45 10.40 8.51 9.47

Readmission Rates for Acute Myocardial Infarction (AMI) 3 Quality 3.80% 3.80 3.80 3.80 4.75 2.85 3.65Notes

1 = Actual Performance Value is from Q1 2008/09 (Apr, May, & June 2008)

2 = Actual Performance Value is from Q4 2007/08 x 4 (Jan., Feb., & Mar. 2008 x 4)

3 = Actual Performance Value is from Q4 2007/08 (Jan., Feb., & Mar. 2008)

Central LHIN MLAA Performance Indicators2008/09 - Aug. 15, 2008

Column

themelisa

Typewritten Text

APPENDIX 4.5

2008/09 IHSP Action Plan - Updated August 13, 2008

2008/09 Planning, Integration &

Community Engagement IHSP and Emerging Priority

Action Plan October 28, 2008

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Appendix 4.6

2008/09 IHSP Action Plan - Updated October 21, 2008

Table Page

1 IHSP Priority - Seniors 1

2 IHSP Priority - Mental Health and Addictions 2

3 IHSP Priority - Chronic Disease Management and Prevention (CDMP)

3

4 IHSP Priority - Neurological Services 4

5 IHSP Priority - Wait Times 5

6 IHSP Priority- Cancer 6

7 IHSP Priority-Emergency Services 9

8 Hospice Palliative Care 10

9 Community Engagement 11

10 Emerging Priority- Alternative Levels of Care 13

11 Integration Activities In Progress 14

12 Integration Activities Complete ( 2007/2008) 15

2008/09 IHSP Action Plan - Updated August 13, 2008

TABLE 1 : IHSP Priority - Seniors ( Board Observers: Colin Benjamin, Raksha Bhayana) (Staff Lead: Chantell Tunney)

# Workgroup Description of Deliverable To Board Activities Status

1.1 Citizen’s Expert Panel for Seniors

Recruitment process of 12 new consumer and caregiver members representative of seniors living in the Central LHIN

CEO Report for

Information- Oct 2008

We have received 52 applications from senior consumers living in the Central LHIN. Evaluation and selection process in September. The first meeting of this group is scheduled for October 22 2008 at the Central LHIN

1.2

Specialized Geriatric Services

Senior Friendly Plans from Central LHIN hospitals

Work underway not anticipated

to require board approval

We have received the third senior friendly plan from York Central Hospital We are expecting the remainder in by late fall.

1.3

Aging at Home

Evaluation and Selection Process for Phase One 2009/10 Aging at Home Proposals

Update per month to

December

Information to be provided to inform the board of the selection process used for 2009/10 Phase One Aging at Home RFP Proposals

1.4

Aging at home

Draft allocation for 2009/10 with applicable criteria

Update per month to

December

In Progress

1.5 Aging at Home Board approval of Phase One 2009/10 Aging at Home Proposals- Draft Year Two Plan Early Draft

For board approval

November 2008

- Ministry Template not yet available - Innovation criteria not yet available

1.6 Aging at Home Second Quarter Year One Aging at Home Project Updates – to be incorporated into the Central LHIN Project Management Report November 2008

CEO Report

For Information- November

2008

Work underway to devise project plan to review evaluate and consider year one projects within longer year two plan.




1.7 Aging at Home

Submission to Ministry- Draft Aging at Home Detail Plan

December 15,

2008

1.8 Supportive Housing

Development of a Supportive Housing Workgroup

CEO Report for

Information October 2008

We have received 19 applications in response to our open invitation for participants on the Central LHIN Supportive Housing Workgroup. A group of 8-10 members will be selected with the first meeting tentatively scheduled for late November/early December.

TABLE 2 : IHSP Priority - Mental Health and Addictions ( Board Observer: Sandy Keshen) ( Staff Lead: Carol Lever)


2.1

Primary Care

Facilitate development of partnerships between family health teams and mental health/addictions health service providers to enhance delivery of care and enhance access to primary care for people with Mental Health and Addictions problems. No resources anticipated

CEO Report for Information in

November 2008

Met with Family Health Team Executive Directors on October 3, 2008 to discuss opportunities for partnership with mental health and addiction HSPs and the MHA Network.

2.2

Consumer/Survivor Leadership Team

Development of a consumer/survivor network including website, education, and support activities and family engagement strategies. Currently funded by the MOHLTC to provide advice to the LHINs; no further resources anticipated

Educational evening with on October 15, 2008 at North York General Hospital; Undertaking community engagement through Town Hall forums with consumer/survivors across the LHIN to develop Network membership.

2.4

Centralized access

Centralized access-Phase 1, Phase 2 plan

To Board for

Approval- October 2008

. Request for Phase 2 funding will be presented to the Board in October 2008.



TABLE 2 : IHSP Priority - Mental Health and Addictions ( Board Observer: Sandy Keshen) ( Staff Lead: Carol Lever)


2.5

Diversity

Mental Health and Addictions Cultural Competency Project

Diversity Lens has been applied with all Central LHIN Health Service Providers delivering mental health and addiction services; developing an environmental scan; planning for education & mentorship initiative roll-out in 2009.

2.6

Education

Education Strategy Phase II

Workplan under development for education to Ontario Works/Ontario Disability Service Program and hospital Emergency Department Staff. Training planned for January 2009.

TABLE 3 : IHSP Priority - Chronic Disease Management and Prevention (CDMP) ( Board Observer: Elaine Walsh) (Staff Lead: Anne Lessio)


3.1 CDMP Advisory Network

Provide leadership to plan, coordinate & evaluate CDMP services/programs.

CDMP Advisory Network recently reconstituted using our Expression of Interest Process. First meeting of new members scheduled for October 2008.

3.2 System Design and Service Coordination (for chronic disease patients)

Work group of CDMP Advisory Network; Deliverables include increasing access for diabetics in northern end of Central LHIN; increasing coordination of diabetes care; developing a continuum of care for diabetes.

For information

Winter 2009

Finalizing approach the work group will use to consider the continuum of care and the coordination of services.

3.3 CDMP Self Management

Deliverables include workshops, seminars, reference document; service inventory Resources: Urgent Priorities Fund

For Information

Winter 2009

Six 4-hour workshops and six 1-hour rounds being offered. On-line registration available; website active; draft literature review available online



TABLE 4 : IHSP Priority – Neurological Services ( Board Observers: Eugene Cawthray and Sandy Keshen)

# Workgroup Description of Deliverable To Board Activities Status 4.1

Neurological Services Advisory Network

Pending

. Network standing down until further notice from Service Need Assessment and Gap Analysis

TABLE 5: IHSP Priority-Wait Times ( Board Observer: Sandy Keshen) (Staff Lead: Ashif Damji)


5.1 Wait Times Strategic Planning Group

Enhance capacity for wait times priority services. Develop models for high volume service delivery.

On-Going

Completed:

- 2007/08 wait times allocation process, resulted in higher volumes for cataract and hip/knee replacement procedures, and more hours for MRI

- Moving towards implementation of two centres of high volume for cataracts (one in the north and one in the south of the LHIN). Overall wait times continue to improve.

- 2007/08 in-year intra- & inter-LHIN reallocation process resulted in additional volumes for cataract, hip/knee replacement and CT hours.

- 2008/09 allocations completed but resulted in lower MRI hours than 07/08

5.2 Streamline data collection and interpretation to achieve full utilization of services

On-Going

Stronger link with Wait Times Information Office to improve data quality, streamline data flow and expand availability. 14 LHINs collaborated with MOHLTC to develop a standardized Wait Time scorecard

5.3 Build a seamless system of care from a patients perspective through: • Consistent and timely reporting of wait times • Coordinated referral and follow-up

N/A CLHIN supporting new models of care (e.g., NYGH Branson Site and Southlake Medical Arts Building) that will be comprehensive centres for wait times priority services. These models include common assessment and other collaborative processes



TABLE 6: IHSP PRIORITY- Cancer ( Staff Lead: Joel Moody)


6.1

Cancer Care Services Steering Committee

Provide leadership to plan, coordinate, evaluate, & implement cancer services/programs and the Ontario Cancer Plan. Lead: Dr. Balough

Work

underway not anticipated to require board

approval

6.2

Colorectal Screening Program

Program of Cancer Care Ontario; Primary Physician Care Lead

Work


approval

CCO in collaboration with RCP have successfully recruited for this position. The individual LHINs can fill this .2 FTE with more than one individual. The plan is to have it filled by September 2008.

6.3


Program of Cancer Care Ontario; Screening and Fecal Occult Blood Test kit and requisition.

Work


approval

CCO plans to transform Screening in province with $152 M from government to be stretched over 5 years. They will invite 300,000 people to see their primary care physician, talk about colorectal screening, and get a Fecal Occult Blood Test kit and requisition. CCO plans to send out 7,000 Fecal Occult Blood Test kits per year for 5 years. Patients that do not have a primary care physician or pharmacists, can call Tele- health and will be mailed a Fecal Occult Blood Test kit and requisition or instructed where in their area there is a primary care physician they can see or which pharmacy to go to get Fecal Occult Blood Test kit and requisition. There are primary care physicians who have agreed to handle these patients if they have a positive result.




6.4


Program of Cancer Care Ontario; Screening and Fecal Occult Blood Test kit and requisition.

Work


approval

CCO plans to transform Screening in province with $152 M from government to be stretched over 5 years. They will invite 300,000 people to see their primary care physician, talk about colorectal screening, and get a Fecal Occult Blood Test kit and requisition. CCO plans to send out 7,000 Fecal Occult Blood Test kits per year for 5 years. Patients that do not have a primary care physician or pharmacists, can call Tele- health and will be mailed a Fecal Occult Blood Test kit and requisition or instructed where in their area there is a primary care physician they can see or which pharmacy to go to get Fecal Occult Blood Test kit and requisition. There are primary care physicians how have agreed to handle these patients if they have a positive result.

6.5

Medical Oncology

Work group of Cancer Care Services Steering Committee; Regional Systemic Therapy Program

Work


approval

It was identified that there is a need to examine the inconsistent distribution of resources among the academic versus community based hospitals. Projections are for a 5 year plan and one should consider what is reasonable and achievable in next few years with the current resources. The projections should also reflect the expected repatriation of patients back to our LHIN, volumes that provide enough critical mass for hospitals to be self-sufficient regardless of size.

6.6

Radiation Medicine

Work group of Cancer Care Services Steering Committee; Radiation Oncology at Southlake/Princess Margaret Hospitals

Work


approval

Report deferred.




6.7

Palliative Physician Lead

Work group of Cancer Care Services Steering Committee;Palliative Care for Central LHIN

Work


approval

Report deferred.

6.8

Surgical Oncology

Work group of Cancer Care Services Steering Committee; Surgical Oncology

Work


approval

Multidisciplinary Cancer Conference is up and running in all facilities and the surgeon from Alliston will be attending the Multidisciplinary Cancer Conference at Southlake by video conference. Humber River Regional Hospital lung is still unresolved, there is a MOU with St. Joseph’s yet to be signed. North York General Hospital and East General have an agreement, and only York Central Hospital is still pending. Hepatic Biliary Procedure surgery is the next project for surgical oncology. Data on the usage patterns for our LHIN to determine where the patients are going. The question is there enough volume in our LHIN?

6.9

Prevention and Screening

Work group of Cancer Care Services Steering Committee; Cancer Prevention and Screening

Work


approval

Report deferred.



TABLE 7: IHSP Priority- Emergency Services ( Board Observer: TBD) (Staff Lead: Saifa Sidi)

# Description of Deliverable To Board Activities Status 7.1

Emergency Services Advisory Network will develop a plan to address challenges faced by residents of the Central LHIN and in alignment with the Ministry’s strategies and initiatives. Activities may include exploring initiatives that: 1. improve access for patients, 2. increased coordination and collaboration between hospitals 3. improve data collection and management. Four workgroups are underway:

1. Rapid Response Team 2. Access to diagnostic imaging/lab services 3. Access to specialists in the hospital

Access to support services

Board Approved- August 2008

To Board for

approval pending outcome of Ministry

review

August 2008 – Emergency Department Action Plans Nurse-led Outreach Team proposal submitted to the Ministry of Health and Long-Term Care on August 22nd – Ministry review pending.

TABLE 8 : Hospice Palliative Care ( Board Observer: Ken Morrison) (Staff Lead: Carol Lever)

# Workgroup Description of Deliverable To Board Activities Status 8.1

Palliative/End-of-Life Care Steering Committee

Provide leadership to plan, coordinate & evaluate palliative/End of Life care; to improve quality, choice & access to palliative/End of Life care.

Work underway

not anticipated to require board

approval

Functional Program for York Region Residential Hospice complete. Operating Plan under development. Network website under development. Integration request for coordinated volunteer training anticipated through Aging At Home RFP Process. Network Conference scheduled for October 7, 2008 focusing on Dyspnea, Integration of Hospice Services, Energy Conservation, Interdisciplinary Teams, and the Ontario Cancer Symptom Management Collaborative.



