· Central LHIN Updates Central LHIN Board of Directors Page 1 CEO Report – January 27, 2009 4 Table of Contents 1.0 Strategic Priorities

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4 Table of Contents 1.0 Strategic Priorities...........................................................................................................................................2

1.1 Quality (Appendix 1.1) .........................................................................................................................2 1.2 Aging at Home 2008/09 Project Update ..............................................................................................2

1.2.1 Revised Aging at Home 2009/10 Strategy Timeline for Decision Milestones ........................2 2.0 Board Follow-up - Board of Directors – December 16, 2008 ........................................................................2

2.1 Alternative Level of Care – Hospital Reporting / Targets (Appendix 2.1) ...........................................2 2.2 Q3 Allocation/Reallocations Follow-up: Movement Disorders/Unit of Service ..................................3 2.3 Stabilization Funding for Community Health Centres – MOH Follow-up...........................................3 2.4 LHIN-Wide Performance Evaluation/Performance Metrics ................................................................3 2.5 Auditor General Report – LHIN Accountabilities ................................................................................4

3.0 2008/09 Business Plan (Appendix 3.0) ...........................................................................................................4 4.0 Compliance Declaration (Appendix 4.0).........................................................................................................4 5.0 IHSP Action Plan (Appendix 5.0)...................................................................................................................4 6.0 Multi-Sector Accountability Agreement – Indicators .....................................................................................4 7.0 2008/09 Third Quarter (Q3) Report Submission (Appendix 7.0)....................................................................4 8.0 Incremental Funding Summary for Central LHIN (Appendix 8.0) .................................................................4 9.0 Communications .............................................................................................................................................4 10.0 Proposed Feasibility Study: Shared Human Resource Information System and Business Processing

Capability ........................................................................................................................................................5 11.0 Emergency Department Reporting System (Appendix 11.0) ..........................................................................5 12.0 2008/09 3rd Quarter Budget Report for Operations (Appendix 12.0)..............................................................5 13.0 Central LHIN Health Service Needs Assessment and Gap Analysis Project and Integrated Health Services

Plan 2010/11-2012/13 (Appendix 13.0) ..........................................................................................................6 14.0 Dialysis Program at Humber River Regional Hospital (Appendix 14.0) ........................................................6 15.0 York Central Hospital – Dialysis Satellite at Vaughan Health Centre Campus (Appendix 15.0)...................6 16.0 Health Professionals Advisory Committee – Minutes of September 15, 2008 (Appendix 16.0) ....................6 17.0 Aging at Home Capacity Building Plan (Appendix 17.0)...............................................................................6 APPENDICES ..............................................................................................................................................................8



4 1.0 Strategic Priorities 1.1 Quality (Appendix 1.1) The quality initiative has gathered additional information about quality frameworks, high performing health systems and other planning considerations via the Health Professionals Advisory Group, a reference (focus) group of health service providers and a Board Education session (December 17th) involving the University of Toronto and the Centre for Healthcare Quality Improvement. The reference (focus) group was held on January 9, 2008 and solicited preliminary feedback on information gathered thus far and considerations for future planning activities, including a proposed survey of local health service providers. Many Health Service Providers in the Central LHIN have identified a lead staff member in their organization, who might serve as a key contact on the topic of quality/performance improvement in the coming months. A survey of quality improvement practices and related information is being distributed to key Health Service Provider contacts in January. Planning activities continue as described in the attached Central LHIN Quality workplan. 1.2 Aging at Home 2008/09 Project Update 1.2.1 Revised Aging at Home 2009/10 Strategy Timeline for Decision Milestones February 2009

• Remaining Aging at Home 2009/10 projects Recommended to Board for Approval contingent on working through new process with Ministry

• Update on 2008/09 Aging at Home projects slated for March 2009 approval recommendations March 2009

Year 1 (2008/09) Aging at Home 2008/09 project approval recommendations to the Board for Year 2 (2009/10) funding (includes project enhancements)

• Remaining Aging at Home 2009/10 projects Recommended to Board for Approval

2.0 Board Follow-up - Board of Directors – December 16, 2008 2.1 Alternative Level of Care – Hospital Reporting / Targets (Appendix 2.1) Hospital-level reporting for Alternative Level of Care is available to the Central LHIN every 6 months through the Provincial Health Planning Database (PHPDB). Although monthly raw data is available its validity is suspect until CIHI has completed its review. The Central LHIN has obtained complete 2007-08 data by hospital which includes: percentage of Emergency Department visits that could be managed elsewhere; Emergency Department length of stay; and ALC data by discharge destination and length of stay. The attached tables detail this information by hospital. The percentage of Emergency Department visits that could be managed elsewhere and Percentage of Alternate Level of Care Days are included in the MLAA Performance Indicators provided quarterly to the Board through the Business Plan. Based on the Central LHIN August 2008-09 MLAA Performance Indicators data, which is the latest complete information available, the Central LHIN is tracking as follows:



4

Performance Indicator

Performance Target 2008/09

Performance Corrider –

Higher Value

Performance Corrider –

LowerValue

Actual Performance

% Alternate Level of Care Days 9.6 10.73 8.78 10.59

Rate of Emergency Department Visits that could be managed elsewhere

9.4 10.4 8.51 9.47

Although the Central LHIN is not meeting the performance target, we are within agreed to corridors. A number of initiatives including Aging at Home projects are designed to reduce and manage the desired level of performance. 2.2 Q3 Allocation/Reallocations Follow-up: Movement Disorders/Unit of Service As part of the Q3 Allocation/Reallocation briefing note it was referenced that the Centre for Movement Disorders realized a surplus of $40,000. A follow up meeting was held with Dr. Guttman and the Central LHIN. It is our understanding that the surplus was due to delays in hiring and replacing staff. The following chart outlines the performance of the Centre for Movement Disorders by services offered. Performance Measures- Clinic Utilization

Service Type Number of

Services Fiscal 2006-

07

Number of Services

Fiscal 2007-08

Forecast Number of


09

Planned Number of


10

Planned Number of

Services 2009/10

Annualized Total Number of Patients 2200 2455 2740 3200 3700Physician Patient Visits 5101 4857 5068 5800 6300Nursing Patient Visits 779 926 1012 8887 1350Nursing Phone Calls 6234 5939 7628 536 10000Social Work Visits 420 539 460 975 750Social Work Phone Calls 1060 1201 780 695 1250OTN video visits 427 459 556 650 700OT Patient Visits 220 300 300OT Phone Calls 60 100 100OT Exercise Group 324 400 400

2.3 Stabilization Funding for Community Health Centres – MOH Follow-up The Central LHIN is still awaiting formal communication from the Ministry of Health and Long-Term Care regarding the 2008-09 2.25% stabilization increase for Vaughan Community Health Centre. 2.4 LHIN-Wide Performance Evaluation/Performance Metrics An update will be provided at the meeting.



4 2.5 Auditor General Report – LHIN Accountabilities An update will be provided at the meeting. 3.0 2008/09 Business Plan (Appendix 3.0) An updated Business Plan is included in the appendices. 4.0 Compliance Declaration (Appendix 4.0) The Compliance Declaration for January 2009 is included in the appendices. 5.0 IHSP Action Plan (Appendix 5.0) An updated IHSP Action Plan is included in the appendices. 6.0 Multi-Sector Accountability Agreement – Indicators All Community Annual Planning Submissions (CAPS) have been received (except for Chippewas of Georgina Island First Nations). The submissions are being analyzed in accordance with the principles approved at the November 25, 2008 Board meeting. The Community Annual Planning Submissions (CAPS) for all 58 community agencies (for 62 programs) will be brought forward for Board approval in February 2009. 7.0 2008/09 Third Quarter (Q3) Report Submission (Appendix 7.0) The 2008/09 Third Quarter (Q3) Report was completed and submitted to the Ministry of Health and Long-Term Care on December 31, 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. 8.0 Incremental Funding Summary for Central LHIN (Appendix 8.0) An updated summary of the Ministry of Health and Long-Term Care Incremental Funding for Central LHIN is included in the appendices. Also included as an appendix to the summary is the Central LHIN 2008/09 Urgent Priorities Funding. 9.0 Communications A new webpage for Chronic Disease Management and Prevention is being developed. Once complete, the page will be located under the Integrated Health Service Plan navigation bar on the left-hand side on Home-page. An online collaboration tool is also being developed for the Chronic Disease Management and Prevention Network. Other website considerations include exploring the development of a “CEO Corner” to Hy-light CEO quarterly messages, letters to the editor or op-ed pieces. Final, a Year-in Review interview with the CEO was posted online. The January issue of Health Check-In was published and circulated to MPPs and media. Web Metrics ( Dec. 1 – Dec. 31, 2008) Visitors Overview 1,991 people visited the site/ Absolute Unique Visitors 3,946 Visits 14,812 Page views 3.75 Average Pageviews

Web Metrics ( Nov. 1 – Nov. 30, 2008) Visitors Overview 1,778 people visited the site/ Absolute Unique Visitors 5,060 Visits 18,817 Page views 3.94Average Pageviews

http://www.centrallhin.on.ca/uploadedFiles/Public_Community/News_Room/Health_Check-in/HealthCheck-InJanuary2009Final.pdf�



4 00:02:36 Time on Site 44.53% Bounce Rate 35.12% New Visits

00:02:47 Time on Site 35.10% Bounce Rate 43.81% New Visits

10.0 Proposed Feasibility Study: Shared Human Resource Information System and Business Processing

Capability A Health System Improvement Pre-Proposal has been submitted to Central LHIN for an initiative to assess the feasibility and cost/benefit of a shared Human Resource Information System and Human Resource business processing capability for Central LHIN health care providers is planned cross sector. York Central Hospital is the champion for this proposed initiative and has taken the lead in developing the proposal. There is general support from Central LHIN hospitals but also agreement that there is a need to understand the nature of the return on investment before proceeding. As such, a feasibility study is proposed. A request for funding for the feasibility project may be forthcoming at a future board meeting. 11.0 Emergency Department Reporting System (Appendix 11.0) The Emergency Department Reporting System, a data dashboard maintained by the Ministry of Health, was implemented effective October 1st 2008. The data from September 2008 was available on January 1st. It is noteworthy to mention that the data available thus far does not capture the impact of the Emergency Department Pay for Performance initiatives. The funding for these initiatives was disbursed to the 3 hospitals in October 2008. It is expected that data from October 2008 will be available on the Emergency Department Reporting System in February 2009. The System will be tracking performance on the following three indicators:

1) Ensure that Emergency Department-Length of Stay does not exceed 24 hours for more than a maximum of 2% of the emergency department’s total patient volume

2) Designated Hospitals to demonstrate a 5% absolute improvement in the proportion of Canadian Triage and Acuity Scale (CTAS) I and II patients treated within Emergency Department-Length of Stay of 8 hours or less, and within 6 hours or less for Canadian Triage and Acuity Scale (CTAS) III patients, as measured against National Ambulatory Care Reporting System (NACRS) 2007/08 baseline data

3) Designated Hospitals to demonstrate improvement in the proportion of patients treated within Emergency Department-Length of Stay of 4 hours for Canadian Triage and Acuity Scale (CTAS) IV and V patients, as measured against National Ambulatory Care Reporting System (NACRS) 2007/08 baseline data

12.0 2008/09 3rd Quarter Budget Report for Operations (Appendix 12.0) The Central LHIN Operations spending is on track at 74 % of budget at December 31, 2008. Aging at Home costs are not recorded separately since there is no specific Aging at Home funding for Operations in the 2008-9 calendar year. Special funding was provided for three projects – e-Health, Aboriginal Engagement, and the Emergency Department Lead project. All of those budgets are forecasted to be fully spent by year-end. The LHIN received $190,000 Capital Grant to assist with the Master Plan for the Vaughan Initiative. Funding is intended to cover expenses in the 2008-9 and the 2009-10 fiscal years; carryover of funds will be permitted. It is anticipated that there will be no surplus or deficit at year-end.



4 13.0 Central LHIN Health Service Needs Assessment and Gap Analysis Project and Integrated Health

Services Plan 2010/11-2012/13 (Appendix 13.0) The Central LHIN Health Service Needs Assessment and Gap Analysis Project report from KPMG is available on the Central LHIN website at http://centrallhin.on.ca. The letter sent to Central LHIN Health Service Providers is included in the appendices. 14.0 Dialysis Program at Humber River Regional Hospital (Appendix 14.0) A letter was sent to Carrie Hayward, Director, LHIN Liaison Branch, Ministry of Health and Long-Term Care on December 18, 2008 requesting assistance in resolving issues associated with the Dialysis Program at Humber River Regional Hospital which is funded by the Ministry’s Priority Programs Unit. A copy of the letter is included in the appendices. 15.0 York Central Hospital – Dialysis Satellite at Vaughan Health Centre Campus (Appendix 15.0) The York Central Hospital is proposing to establish a new dialysis satellite located in the Vaughan Health Campus of Care as per the Ministry of Health and Long-Term Care’s Chronic Kidney Disease hub-and-spoke model with York Central Hospital as the regional Centre responsible for funding and operating the Vaughan Dialysis Centre. The hospital submitted their proposal to the Ministry prior to the LHINs being operational. The Approval Protocols recently established and agreed upon by the LHIN Liaison Branch and the Ministry of Health and Long-Term Care regarding consideration of a hospital proposal under Section 4 of the Public Hospital Act identified that LHINs are to submit their review of the hospital proposal and address the following:

1. Summary of the Hospital Business Case 2. LHIN Advise, and rationale, to either support or not support the proposal. 3. Identification of potential risks or proceeding or not proceeding 4. Any other matter the LHIN consider important

In a letter dated January 21, 2009 was sent to Irv Mapa, Senior Program Consultant, LHIN Liaison Branch, Central LHIN confirming Central LHIN’s management support of the York Central Hospital Dialysis Satellite at the Vaughan Health Centre Campus. The letter and business case are posted on the Central LHIN Board Update. 16.0 Health Professionals Advisory Committee – Minutes of September 15, 2008 (Appendix 16.0) The Health Professionals Advisory Committee met on December 15, 2008 and approved the minutes of September 15, 2008. The minutes are included in the appendices. 17.0 Aging at Home Capacity Building Plan (Appendix 17.0) The Central LHIN has received a $106.5 million allocation, as planned funding over a three-year period for Aging at Home. Although the Ministry provided $263,000 in operating dollars to plan year one for Aging at Home, planning dollars for subsequent years have not been allocated. Central LHIN staff are required to plan according to the Aging at Home strategy and ensure materials are produced in appropriate time to support the board in its role to carry out due diligence. In addition to the planning, Aging at Home requires implementation of initiatives, ongoing monitoring and performance engagement. Central LHIN has allocated six FTEs to plan, implement and monitor Aging at Home. Staffing and operating funds for other planning activities have been redirected to meet the needs of the Aging at Home Requirements. Staff project that an additional three FTEs are required, given the current understanding of expectations for year two or three.

http://centrallhin.on.ca/�



4 A briefing note included in the appendices captures the projected staffing requirements to carry out the Aging at Home plan given the increasing magnitude of yearly allocations.



4

APPENDICES

Central LHIN – DRAFT QUALITY WORKPLAN

Draft Quality Workplan – January 15, 2008 Page 1 of 2

Work plan

Description Output Timeline (& Key Meetings)

Project Organization / Information Gathering

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

• Inventory of Quality and System Frameworks

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

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

system and local frameworks

October-November

Preliminary Analysis / Information Gathering

• Board Education Session #1 – U of T, Centre for Healthcare Quality Improvement

• Stakeholder Focus Group Session

#1 • Inventory of HSP Quality

Initiatives • Performance Indicator Sets • Updated Inventory of Cross LHIN

initiatives

• Identification of Board Champion

• Definitions, Frameworks, Other Considerations (High Performing Systems)

• Preliminary Stakeholder Feedback • Updated Compilation to include

indicator Sets and survey results

Additional Analysis / Scenario Development

• Scenario Analysis / Options Framework Draft – Two-Three

• Draft Critical Path • Stakeholder Focus Group Session

#2

• Board Education Session #2 including Review of Findings with Board – draft recommendations

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

• Terms of Reference/Draft project charter

• Updated Stakeholder Feedback • Revise draft project charter

October-March √ Board Education Session #1 (Dec 2008) √ Health Professionals Advisory Committee (Dec 2008) √ Health Service Provider Reference/Focus Group (Jan 2009) February/March Stakeholder Focus Group February/March Board Education Session

Monitoring Framework • Process Plan to Develop Framework

• Process Plan to Implement Framework

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

February-/March

Organizational and Stakeholder Impact

• Plan to address: Culture, Competency, Structure

• Quality Forum/Series Plan

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

February-March

Quality Initiative Finalized • Final Draft Charter & Presentation

• Board Review and Approval April

Quality Forum or Series • Roll-Out Quality Initiative • Concepts, HSP Examples

• Sessions: Education and Knowledge Transfer

May (Start date for series)

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APPENDIX 1.1a

Central LHIN – DRAFT QUALITY WORKPLAN

Draft Quality Workplan – January 15, 2008 Page 2 of 2

Key Stakeholders

1. Ontario Health Quality Council 2. Quality Healthcare Network 3. Centre for Healthcare Quality Improvement 4. University of Toronto 5. York University 6. Select Health Service Providers 7. 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 5. Emergency Room / Alternate Level of Care / Aging at Home

Resources

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

Defining a Quality Agenda in the Central LHIN

Context Setting / Environmental Scanning (updated)Definitions, Frameworks, Other considerations

January 27, 2008

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APPENDIX 1.1b

2Defining a Quality Agenda for Central LHIN – Draft Context for Feedback, Jan. 27/08

• Purpose

• Context

• Defining Quality

• Dimensions & Frameworks

• Quality Measurement Context

• System Planning Considerations

• Central LHIN Considerations

• Summary

• Appendix

Table of Contents


Purpose *

• This presentation provides updated context (environmental scan) for defining a quality agenda for Central LHIN. It also presents preliminary information about quality definitions, frameworks and draft LHIN planning considerations.

• The first version of the environmental scan was sent to the Board in December 2008

• Since that time, additional information has been gathered via:• a LHIN Board Education Session on December 17, 2008• a Health Professionals Advisory Committee Meeting on December

16, 2008• Internal consultations with LHIN staff and consultants

* New information is found on slides with asterisk on title


Context – Quality in the IHSP (October 2006)The Integrated Health Service Plan has proposed quality agenda

parameters:

• Three principles:• The LHIN quality agenda will be consistent with the Ontario Health Quality

Council plan and Ministry policies, and will align with the Plan• LHIN will not duplicate quality measures by Quality Councils and other

organizations engaged in this work, but will apply those measures locally• It will act as champion for quality improvement

• Proposed Activities to develop a Quality Action Plan• Work with the Ministry and the Ontario Health Quality Council to review

and refine the Local Health System Scorecard to provide a local picture of quality.

• Work with local health service providers to define the LHIN role and responsibilities in developing a system level approach to quality.

• Develop plans to address opportunities identified in the first quality scorecard.

• Encourage participation of health service providers in national and provincial quality improvement initiatives.

• Create a Continuous Quality Improvement Working Group to guide development of a Quality Strategy.


Context – Central LHIN Focus Group (June 2008)

Participants and Purpose:• Involved provincial, health service provider and LHIN Board/staff• To understand the current landscape for defining a LHIN-level role in quality

Key Themes:• Quality is integral to Performance Improvement. Describe quality initiatives

with “Performance Improvement” language.• Build capability and a foundation, then link with targeted initiatives at the LHIN

level (IHSP priorities, Health Service Provider priorities). • Focus on structure - culture - skills.