Table 9: Community Engagement (Staff Lead: Sandi Pelly)

Description of Deliverable/Activity To Board Outcome

Central LHIN Stakeholder Engagement Strategy (February 2006) Revised Community Engagement Strategy (October 2008) Draft strategy to be developed with input from HSPs, other LHINs and staff Key targeted engagements will reported on monthly in the PICE Action Plan

Board Approved-February 2006

November 2008

Draft Stakeholder Engagement Strategy developed

Aging at Home Community engagement strategy developed for Aging at Home Sessions to obtain information on dementia, palliative care, supports for independent

living, supportive housing, diversity, emergency room usage (August – September 2008)

Report of themes summarized in CEO report (October 2008)

Themes in CEO report October 2008

More than 50 sessions were conducted with over 1000

seniors, caregivers and providers LHIN awareness raised Connections made with community leaders Gaps and issues for specific topics are better understood

(CEO report summary and presentation) Service Needs and Gaps Analysis Interviews and focus groups conducted with health service providers to provide

qualitative input for identifying the current state (Summer 2008) Expert sessions for each domain conducted to confirm current state (August/Sept 2008) Visioning sessions by domain to identify potential future state models (August/Sept

2008) 7 Geographic area sessions to review potential future state mitigation strategies

(Sept/Oct 2008) Consumer survey undertaken (Oct 2008)

Input from engagement sessions has being analyzed

with the quantitative date and will be incorporated into the final report

Schedule B Survey of health service providers to gather inventory of current engagement activities

to inform development of collaborative process to develop a community engagement framework for providers

Task Force of hospital and community providers being established to assist with process

Survey is complete and results analyzed

Aboriginal Community Engagement regulation was available on the Ministry website for public

input until Sept 26, 2008 Greater Toronto Area LHINs discussing ways to collaborate for urban Aboriginal

engagement and planning. Drafted proposal to conduct a meeting with all GTA Aboriginal organizations and contacts to determine best methods for engaging and planning across the GTA for the urban Aboriginal population

Developing communiqué to Georgina Island to determine next steps for on-reserve engagement

Greater Toronto Area urban Aboriginal proposal has

been developed



Description of Activity To Board Outcome

Francophone Community Engagement regulation has been posted on the Ministry’s website and is

available for comment before November 12, 2008 Greater Toronto Area LHINs have begun meeting monthly to discuss ways to

collaborate for Francophone engagement and planning. Waiting to ensure that Francophone regulation will allow a collaborative engagement and planning process.

French-speaking stakeholders were consulted as part of Aging at Home and Service Needs and Gaps Analysis consultations

Requests for local engagement • Engagement with the Family Councils • Met with York Region District School Board in October • Met with York Region Tri-hospital and York Region Police committee to explore

potential collaborative opportunities in mental health

Family Councils has received additional information about

the LHIN and distributed Aging at Home surveys York Region District School Board and the LHIN have

identified 3 potential collaborative opportunities being explored

Provincial Engagement Activities • Provincial steering committee has been established to develop a community

engagement toolkit for health service providers. Central, North West and Mississauga Halton are representing LHINs on this committee.

• Provincial engagement team met with provincial LHIN communications leads in October to determine potential areas for collaboration

• Provincial engagement team met with Julia Abelson from McMaster in October to explore evaluation measures for community engagement

• Central and 2 other LHINs are involved in a project with the Ministry to develop indicators for successful engagement that will tie into the work being conducted by McMaster

• Provincial Community Engagement training is being conducted by the International Association of Public Participation (October 2008)



Table 10: Alternate Levels of Care (Colin Benjamin, Sandy Keshen) ( Staff Lead: Mary Byrnes)

# Description of Deliverable To Board Activities Status

10.1

Alternate Levels of Care Framework (Interim)

To Board for information –

Fall 2008

A current state analysis and an interim strategy is being developed to provide high level context for ALC planning and performance monitoring in Central LHIN. Feedback will be incorporated into the Framework update, in the CEO Report

10.2

Alternate Levels of Care Initiatives Targeted for 2008-2009 - Urgent Priorities Fund (UPF)

Board Approval in Principle in

September 2008. To Board in

October/November for Approval pending Ministry response.

Central CCAC took the lead in developing a proposal for interim long-term care home beds, building on information from the Ministry, Central LHIN Joint Hospital/CCAC Collaborative and Transitional Bed Survey. Submitted on September 29, 2008 for review by Ministry.

Table 11: Integration Activities In Progress (Staff Lead: Carol Lever)

Project Name Decision Date Description/Partners Status

Draft Integration Strategy and Process

Fall 2008/Winter

2009

Under continued development

Stevenson Memorial Hospital

Pending

Southlake Regional Health Centre; Part of HAPS Process

Bethany Lodge/Markhaven

Pending

Financial Collaborative

My Friends Place Divestment from Consumer Survivor Project Simcoe County to the Krasman Centre

November 2008

Facilitated integration: North Simcoe Muskoka LHIN to transfer funding for MY Friends Place in Alliston from the Consumer Survivor Project Simcoe County in NSM LHIN to the Krasman Centre in Central LHIN



North York Central Meals on Wheels

January 2009

Facilitated Integration Don Mills Foundation for Seniors

Markham Stouffville Hospitals

Pending

Part of HAPS Process

PalCare Network

Pending

Voluntary Integration Transfer of Pain & Symptom Management Program

York Central Hospital/Southlake Regional Health Centre Cataract Surgery Collaboration

To Board for Approval in

November 2008

Voluntary integration request, received October 7, 2008, to transfer cataract surgery base volumes from York Central Hospital to Southlake Regional Health Centre.

North York General Hospital Sleep Lab

Pending

Potential Voluntary Integration

Table 12: Integration Activities Complete ( 2007 & 2008)

Project Name Decision Date Description/Partners Status

Deaf Access Simcoe/Canadian Hearing Society

June 2007

Voluntary integration request to co-locate services. Support by Board June 22, 2007

North York General Hospital/St. John’s Rehab Hospital

November 2007

Voluntary integration request to transfer short-term rehab services to St. John’s Rehab Hospital. Supported by Board November 27, 2007.

Central Ontario Hospital Procurement Alliance

February 2008

Voluntary integration request received January 18, 2008. York Central Hospital, Markham Stouffville Hospital, and Southlake Regional Health Centre to participate in a supply chain management initiative with hospitals in the NSM and CE LHINs. Supported by Board February 25, 2008

Council of Academic Hospitals of Ontario Capital Equipment Group Purchasing Initiative

March 2008

Voluntary integration request received January 31, 2008 by North York General Hospital to participate in a group purchasing initiative with 24 other hospitals in Ontario. Supported by Board March 25, 2008



Matthews House Hospice Divestment from Hospice Simcoe to Hospice Alliance

April 2008

Facilitated integration initiative with North Simcoe Muskoka LHIN to transfer funding for Matthews House Hospice in Alliston from Hospice Simcoe in NSM LHIN to Hospice Alliance in CLHIN.

Back-Office Integration Project: Phase I

Approved by

Board July 2008

Development of business cases for group purchasing and financial integration in the community sector.

Note that many other integration activities have been approved by the Board through targeted funding initiatives since Section 19(1) of the Local Health System Integration Act gives LHINs the authority to “provide funding to a health service provider in respect of services that the service provider provides in or for the geographic area of the network”. These activities are not included in the above listing.

LHIN Operations Sub-category Approved Budget Actuals Forecast to Forecasted2008-9 Apr 1 - 08 to Sep 30- 08 Year-End Variance

Salaries & Wages

1.0 Salaries & Wages 2,351,480 1,197,779 2,351,480 - Subtotal (Salaries & Wages) 2,351,480 1,197,779 2,351,480 - Employee Benefits

2.1 HOOPP * 178,240 95,805 178,240 -

2.2 Other Benefits 386,115 152,993 386,115 - Subtotal (Employee Benefits) 564,355 248,798 564,355 - Transport & Communication

3.1 Staff Travel 35,000 8,557 35,000 - 3.2 Governance Travel 12,000 4,562 12,000 - 3.3 Communication 70,000 23,971 70,000 - 3.4 Other - - - -

Subtotal (Transport & Communication) 117,000 37,090 117,000 - Services

4.1 Accomodation 275,000 165,600 275,000 - 4.2 Advertising incl. website 25,000 12,558 25,000 - 4.3 Banking - - - - 4.5 Consulting Fees 85,000 32,217 85,000 - 4.7 Governance Per Diems 140,000 70,000 140,000 - 4.8 Insurance - Operations only 5,000 5,000 5,000 - 4.9 LSSO Shared Costs 300,000 150,000 300,000 -

4.10 Other Meeting Expenses 70,000 35,014 70,000 -

4.11 Other Governance Costs (mtgs, prof Liab Ins) 55,000 29,102 55,000 - 4.12 Printing & Translation 25,000 21,802 25,000 - 4.13 Staff Development 55,000 11,288 55,000 -

Other Services * 25,000 24,568 25,000 -

Subtotal (Services) 1,060,000 557,149 1,060,000 - Supplies & Equipment

5.1 IT Equipment * 15,000 3,410 15,000 - 5.2 Office Supplies & Purchased Equipment 51,402 22,698 51,402 -

Other Services & Equipment * 15,000 14,967 15,000

Subtotal (Supplies & Equipment) 81,402 41,075 81,402 - 6.1 Capital Assets Purchased 85,000 83,400 85,000 -

Amortization - - - - Subtotal (Capital Assets Purchased) 85,000 83,400 85,000 -

TOTAL BUDGET for 2007-08 4,259,237 2,165,291 4,259,237 -

e-Health 275,000 54,180 275,000 - Aboriginal Community Engagement 10,000 - 10,000 - ED Lead 43,700 30,000 43,700 - Total Special Programs 328,700 84,180 328,700 -

Notes for variances noted above (under and over- spending)none to note

Other Notes* Several new categories are reflected in this report as requested by the MOHLTC as highlighted by asterisks. Changes are for nominal amounts; several categories were split into further sub-categories

Central Local Health Integration Network

Q2 - FORECASTED REQUIREMENTS FOR FISCAL 2008-9based on September 30, 2008 actuals

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Appendix 4.7


MEMORANDUM

Sent via e-mail: [email protected]

September 30, 2008 TO: Carrie Hayward Director, LHIN Liaison Branch Ministry of Health and Long-Term Care FROM: Hy Eliasoph CEO, Central LHIN RE: 2008/09 SECOND QUARTER REPORT

Please accept the attached report on Central LHIN’s second quarter position for fiscal year 2008/09. It is submitted in accordance with the reporting requirements established in the Ministry-LHIN Accountability Agreement. If you have any questions or comments, please contact Shaukat Moloo at 905-948-1872 ext 216. Sincerely

Hy Eliasoph CEO Central Local Health Integration Network /at (Attach.) c. Kim Baker, Senior Director, Planning, Integration & Community Engagement Shaukat Moloo, Senior Director, Performance, Contracts & Allocations

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Appendix 4.8a

1

Central Local Health Integration Network 2008/2009 Second Quarter Report

September 30, 2008

Quarterly Reporting Template – Revised August 29, 2008

Required Elements (Changes from previous QR are Highlighted): Section A Transmittal Letter Section B Local Health System Update Section C Status Update on Special

Initiatives Status update report required for Aging at Home Initiative

Section D Status Update on Integration Activities

Required for Q2 only

Section E Forecast Section F Reallocation Tables Section G Risk Summary Section H Report on LHIN Operations

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Appendix 4.8b

2

A. Transmittal Letter (see Section 2.2 in guide)

(Send to the following e-mail address: [email protected] ) September 30, 2008 MEMORANDUM TO: Carrie Hayward

Director LHIN Liaison Branch

Ministry of Health and Long-Term Care FROM: HY ELIASOPH CEO CENTRAL LHIN RE: 2008/09 SECOND QUARTER REPORT

Please accept the attached report on CENTRAL LHIN’s second quarter position. It is submitted in accordance with the reporting requirements established in the Ministry-LHIN Accountability Agreement. If you have any questions or comments, please contact Shaukat Moloo at 905-948-1872 ext 216. Sincerely HY ELIASOPH CEO Central Local Health Integration Network

3

B. Local Health System Update (see Section 2.3 in guide) Description: The Local Health System Update is meant to provide a snapshot of the local health system and serve as an executive summary outlining key elements of the quarterly report and highlighting key initiatives, important developments and particular challenges they may be facing. This assessment may include:

a) A discussion of major initiatives underway; b) Planning and community engagement activities; c) Any IHSP priorities that the LHIN wishes to report on; d) A discussion of key risks to financial and non-financial performance including variance

to Local Health System indicators; e) An update on key negotiations; f) Key issues/cost drivers; and g) Any important developments or initiatives within sectors.

a) A discussion of major initiatives underway Health Service Needs Assessment and Gap Analysis The Health Service Needs Assessment and Gap Analysis (SNAGA) project is a comprehensive and integrated assessment and analysis of health services that will help Central LHIN better understand existing gaps. It will provide an epidemiological population-based framework of the need for Central LHIN health services to: accommodate growth; impact health human resources; and identify efficient service delivery models with appropriate service levels. This assessment will cover a ten-year planning horizon. Additionally, SNAGA will focus on the impact related to the key social determinants of health and associated disease prevalence in order to begin to reduce health disparities. Key to all LHIN projects is an extensive community and stakeholder engagement strategy involving clinicians, providers, community partners, citizens and key stakeholders. During the next quarter, the SNAGA project will complete the quantitative data analysis. A final report will be produced in the third quarter. Health service gaps will be identified and the factors required to close the gaps will be articulated. Preliminary models of health care will be developed based on the literature / jurisdictional review of national and international models to support the health transformation agenda. During the last quarter of the fiscal year 2007/08, Central LHIN hired KPMG to complete an extensive Health Service Needs Assessment and Gap Analysis (SNAGA) project. During the first half of this fiscal year, the activities for the SNAGA project have included: • Project Advisory Committee

Established in April 2008, the Project Advisory Committee has met monthly to provide input and guidance to the various elements of the SNAGA project. The 24-member committee consists of intersectoral and interdisciplinary representation from the LHIN’s health service providers as well as other relevant stakeholders e.g. Family Health Teams.

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• Domains of Interest

To focus and manage the needs assessment, six (6) domains of interest were selected for in-depth analysis through a decision making exercise considering the Central LHIN Integrated Health Service Plan, the Ministry of Health Priorities and the services under direct Central LHIN control. The six domains of interest are: cardiac, cancer, chronic disease (diabetes), emergency, seniors and mental health and addictions.

• Needs Assessment through epidemiological population based data collection and analysis For each of the six domains of interest, epidemiological population based data was collected to determine the current health impacts and burdens in Central LHIN and to identify the risk factors or driving forces for growth. Using this information, a mathematical model was developed to project the impact of this domain over the next ten years. Data was presented both by charts and in geospatial format. This quantified the Needs Assessment.

• Gap Analysis During the first half of this fiscal year, an inventory of health services was conducted forming a baseline of services available in Central LHIN. During the second half the fiscal year, the service capacity represented by this service inventory will be compared to the service needs identified in the Needs Assessment to elicit the Gaps anticipated in Central LHIN over the next 10 years if no mitigating strategies are implemented.

• Community Engagement in SNAGA Extensive community engagement activities have occurred at various times throughout the SNAGA project to both capture community input and validate project findings. The first opportunity for community input was at the beginning of the project where multiple interviews occurred with Central LHIN health service providers to identify health care needs. This information supplemented the epidemiological population-based data for the Needs Assessment. To further complement the quantitative data, focus groups were held with many of the Central LHIN Advisory Committees to capture their perspectives on health care needs. The third main community engagement activity occurred in September. Six half-day sessions were organized according to the six domains of interest to permit content specialists to validate and confirm the findings of the Needs Assessment for each domain of interest. Furthermore, the groups were asked to consider elements of a Vision for their particular domain of interest and short-term mitigating factors. The last community engagement activity, which will occur in the last half of the year, will be organized according to Central LHIN’s seven geographical planning areas. .

• Consumer Engagement While some consumers have been engaged in the SNAGA project to date, Central LHIN is interested in more input by the users of the health services. The staff of Central LHIN is in the process of developing a method to further engage the consumers which will be implemented in the second half of the year.

b) Planning and Community Engagement Activities Community Engagement Activities

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At Central LHIN, community engagement is a key function that supports the activities and outcomes of the Integrated Health Service Plan and other LHIN activities. In April, Central LHIN participated in the Innovations and Aging at Home Expos with thousands of participants from across the province. During the first part of the fiscal year, education sector sessions with 53 education and public health providers were held to discuss potential ways to work together. Two Aboriginal engagement sessions were held on Georgina Island – one with 9 Aboriginal leaders and one with more than 50 community members at a health fair. Through the Health Service Needs and Gaps Analysis, a significant amount of community engagement activities took place. Many interviews and more than 16 focus groups were held with hundreds of health service providers, experts in the health field, Central LHIN Network and Advisory Group members, Francophone providers and others informed the process of understanding the needs and gaps in Central LHIN. Plans are underway for conducting seven sessions across the geographic planning areas of the LHIN for later this fall. In spring 2008, two Aging at Home sessions were held with over 100 seniors as well as a seniors housing forum where Aging at Home was presented to over 80 seniors. In the summer, a community engagement strategy was developed to inform the Aging at Home plan for 2009/10. The strategy includes more than 20 focus groups with hundreds of service providers, caregivers and seniors on a variety of topics including dementia, supports for independent living, diversity, palliative care, supportive housing, and emergency room visits. Early analysis indicates that these initiatives are in line with the needs of the community. Community Engagement Strategy A high level draft community engagement strategy has been developed to look at how Central LHIN can move community engagement forward. The strategy identifies new approaches to leverage engagement in Central LHIN, including a community leaders group and working with our health service providers in reaching the community. Detailed implementation plans have also been developed for Aging at Home; Members of Provincial Parliament constituency groups; and Aboriginals. Part of the 2008/09 strategy includes a survey of health service providers to better understand approaches they use to reach their communities. This will also help to inform a collaborative process that is being established to work on a community engagement framework with hospitals and other providers. Central LHIN is involved with a provincial planning table to develop a refreshed community engagement framework for all LHINs and the OHA Community Leaders Group As part of the refreshed community engagement strategy for Central LHIN, new partnerships have been established with community leaders to reach culturally diverse groups. Fifteen members attended an orientation session on July 30, 2008 representing the following geographic and ethno-cultural communities: Jane Finch, rural areas in the northwest part of the LHIN, South Asians, Italian, Korean, Filipino, Jewish, Chinese, Iranian, Russian and Francophones. The group was provided with an overview of the LHIN and explained the purpose of having community leaders assist us in reaching out for input into health needs and access issues. The group was then provided with a set of tools and templates to use in reaching out to groups of diverse seniors to gather input into Aging at Home planning for 2008/09. This activity is a pilot for the group and the feedback will be reviewed to determine the feasibility of using the group to gather input for the LHIN for future activities.

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Other activities Central LHIN is involved in a GTA-LHIN Community Engagement group that is working to collaborate on strategies to engage the Franocphone and Aboriginal communities that live in the GTA. A provincial Toolkit Steering Committee is being established with representation from LHINs, the Ministry, hospitals and other health service providers to provide overall direction and support to the development of a community engagement toolkit.

c) Any IHSP priorities that the LHIN wishes to report on 1. Seniors/SGS Priority The Aging at Home strategy has been aligned with Central LHIN IHSP initiatives. As 2008/09 Aging at Home projects are addressing gaps in our services and geography, we have begun planning for 2009/10 and issued the first call for submissions for Aging at Home 2009/10 in the areas of Supportive Housing, Dementia, Ethno-cultural Adult Day Programs, Increased Services in Rural Areas as well as Supports for Independent Living. These areas cover some of the key identified gaps for seniors and will comprise a portion of the 2009/10 Aging at Home allocation. We will continue to explore other opportunities for investment to address standing issues such as transportation services, specialized geriatric services as well as interim beds. Doorways to Care, an information and referral service for seniors living in Central LHIN was launched and is operational. This project increased system navigation for our seniors and aims to support greater collaboration and access as E-Health related options such as e-referral are made available to the group. Seniors Related Community Engagement We are in the process of creating a new community engagement group called the Citizen’s Expert Panel for Seniors that is made up of consumers living in Central LHIN. This group will advise and give feedback to the LHIN regarding services and their delivery to seniors beginning in October 2008.

2. Mental Health and Addictions In 2006/07, Central LHIN established a Mental Health and Addictions Network made up of Health Service Providers, consumer/survivors, family members, and partnership organizations (research, education, social services). The Network has been engaged in several key activities for 2008/09. 1. Development of a Centralized Access Model for Case Management Services: In 2007/08, the Central LHIN Board approved $200,000 for the development of the model to provide short-term case management to people on the wait list, and to develop communication tools for culturally diverse populations. In July 2008, Central LHIN received the consultant’s

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report outlining a centralized access model, the Steering Committee’s response to the report, and an evaluation framework for the project. This project is going forward to the Board for approval for Urgent Priority funding to implement the model at the October 2008 Board meeting. In addition, a Business Case has been submitted to the Ministry under the Priorities for New Investments for 2009/2010 annualized funding ($500,000). Key features of the model include: single point of entry with alternate entry points for marginalized and under-service populations, the use of service navigators and peer support workers, and centralized wait list management. 2. Enhancing Data Quality: Central LHIN mental health and addiction agencies are MIS compliant; however, the quality of the data is poor due to several factors including the interpretation of the definitions, number of indicators (89), and timeliness of the analysis. As well, LHINs have restricted access to the MIS/CDS/DATIS data and reports. The Service System Work Group has been working with former MIS/CDS mentors in Central LHIN to develop a set of key indicators for use by the Network and Central LHIN in monitoring performance, and in planning for mental health and addiction services. The indicators selected by this Work Group have also supported the work of the Provincial Mental Health and Addictions Data Advisory Group for the Multi-Sectoral Service Accountability Agreement. A webinar will be held in early October to train health service provider staff of the use of the tool. 3. Mental Health and Addiction Education to Ontario Works/Ontario Disability Support

Program/Emergency Department Staff: A project coordinator has been contracted by the Education Work Group to develop a curriculum to provide a base of knowledge on mental health and addictions issues and incorporate sensitivity training in service delivery for staff of Central LHIN, Ontario Works, Ontario Disability Support Program offices, and hospital Emergency Departments. This initiative is being conducted in cooperation with the Ministry of Community and Social Services, and local hospital mental health units. Educational events are scheduled for January 2009. 4. Increasing Cultural Competence of Health Service Providers: All health service providers funded to deliver mental health and addiction services in Central LHIN have implemented the Diversity Lens (CMHA BC, revised) to identify their current cultural competencies in the areas of administration and direct services. An evaluation framework has been developed, and the mentorship and education program to support the further cultural competence of health service providers is under development. These programs will be initiated in January 2009. 5. Development of a Mental Health and Addiction Webpage: A webpage for the Mental Health and Addiction Network was launched developed as part of Central LHIN’s website in April 2008. This webpage provides information about mental health and addiction services in Central LHIN, Network activities, and the Consumer Survivor Network. 6. Addictions Supportive Housing: Central LHIN has identified potential for uptake of 48 units in the Provincial Addiction Supportive Housing Initiative through consultation with addiction and mental health providers. Participation

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in monthly Provincial teleconferences will further prepare the LHIN for implementation of this initiative.

3. Chronic Disease Management and Prevention During the first half of 2007/08, the CDMP Advisory Network has been engaged not only in programming activities, but also in redefining itself and its role. By mid-May, the need to restructure the CDMP Advisory Network to facilitate its ability to plan strategically and to be responsive to Ministry of Health directives had been identified. The new structure to address chronic disease in Central LHIN would include a community wide CDMP Coalition consisting of health service providers, community groups, community support services/agencies, and individuals interested in chronic disease in Central LHIN. The Advisory Network would have a smaller and more focused membership and act in a role similar to a steering committee. And the Workgroups would be project specific, rather than standing committees, and established at the direction of the Advisory Network. The Expression of Interest for the newly developed Advisory Network was distributed in late July and the Network should be established by early October. On the programming side, during the first half of the fiscal year, the Advisory Network was heavily engaged in revising the Self-Management workshops for health professionals. These workshops are being delivered in two distinct formats to achieve two different objectives. The longer four-hour workshop is designed to increase awareness and skills for those delivering self-management services to patients; while the shorter 1-hour workshop is designed to increase physician awareness of their need to reorganize practice to support chronic diseases. During the second half of 2007/08, seven workshops in each format will be delivered. The Advisory Network was also engaged in an activity designed to increase diabetic services to people in the northern rural area of Central LHIN. This partnership between Southlake Hospital and VON included the creation of three community Diabetic Education Clinics along with tele-home monitoring and in-home visits for those not well enough to attend the clinics. This project will improve the status of diabetes and delay or even eliminate the onset of diabetes complications. Both programs are progressing into the second half of the fiscal year.

4. Emergency Services

In April 2008, the Emergency Services Advisory Network was established under the leadership of the Emergency Department Lead for Central LHIN. In Q2, the Emergency Services Advisory Network established short-term workgroups to develop recommendations to improve access to: 1. Specialist (Consultant) Response Time 2. Diagnostic Imaging and Lab Services 3. Rapid Response Team (i.e. a team deployed to treat elderly patients in Long-Term Care

facilities 4. Support Services (e.g. Social Workers, GEM Nurses, Occupation Therapists,

Physiotherapists, etc. These recommendations are expected to be presented to the Network in Q4. The Central LHIN Emergency Department Lead has been actively involved with the implementation of the Ministry of Health and Long-Term Care’s Emergency Department/ALC strategy.