Key Success Factors:• Dedicated funding (for performance improvement initiatives)• Focused efforts (2-3 priorities) • Targeted initiatives (leaders, not everyone) • Performance measurement/accountability • Capacity building

Considerations:• Work with the Boards of Health Service Providers• Find a balance between performance and accountability • Use/adapt existing tool and methodologies • Appeal to multiple stakeholders • Look for quick wins


Context – Central LHIN Scoping Initiative (to March 2009)

• August 2008 - Central LHIN Board identifies quality as one of two future strategic priorities…. “new lens”

• October 2009 to March 2009 – Central LHIN Quality Scoping Initiative includes:• Inventory of Quality and System Frameworks, Quality

Initiatives, Performance Indicator Frameworks• Central LHIN Quality/Performance Framework• Board Education, Health Service Provider Focus Groups,

Quality Forum• Charter (to include implementation plan and budget) to roll-

out framework over multi-year period


• The people of Ontario have a common vision of a high performing health system that is: accessible, effective, safe, patient-centre, equitable, efficient, integrated, focused on population health and has the appropriate resources to get the job done. (Ontario Health Quality Council)

• “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine)

• “Quality focus on the patient/client experience, and are defined when a patient/client comes in contact with the health system and the system is seen as Acceptable, Accessible, Appropriate, Effective, Efficient and Safe” (Alberta Quality Matrix-Health Quality Council of Alberta)

• Quality health care means doing the right thing at the right time in the right way for the right person and having the best possible outcome. (Health Quality Council of Saskatchewan)

Additional definitions have been collected

Defining Quality – Examples*


Defining Quality Improvement - Considerations

General Description – Umbrella Term(p.14)

“Efforts to improve healthcare services”

Overlapping Concepts (pp.14-15)

•Continuous improvement•Organization-wide commitment and worker participation, •Knowledge of customer needs, •Systems thinking, •Systematic analysis of processes, •Use of scientific data-driven analytical methods, •Involvement of interdisciplinary & cross-functional teams

Attributes of Successful Improvement (p.18)

•Culture•Leadership•Strategy and Policy•Structure•Resources•Information•Communication channels•Skills Training•Physician Involvement

Source: High Performing Health Systems –Delivering Quality by Design, Chapter 1


Quality Dimensions and Frameworks: Overview


Source: Ontario Health Quality Council. 2008. Q Monitor: 2008 Report on Ontario’s Health System.

Quality Dimensions and Frameworks – Example 1 Ontario Health Quality Council


The Ontario Health Quality Council has a dual mandate of public reporting and quality improvement

Reports include: • Annual Report on Ontario’s Health System (2008 focus on Chronic Disease

Management and Prevention, and includes the framework described earlier)• White Papers such as “Accountability Agreements in Ontario’s Health System:

How Can They Accelerate Quality Improvement and Enhance Public Reporting?”

Information include:• Measurement Tools and Sample Measures• Patient Resources for Quality Improvement

Activities include:• Sponsorship of the Pan-Canadian Webcast (Dec 10 & 11) of the 2008 Institute

for Health Care Improvement’s National Forum on Quality Improvement in Health Care

• Tasked by the Ontario Government to measure and publicly report quality of care and resident satisfaction in long-term care homes

Quality Dimensions and Frameworks – Example 1 Ontario Health Quality Council


Quality Dimensions and Frameworks – Example 2 Health Quality Council of Alberta

Tool facilitates a common language amongst system stakeholders

Tool allows summary of performance measures for various types of initiatives, e.g. a Hip & Knee Replacement Project

User can capture all “dimensions of quality” or just some

User can focus on specific “areas of need” – which is a continuum: prevention, acute, chronic, end of life


Appropriateness

Effectiveness

Acceptability

CompetenceSafety

Continuity

Accessibility

Efficiency

Patient/Client

Quality Dimensions and Frameworks – Example 3 Accreditation Canada


• Mission is to drive quality in health services through accreditation. (They) help organizations across Canada and internationally examine and improve the quality of service they provide to their patients and clients.

• Commitment to Quality with a focus on :• Client –know who we serve• Process & Outcomes- Concentrate on what we do to achieve the intended results• Teams-Involve those who carry out processes• Leadership- Encourage, facilitate and guide

• Recognition of Quality • Have services recognized as meeting national standards of excellence• Benchmark against national standards of excellence • Seal of quality and on-going commitment to improve care/service • Promotion of leading practices using national standards of excellence • Supporting leadership in achieving goals (e.g. development of quality plan)

• Core Standards: • Leadership and Partnerships (Governance and Management)• Environment Management• Human Resources Development and Management• Information Management

Quality Dimensions and Frameworks – Example 3 Accreditation Canada


Quality Dimensions and Frameworks – Example 4* Commonwealth Fund Framework for High Performance, 2006


Quality Measurement Context

OECD Health Care Quality Indicators Project


System Planning Considerations Regulatory Colleges

Regulatory Colleges: Focus on Quality Assurance

• Example Colleges: • College of Physicians & Surgeons of Ontario (CPSO), • College of Nurses of Ontario (CNO)

• Example Activities:• Quality captured in strategic direction and 2 year strategic

priorities (CPSO)• Registration requirements include quality assurance (CNO)• Quality assurance committee (CPSO, CNO)• Quality assurance activities (e.g. random audits)


System Planning Considerations Provider & Professional Associations

Associations: Education, Best Practices and Tools (Examples)

Ontario Hospital Association• Provides education, literature, and tools around quality and patient

safety. • Education includes quality improvement techniques and measurement

Registered Nurses Association of Ontario• Best practice guidelines include a focus on the quality of care and

improved outcomes (e.g. Asthma Care, Assessment & Management of Pressure Ulcers, Wound Care)

Ontario Medical Association• Quality captured in mission and vision • Journal considers physician engagement in quality improvement


• Quality by Design Project – Publication entitled “High Performing Health Systems –Delivering Quality by Design”

• Ministry of Health & Long-Term Care, Other Stakeholders• Opportunity to align with targeted initiatives • A preliminary list of initiatives has been gathered. A list of sample

stakeholders is found in the appendix

• Ontario Health Quality Council• Opportunity to align with performance/quality framework & its

dimensions

• Health Service Providers• Opportunity to build on existing efforts, measures and best

practices

System Planning Considerations Other


Central LHIN Considerations*

• Quality as a lens

• Quality to support concept of high performing systems (and performance improvement)

• Target “ready” health service providers

• Capacity Building for all

• Limit the number of areas of focus (1-2). Possible Criteria for selecting areas of focus:

• Strategic priority for LHIN• Strategic priority for province• Evidence of gap between leading practice and current performance• Presence of local champions (and perhaps local successes)• Probable impact on multiple aims (such as quality of care, costs, patient

experience, improved access for disadvantaged populations)• Will and ideas already exist or are easily created

Example: ER-ALC/ Aging at Home


Summary*

• This presentation provides updated environmental scan information including quality definitions, frameworks and LHIN planning considerations

• Next Steps include additional information gathering, analysis and scenario development as described by the work plan

Appendix


Quality Improvement – Ontario Stakeholders & Initiatives

A preliminary list of initiatives involving the following system stakeholders has been gathered:

• Ontario Ministry of Health and Long-Term Care• Ontario Health Quality Council• Centre for Healthcare Quality Improvement (Change Foundation)• Quality Healthcare Network• Cancer Care Ontario• Centre for Research in Healthcare Engineering• Centre for Effective Practice• Patient Safety Institute• Etc.


Central LHIN Health Service Providers* Providing Name of Quality/Performance Contact to December 2009

• Hospitals (8, including 1 private hospital)

• CCAC (1)

• Community Health Centres (2)

• Long-Term Care Homes (10+)

• Other Health Service Providers (18+)• Community Mental Health and Addictions, Community Support

Service Agencies


The Institute for Healthcare Improvement (IHI) in the United States helps accelerate change by cultivating promising concepts for improving patient care.

Its 100,000 Lives Campaign has enlisted more than 3000 hospitals in making six changes to avoid 100,000 deaths over an 18-month period.

Its “Strategic Initiatives” test 5 innovations to be deployed throughout healthcare such as:• Triple Aim: is an initiative to better understand new models that can improve the

individual patient experience and the health of entire communities, at a reasonable per capita cost.

• Transforming Care at the Bedside: is an initiative that aims to create, test, and implement changes that will dramatically improve care on medical/surgical units, and improve staff satisfaction as well.

Its 2008 National IHI Forum on Quality Improvement in Healthcare covers topics such as:• Hospital Care• Innovation and Spread • Leadership and Governance • Measurement, Tools, Technology, and Quality Processes • Office Practices and Outpatient Settings • Patient- and Family-Centeredness • Patient Safety • Quality Improvement Research • Quality Improvement for Vulnerable Populations

Quality Improvement – Other Jurisdictions (Example) Institute for Healthcare Improvement

26Defining a Quality Agenda for Central LHIN – Update, January 12/08 DRAFT FOR DISCUSSION

Quality Improvement – Other Jurisdictions (Example)* Institute for Healthcare Improvement

27Defining a Quality Agenda for Central LHIN – Update, January 12/08 DRAFT FOR DISCUSSION

Triple Aims

Providers• Building quality as

a business strategy• Improving metrics to

achieve patient levelaims

LHIN• Integrator partnering

with other agencies contributing to other determinants of health

• Improving metrics toachieve system aims

1

Alternate Level of Care separations, days, and average length of stay by LHIN and hospital, 2007/08

18.6855,69745,950Ontario Total

15.353,1503,467Central Total

9.77,582783York Central

24.81,04042Stevenson Memorial

10.94,379401Southlake Regional Health Centre

13.816,8841,221North York General

28.36,280222Markham Stouffville

18.15,201287Humber River Regional-York-Finch

––<5Humber River Regional-Northwestern

23.111,783510Humber River Regional-Humber MemorialCentral8

Average Length of

StayDaysSeparationsHospital NameNameLHIN #

Alternate Level of CareLHIN of Hospital

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APPENDIX 2.1

2

Number and Rate of Emergency Department Visits that could be managed elsewhere, 2007/2008

6.34,527,678286,854Total ED visits in Ontario that could be managed elsewhere, 2007/08

3.6347,50112,557Cen LHIN institutions, subtotal

1.754,282948YORK CENTRAL HOSPITAL

14.728,1314,127STEVENSON MEMORIAL HOSPITAL ALLISTON

1.860,1311,101SOUTHLAKE REGIONAL HEALTH CENTRE

8.726,0002,267NORTH YORK GENERAL HOSPITAL-BRANSON SITE

1.757,553981NORTH YORK GENERAL HOSPITAL

3.044,4371,346MARKHAM STOUFFVILLE HOSPITAL

2.737,8541,038HUMBER RIVER REGIONAL HOSP-YORK-FINCH

1.939,113749HUMBER RIVER REGIONAL HOSP-HUMBER MEMCentral LHIN Institutions

Institution nameLHIN of institution

% of ED visits that could be managed elsewhere

ALL ED Visits, (age

1-74) 2007/08

Total ED visits that could be managed elsewhere

2008/09 Business Plan Status Report – January 27, 2008 MINISTRY/LHIN ACCOUNTABILITY AGREEMENT

08/09 Business Plan Status Report- Updated January 19, 2009 1 Note: Changes highlighted BOLD.

Status Legend On-track slightly off-plan significantly off

Central LHIN 2008/09 Business Plan Status Report

January 27, 2009

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 3.0




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. The Ministry has not committed to a date.

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 The Effectiveness Report was publicly released on Nov 7/08. An Action Plan is being developed and due by Feb. 5/09.




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.

February/09 A community engagement strategy is being developed for the Central LHIN. As part of Schedule B, a community engagement framework is being developed collaboratively with hospitals and other providers. That framework will be coming to the board in February.

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

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.

March/09 To date, four voluntary and two facilitated integration decisions have been completed. A feasibility study for back-office integration in the community sector is underway. Project completion target is March 31 2009. Staff is developing an Integration Strategy for presentation to the Board in 2009. Central LHIN roll-out of the Governance Toolkit in 2009.

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.

March/09 A Service Needs Assessment and Gap Analysis for Central LHIN was received by the Board at the November Meeting. An implementation plan is being developed for Board approval in March/09.




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 was presented and approved at the November Board Meeting.

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

Dec/08 One hospital agreement remains outstanding. 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) under Schedule B of the H-SAA tracked quarterly and reported to the Board.

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.

Completed 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. Hospital performance will be monitored and reported monthly through the Central LHIN Update.

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

Underway A joint working group has been established.




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

Steering Committee continues to meet to discuss service delivery issues. Additional 2008/09 incremental oncology volumes reported in the IHSP Action Plan monthly.

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 Board approved the disbursement of the 2008/09 incremental hospital volume allocations for general surgery at the December meeting.

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.

Completed The Central LHIN Board approved in principle Urgent Priorities funding for 35 interim LTC beds (Sept/08). The proposal was sent to the Ministry on Sept. 29/08. Central LHIN received Ministry approval on Nov. 17 and Board approval at the Nov. Board Meeting.




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.

In Place 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. A survey to LTC home operators has been sent out.

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.

Completed 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.

In Place 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.

In Place

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


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 community health service providers.

March/09 A plan for negotiating new service accountability agreements with community health service providers based on planning targets was presented and approved at the November Board Meeting.

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

balanced budget provisions. Mar 31/09 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 hospitals on Jan 21/09 to determine appropriate mitigation strategies and scenario planning for 2009/10 and beyond.




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. Q3 finalized and submitted on Dec 31/08 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. Q3 risk template was submitted to the Ministry on Dec 31/08.

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 draft 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.

In Place The MOHLTC/ LHIN Capital Working Group has developed 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 Minister has approved a capital planning grant to commence Master Programming for hospital services in Vaughan. 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.




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. Board approved the allocation/reallocation plan tabled at the December Board

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.

March/09 The MOHLTC/LHIN Capital Working Group has developed 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. A draft policy was presented on Oct. 9/08 at the LHIN Senior Directors meeting.

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.




meeting. Post Q3 reallocation plan is being presented in January for approval.

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. Q3 submitted Dec 31/08.

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.

March/09

The Ministry working group is finalizing a proposed draft for review. A roundtable discussion on approach was held on Oct. 27/08. The workload implications are 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 draft will be shared with the LHIN however no date has been indicated.

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 March/09

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 Completed

Submitted to Ministry on Dec 31/08.

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. 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.

Complete

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.

Completed

A draft Annual Business Plan was submitted to the Ministry of Health and Long-Term Care on Monday, November 3, 2008.




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.

Completed 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 provincial 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.

Completed Board approval secured for continued operation of and support for the joint LHIN E-Health Council. 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.

Completed

The allocation of current in year funding from the ministry has been approved by the Central LHIN Board. This funding is being applied to four priority projects under the auspices of the Joint E-Health Council with the Toronto Central LHIN.

PART B – OTHER BUSINESS PLAN

Operations

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

various

Met with the external auditors January. A recommendation is being brought forward for the Central LHIN Board to retain an external auditor for 2008/09.

1.2 Recruit LHIN staff. As Required

None at present.




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. N/A

Confirmation received from the Ministry on November 6, that there is no requirement for agencies to submit information to this report.

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, 1 remains outstanding. 1 unsigned agreement has been extended. 1 hospital under negotiation

PART D – QUARTERLY MLAA PERFORMANCE REPORT

The Ministry has developed 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 Q3 report (due December 31, 2008). As seen below, all indicators are within acceptable limits and thus, no variance report was required for the Q3 report as it relates to performance.

Doing Well - Below Corridor & LHIN Starting PointImproving - In Corridor & below LHIN Starting Point Monitor - In Corridor & above LHIN Starting Point Attention - Above Corridor & above LHIN Starting Point - Reporting


08/09 Business Plan Status Report- Updated October 16, 2008 23 Note: Changes highlighted BOLD.

(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 53.00 58.30 47.70 49.00

90th Percentile Wait Times for Cardiac By-Pass Procedures 1 Access 182 Days 68.00 60.00 64.00 70.40 57.60 62.70

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 183.00 182.00 182.50 200.75 164.25 146.00

90th Percentile Wait Times for Knee Replacement 1 Access 182 Days 217.00 195.00 206.00 226.60 185.40 158.00

90th Percentile Wait Times for Diagnostic MRI Scan 1 Access 28 Days 110.00 105.00 107.50 134.38 80.63 100.00

90th Percentile Wait Times for Diagnostic CT Scan 1 Access 28 Days 46.00 42.00 44.00 55.00 33.00 24.00

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

100,000 210.00 210.00 210.00 231.00 189.00 -

Median Wait Time to Long-Term Care Home Placement -All Placements 3 Integration 50 Days 63.00 55.00 59.00 73.75 44.25 66.00

Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 2 Integration 9.46% 9.80 9.60 9.70 10.67 8.73 -

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

1,000 9.47 9.40 9.44 10.38 8.49 -

Readmission Rates for Acute Myocardial Infarction (AMI) 2 Quality 3.80% 3.80 3.80 3.80 4.75 2.85 -Notes

1 = Actual Performance Value is from Q2 2008/09 (Jul, Aug, & Sep 2008)

2 = No data to facilitate analysis & reporting for this Quarter (Q2 2008/009)

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

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

Column

themelisa

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APPENDIX 4.0

2008/09 IHSP Action Plan - Updated January 15, 2009

2008/09 Planning, Integration &

Community Engagement IHSP and Emerging Priority

Action Plan JANUARY 27, 2009

SuraceC

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APPENDIX 5.0


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 - Wait Times 3

5 IHSP Priority- Cancer 4

6 IHSP Priority-Emergency Services 7

7 Community Engagement 7

8 Emerging Priority- Hospice Palliative Care 9

9 Emerging Priority- Alternative Levels of Care 9

10 Integration Activities In Progress 10

11 Integration Activities Complete ( 2007/2008) 10


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

Seniors Advisory Network

Seniors Advisory Network endorsement of 2009/10 Aging at Home Allocation Plan and Draft January Slate of 2009/10 Aging at Home Projects

To Board-

February 2009

On January 13, 2009 the Seniors Advisory Network endorsed the Draft 2009/10 Aging at Home Allocation Plan and January project slate.

1.2 Citizen’s Expert Panel for Seniors

Recruitment of 12 new consumer and caregiver members representative of seniors living in the Central LHIN to provide input into Central LHIN planning activities

Update to

Board March 2009

First meeting took place on Oct. 22. Group members will be attending a focus group to provide feedback on Doorways to Care marketing strategy

1.3 Transportation

Undertaking planning activities to adopt a coordinated transportation model in the central LHIN-Contemplated as part of Aging at Home Year Two Plan.

Update to

Board in April 2009

Final report from the planning sessions is currently under development and next steps are being identified to address coordinated transportation services across Central LHIN

1.4 Supportive Housing

Development of a Supportive Housing Workgroup- to address short and long term needs of the Central LHIN

CEO Report for

Information March 2009

The first Supportive Housing workgroup meeting will be taking place in February 2009.

1.5

Aging at Home

Central LHIN 2009/10 Aging at Home Allocation Plan and Project Slate- Year 2 new incremental funding

To Board for

Approval- January 2009

Package has been prepared for board meeting scheduled for January 27, 2009

1.6 Aging at Home Central LHIN Board Approval of 2009/10 Aging at Home February Project Slate

For Approval February 2009

In progress and partially contingent on Ministry process, timelines and coordination

1.7 Aging at Home Central LHIN Board Status Report of 2008/09 Aging at Home projects (year 1)

For information March 2009

In progress


2 Status Legend On-track slightly off-plan significantly off

1.8 Aging at Home Central LHIN Board Approval of year 1 project recommendations for 2009/10 Aging at Home Funding

For Approval March 2009

In progress

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

# Workgroup Description of Deliverable To Board Activities Status

2.1

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

2.2

Centralized access

Centralized access-Phase 1, Phase 2 plan

Board

Approved- October 2008

. Request for Phase 2 funding was presented to the Board in October 2008. Ministry has reviewed and responded

2.3

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. Professional Development Day scheduled for January 2009 to share leading practices and to provide mentorship regarding cultural competency.