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The Emergency Department Pay for Performance initiative involved submission of action plans by targeted Hospitals with the highest wait times, as specified by the Ministry announcement of May 30, 2008. A subgroup from the Network reviewed the action plans and provided recommendations for implementation. The Central LHIN Emergency Department action plan together with a summary of initiatives by each hospital was submitted to the Ministry’s Wait Times portfolio. The pay for performance initiative is intended to meet specific performance goals – these performance indicators will be monitored via the Emergency Department Reporting System which is expected to be operational by October 1st. Emergency Services Priority Goals are as follows: - Identify barriers to access for emergency services in Central LHIN - Develop communications and transition strategies between primary care providers,

community and long-term care providers and emergency services. - Assess patient and provider satisfaction with emergency services - Improve flow through procedures in emergency departments in the Central LHIN - Develop strategies to add alternatives to emergency services The priority goals meet the Central LHIN system goals of access, coordination, quality, efficiency and integration.

d) To identify risks and related mitigation strategies The risks identified are related to an inability for health service providers to deliver services to our community with the existing approved allocation. Attached is a completed Ministry Risk Management Template. The following comments apply to Q2 risks and related mitigation strategies:

o Based on Ministry direction, risks associated with Business Cases submitted to the Ministry as part of the Central LHIN Annual Service Plan have been identified in the Ministry Annual Service Plan risk template.

o As part of ongoing monitoring of hospital budgets, hospitals were asked to identify risks, which have been reflected in the attached Q2 Risk Template. These risks are associated with MLAA requirement to operate within a balanced budget plan. The following is a summary of deficits submitted by the hospitals:

Hospital Name 2008/09 Deficit (Forecast) 2009/10 Deficit (Forecast) ALLISON Stevenson Memorial ($373,000) ($730,000) RICHMOND HILL York Central ($1,800,000) ($1,300,000) NEWMARKET Southlake Regional ($6,000,000) ($6,000,000)

MARKHAM Stouffville ($3,000,000) ($4,800,000) TORONTO Humber River Regional ($950,000) ($2,400,000)

CLHIN Total ($12,123,000) ($15,230,000)

*Current Status: Subject to change as Central LHIN currently in negotiations

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*Data Source: 2008/09Q2 Risk Management Submission

o Even though the Central Community Care Access Centre is planning to operate within a balanced budget, risk associated with the creation of wait lists has been identified.

o Other non-financial risks have been identified such as the risk of not accepting new dialysis clients at Humber Hospital has been reflected.

Consistent with Ministry directions, the risks identified are focused, and limited to key, significant risks.

e) To provide an update on key negotiations

Public Hospitals Central LHIN has successfully negotiated Hospital Service Accountability Agreements (H-SAA) with 4 of its 7 public hospitals. Third party assessments have been initiated for one of the three hospitals to better understand and potentially mitigate the factors related to each hospital’s inability to submit a balanced budget. Negotiations with the remaining two hospitals are being finalized. Private Hospitals Central LHIN has successfully negotiated Private Hospital Service Accountability Agreements (PH-SAA) with 2 of its 3 private hospitals. Negotiations with the remaining private hospital could not be completed until there was greater clarity on previous agreements brokered by the Ministry. In the early part of August, the Ministry provided clarification related to previously negotiated agreements with the private hospital. Central LHIN has since resumed dialogue with the private hospital and endeavours to sign a PH-SAA with the private hospital by the end of October. Community Health Service Providers A plan for negotiating new Multi-Sectoral Service Accountability Agreements (M-SAA) with community health service providers is in the final stages of development. The process for these negotiations will emulate the hospital process and will be initiated in the coming weeks. Agreements are expected to be in place by March 31, 2009. f) Key Issues/Cost Drivers

The following are Central LHIN’s key cost drivers: • Changing demographics: According to data extracted from the Provincial Health Planning Data Base (August 7, 2007), the population of seniors 65+ and 75+ is growing twice as fast as the provincial average. Therefore, the population of Central LHIN is projected to

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experience a ‘shift up’ over the next 12 years. This shift illustrates an increase in the proportion of seniors in the LHIN’s population and a decrease in the proportion of children and youth. The proportion of seniors is an important indicator of potential health service needs in a population. • Population: Central LHIN is the most populous LHIN in Ontario, and is home to 1.61 million people, or approximately 12.5 percent of Ontario’s population. It is one of the fastest growing regions in the province. Based on Ministry information, population growth in Central LHIN from 1997-98 to 2007-08 period was 31.4 percent whereas the provincial average was only 14.4 percent. It is expected that, by 2016-17, Central LHIN will see growth of 55.3 percent whereas the provincial average is expected to be 27.1 percent. • Immigration: High levels of immigration of ethno-culturally diverse newcomers and an evolving urban-suburban-rural settlement pattern have contributed to this status over a period of more than a decade. • Hospital Needs: As part of the hospital negotiations for the 2008-10 period, Central LHIN hospitals have identified that the current allocation for hospital high growth funding is not sufficient to meet their needs. As a result, our hospitals are not in a position to expand service load. Sustaining existing service load is a challenge in itself. Central LHIN is not receptive to cuts in core services. As part of our mitigation strategy, GTA-LHINs have submitted a Business Case for additional high growth funding allocation. • Humber River Regional Hospital (HRRH) Dialysis: HRRH notified the LHIN and the Ministry about limited dialysis capacity in October 2007. Since that time, Central LHIN has worked with the hospital in a two-pronged approach: first to provide support to ensure dialysis services are available for any new patients arriving at HRRH and secondly to facilitate a process between the Hospital and the Ministry to review dialysis need and obtain approval for appropriate expansion of dialysis services at HRRH. During the first quarter of 2008, Central LHIN worked with the Hospital and three branches of the Ministry – Health Reform Implementation Team (HRIT), Priority Programs and LHIN Liaison Branch – to develop a series of meetings and a proposal that is agreeable to both the Hospital and the Ministry, and lead to an increase in HRRH’s dialysis capacity. During the remainder of the fiscal year, the LHIN will continue to work with HRRH and will engage the remainder of the dialysis providers to develop a LHIN-wide dialysis plan.

g) Any important developments or initiatives within sectors

Health Based Allocation Methodology (HBAM) The Ministry announced a 4 percent increase to the Community Care Access Centre sector for a stabilization increase, which includes inflation and growth components. It is fair to allocate the inflation component uniformly across all Health Service Providers, which is what the Ministry has done. However, for the growth component, we submit that the Health Based Allocation Methodology (HBAM) ought to be used because there should be recognition that various Community Care Access Centres are facing different levels of growth. Central Community Care Access Centre is facing a substantial increase in wait times for the first time and will cost

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approximately $13 million in 2008-09 to address (see Risk Template). If HBAM is not used, the implications in the out-years will be even more severe. C. Status Update on Special Initiatives (see Section 2.4 in guide) Description: This section should include updates on the status of any special initiatives that may need to be tracked separately, e.g. e-health programs, Critical Care, Wait Times or other special projects. The LHIN Liaison Branch may provide specific guidance on this section in advance of the Quarter. Hospice Palliative Care In 2007/08, Central LHIN established a Hospice Palliative Care Network made up of Health Service Providers, and physicians. The Network has been engaged in several key activities for 2008/09: 1. Planning a Residential Hospice for York Region: A functional program and site selection criteria have been developed for a 10-bed residential hospice in York Region. Discussions are underway with the Region of York and other partners to identify suitable property and capital donations. An operational plan is under development. A proposal will be submitted under the Aging At Home Initiative to support the operations of the hospice. 2. Developing Communication Vehicles: A quarterly newsletter is produced and distributed to over 100 people in health service provider organizations and the general public; a website is under development and will be launched later this Fall. 3. Enhancing Skills of Direct Service Providers/Volunteers: A conference is being planned for October 7, 2008 that focuses on skill-building for hospice palliative care workers e.g. Dyspnea techniques for nurses, use of assessment tools from the Cancer Symptom Management Collaborative, guiding families through terminal illness, energy conservation, and working in interdisciplinary eams. All sessions are focussed on reducing emergency department use by palliative clients. 4. Identifying Integration Initiatives: On June 3, 2008 an open space session focussed on integration was held with day hospice providers in the Central LHIN. Board, management, administrative, and volunteer staff attended. 28 integration activities highlighted at the session. The highest priority for implementation was collaborative volunteer training. A proposal is currently being developed by the sector in response to Central LHIN’s Aging At Home Request for Proposals. Other integration activities underway by the Network include linking the day and new residential hospice services (including collaborative volunteer recruitment), common assessment tools and referral protocols, and participation in Central LHIN’s back-office integration project (see integration section of Q2) Alternate Level of Care (Emerging Priority)

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This emerging priority is linked to the both the Seniors (Aging at Home) priority and the Emergency Services priority within the Central LHIN integrated Health Service Plan. Key Alternate Level of Care patient flow bottlenecks in Central LHIN include discharge to: long-term care homes, inpatient rehabilitation, and complex continuing care (Source: OHA survey, Central LHIN results, April 2008). In Q2, steps have been taken to gain a better understanding of the complexities of the Alternate Level of Care situation in Central LHIN and to identify short-term opportunities for local action. The Central LHIN Joint Hospital/Community Care Access Centre Collaborative has submitted a set of preliminary Alternate Level of Care flow recommendations (causes and solutions) to the LHIN. An Alternate Level of Care strategic framework is being developed. As well, Aging at Home has focussed on planning for various initiatives in 2009/2010 to further build capacity,to address Alternate Level of Care and Emergency Room Diversion. In Q2, a proposal for interim long-term care beds and “Waiting at Home” services was developed and submitted to the LHIN Board for review and approval (pending – September 23, 2008) and submission to the Ministry (pending – September 30, 2008) for consideration under Urgent Priorities Funding (Alternate Level of Care). This initiative is intended to address growth pressures, long-term care needs, and to promote a smoother flow of patients from acute care to long-term care while permanent capacity building continues through Aging at Home and Emergency Services. In addition, two proposals – related to Nurse-Led Long-Term Care Outreach Teams - were received from targeted providers in the southern- and northern-parts of the Central LHIN, and submitted to the Ministry for funding consideration. Some emerging Alternate Level of Care issues include: - Limited eReferral capacity of Central LHIN Health Service Providers, particularly as it relates

to rehabilitation and complex continuing care. It is noted that eReferral has been placed within one of the four strategic priorities identified by the Joint Toronto Central LHIN and Central LHIN eHealth Council.

- Health Human Resource gaps for certain types of workers, particularly in the area of rehabilitation.

Diversity and Inclusion Central LHIN's Diversity and Inclusion Advisory Group has met several times in the first half of the year. The focus of the group is to reduce health disparities among the diverse groups in the LHIN. Several projects are being undertaken to assist in reaching this goal, including the development of a population profile; an inventory of best practices in health equity; the development of a vision statement and policies realted to health equity; additional staff and board development; the development of a health equity plan for Central LHIN and a framework of a health equity plan for hospitals. A Community of Practice in the Jane and Finch community is being implemented to improve health services to diverse clients in the Jane-Finch neighbourhood, with an emphasis on inclusion and equitable outcomes. Connections are being created among community residents, groups, service agencies and health care providers that represent diverse populations. Members of this group share information about barriers and promising practices to overcome

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those barriers in health services. Concrete tools are being developed to support health practitioners in Jane-Finch to achieve diversity and inclusion; to improve access to health service by newcomers to Jane-Finch, including newcomers with language barriers; and to improve the Jane-Finch community’s access to information on the health services and health issues.

e-Health Program

Joint LHIN e-Health Program

Central and Toronto Central Local Health Integration Networks (LHINs) joined efforts in September 2007 with respect to e-Health planning and implementation. As a result, the newly formed Joint LHIN e-Health Council has developed a refreshed e-Health Strategic Plan that reflects shared e-Health priorities of the two LHINs, as well as principles for its governance, implementation, and funding. The Joint e-Health Strategic plan will be presented to the respective LHIN Boards for approval in the fall of 2008. Other changes that resulted from the Collaboration include the establishment of a Joint LHIN e-Health Office, which is comprised of shared recourses that provide day-to-day e-Health support for the staff of the two LHINs and aid in the implementation of the e-Health Strategy.

Greater Toronto Area Health Integration Access Layer (HIAL) and Provider Portal Initiative

Timely access to information that is integrated and available to providers and clinicians in one comprehensive view will lead to transforming health care delivery. To enable this vision, two components of Information Technology infrastructure are required: a Health Integration Access Layer (HIAL) and a Provider Portal. The five Greater Toronto LHINs (Central LHIN, Central East LHIN, Central West LHIN, Mississauga Halton LHIN and Toronto Central LHIN) are working together to plan for a HIAL and Provider Portal. The project was initiated in Q2; Steering, Business, and Technical Advisory Committees have been formed. Current state assessment and clinical priorities for this initiative will be identified by fall 2008. The definition of the complete solution and the selection of the implementation sites for the first release are targeted for completion by Mach 2009.