2.4

Education

Education Strategy Phase II

January 2009: Training has commenced for Anti Stigma education/training to Ontario Works, Ontario Disability Support Program and Hospital Emergency Department Staff. Training will be complete in March 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.

For

information-February 2009

Over the next 3 months, the group will utilize the Health Service Needs Assessment and Gap Analysis to create a system-level plan addressing CDMP across the continuum which builds on the current IHSP and will inform the IHSP 2 process.

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

CDMP Advisory Network will identify and delegate approach to the work group, who will use 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-Wait Times ( Board Observer: Sandy Keshen) (Staff Lead: Ashif Damji)


4.1 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 - 2008/09 in-year intra- & inter-LHIN

reallocation process underway; awaiting final MOHLTC confirmations.

- 2008/09 in-year intra- & inter-LHIN reallocation process will hopefully result in additional volumes for hip/knee replacement, paediatric surgery, MRI hours, and CT hours.

4.2 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

4.3 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 5: IHSP PRIORITY- Cancer (Staff Lead: Joel Moody)


5.1

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

5.2

Colorectal Screening Program

Program of Cancer Care Ontario; Primary Physician Care Lead

Work


Dr. Balogh announced that the position of Primary Physician Lead had been filled and the successful candidate was Dr. Marla Ash. During the interview process candidates were asked to consider supporting the CLHIN in the future by



approval

sitting on a committee and some expressed an interest

5.3

Colorectal Screening Program

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.

5.4

Medical Oncology

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

Work


approval

One of the working groups at CCO is looking at human resources across the disciplines that work in the Systemic suites. One of the areas that stood out was that we look very healthy regarding the number of nurses. What are not included are roles of the nurses and what other tasks they do. There is a shortage of social workers or other supporting disciplines. The numbers of social workers is low and previous patient satisfaction surveys indicate that patients seek additional support in this area and it is not met by the nurses. This group is of the opinion that in order to deliver the high quality of care desired by CCO and all our programs alike, we require the appropriate number of professionals and disciplines focused on their area of expertise and knowledge.

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

Work underway not anticipated to require board

approval

Progress is on track. May 2009 is still the date for the Linear accelerators to arrive .Patient will commence treatment mid November 2009. In order to reduce stress for patients who are seen by a radiation oncologist at SRHC and must



travel to PMH for radiation treatment, SRHC offered a free shuttle service from PMH to SRHC. Since it started in June there have been a number of calls from people who are going to PMH for various reasons who are not patients registered with Southlake Radiation Oncology clinic. At this time we do not have the support or resources to transport these people. An explanatory letter has been prepared which includes other options.

5.6

Palliative Physician Lead

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

Work


approval

Functional Program for York Region Residential Hospice complete. Operating Plan under development. Network website under development.

5.7 Surgical Oncology

Work group of Cancer Care Services Steering Committee; Surgical Oncology

Work


approval

Surgical Morbidity – While reviewing the CSQI web site, Dr. Balogh noted a discrepancy with the data reported on pancreatic surgical morbidity rate. In one section it was reported at 0% but the graph displayed 7%. This was brought to the attention of CCO who discovered a transcription error n the web site. This error will be corrected.. 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?

5.8

Prevention and Screening

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

Work


approval

The request for proposal form and process regarding access to the money that is granted to the CLHIN for local Prevention and Screening projects is under development. Over the next few meetings the committee plans to determine how to accomplish its next goals. The direction from CCO next year will be the focus on Prostate Screening therefore the committee plans to position it self to look at the common prevention factors, such as healthy eating, exercise as well as screening.



TABLE 6: IHSP Priority- Emergency Services ( Board Observer: TBD) (Staff Lead: Saifa Sidi)

# Description of Deliverable To Board Activities Status 6.1

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

To Board for approval -January

2009

Nurse-led Outreach Team proposal submitted to the Ministry of Health and Long-Term Care on August 22nd – Ministry review pending. Approval received from Ministry on December 18,2009

Table 7: Community Engagement (Staff Lead: Sandi Pelly)

Description of Deliverable/Activities To Board Outcome

Revised Community Engagement Strategy (DRAFT) 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

Draft Stakeholder Engagement Strategy and plan

Aging at Home Sessions to obtain information on dementia, palliative care, supports for independent

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

More than 50 sessions were conducted with over 1000

seniors, caregivers and providers Connections made with community leaders Report of themes summarized in CEO report (October

2008) Health Service Needs Assessment 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)

To Board-November 2008

Input from engagement sessions incorporated into the

final SNAGA report



Description of Deliverable/Activities To Board Outcome 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 established

Survey is complete and results analyzed Task Force kick off-November 2008

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

input until Sept 26, 2008 Communiqué to Georgina Island to determine next steps for on-reserve engagement

(December 2008) Hired Aboriginal Consultant for Georgina Island engagement and planning initiative

related to obesity and diabetes. Greater Toronto Area LHINs urban Aboriginal engagement session has been

scheduled for March 3, 2009

Greater Toronto Area urban Aboriginal meeting to

support cross-LHIN collaborative approach has been scheduled for January 27, 2009

Communiqué to Georgina Island has been developed and distributed to Band leadership and will be disseminated to residents

Meeting with band leadership on Georgina Island has resulted in the identification of an issue that a health plan will be developed

Aboriginal report to be completed by March 31, 2009 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

Needs and Gaps Analysis consultations Greater Toronto Area LHINs are distributing a survey to health service providers to

better understand how to meet needs Central and Toronto Central will plan a community session for early next fiscal as part of IHSP engagement

MASS LBP • Central, North West and South East LHINs are involved in a project with MASS LBP

and the Ministry to develop indicators for successful engagement

• Development of indicators for engagement from the public

perspective that will feed into the common assessment tool for community engagement – report will be complete by end of January

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

• Development of a web-based community engagement

toolkit for LHINs and helath service providers • Methods in place to ensure that communications and

community engagement are working closely together across LHINs

• Common assessment tool is being developed for all LHINs



• 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 and January 2009)

• Member of Advisory Group for the Change Foundation session on public engagement

to use in evaluating their community engagement efforts (as per MLAA requirements)

• Development of indicators for engagement from the public perspective that will feed into the common assessment tool for community engagement

• Community engagement consultants in 9 LHINs will receive certificates in Public Engagement and be trained in using similar tools and techniques

• Session on public engagement targeted to LHIN Boards, CEOs and health service providers

TABLE 8 : Hospice Palliative Care ( Board Observer: Ken Morrison)

# 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.

Table 9: Alternate Levels of Care (Colin Benjamin, Sandy Keshen) ( Staff Lead: Mary Byrnes)

# Description of Deliverable To Board Activities Status

9.1

Alternate Levels of Care Framework (Interim)

To Board for information –

Fall 2008

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

Ministry inspection considerations are extending implementation dates for interim beds.

9.2

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

Board Approval in

Principle in September 2008.

LHIN submission to Ministry Emergency Department/Alternate Level of Care Overarching on December 17, 2008. LHIN presentation to Ministry on January 7, 2009 (materials included in January 2009 CEO Report).



Table 10: Integration Activities In Progress

Project Name Decision Date Description/Partners Outcome

Draft Integration Strategy and Process

Winter 2009

Information session(s) and related materials for health service providers.

Consultant retained. Draft to Board for discussion Winter 09.

Bethany Lodge/Markhaven

Pending

Financial Collaborative

HSIP pending

North York Central Meals on Wheels

To Board for

approval- January 2009

Voluntary Integration Don Mills Foundation for Seniors

Don Mills Foundation Board approval November 2008. North York Central Board received December 10, 2008

York Central Hospital/Southlake Regional Health Centre Cataract Surgery Collaboration

To Board –

January 2009

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

Community Engagement Report received on December 18, 2008

Table 11: Integration Activities Complete ( 2007 & 2008)

Project Name Decision Date Description/Partners Outcome

Deaf Access Simcoe/Canadian Hearing Society

June 2007

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

1-year update provided Sept08

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.

See CEO Report for Update



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

1-year update due February09

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

1-year update due March09

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.

Request submitted to LHINs to support legal costs. Will review in Q3 pending availability of funding.

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.

MOHLTC approval October08. RFP in progress.

Stevenson Memorial Hospital/Southlake Regional Health Centre

Approved by

Board November 2008

Integration by Funding: Administrative and clinical obstetric collaborative.

1-year update due November 2009

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

Approved by

Board 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 North Simcoe Muskoka LHIN to the Krasman Centre in Central LHIN

6-month update due June 2009.

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.

1

Quarterly Reporting Template – Revised November, 2008 Required Elements: Section A Transmittal Letter Section B Local Health System Update Section C Status Update on Special

Initiatives

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 A. Transmittal Letter (see Section 2.2 in guide) Description: Please complete a cover-memo to be signed by the LHIN’s CEO. (Send to the following e-mail address: [email protected] ) November 24, 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 THIRD QUARTER REPORT

Please accept the attached report on CENTRAL LHIN’s third 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

SuraceC

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APPENDIX 7.0

2

B. Local Health System Update (see Section 2.3 in guide) Description: The LHS 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 discussion of major initiatives underway; • planning and community engagement activities; • any IHSP priorities that the LHIN wishes to report on; • a discussion of key risks to financial and non-financial performance including variance to

Local Health System indicators; • an update on key negotiations; • key issues/cost drivers; and • any important developments or initiatives within sectors.

a) A discussion of major initiatives underway;

Health Service Needs Assessment and Gap Analysis Central LHIN engaged KPMG to undertake an extensive Health Service Needs Assessment and Gap Analysis project. Now complete, the Health Service Needs Assessment and Gap Analysis project is a comprehensive and integrated assessment and analysis of health services in Central LHIN. This report provides an epidemiological and population-based framework of the need for Central LHIN health services for the next decade to: accommodate growth; impact health human resources; and identify efficient service delivery models with appropriate service levels. The project also focused on understanding the impact related to the key social determinants of health and associated disease prevalence as they relate to reducing health disparities. Key to all LHIN projects is an extensive community and stakeholder engagement strategy involving clinicians, providers, other community partners, citizens and other key stakeholders. Staff are in the process of developing a work plan based on the findings to engage with stakeholders to develop priorities for Central LHIN. More information on staff recommendations will be made available in the fourth quarter of this fiscal year .