ONETM Mail Initiative

ONETM Mail is an electronic mail (e-mail) solution for the secure electronic exchange of personal health information provided by the Smart System’s for Health Agency (SSHA). E-mail is routed among registered ONE Mail users across SSHA’s managed private network (ONE Network). By April 2009, Central LHIN has targeted to have eighty-percent of its organizations connected to ONETM Mail. As of August 30, 2008, the current status of the project is as follows:

Deployed: 14 sites

In progress: 29 sites

Delayed/On hold: 14 sites

The Joint LHIN e-Health Office has been requested to facilitate the engagement of the remaining health service providers in Central LHIN. Information sessions have been scheduled at Central LHIN, to which these sites have been invited.

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A status report on the Aging at Home Strategy 1. Emerging Issues and Themes Please describe any problems, risks, challenges and opportunities that have been identified related to the implementation of the Aging at Home Strategy.

Delayed E-Health Deployment

System coordination and cross-sector collaborations rely upon consistent e-health tools such as an e-referral option as well as electronic health record, to properly refer between organizations and sectors and to provide collaborative care. Central LHIN providers have continued to request this issue be resolved as soon as possible.

Health Human Resource Shortages

The Aging at Home strategy challenges the high demand for key human resource professionals such as Personal Support Workers, GEM nurses, Physiotherapists, Geriatricians and so on. Some of our Aging at Home project teams are experiencing recruitment delays and compensation difficulties due to the provincial influx for these types of supports.

Community Support Sector Capacity and Aging at Home

The community support sector continues to evolve to meet the growing need for their services in providing home and community supports for seniors. Issues such as poor infrastructure, operational risk, financial due diligence, dated information technology as well as the recruitment of qualified human resources needs to be addressed on an ongoing basis to ensure the sector is capable of responding to the increased demands of Aging at Home.

Funding for Aging at Home Planning Activities

Aging at Home remains a large initiative at Central LHIN due to the size of the funding allocation. Staffing required for planning and implementation purposes continue to create human resource pressures on the existing staff complement.

Knowledge Transfer Opportunities

Recognizing that our communities would like to see their needs and available services recognized in the places where they live, we have developed a communication strategy specifically for celebrating Aging at Home at the local level. Newsletters and up to date website information aims to bridge the gap between a provincial strategy and local service. In addition, we have increased knowledge transfer between our providers by profiling every 2008/09 project on our website.

2. Risk Management and Mitigation Strategies – Aging at Home

What solutions or mitigation strategies have been identified to address all of the issues above, specifically strategies or solutions that will be implemented within the 2008-09 fiscal year? Delayed E-Health Deployment

Central LHIN Joint E-Health Council has engaged with a number of Central LHIN stakeholder groups to identify possible interim solutions to increase electronic communication between providers and sectors.

Health Human Resource Shortages

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Aging at Home has been brought to our Health Human Resource Advisory Group to assist with possible solutions around shortages experienced and projected for the strategy over the next three years.

Community Support Sector Capacity and Aging at Home

The Community Support Sector Capacity Development Initiative has been working towards developing a Human Resource Strategy, assisting remaining organizations to complete the conversion to MIS as well as develop a set of best practises by which the sector can share for greater standardization. Central LHIN will continue to monitor the progress of this project.

3. Other Pertinent Information Please include any other significant information related to the LHIN Aging at Home Strategy (e.g. cross-LHIN issues). Linking Aging at Home Strategy and the ER/ALC Strategy We continue to work in collaboration with our ER/ALC stakeholders and explore new ways to utilize community services to augment hospital pressures as well as integrate potential opportunities for hospital to home programs. D. Status Update on Integration Activities Description: This section should include a summary of integration activities undertaken by the LHIN this fiscal year to date, and a summary of planned integration activities to be undertaken by the LHIN by year-end. The financial impacts of integration activities are to be included in Section E (Forecast Table) and in Section F (Reallocation Table). Central LHIN has been involved in several integration activities this fiscal year. To date, the following initiatives have been approved by the Central LHIN Board of Directors for 2008/09: 1. Transfer of Matthews House Hospice from Hospice Simcoe to Alliance Hospice: this

facilitated integration activity further aligns day hospice services in Central LHIN. This integration activity was undertaken in partnership with the North Simcoe Muskoka LHIN.

2. Transfer of My Friends’ Place from The Consumer Survivor Project of Simcoe County to The Krasman Centre: this facilitated integration activity further aligns mental health consumer/survivor peer support services in Central LHIN. This integration activity is going to Central LHIN Board of Directors for approval in September 2008, and is undertaken in partnership with the North Simcoe Muskoka LHIN.

3. Back-Office Integration: Central LHIN is investigating the feasibility of back-office integration in the community sector. The outcome of this project will be two Business Cases for back-office integration: one for group purchasing, and one for finance. Central LHIN conducted a back-office integration forum with community agencies in June 2008. As a result, 31 agencies have identified their interest in participating in this project. Central LHIN is in discussion with Ministry of Finance, OntarioBuys regarding a potential partnership for the further development and implementation of this project.

4. Provincial Integration Repository: Central LHIN has taken the lead to develop a Provincial Integration Repository. This repository is available on the N-drive, and captures all Board

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approved integration activities across the Province. Individual LHINs are responsible for updating the repository after their monthly Board meetings to ensure that the information is current. Central LHIN provides a synopsis to the LHIN CEOs and LHIN Liaison Branch on a quarterly basis.

5. Integration Strategy: Central LHIN has developed an integration strategy to support integration activities in our LHIN. The strategy provides an overview of the legislation, provides examples of integration at three levels (governance, administrative, and service), a criteria for bringing integration items to the Board for approval, an overview of the Central LHIN process, and highlights strategic direction that the LHIN is taking for 2008/09 and 2009/10.

The following integration activities are being planned for implementation before the end of the fiscal year: 1. Stevenson Memorial Hospital/Southlake Regional Health Centre Administrative

Collaborative: as a result of the Supervisor’s recommendations, these two hospitals are developing an administrative collaborative for coordinated planning, development and application of administrative efficiencies, application of joint clinical service delivery models, education programs, and e-Health/IM/IT initiatives. This initiative is expected to go forward to the Central LHIN Board of Directors for approval as part of the H-SAA package for Stevenson Memorial Hospital in October 2008.

2. Bethany Lodge/Markhaven Back-Office Integration: these two Long-Term Care Homes have been working together to integrate their finance and human resource activities. Rather then outsourcing these services, expertise will be provided within one of the two organizations. Support for this initiative will be provided through an area-wide SSHA Network between the two Homes. This initiative is expected to go to the Central LHIN Board of Directors for approval in November 2008.

3. Merger of North York Central Meals on Wheels with the Don Mills Foundation: this facilitated integration activity will support the coordination of Meals on Wheels Services in North Toronto, and stabilize the governance and administration of Meals on Wheels services in North York. This governance integration is expected to go to the Central LHIN Board of Directors for approval in January 2009.

4. Central LHIN North Collaborative for Cataract Surgery: Central LHIN is working with hospitals to develop a north and a south collaborative for cataract surgeries to reduce wait times for this service. A proposal has been received by York Central Hospital and Southlake Regional Health Centre to consolidate cataract surgery at Southlake Regional Health Centre, promoting the growth of an Eye Centre of Excellence and expanding the availability of ophthalmology services.

5. PalCare Net: Central LHIN is working with PalCare Net to transfer the Pain and Symptom Management Program to an alternate provider to support clinical supervision of the Program, and further integration with the new hospice palliative care multi-disciplinary teams funded through the Aging At Home Initiative

E. Forecast (see Section 2.6 in guide) Description: The forecast table provides the financial status of the LHIN’s local health system (by sector) to-date and projected expenditures for the remaining quarters of the current fiscal year. The forecast table does not include information on the LHIN’s own Operations; this will be included in Section H (Report on LHIN Operations).In alignment with consolidation reporting requirements, the forecast must separately capture payments made and to be made by each sector to Government Reporting Entities (GREs) and

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non-GRE recipients.] The forecast aligns with the Ministry’s Chart of Accounts, by sector, and has the following elements: • Preliminary allocation • In-year adjustments • Revised allocation • Year-to-Date Actuals by Month • Estimated Quarter-End Expenditure • % Expended to Date • Forecast by Quarter • Forecast year-end position • Variance • Explanation of Variance Complete Attachment 2 (a for Q1, b for Q2, c for Q3)

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Ministry direction is that the forecast is to be a complete year-end forecast. In reviewing the Ministry template, the following announcements are not yet reflected in the approved allocation portion of the forecast (pre-populated by the Ministry):

Sector Purpose AmountOperation of Hospitals Implement Operational Improvement - Obstetrics, Collaboration & ED viability 883,000 Long-Term Care Homes Personal Support Workers 2,208,288 Acquired Brain Injury Additional 2.25% stabilization 46,496

TOTAL 3,137,784

It is anticipated that these announcements will be reflected by the Ministry in the Q3 forecast, at which time Central LHIN will include the amounts in the forecast. In addition, there are other adjustments which the Ministry will make in Q3 forecast:

Sector Items AmountCommunity Support Services EDAP for CCAC sector is included 133,700 Community Support Services Net adjustment on reassignment of service providers (188,856-219,735) (30,879)Community Mental Health Urgent Priorities Fund - allocated as base in 2007/08 200,000 Initiatives EDAP for CCAC sector (133,700)Initiatives Urgent Priorities Fund - allocated as base in 2007/08 (200,000)

TOTAL (30,879)

F. Reallocation Tables (see Section 2.7 in guide) Description: The reallocation tables summarize reallocations between Health Service Providers and/or programs within sectors and reallocations between sectors within the LHIN. One table should be completed for each sector in which a variance has been forecasted. The reallocation tables have to align with and reconcile to Section E (Forecast). Reallocations within sectors should be reported if they meet the following criteria: • No reallocation of less than $50,000 should be reported; • All reallocations of more than $100,000 is required to be reported; and • Any reallocations that comprise more than 1.5% of a TP recepient’s base allocation are to be

reported. Complete Attachment 3 (a for reallocations between sectors, b for reallocations within sectors) The following is an update regarding inter-LHIN transfers: Agencies were initially assigned to the LHINs based on the location of the agencies. The Ministry of Health and Long-Term Care has reassigned the agencies listed below due to the relocation of their organizations. The Ministry will provide an updated addendum to Schedule 9 of the Minister-LHIN Accountability Agreement (MLAA), and reflect in the Q3 forecast. . The transfer of agencies does not constitute integration under the LHIN Legislation; this is solely a Ministry/LHIN administrative transaction.

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Transfer from Toronto Central LHIN to Central LHIN: (1) Hazel Burns Hospice (i) Community Support Services – Palliative Care $ 188,856 Transfer from Central LHIN to Toronto Central LHIN: (1) The Phil Aziz Centre for Hospice and Palliative Care (i) Community Support Services – Palliative Care $ 219,735

Central LHIN will receive Health Service Provider forecast information in November as part of Q2 requests to Health Service Providers. At this time, Central LHIN has not identified any reallocation between sectors. It is our understanding that the Ministry’s Priority Programs Branch will seek a Q2 update from hospitals, analyze the results, and share with LHINs for any reallocations relating to Priority programs to be reflected in the Q3 Report.

G. Risk Summary (see Section 2.8 in guide) Description: The risk summary is a tool with which to focus the attention of decision-makers, stewards and those in a governance role on the key risks to the achievement of their objectives. Please Note: The Risk Summary Template (RST) is also to be used to support the reporting of mitigation strategies and performance improvement plans for performance indicators in Tables A to D as set out in the MLAA Schedule 10: Local Health System Performance, where variance has been identified and until the variance is resolved. For performance indicators where a variance has been identified, an additional template has been provided to support the Risk Management Plan portion of the RST (i.e. Column Y) associated with the performance indicators where a variance has been identified. A variance report is not being submitted as Central LHIN is within the agreed upon corridors for all performance indicators identified in Schedule 10 of the Ministry-LHIN Accountability Agreement The Q2 Risk Summary is attached.

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Complete Attachment 4 H. Report on LHIN Operations (see Section 2.9 in guide) Description: The Report on LHIN Operations outlines the LHIN’s financial situation to date and projected expenditures for the remaining quarters of the current fiscal year. The Report on LHIN Operations does not include information on the local health system, which is found in Section E (Forecast). The report will be organized according to the same elements as in Section E (Forecast). Complete Attachment 5 (a for Q1, b for Q2, c for Q3)

Generally speaking, the 2008-2009 LHIN Operations finances are in line with forecasted expenditures for the year at Q2. The one exception is the Aging at Home Program, which will be discussed further in this Report. There are five major groups of expenditures for the LHIN as follows:

Budget %Salaries and Benefits 2,915,835 69%Accommodation & Capital Assets 360,000 8%LSSO Shared Costs 300,000 7%Governance Costs 207,000 5%

Other Operating Costs 476,402 11%4,259,237 100%

The Salaries and Benefits line is slightly under-spent at the end of Q2. This under-spending is intentional, as a re-organization plan is being developed and funds have been set aside to enable a new structure. It is forecast that the full Salaries and Benefits budgets will be spent by year-end.

The second largest variable expense group in the LHIN is for Accommodations and Capital Asset spending. The Accommodations line includes all Rent expenses, as well as minor Repairs and Maintenance and Leasehold Improvement costs. Central LHIN expanded its premises in late spring by moving its Executive Offices to the fifth floor of 140 Allstate Parkway in Markham. Since construction had begun in the previous fiscal year, half the costs were recorded in that year. The cost for finishing this work is reflected in the Accommodations line of the budget as well as the Capital Assets line. The LHIN’s largest fixed expense is the monthly payment of $25,000 to support the LSSO Shared Costs. This is withdrawn automatically on a monthly basis. No variance is expected. The fourth group, Governance Costs, is made up of Per Diems, Board Travel and other Governance costs, including Insurance and meeting expenses. Historically, the Central LHIN

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Governance budgets are fully spent at year end. The same is anticipated for the 2008-9 fiscal year. The balance of the budget is a sum of various Operations accounts, including Consultants, staff travel costs, meeting expenses, Office supplies and Communication expenses, making up 11% of the budget. This last group of expenditures is monitored very closely and is expected to come in on target at year-end. The LHIN has four Special Projects this year: e-Health, Aboriginal Community Engagement, the Emergency Department Lead Funding and the Aging at Home Initiative. Funding for the first three projects has been provided as follows:

BudgetE-Health 120,000 Aboriginal Community Engagement 10,000 ED Lead 43,700

The fourth special project is the Aging at Home Initiative for which no Operational funding was provided in the 2008/9 fiscal year. The Central LHIN continues to experience staffing pressures due to a lack of planning dollars allocated to the LHINs this fiscal year for planning and managing the aging at home process . The Aging at Home strategy in Central LHIN has had a large impact on our existing internal resources due to the magnitude of the funding allocation. The LHIN is required to identify, collect and re-allocate in year surplus from 08/09 (year 1) as well as plan for the $20M 2009/10 allocation in this fiscal year. In 2009-10, there will be more adjustment of prior year funding and a further $26 M to allocate. The LHIN has requested that the prior year Planning funding level of $263,000 be extended into this fiscal year and 2009/10 to offset pressures related to planning requirements for the Aging at Home Initiative. As shown above, there are no surpluses from which the LHIN can draw to fund these planning requirements.


MEMORANDUM DATE: September 29, 2008 TO: Bonnie Adamson, CEO, North York General Hospital Janet Beed, CEO, Markham Stouffville Hospital Dan Carriere, CEO, Southlake Regional Health Centre Reuben Devlin, CEO, Humber River Regional Hospital Bruce Harber, CEO, York Central Hospital

FROM: Hy Eliasoph COPY: Diane Salois-Swallow, Central LHIN E-Health Lead Ken Morrison, Chairman of the Board of Directors, Central LHIN Gary Ryan, CEO, Stevenson Memorial Hospital RE: Feasibility Study for Data Centre Consolidation Central LHIN Hospitals - Agreement in Principle As implementation of the MoHLTC e-Health strategies is moving forward, the need to assess the readiness and capacity of your organizations to undertake these initiatives is significant. One component of a readiness assessment is to examine current data centre capacity for growth, expansion and business continuity. The Central LHIN is undertaking a Feasibility Study for Data Centre Consolidation for the hospitals in our LHIN. You may have received information from your CIO. Consolidation will provide significant benefits:

- Accelerated deployment of provincial and regional e-Health initiatives - Implementation of business continuance for critical applications - Implementation of best practice data centre technologies and processes to reduce the

technical risk to hospital applications - Leveraging economies of scale to: improve service; minimize operating risk; reduce operating

costs and reduce or eliminate investment costs. The Central East, South West and North Simcoe Muskoka LHINs have engaged IBM and Healthech to assist them with this assessment with a view toward data centre consolidation. The MoHLTC e-Health Program is very supportive of our undertaking this assessment and will offer some funding assistance. We anticipate that the maximum funding will be as follows:

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Humber River Regional Hospital - $6,000 Markham Stouffville Hospital - $3,850 North York General Hospital - $1,500 Southlake Regional Health Centre - $6,000 York Central Hospital - $6,000 These costs do not include taxes or out of pocket expenses. Out of pocket expenses will be billed separately. Diane Salois-Swallow will manage the logistics of this project including invoicing for your respective cost allocation and incidentals etc. Diane will be in contact with your Director of IT. The scope of the feasibility study will examine the viability of consolidating the data centres from York Central Hospital, Humber River Regional Hospital, Southlake Regional Health Centre, North York General Hospital and Markham Stouffville Hospital. North York General Hospital has a current outsourcing arrangement with Teranet and will have reduced participation in this initiative. Completion of this study will facilitate the Central LHINs ability to join the three previously noted LHINs with their request to Ontario Buy for capital funding. It is anticipated that the project will take approximately 10 weeks to complete. Please do not hesitate to contact either Diane or myself if you wish to discuss this further. Yours sincerely,

Hy Eliasoph CEO, Central LHIN

140 Allstate Parkway 140, Allstate Parkway bureau 210

Suite 210 Markham, ON Markham, ON L3R 5Y8 L3R 5Y8 Tel: 905-948-1872 Fax: 905-948-8011 Toll Free: 1-866-392-5446 http://www.lhins.on.ca

Tél: 905-948-1872 Téléc: 905-948-8011 Sans frais: 1-866-392-5446 http://www.lhins.on.ca

MEMORANDUM

February 5, 2008 To: Central LHIN Acute Hospital CEOs RE: Central LHIN Cataract Surgery Strategy To align with and maximize the opportunity to increase cataract surgery volumes, the Central LHIN Wait Time Strategic Planning Group (with membership from Central LHIN hospitals and the Central CCAC) developed and recommended a strategy to build a North-South Collaborative. This collaborative would be anchored by two high-volume cataract centres - the Branson site of North York General Hospital and the new Medical Arts Building site of Southlake Regional Health Centre. This strategy has also been endorsed by the Provincial Wait Time Strategy Group. This model is consistent with the evidence-based practice of quality and efficiency in high volume centres, while affording access to cataract procedures to all residents of Central LHIN. The goal, over time, would be to fully develop these programs to serve the complete ophthalmology needs of residents in Central LHIN and beyond. Some initial transfer of cataract procedures from Humber River Regional Hospital to North York Branson has already taken place. Central LHIN anticipates that all cataract procedures performed in other Central LHIN hospitals would, over time, migrate to the two high volume centres. This will strengthen the best practice model of evidence-based care while, at the same time, serve to free up operating room capacity in the other Central LHIN hospitals.

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Central LHIN senior management is considering the most appropriate approach in working toward the fulfillment of the recommended North-South Collaborative. The preferred approach would be a Voluntary Integration proposal developed by all Central LHIN hospitals that we can bring forward for Board approval. This would entail all hospitals coming together to develop a migration plan and timetable. Alternatively, if the hospitals prefer, we (Central LHIN) could work with you to achieve a Facilitated Integration that could be brought forward for Board approval. Another approach is for us to recommend to our Board changes to hospital funding for cataract services that would achieve the same end result without the need for an integration proposal.

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Irrespective of the approach taken, we would anticipate that plans to work toward achieving the North-South Cataract Collaborative would be rolled out over the period encompassing fiscal 2008/09 and 2009/10, and be reflected in the Hospital Service Accountability Agreement now being developed for all hospitals in Central LHIN. We would be most interested in hearing back from you by our upcoming monthly hospital CEO meeting on February 20, 2008 as to your preference for how best to proceed. It is our expectation that at our upcoming meeting we will discuss and possibly reach agreement on whether the hospitals are willing/prepared to develop a collaborative voluntary integration proposal or whether we should consider other alternatives. If you require further information or clarification, please do not hesitate to contact me. Thank you for your continued support.

Hy Eliasoph CEO, Central LHIN c. Ken Morrison, Chairman of the Board of Directors, Central LHIN Paul Barker, Senior Director, Performance, Contract and Allocation, Central LHIN Kim Baker, Senior Director, Planning, Integration and Community Engagement, Central LHIN Phoebe Jibunoh, Chair, Central LHIN Wait Times Strategic Planning Group Malcolm Moffat, CEO, St. John’s Rehabilitation Hospital Cathy Szabo, Executive Director, Central CCAC

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140 Allstate Parkway Suite 210 Markham, ON L3R 5Y8 Tel: 905-948-1872 Fax: 905-948-8011 Toll Free: 1-866-392-5446 http://www.lhins.on.ca

140, Allstate Parkway bureau 210 Markham, ON L3R 5Y8 Tél: 905-948-1872 Téléc: 905-948-8011 Sans frais: 1-866-392-5446 http://ww.lhins.on.ca

News Release

March 11, 2008

CENTRAL LHIN Promotes Strategy to Develop High Volume Cataract Centres Hospitals get on board with planning proposed integration: centres of excellence would result in

positive patient outcomes, shorter wait times and more surgeries

Markham – Central Local Health Integration Network (LHIN) hospitals have agreed to work together to explore a new model of centralized delivery for cataract procedures that would see all cataract surgeries in Central LHIN performed at two high volume centres: one located at Southlake Regional Health Centre in Newmarket, and the other at the Branson site of North York General Hospital, in North York. The proposed strategy was developed by the Wait Times Steering Committee of the Central LHIN, which is comprised of representatives from Central LHIN hospitals and the Central Community Care Access Centre. According to the Committee, the creation of high volume cataract centres of excellence would result in a number of positive benefits for patients, including better clinical outcomes, shorter overall wait times for surgery, and enhanced capacity within the system to deliver more surgeries each year. “We support the recommendations of our Wait Times Steering Committee and believe that creating these two high volume specialty cataract centres is good for patient care,” says Hy Eliasoph, CEO of the Central LHIN. “Having specialized teams in our hospitals focused on the unique needs of patients requiring cataract surgery will enhance the overall quality of patient care and provide improved access for people who require the surgery.” Creating high volume cataract centres at Southlake Regional Health Centre and the Branson site of North York General Hospital aligns with similar new models of cataract surgery delivery in other jurisdictions in the province, and is a strategy endorsed by the Provincial Wait Times Strategy. “The Province strongly encourages integration to high volume, high quality cataract centres. This allows improved access for patients and improved efficiency and optimal use of taxpayers dollars, says Dr. Alan Hudson, who leads the provincial initiative to address patient wait times for key procedures. “We must get rid of unnecessary duplication of services in the LHIN,” he adds. According to Eliasoph, the six hospitals in the Central LHIN that perform cataract procedures have agreed to voluntarily get together to determine how they could implement the strategy and to develop a proposed integration plan for approval by the Central LHIN Board of Directors.

-more-

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“We are keen to work with the hospitals and ophthalmology leadership to move toward this new and enhanced service for residents of the Central LHIN and beyond,” says Eliasoph. “In so doing, we will ensure that we address relevant concerns of patients, caregivers and others before we proceed to implement the plan.” Central Local Health Integration Network (LHIN) is one of 14 LHINs established by the Government of Ontario as community-based organizations to plan, co-ordinate, integrate and fund health services at the local level. One of the most populous and diverse LHINs, Central LHIN encompasses the majority of York Region, as well as north Toronto and south Simcoe. Through its Integrated Health Service Plan, Central LHIN is dedicated to improving the accessibility, coordination, quality and efficiency of our health system, to help people lead healthier lives.

-30- For more information please contact: Sheena Campbell Communications Manager Central LHIN 905-948-1872 ext 214 For more information on the Provincial Wait Times Strategy, visit www.ontariowaittimes.com.


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Extract from September 25, 2008 Board of Trustees Minutes BOARD MOTION RE REQUEST FOR VOLUNTARY INTEGRATION OF SERVICES: Cataract Surgery After much discussion, it was moved by John Beech, seconded by Shafiq Ebrahim, and carried, with five members opposed: That the Board of Trustees support the voluntary integration request to complete the transfer of cataract surgery from York Central Hospital to Southlake Regional Health Centre (SRHC), and

DECISION

Furthermore, it was moved by Mark Liddy, seconded by Shafiq Ebrahim, and carried: That staff be directed to report back to the Board on further communication, mitigation, and review on this matter.

DECISION

Extract from minutes of the September 24, 2008 Southlake Regional Health Centre Board of Directors’ meeting BOARD MOTION RE REQUEST FOR VOLUNTARY INTEGRATION OF SERVICES: Cataract Surgery On motion of B. Gilmore, seconded by R. Morley and carried unanimously, it was MOVED THAT THE SOUTHLAKE REGIONAL HEALTH CENTRE BOARD OF DIRECTORS APPROVES THE PRE-INTEGRATION ORDER FOR TRANSFER OF CATARACT SURGERY FROM YORK CENTRAL HOSPITAL TO SOUTHLAKE REGIONAL HEALTH CENTRE.