The activities for the 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 project. The 24-member committee consists of inter-sectoral and interdisciplinary representation from LHIN health service providers as well as other relevant stakeholders e.g. Family Health Teams.

3

· 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 (with a focus on 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 reflect its current impact and burden in the 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 the 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 Community engagement activities have occurred at various times throughout the project to capture both community input and inform 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 data for the Needs Assessment. To further complement the quantitative data, focus groups were held with many of Central LHIN’s Advisory Committees to capture their perspectives on health care needs. The third main community engagement activity occurred in September where 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. Further, 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, occurred in the last-half of the year, was organized according to the seven geographical planning areas.

· Consumer Engagement While some consumers have been engaged in the project to date, Central LHIN will continue to engage its public as the work plan is implemented. b) planning and community engagement activities;

Community Engagement

4

As part of the Health Service Needs and Gaps Analysis, seven geographic sessions were held to present geographic-based data and obtain input on understanding the quantitative information by service providers and community agencies. A team of community engagement leads from the GTA LHINs have developed a plan to engage with urban Aboriginal residents from the five LHINs and a session will be held in the next quarter as part of this plan. The Aboriginal health providers on Georgina Island are being engaged by Central LHIN through a separate process to determine a health issue that will be an area of focus for the last quarter of this year. As part of the Hospital Accountability Agreements, Central LHIN hospitals are required to collaborate with each other and other health service providers and the LHIN to develop a community engagement strategy by fiscal 2008/09 year end that will inform their strategic planning, their integration efforts and HAPS submission. To facilitate this process, a task group has been established and a strategy and guidelines for engagement as well as implementation plans for each hospital are currently being developed. Community Engagement Evaluation There is broad agreement among LHINs about the need for more robust evaluation tools that are able to comprehensively assess the impact of community engagement strategies. The Ministry of Health and Long-Term Care expects the LHINs to evaluate their respective community engagement strategies using a common assessment tool. The development of a common framework is the first, critical step towards the development of a common assessment tool. A research initiative led by Julia Abelson and Amina Jabbar (McMaster University) will be developing a common Community Engagement framework including shared goals and indicators of effectiveness and an evaluation instrument that will be piloted across several LHINs. Central LHIN is involved in an initiative to advise the ministry on the value of existing community engagement efforts and create a scorecard that will help evaluate the LHINs’ engagement activities moving forward. The project includes commissioning several papers from leading thinkers on engagement and evaluation; conducting a series of in-depth interviews with LHIN engagement teams and running a series of citizen’s discussions to solicit input about the attributes of effective community engagement. In Central LHIN, the discussion took place on Saturday November 29, 2008 and randomly selected community members from across the LHIN attended. Presentations on the health system followed by work group sessions to identify community engagement experiences and values; define community engagement; and articulate goals, indicators and evidence for engagement. Community Engagement Toolkit Representatives from the OHA, health service provider associations, the Change Foundation and several LHINs, including Central, have established a collaborative Community Engagement Project Steering Committee to develop a resource for the sector. The intent of the project is to create a website devoted to excellence in community engagement, highlighting leading practices from several regions and sectors. The resource is intended to support community engagement practices at the health service provider level.

c) any IHSP priorities that the LHIN wishes to report on;

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Seniors The Aging at Home strategy has been aligned with Central LHIN IHSP initiatives. As part of our Aging at Home planning for 2009/10, the targeted calls for submissions under the Aging at Home initiative resulted with a total of 68 submissions from our health service providers in the areas of Supportive Housing, Dementia, Ethno-cultural Adult Day Programs, Increased Services in Rural Area, and Supports for Independent Living. The evaluation process is currently taking place in Central LHIN whereby these submissions are being screened through various levels of evaluations including a panel of experts. As we continue with our planning activities for 2009/10, we aim to address the identified gaps for seniors and will explore opportunities for investment among standing issues such as specialized geriatric services, interim beds, linkages with primary care, community service enhancements and palliative care. The Citizen’s Expert Panel for Seniors is a community engagement group consisting of senior caregivers and consumers. This newly formed group had its first meeting in October 2008. The members of the Expert Panel will be providing input into the different Central LHIN activities pertaining to seniors. A two-day Transportation Planning Initiative is scheduled to begin in November 2008. This event is open to stakeholders and intended to facilitate the adoption of a coordinated transportation model in the LHIN. The Doorways to Care initiative which has the aim of facilitating system navigation for seniors has successfully launched and the early implementation improvements are underway. Agencies are now trained and aware of each other’s services and have established referral relationships. Priority efforts are underway to increase the awareness of seniors and caregivers about DWTC (including the types of services and fees) via senior to senior “word of mouth” and trusted sources, including key health professionals (in hospitals and the community). 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: Central LHIN’s Board has approved a total of $290,000 for the 2008/09 fiscal year to support the implementation of a Centralized Access Model for Case Management Services across the LHIN. 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, short-term case management, and centralized waitlist management. A Business Case has been submitted to the Ministry under the Priorities for New Investments for 2009/2010 annualized funding to support this initiative on an on-going basis ($500,000).

2. Mental Health and Addiction Education to Ontario Works/Ontario Disability Support Program/Emergency Department Staff: Sensitivity training curriculum has been developed for implementation with staff of Central LHIN, Ontario Works & Ontario Disability Support Program offices, and hospital Emergency Departments from January to March 2009. This initiative is being conducted in cooperation with the Ministry of Community and Social Services, and local hospital mental health units..

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3. 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 as 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.

4. 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. To date the ministry has only identified 8 units for the LHIN. Central LHIN will continue to negotiate with the ministry for additional units.

Chronic Disease Management and Prevention During the third quarter of 2008/09, the new members of the CDMP Advisory Network were selected using a combination of Expression of Interest and invitation. The Network consists of clinical and administrative representatives from across the entire continuum of service who have agreed to meet on a monthly basis to consider system-level changes to better manage and prevent chronic disease. The first meeting of the new CDMP Advisory Network is December 2008. On the programming side, the first six of twelve LHIN-led Chronic Disease Self Management workshops have been well received with approximately 20 people participating at each workshop. Finally, in the northern part of the LHIN, the in-home telemonitoring project between the VON and Southlake Regional Health Centre was launched with 12 residents with out-of-control diabetes being placed on the program. Daily blood parameters are monitored by a VON nurse who can arrange an in-home visit should blood levels warrant it. This will improve diabetic control thereby avoiding unnecessary emergency department usage. Emergency Services / Alternate Level of Care (ALC) During the third quarter of 2008/09, a proposal for 35 interim long-term care beds and enhanced funding for CCAC “Waiting at Home” / Service Maximums received approval from the Ministry of Health and Long-Term Care and the Central LHIN Board. Implementation has been initiated. As requested by the Ministry, Central LHIN has completed an Overarching ER-ALC Plan. The submission of the plan on December 15, 2008, is pending. Aging at Home planning for 2009/2010 continues and is targeted toward addressing ER-ALC issues as per Ministry instructions. Emerging Emergency Room / Alternate Level of Care Issues:

• Central LHIN Alternate Level of Care flow barriers to rehabilitation services • Limited eReferral capacity of Central LHIN Health Service Providers • Lack of capital funding for investments in transitional beds

Other considerations:

• Central LHIN is awaiting a Ministry response to nurse-led outreach team proposals submitted in August, 2008.

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• The Emergency Department Reporting System (EDRS) was ‘live’ effective October 1, 2008. Data is being collected on performance measures as per the Ministry’s criteria. At present, the data from August 2008 is available.

• In order to effectively gauge impact from the Emergency Department Pay for Performance initiatives, the data from Q3 is expected to be available in Q4.

• Central LHIN’s Emergency Department Lead is actively involved in scoring proposals targeted for year 2 of the Aging at Home strategy.

d) a discussion of key risks to financial and non-financial performance including

variance to Local Health System indicators;

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 Q3 risks and related mitigation strategies:

o Based on Ministry direction, risks associated with Business Cases submitted to the Ministry as part of the LHIN’s Annual Service Plan have been identified in the Ministry Annual Service Plan risk template and are not repeated as part of Q3 submission.

o As part of ongoing monitoring of hospital budgets, hospitals were asked to identify risks, which have been reflected in the attached Q3 Risk Template. These risks are associated with MLAA requirement to operate within a balanced budget plan.

As noted in the “Key Issues/Cost Drivers” section, Central LHIN is facing significant growth pressures due to rapidly expanding population base, particularly seniors’ population. Our hospitals are facing the following challenges:

o Uncontrolled growth in volumes through Emergency Department visits.

o The ER visits often need extended acute care requiring acute care beds or step down beds.

o The current level of funding, including hospital high-growth funding, does not address these pressures.

o As part of mitigation strategy, Central LHIN is pursuing a number of ER/ALC strategies and has requested additional Hospital high-growth funding as part of our 2009-10 Annual Business Plan submission.

The following is a summary of hospital deficits projected for 2008/09. In order for hospitals to cope with growth demands, Central LHIN allowed hospitals to operate within 1% negative margin. The table below compares the forecast against the signed H-SAA:

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Public Hospitals [CLHIN]

2008/09 YE Forecast

Total Margin $000

2008/09 YE Forecast

Total Margin%

2008/09HAPS$000

2008/09Total Margin

%

2009/10HAPS$000

2009/10Total Margin

%

Stevenson Memorial Hospital ($155) -1.0% ($179) -1.0% ($174) -1.0%North York General Hospital $2,876 1.3% $2,715 1.2% $964 0.4%York Central Hospital ($2,444) -1.6% ($1,792) -1.2% ($1,301) 0.8%Southlake Regional Health Centre ($2,144) -1.0% $0 0.0% $0 0.0%St. John's Rehab Hospital $0 0.0% $0 0.0% $0 0.0%Markham Stoffeville Hospital * ($2,000) -2.1% TBD TBDHumber River Regional Hospital ($154) 0.1% ($900) 0.4% ($2,400) -1.0%Note 1: As of 2008/09Q2 Submissions.Note 2: % margin based on Central LHIN funding only; source MLAANote 3: 2009/10 information is based on Public Hospital Annual Planning Submission (HAPS)* Note 4: MSH: HAPS is not yet signed. The forecasted deficit in 2008-09 is after recognizing $1 M in high growth revenu. The margin for 2009-10 is TBD. Note 5: The additional high growth funding of $ 1.698 has been applied to 208-09 forecast numbers.

Based on Ministry directions, the risks identified are focused, and limited to key, significant risks. Please see attached risk template.

e) an update on key negotiations;

Public Hospitals Central LHIN has successfully negotiated Hospital Service Accountability Agreements (H-SAA) with 6 of its 7 public hospitals. A third party assessment has been initiated for the remaining hospital to better understand and potentially mitigate the factors related to the hospital’s inability to submit a balanced budget. Private Hospitals The Central LHIN has successfully negotiated Private Hospital Service Accountability Agreements (PH-SAA) with 2 of its 3 private hospitals. Negotiations with the remaining private

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hospital are in the final stages and endeavours to sign a PH-SAA with the private hospital in the coming weeks. Community Health Service Providers A plan for negotiating new Multi-Sectoral Service Accountability Agreements (M-SAA) with community health service providers has been implemented and emulates the hospital process. Agreements are expected to be in place by March 31, 2009. The process is initiated by a Community Annual Planning Submission (CAPS) by each community health service provider. To date, 61 of 62 community health service providers have submitted a CAPS.

f) key issues/cost drivers;

a) 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 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 2008-10, 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

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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.

b) Any important developments or initiatives within sectors

Health Based Allocation Methodology (HBAM) The Ministry announced a four 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 approximately $4 million in 2008-09 (due to additional one time support provided by Central LHIN to mitigate impacts on wait lists) with annualized implication of $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.

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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. 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. Health Equity Several health equity initiatives are underway in Central LHIN. As part of the Hospital Accountability requirements, Central LHIN hospitals are working together with the LHIN to develop a Population Health Equities Plan by fiscal 2008/09 year end. A consultant has been hired and a task group made up of representatives from each of the LHIN hospitals and a member from each other sector are working collaboratively to develop a framework and template for the population health equity plans. Central LHIN will also undertake a review of policies and procedures as they relate to equity as well as develop a health equity plan for the LHIN. Joint e-Health Program Joint e-Health Strategy The Joint e-Health Council for Central and Toronto Central Local Health Integration Networks (LHINs) have developed a Joint e-Health Strategy that reflects the e-Health priorities for the LHINs, principles for LHIN e-Health governance, implementation, and funding. The Joint e-Health Strategy was presented to the Boards of the respective LHINs this quarter (September and October 2008) and was approved for implementation The Joint e-Health Strategy was developed to align with the goals set out in the LHIN’s Integrated Health Service Plan (IHSP), as well as to align with and support the Provincial e-Health Strategy. The four key are of focus and potential projects, as identified in the e-Health Strategy are as follows:

Improve the Care Process – through initiatives such as chronic disease management (beginning with diabetes), resource and referral management.

Improve the ability to exchange information across the health system – including initiatives such as the Greater Toronto Area (GTA) wide Health Integration Access Layer (HIAL) and Provider Portal.

Support client participation in their health care - through initiatives such as Patient Portals.

Support Implementation of Provincial e-Health Initiatives – which includes necessary infrastructure such as registries, Ontario Lab Information System (OLIS), Drug Information System (DIS), Wait Time Information System (WTIS), completing implementation of Diagnostic Imaging /PACS, Panorama Public Health System, and Telemedicine.

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The Joint e-Health Office is currently drafting a communication plan to broadly communicate the Joint e-Health Strategy to health service providers, and to the public, across both LHINs. This plan will be executed in the fourth quarter of this fiscal year (2008/2009).

Joint LHIN e-Health Office In addition to implementing its e-Health Strategy, the LHIN plays a critical role in supporting the implementation and adoption of the initiatives in the Provincial e-Health Strategy. To accomplish this, the LHIN, with support from the Ministry of Health and Long-Term Care (MOHLTC), has established an e-Health Office, which is situated at the LHIN and contains the following functions:

• Senior Project Manager function – accountabilities include the management of the

operations of the LHIN e-Health Office, internal/external partnerships and communications with stakeholders on project progress. This position reports directly to the LHIN e-Health Lead. This position was filled earlier this fiscal (2008/2009).

• Project Coordinator/Analyst function – accountabilities include tracking and monitoring on local progress, assisting local project management entities in the development of implementation schedules, and coordinating training. This position reports directly to the Senior Project Manager. This position was filled at full-time capacity in the third quarter of this fiscal (2008/2009).

The LHIN e-Health Office is a shared project management office between Central and Toronto Central LHINs. As a result, resources and expertise are pooled and efficiencies are gained.

The LHIN e-Health Office continues to track progress against the implementation and adoption of Provincial e-Health Initiatives, such as the Drug Profile Viewer and the e-Health Ontario ONEMail initiative (formerly known as the Smart Systems for Health Agency (SSHA) ONEMail initiative). The graph below illustrates progress to-date for the deployment of ONEMail in the Central LHIN:

Resource Matching and Referral

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As per the Joint e-Health Strategy, the LHIN has identified Resource Matching and Referral as a key enabler for improving the care process for clients as they move through the health system. The LHIN will begin to assess and document the requirements for implementing this type of initiative to better understand the needs from a functional (workflow) and technical perspective. Furthermore, Central LHIN”s e-Health Lead has recently been invited to participate in the newly formed Provincial e-Referral Steering Committee; this will ensure alignment with the LHIN’s Resource Matching and Referral Strategy (to be developed) with that of the MOHLTC.

Greater Toronto Area (GTA) Health Integration Access Layer and Provider Portal The Health Integration Access Layer HIAL and Provider Portal Initiative is a joint project amongst the five GTA LHINs (Central LHIN, Central East LHIN, Central West LHIN, Mississauga Halton LHIN and Toronto Central LHIN). The five LHINs are working together to develop a solution strategy and proposed implementation plan for the HIAL and Provider Portal. The HIAL and Provider Portal are two components of information technology that will allow timely and secure access to client information that is integrated and available to providers and clinicians in one comprehensive view. This initiatives is reflected in the Joint e-Health Strategy for the Central LHIN. With support from the MOHLTC, the project was initiated in the second quarter of this fiscal year (2008/2009) and is soundly progressing toward March 2009 deliverables. Specifically, the deliverables include the completion of solution strategy document (Business, Technical, Information, and Operational Governance requirements) and the selection of implementation sites for the first release. The HIAL and Provider Portal Steering Committee and Business Advisory Committee, which includes representation from all five GTA LHINs, have approved the clinical priority areas of: Diabetes, Mental Health, and Seniors Care. These priorities will be reflected in the proposed implementation plan for this initiative. C. Status Update on Integration Activities (Report Required for Q2 Only) (see

Section 2.5 in guide) 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). Report not required for Q3 D. 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

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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 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) The following assumptions have been made in developing Q3 forecast:

1. Only confirmed Ministry funding announcements have been reflected in the forecast. Central LHIN is awaiting Ministry announcements for additional funding such as priority programs funding and CCAC Care Connectors program; these have not been reflected in the forecast. Consistent with last year, these amounts will be added separately when such funding announcements have been reflected by the Ministry in the approved allocation column of the forecast.

2. On November 19, 2008, Central LHIN requested LHIN Liaison Branch to approve the use

of Infection Control funding of $935,000 held by North York General Hospital. This funding represents funding provided in the prior years, for which projects have not yet been completed.

Central LHIN has received recommendations from the Central LHIN Infection Control Committee on the use of this funding to support Infection Control programs in Central LHIN. We are anxious to move forward with review and approval of these recommendations. There is a defined need to promote infection control programs in Central LHIN hospitals. Based on verbal directions of LLB, we have included this amount in the Q3 forecast as a means to seek Ministry approval for the use of these funds.

3. On December 19, 2008, the Ministry informed Central LHIN of $479,493 in the form of in-

year recoveries from Long Term Care sector, and requested re-allocation plans to be identified in the January 2009 forecast. This has not been identified in the current Q3 forecast, and will be reported in the January 2009 forecast update.

4. Central LHIN has projected availability of $500,000 from Community Support Sector and

another $500,000 from Mental Health and Addiction sector in the form of in-year recoveries to be recovered in Q4. This has been identified in the forecast.