October 9, 2008 Mr. Bruce Harber Mr. Dan Carriere President & CEO President & CEO York Central Hospital Southlake Regional Health Centre 10 Trench Street 586 Davis Drive Richmond Hill, ON L4C 4Z3 Newmarket, ON L3Y 2P9 Dear Mr. Harber/Mr. Carriere: RE: Voluntary Integration Request Thank you for your letter received in our office on October 7, 2008 confirming your earlier expression of intent for a voluntary integration opportunity. It is our understanding that York Central Hospital and Southlake Regional Health Centre have been working together for many months regarding the potential transfer of cataract surgery from York Central Hospital to Southlake Regional Health Centre. Some of the benefits of such an integration activity, as outlined in your letter include: • A Positive Patient Experience • Optimal Clinical Outcomes • Health and Wellness of Our Community We understand that both Boards have agreed at their respective September 2008 Board meetings to pursue this opportunity for the benefit of your patients. As part of the initiative, you are seeking approval from the Central LHIN Board of Directors for York Central Hospital to transfer approximately $733,000 (exact number to be verified) to support the integration of cataract surgical services at Southlake Regional Health Centre. This is equivalent to 1086 cataract surgical cases. This request will be carefully reviewed in the context of the Local Health System Integration Act, 2006, to ensure that the integration activity meets the requirements outlined in the legislation. It will also be reviewed using the interim process and criteria approved by the Central LHIN Board of Directors on March 27, 2008 as well as guidance provided in the Local Health Integration Network Governance Resource and Toolkit for Voluntary Integration Initiatives (2008). Central LHIN’s Integration Health Service Plan (IHSP) identified five criteria for measuring LHIN integration efforts: stakeholder consultation, access, coordination, quality, and efficiency. These criteria and criteria described above will be used in our decision making process.

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You will be notified of the Board’s decision within 60 days of receipt of your letter, which is the period of time under the Act for LHIN consideration of your voluntary integration request. Sincerely,

Hy Eliasoph CEO, Central LHIN /cs c: Ken Morrison, Chairman of the Board of Directors, Central LHIN Kim Baker, Senior Director, Planning, Integration and Community Engagement, Central LHIN

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You will be notified of the Board’s decision within 60 days of receipt of your letter, which is the period of time under the Act for LHIN consideration of your voluntary integration request. Sincerely,

Hy Eliasoph CEO, Central LHIN /cs c: Ken Morrison, Chairman of the Board of Directors, Central LHIN Kim Baker, Senior Director, Planning, Integration and Community Engagement, Central LHIN

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Ophthalmology Working Group Terms of Reference

Purpose The purpose of the Ophthalmology Working Group is to develop a proposal and implementation strategy for the consolidation of surgical ophthalmology services within the Central LHIN. In so doing, the Working Group will give consideration to how best to provide timely access to an appropriate range of surgical ophthalmology services at the Branson site of North York General Hospital (NYGH) and Southlake Regional Hospital while retaining an ophthalmology presence in each hospital community. The Working Group will report on the impact of the implementation plan on human resources and finances at each hospital site and identify key investment requirements. Overall leadership for the project will be provided by senior Leaders from each of Southlake and NYGH who will also serve as co-chairs to the Working Group. The Working Group will appoint task teams to undertake key components of the planning work/

Responsibilities The key responsibilities of the Ophthalmology Working Group include:

1. Developing a common vision for ophthalmology surgical services within the Central LHIN that focuses on improving access to care and promoting high standards of patient safety as part of a cost effective delivery system;

2. Recommending the scope and location of surgical services, identifying clinical service gaps and the range of tertiary ophthalmology care that should be provided within the Central LHIN giving consideration to referral patterns, patient need/demand, potential capital and operational investment and physician manpower implications;

3. Developing principles to guide planning;

4. Formulating a planning process including the appointment of task teams to undertake the detailed planning work;

5. Formulating an implementation plan that details the operational requirements associated with consolidation of surgical services including the care model, support service requirements and the ongoing provision of emergency, inpatient, clinical support and on-call support across the LHIN;

6. Identifying incentives to retain community based ophthalmology practices in each home community;

7. Determine the impact of the implementation plan on human resources, finance and surgical capacity at each acute care hospital within the LHIN;

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8. Advising on governance and organizational structure and responsibilities including physician leadership structures and accountabilities;

9. Determining processes for common physician credentialing;

10. Monitoring the implementation planning process, time lines and deliverables;

11. Advising and/or addressing issues and concerns that arise over the life of the project;

12. Advising on a communication strategy with key stakeholders within partner organizations;

13. Developing a proposal for the future of Ophthalmology services in the Central LHIN.

Membership The Working Group will include:

Co-chairs - Administrative lead (NYGH) and clinical leader (Southlake) Hospital representatives from each Central LHIN partner organization:

Ophthalmologist (Chief or delegate) Ophthalmologist Chief of Surgery or Surgical Program Leader (MD) VP Surgical Program Administrative Program Leader/Director

Designated representative Central LHIN Project Facilitator/Advisor

Note: Representatives from Sunnybrook and/or other academic centres outside of the Central LHIN will be invited at the request of the chair

Time Lines The overall project time line is illustrated below. The Working Group will be responsible for managing the time line, the work of the planning teams and ensuring key deliverables are provided as required. May June July Aug Sept Oct Nov Ophthalmology Group Meeting 26th 15th Working/Strategy Group 18th x x 15th Develop Work Plan/Time Line Identify Planning Team

Charters and Membership

Planning Team Work Interim Report 1st Final Draft Report 30th

Financial Impact Analysis 15th Senior Leadership/Board Approval

31st

Implementation Plan to LHIN 15th

Frequency of Meetings The Working Group will meet at the outset of the planning work and thereafter at six week intervals.


Working Definitions of the Diversity and Inclusion Advisory Group The Central LHIN Diversity & Inclusion Advisory Group recognizes that language is fluid and that meaning changes over time and is subject to context, therefore the definitions provided below are meant as “working definitions” or guidelines for current use. Equitable access All individuals have similar capacity (with assistance when needed) and similar opportunity (with assistance when needed) to make use of necessary health services of similar quality, regardless of any barriers posed by social, geographical, ethnocultural/ linguistic, gender or socioeconomic factors, or physical, intellectual, cognitive, emotional or other challenges. Equitable outcomes Everyone should receive equal access to the services that help them effectively manage their health. Therefore, each person should expect to have outcomes equal to other members of the community. The aim of equity is to close the racial, ethnic, and socioeconomic gaps in health status.

Health Equity

A systemic and systematic approach to health, health care, and health service delivery that enhances the social well-being for all population groups and individuals, regardless of different levels of underlying social dis/advantage.

Health Inequities

“Health inequities refer to those inequalities in health that are deemed to be unfair, unacceptable or stemming from some form of injustice such as inadequate access to essential health and other public services and/or health-damaging behaviour where the degree of choice of lifestyles is restricted” (Kawachi, Subramnian, etc., 2002. in Europe Partners for Equity in Health, 2006). Cultural Competence Culturally competent health service providers will advance the goals of diversity and inclusivity of the targeted groups by fully understanding their diverse needs and delivering services accordingly in a sensitive, meaningful and knowledgeable manner.

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Diversity Diversity addresses issues of difference. The diversity of identifying characteristics includes race, culture, language, faith/religion, gender, sexual identity and orientation, gender identity, family status, ability, socio-economic status, refugee/immigrant status, age, and other relevant life experiences such as homelessness, mental health issues and addictions. It also includes literacy level, educational level, legal history and membership of Aboriginal heritage, residential context (e.g. urban, suburban, and rural). Inclusion Inclusion is where people with diverse backgrounds, characteristics and abilities feel valued, respected and supported to fully and actively participate in their communities. Inclusion welcomes a broad range of ideas, perspectives, experiences, viewpoints and approaches. A culture of inclusion is achieved when all members of a community are seen to be treated with fairness, dignity and participate as full citizens of their communities.

Chair of the Board of Directors at (905) 948-1872 ext. 208.

Our Mission: Enable access to an integrated health system for our communities

Caring Communities – Healthier People: Making a Difference

Health Check-In September 2008

Planning to meet our needs Central LHIN is working on developing its Annual Service Plan. The plan is a public document that allows our community, health service providers and the government to understand how we are going about addressing the healthcare needs of our residents. Once complete, the plan will be available on our website at www.centrallhin.on.ca. New Hospice Planned for York Region The Central LHIN Hospice Palliative Care Network, in partnership with the Central Community Care Access Centre and Southlake Regional Health Centre is developing an operational plan for a 10-bed hospice for York Region. Community engagement will be undertaken once site options have been confirmed. It is anticipated the hospice will be opened by 2010. Listening to Seniors and Caregivers To encourage participation from those who are best able to share their wisdom into the needs of seniors and caregivers, we set out to recruit community members from this group to share their experiences and knowledge. The panel’s work will: • Provide input and feedback on the effectiveness of

our strategies and initiatives related to seniors and their caregivers

• Provide input and feedback on issues such as co-ordination, access and efficiency within the health-care system for seniors

• Share with us the local health issues or needs that may arise in our community

We are working to have the group together for their first meeting in October.

Assembling Community Leaders New partnerships are being established with community leaders to reach culturally diverse groups across the LHIN. An orientation session held earlier this summer included groups from: Jane-Finch, rural areas in the northwest part of our LHIN, South Asians, Italian, Korean, Filipino, Jewish, Chinese, Iranian, Russian and Francophones. A GEM of a plan – Aging at Home In an effort to help seniors access the care that they need to age at home with dignity and avoid recurring visits to the emergency room or unnecessary hospital visits, the Geriatric Emergency Management (GEM) initiative is being expanded to every emergency department in Central LHIN. As part of the Aging at Home Strategy, we are providing more than $500, 000 to create new GEM positions in the emergency departments at Humber River Regional Hospital, North York General Hospital, Markham Stouffville Hospital, Southlake Regional Health Centre and Stevenson Memorial Hospital. Planning for Tomorrow We are working on a new initiative that will help us better understand and plan to meet the health needs of our community. Ten years from now, what will our healthcare system look like? Do we know what healthcare services will be needed? What will be the demographic makeup of our LHIN in 2018? We will answer these questions with the help of healthcare experts, consultants and our community.

For additional information about these items or other Central LHIN initiatives, please contact Mario Longo at (905) 948-1872 ext. 214 or by e-mail at [email protected].

http://www.centrallhin.on.ca/


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Appendix 4.20a

Chair of the Board of Directors at (905) 948-1872 ext. 208.

Our Mission: Enable access to an integrated health system for our communities

Caring Communities – Healthier People: Making a Difference

Health Check-In October 2008

Quality Becomes a Central LHIN Focus A newly identified strategic priority for our LHIN is “Quality.” With input from our Board, we will be looking to target select stakeholders, provincial leads and experts to help define our quality agenda. It will be developed by identifying measurable initiatives and objectives that are aligned with our Integrated Health Service Plan and the Ministry’s strategic direction. Mental Health & Addiction through Diversity Lens The message we have heard from residents and health service providers is that there is a need to improve access for people of diverse ethnic backgrounds, people with disabilities and those with access difficulties because of income, education or transportation. Our Cultural Competency Project will guide our health service providers – responsible for delivering mental health and addiction services – to measure their ability to work with people of different cultures. The results will be used to identify the supports that they may require to further diversity goals through formal training or mentorship. LHIN and York U Partnership We are partnering with the Faculty of Health at York University to develop a comprehensive evaluation of our health system. The evaluation will focus on health system, population and community health needs. A key objective is to create a shared vision among our health partners and produce a plan that will help us get there. Planning for Tomorrow Our Health Service Needs Assessment and Gap Analysis project has completed an analysis of health services in our LHIN. We are now in the final rounds of community engagement sessions being organized by geographic planning zones to allow participants to provide feedback on the information we have collected.

Aging at Home: Year 2 Our call for proposals for the second year of Aging at Home closed on September 26. We received over 65 proposals from all organizations committed to seniors’ and healthy aging at home or in the community. Our goal is to find solutions that improve supports in the home, enhance supportive social environments, and senior-centered care. The year-two plan will work toward supporting improvements in how our health system us used by reducing hospital Emergency Room visits, inpatient days and Alternative Level of Care Days, and the prevention of avoidable admissions to long-term care homes. LHIN 101: A new How-to-Guide To assist the Boards of health service organizations better understand the evolving roles of LHINs, processes and expectations, Central LHIN along with four other LHINs, several associations representing health service providers and the Ministry launched the Local Health Integration Network/Health Service Providers Governance Toolkit for Voluntary Integration Initiatives. Engaging Docs On October 29th, we’ll be talking shop with the docs in our LHIN. In partnership with the Ontario Medical Association, we will discuss the interdependencies among doctors, patients and our LHIN. Doorways to Care Open A single phone call can change the way older adults get needed services in the Central LHIN. By phoning 1-866-626-0222, the toll-free number of the Doorways to Care (DWTC) program, seniors can now talk to live operators trained to navigate community health services and help them maintain their independence at home for as long as possible. For more information about Doorways to Care or to view a list of participating agencies, please visit www.doorwaystocare.ca.

For additional information, please contact Mario Longo at (905) 948-1872 ext. 214 or by e-mail at [email protected].

http://www.centrallhin.on.ca/integratedhealthserviceplan.aspx?ekmensel=e2f22c9a_72_204_btnlink

http://www.centrallhin.on.ca/integratedhealthserviceplan.aspx?ekmensel=e2f22c9a_72_204_btnlink

http://www.centrallhin.on.ca/page.aspx?id=3860



http://www.doorwaystocare.ca/


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Appendix 4.20b

Website Metrics The metrics outlined below illustrate Central LHIN’s website traffic volume or site reach. News stories receive positive and consistent attention from visitors. These metrics suggest that our site is a reliable source for information among visitors. It should also be noted that communication staff continue to receive requests from HSPs and the general public to guide them through the registration of MyPage so that they can automatically receive notifications. September Newsclips Total Views 1664 Total Visitors 173 Views/Visitor 9.62

Newsroom Total Views 3798 Total Visitors 398 Views/Visitor 9.54

Site Total Views 239438 Total Visitors 10559 Views/Visitor 22.68 New Visitors 9780 Returning Visitors 1374

August Newsroom Total Views 2958 Total Visitors 292 Views/Visitor 10.13

Newsclips Total Views 1508 Total Visitors 180 Views/Visitor 8.38


July Newsroom Total Views 3049 Total Visitors 337 Views/Visitor 9.05

Newsclips Total Views 1561 Total Visitors 223 Views/Visitor 7


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Appendix 4.21

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Appendix 4.23

Joint LHIN/OHA HSAA Review Task Force UpdateAs announced in July, the Joint LHIN/OHA HSAA Review Task Force (Task Force) will bereviewing and providing recommendations on the leading practices and processes of the2008-10 Hospital Services Accountability Agreement (HSAA) negotiations. This Task Forcewas developed out of the 2008-10 template agreement negotiations between the Local HealthIntegration Networks (LHINs) and the Ontario Hospital Association (OHA). The Task Force,co-chaired by Sandra Hanmer, CEO, Waterloo Wellington LHIN and Tom Closson,President and CEO, OHA, has approved its Terms of Reference (ToR), membership andscope of work.

Process Review

The Process Review will examine education/communications and negotiations to identify“lessons learned” for the development and negotiation of HSAAs for 2010-11. It will alsoassess the extent to which HSAA processes are being utilized to monitor and move forward with scenarios where one or both parties arenot meeting a performance obligation. The Process Review will be conducted by an external consultant and contract negotiations arecurrently underway.

Leading Practices Review

The Leading Practices Review will identify the practices that LHINs and hospitals are using to balance budgets and improve financialperformance that could be applied in other LHINs. These leading practices will be assessed by the LHIN-OHA Review Task Force todetermine those that might have the greatest impact and that could be considered for implementation in other LHINs and hospitals. Thereview will be undertaken by a work group made up of four LHIN and four hospital members with expertise and involvement in thesigning of the current HSAAs. Consideration was given to maximize representation, LHIN or hospital, from across the province. TheLeading Practices Review working group includes:

Each hospital and LHIN will be asked to identify one contact involved in the HSAA negotiation so that the working group can collectfeedback as needed. This request will be sent to the executive offices of the LHINs and hospitals in the very near future. In the interim,please feel free to contact either of us for further information.

Sincerely,

Sandra Hanmer Tom ClossonCo-chair, Joint LHIN/OHA HSAA Review Task Force Co-chair, Joint LHIN/OHA HSAA Review Task Force

Hospital Service AccountabilityAgreement Update

October 2, 2008 VOLUME 2 / ISSUE 5 Published by ONTARIO’S LOCAL HEALTH INTEGRATION NETWORKS

Inside

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Appendix 1: Terms of Reference . . . . . . .2

Appendix 2A: Scope of Process Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Appendix 2B: Scope of Leading Practices Review . . . . . . . . . . . . . . . . . . . . . . .3

Hospitals• Susan Hollis, CFO, St. Joseph’s Healthcare, Hamilton• Mike Prociw, CFO and VP Informatics and Diagnostics, Quinte

Healthcare Corporation, Belleville• Mary Wilson Trider, Vice President, Finance and Information

Services, Halton Healthcare Services, Oakville• Tomi Nieminen, Health Finance and Research, OHA, Toronto

LHINs• Mark Brintnell, Team Lead, Business and Performance,

South West LHIN, London• Suzanne Dionne, Senior Director, Performance, Contract

and Allocation, Champlain LHIN, Ottawa• Two others to be designated by LHINs based on geography

and expertise

http://www.jppc.org/new/files/acrobat/HSAA%20Update%20-%20July%2023%202008.pdf

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Appendix 6.1

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Mandate

The Joint LHIN-OHA HSAA Review Task Force will undertake a review of the 2008-10 HSAA negotiation leading practices andprocess and provide recommendations to achieve balanced budgets for 2009/10 and improved HAPS/HSAA processes for 2010/11.

Scope of Review

The HSAA Review would be undertaken with a lens on two distinct areas: (1) leading practices and (2) negotiations processes.

The leading practices review will identify the practices that LHINs and hospitals are using to balance budgets and improve financialperformance that could be applied in other LHINs. These leading practices will be assessed by the LHIN-OHA Review Task Force todetermine those that might have the greatest impact and that could be considered for implementation in other LHINs and hospitals.

The review of negotiations processes will focus on: HAPS planning, submission and review, communications, education, monitoring, andLHIN-hospital negotiations. This would include an examination of the following:

• Education/communications – This would include a review of the nature and adequacy of materials provided to facilitate understanding of the new HSAA process, communications between hospitals and LHINs, as well as those provided by OHA and LHINs jointly.

• Negotiations Process – This aspect of the review would look at how hospitals were engaged in negotiations with their LHIN (e.g., type and extent of engagements), areas of the agreement that posed significant challenges for the parties, as well as use of the compliance framework set out in the Commitment to the Future of Medicare Act.


Sources of Information

Both reviews will utilize (but not limited to):

• HAPS/HSAA documents;• Web Enabled Reporting System (WERS);• MIS Trial Balance;• Clinical statistics (i.e. DAD, NACRS);• Performance Improvement Plans (PIP); and• Interviews with negotiators from both the LHINS and the hospitals.

APPENDIX 1 : Joint LHIN-OHA HSAA Review Task Force Terms of Reference

continued on next page

BACKGROUND

As part of their commitment to greater accountability in the healthcare sector, the Ontario Ministry of Health and Long-Term Care(Ministry) and hospitals implemented accountability agreements in the hospital sector in 2005.

The first mutually-negotiated hospital agreement and associated indicators were developed under the auspices of the Joint Policy andPlanning Committee (JPPC) Multi-Year Funding Committee. With the establishment of LHINs, the Ministry transitioned thedevelopment and negotiation of HSAAs to the LHINs.

The 2008-10 HAPS/HSAA process was launched in 2007 with the publication of the Hospital Annual Planning Submission (HAPS)Guidelines (and indicators based on the work of the JPPC Accountability Committee). As a result of negotiations between LHINs andthe OHA, a new LHIN/hospital template agreement was released to the field in January 2008.

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Membership

The Task Force will be compromised of no more than six (6)representatives from the LHINs and six (6) representatives from theOHA, to be selected by each organization, each person havingfamiliarity with the HSAA negotiations.

To ensure a balanced and varied range of experience andperspectives, the LHINs and the OHA will draw uponrepresentation from a variety of LHINs, as well as hospitals ofvarying types and sizes.

The Task Force will be co-chaired by the LHINs and the OHA.

Reporting Relationship

The Task Force will report to their respective constituencies.

Decision-Making

Decisions will be made by consensus.

Frequency of Meetings

The Task Force shall meet monthly in August, September, Octoberand November. Further meetings, if necessary, are arranged at the call of the Co-Chairs. Meetings may be held by teleconference.

Staff Support

Support for the Task Force will be provided by staff from the LHINs and the OHA’s Policy and Public Affairs Division.

TASK FORCE MEMBERS

LHINsSandra Hanmer, CEO, Waterloo-Wellington LHIN (co-chair)Brad Keeler, Senior Director, Performance, Contracts andAllocation, Erie St.Claire LHINBill MacLeod, CEO, Mississauga Halton LHINPat Mandy, CEO, Hamilton Niagara Haldimand Brant LHINPat Stoddart, Senior Director, Performance, Contracts andAllocation, Central West LHIN

HospitalsPat Campbell, CEO, Grey Bruce Health ServicesTom Closson, President and CEO, OHA (co-chair)Anthony Dale, VP, Policy and Public Affairs, OHAPeter Finkle, COO, Southlake Regional Health CentreHal Fjeldsted, CEO, Kirkland & District HospitalMark Rochon, CEO, Toronto Rehabilitation Institute and BoardChair, OHA

APPENDIX 2A: SCOPE OF PROCESS REVIEW

APPENDIX 2B:SCOPE OF LEADING PRACTICES REVIEW

The proposed review of the 2008-10 HAPS/HSAA process willfocus on: HAPS planning, submission and review, communications,education, monitoring, and LHIN-hospital negotiations. Thiswould include an examination of the following:

• Education/communications – This would include a review of the nature and adequacy of materials provided to facilitate understanding of the new HSAA process, communications between hospitals and LHINs, as well as those provided by OHA and LHINs jointly.

• Negotiations Process – This aspect of the review would look at how hospitals were engaged in negotiations with their LHIN (e.g, type and extent of engagements), areas of the agreement that posed significant challenges for the parties, as well as use of the compliance framework set out in the Commitment to the Future of Medicare Act.


The proposed review of the 2008-10 HAPS/HSAA leadingpractices will identify the practices that LHINs and hospitals areusing to balance budgets and improve financial performance thatcould be applied in other LHINs. These leading practices will beassessed by the Joint LHIN/OHA Review Task Force todetermine those that might have the greatest impact and thatcould be considered for implementation in other LHINs andhospitals.

The review will also assess, for each hospital, their financialsituation for the 2009-10 fiscal year. Based upon an assessment ofthe likelihood of indicated assumptions in each hospital’sHAPS/HSAA materializing, the team will prepare a worst case,best case, and most likely case estimate of each hospital’sdeficit/surplus.

The proposed financial situation assessment will include:

• Language in the whole of the agreement (including documents signed by both parties with the understanding thatthe document forms part of the agreement) allowing for 2009-10 re-openers or re-negotiations;

continued on next page continued on next page

• Use of Schedule B, Section 9 for LHIN Specific Performance Obligations;

• The financial circumstance of 2009-10 should assumptions not be fully realized (this would include a financial assessment of unsigned hospitals); and

• The extent that growth in services is addressed.

This financial analysis will then be rolled up by LHIN and for theentire province for discussion by the LHIN/OHA HSAA ReviewTask Force. To maintain confidentiality, each hospital will beprovided with only their own assessment results and each LHINwill be provided with only the results of the assessments for thehospitals that they fund and not those in other LHINs.

Each individual HSAA will be reviewed by a working group ofcore hospital and LHIN representatives in order to providefeedback respecting the issues under examination. The work of theCore Team will be supplemented by LHIN Performance Contractsand Allocations staff members (PCA) and hospital contacts.

Project Oversight

The proposed leading practices review will be carried out byhospital and LHIN representatives under the auspices of theLHIN/OHA HSAA Review Task Force with administrativesupport from the JPPC Secretariat.

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Through a document review (including the appropriate use ofperformance corridors in Schedule D, the use of Schedule B,Section 9, for LHIN Specific Performance Obligations and theextent that growth in services is addressed) stakeholder interviewsand focus group sessions, it will identify:

1. The aspects of the process that were well received by hospitals/LHINs/other stakeholders (i.e. what worked well).

2. The areas needing further improvement (i.e. what didn’t work well).

3. The recommendations that may be made to further improve future HSAA processes and negotiations.

4. Where there is a signed agreement in the monitoring phase, the extent that LHINs and hospitals are utilizing HSAA processes for dealing with scenarios where one party is not able to meet a performance obligation.

The Process Review will also examine the influence of negotiatingHSAAs without a provincial context given the timing of the yet tobe released Ministry of Health and Long-Term Care “StrategicPlan.” The OHA’s “Key Outstanding Issues” document alsoprovides some insight into matters that require provincial decisionswhich could improve future negotiations.

Project Oversight

The proposed review will be carried out by external consultantsunder the auspices of the LHIN/OHA HSAA Review TaskForce. Administrative support will be provided by the JPPCSecretariat.

Hospital Service Accountability Agreement UpdateHospital Service Accountability Agreement Update is published by Ontario’s LHINs, in collaboration with the JPPC, Ministry of Health and Long-Term Care and the OHA.

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Appendix 6.2

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