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E. 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 recipient’s base allocation are to be

reported. Complete Attachment 3 (a for reallocations between sectors, b for reallocations within sectors) F. 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 required as Central LHIN is within the agreed upon corridors for all performance indicators identified in Schedule 10 of the MLAA. Complete Attachment 4 G. 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)

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The Central LHIN Operations Budget totals $4,259,237 at Q3 in 2008-09. Spending levels at the end of the ninth month are on target at 65% of Budget. The attached report shows the various categories organized to align with the Ministry’s standard accounts. Starting in 2008-9, the Ministry has not assigned budgets to various line items, allowing the individual LHINs to set budgets as required. Budgets are assigned to each line at the start of the fiscal year and generally not adjusted in-year. This static budgeting can lead to internal variances within different line items which are considered normal based on developments within the year. The variances net each other out at the bottom line. The LHIN is expecting no variances at year-end. Two thirds of the LHIN’s budget is dedicated to Salaries and Benefits. The LHIN is currently undergoing an Organizational Design review to consider possible solutions for better effectiveness and coordination. This re-design is expected to be announced in Q4 and will require a staggered implementation into the next fiscal year. The second largest expense group in the LHIN is for Accommodations and Capital Asset spending. Most spending occurred in the first half of the fiscal year when the Central LHIN expanded its premises to the fifth floor at 140 Allstate Parkway in Markham. The cost for this work is reflected in the Accommodations line of the budget as well as the Capital Assets line. In Q4, the only costs forecast are for rent and to replace some older laptops. 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 balance of the budget is a sum of various Operations accounts, including Consultants, staff travel costs, meeting expenses, Office supplies and Communication expenses. 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 Vaughan Capital Initiative. Funding for the first three projects has been provided as follows:

BudgetE-Health 425,000 Aboriginal Community Engagement 10,000 ED Lead 75,000 The e-Health Project was supported by three funding letters in this fiscal year. The Central LHIN has a half-time CIO dedicated to e-Health, plus a Project Management Office consisting of three staff, shared with the Toronto Central LHIN. The e-Health Team has three major projects underway, a Gartner Review on Resource Matching and Referral, a Data Centre Feasibility Study and a Patient Portal Initiative. It is expected that all funds will be spent by year-end. The Aboriginal Funding will be fully spent on a Project for the development of a strategic action plan to address diabetes and obesity issues within the First Nations community at Georgina Island. The LHIN has an Emergency Department Lead who started in 2007 who continues to develop a comprehensive ER Strategy focusing on access, quality and system integration.

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The fourth special project is the Vaughan Capital Initiative for which $190,000 in funding was provided in the 2008/9 fiscal year. The Ministry has advised that these funds are a special grant and as such will not be re-claimed at the end of the fiscal year. The LHIN has begun discussions and planning for this Initiative and it will be well underway in Q4.

Date of Ministry Announcement Investment Programs Purpose of Investment Amount in 2008-09 Amount in 2009-10 Amount in 2010-11 Status

11-Sep-07 LHIN Urgent Priorities FundProvide the LHINs with funding to address local priorities based on their IHSPs

$3,609,369 $3,609,369 $3,609,369 See attached urgent priorities slate for approved projects

1-Oct-07 Aging at Home Strategy

To 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

Year 1 approved in principle by the Board on February 26, 2008 and formal approval given on May 13, 2008

2-Jun-08 Post Construction Operating Plan - York Central Hospital

To Provide operating dollars to cover the costs of the new or expanded programs and services, as well as the additional space and equipment amortization for York Central Hospital.

$3,689,900 $3,689,900 $3,689,900 Approved at the August 26, 2008 Board meeting.

6-Aug-08 CCAC - Home care - HomemakingIncrease in the service maximums for home care personal support and homemaking services.

$3,404,100 $6,808,300 $10,779,800 Year 1 approved by the Board on September 23, 2008

13-Apr-08 HOSP - Hospital Growth Demands The base funding increase is for hospitals experiencing high growth to help sustain services

$6,998,000 TBD TBD Year 1 approved by the Board on May 26 and Dec 16, 2008.

23-Jul-08 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 Year 1 approved by the Board on August 26, 2008

26-Aug-08 Critical Care Strategy

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

$391,000 TBD TBDOne - time funding approved by the Board on September 23, 2008

22-Aug-08 Personal Support WorkersFunding to support creation of 873 personal support workers province-wide in LTC Homes

$2,208,288 TBD TBD Year 1 approved by the Board on September 23, 2008

28-Aug-08 Stevenson Memorial Hospital

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

$1,751,700 $950,700 $950,700 Approved by the Board on Dec 16, 2008

17-Oct-08 Wait Time Strategy General Surgery Allocations

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.

$1,448,700 TBD TBD Approved by the Board on Dec 16, 2009

21-Nov-08 Wait Time Strategy - CCAC

Support delivery of in-home rehabilitation services for 1095 additional clients through the Central Community Care Access Centre (CCAC).

$1,642,500 TBD TBDOne - time funding approved by the Board on September 23, 2008

8-Dec-08 Health Care Connect

Establishment of CCAC based Care Connectors to refer unattached persons to local family health care providers.

$66,760 $160,280 $160,280 Approval for disbursement of the allocation will be sought.

18-Dec-08 Wait Time StrategyAdditional funding to reduce wait times in cataracts, hip and knee, MRIand CT procedures.

$1,714,400 TBD TBD Approval for disbursement of the allocation will be sought.

19-Dec-08 Long Term Care SurplusMininstry redistribution of net unused funding in LTC Homes to address pressure in Central LHIN

$479,493 TBD TBD Approval for disbursement of the allocation will be sought.

Total $45,580,211 $48,836,947 $78,565,312

Major New Ministry Announcements for Incremental Funding in Central LHIN

File Updated: December 31, 2008

SuraceC

Typewritten Text

APPENDIX 8.0a

Updated December 31, 2008

Central LHIN-Urgent Priority Fund

Total Total

Base One-Time Base One-Time 2008/09 Base One-Time Base One-Time 2009/10

-$ -$ -$ 3,609,369$ 3,609,369$ -$ -$ -$ $3,609,369 3,609,369$

Base One-Time Base One-Time Base One-Time Base One-Time

LTCH CDMP Self Management Yee Hong Centre for Geriatric Care $ 104,000 $ 104,000 $ - Oct-23-07

CHC Diversity & Inclusion Communities of Practice

Black Creek Community Health Centre $ 105,000 $ 105,000 $ - Phase 2 Apr-22-08

CMHP Cultural Competence ToolThe Canadian Mental Health Association Metropolitan Toronto Branch

$ 60,000 $ 60,000 $ - Oct-23-07

CMHP Educational Initiatives Addiction Services for York Region $ 50,000 $ 50,000 $ - Nov-27-08

CMHP Centralized Access Yor-Sup-Net Support Service Network $ 146,000 $ 146,000 $ - Oct-28-08

CMHP Centralized Access Toronto North Support Services $ 144,000 $ 144,000 $ - Oct-28-08LTCH Community Back Office Integration Bethany Lodge $ 40,000 $ 40,000 $ - Jul-22-08

CCAC Health Equity Policy and Plan Implementation Community Care Access Centre $ 120,750 $ 120,750 $ - Aug-26-08

CCAC ALC Interim Long-Term Care Beds / Waiting at Home Community Care Access Centre $ 1,161,840 $ 1,161,840 $ 124,692 $ 124,692 Annualized amount for 2009/2010 Nov-25-08

LTCH ALC Interim Long-Term Care Beds / Waiting at Home Harold and Grace Baker Centre $ 133,936 $ 133,936 $ 403,744 $ 403,744 Annualized amount for 2009/2010 Nov-25-08

LTCH ALC Interim Long-Term Care Beds / Waiting at Home Bethany Lodge $ 182,640 $ 182,640 $ 550,560 $ 550,560 Annualized amount for 2009/2010 Nov-25-08

LTCH ALC Interim Long-Term Care Beds / Waiting at Home River Glen Haven $ 109,584 $ 109,584 $ 330,336 $ 330,336 Annualized amount for 2009/2010 Nov-25-08

LTCH ALC Interim Long-Term Care Beds / Waiting at Home TBD $ - $ - $ 178,668 $ 178,668 Placeholder

CMHP Integration: Transfer of My Friends' Place The Krasman Centre $ 16,275 $ 16,275 Nov-25-08

HOSP Rehabilitation Capacity Building St. John's Rehad Hospital $ 1,235,344 PendingUnallocated $ - $ - $2,021,369 $ 2,021,369

NON_GRE

GRE NON_GRE

2008/09 Funding Allocation

Sector/TPBE Project Title

Notes Board Approval

NON_GRE

GRE NON_GRE

2009/10 Funding AllocationGRE

Service Provider NameGRE

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Emergency Department Reporting System: The Emergency Department Reporting System, a data dashboard maintained by the Ministry of Health, was implemented effective October 1st 2008. The data from September 2008 was available on January 1st. It is noteworthy to mention that the data available thus far does not capture the impact of the Emergency Department Pay for Performance initiatives. The funding for these initiatives was disbursed to the 3 hospitals in October 2008. It is expected that data from October 2008 will be available on the Emergency Department Reporting System in February 2009. The System will be tracking performance on the following three indicators:

1) Ensure that Emergency Department-Length of Stay does not exceed 24 hours for more than a maximum of 2% of the emergency department’s total patient volume:

2) Designated Hospitals to demonstrate a 5% absolute improvement in the proportion of Canadian Triage and Acuity Scale (CTAS) I and II patients treated within Emergency Department-Length of Stay of 8 hours or less, and within 6 hours or less for Canadian Triage and Acuity Scale (CTAS) III patients, as measured against National Ambulatory Care Reporting System (NACRS) 2007/08 baseline data:

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3) Designated Hospitals to demonstrate improvement in the proportion of patients treated within Emergency Department-Length of Stay of 4 hours for Canadian Triage and Acuity Scale (CTAS) IV and V patients, as measured against National Ambulatory Care Reporting System (NACRS) 2007/08 baseline data:

Of the designated sites, North York General Hospital, on a consistent basis, has had more than 2% of its total Emergency Department patient volume have a length of stay greater than 24 hours. A significant contributor to this may be the lack of inpatient beds available to transfer these patients out of the Emergency Department. With respect to the other two indicators and the Pay for Performance strategy, the data from Q3 and Q4 for 2008/2009 will need to be compared to baseline data (i.e. National Ambulatory Care Reporting System) data for the same quarters (i.e. Q3 and Q4 for 2007/2008).

LHIN Operations Sub-category Approved Budget Actuals Forecast to Forecasted2008-9 Apr 1 - 08 to Dec 31- 08 Year-End Variance Notes

Salaries & Wages

1.0 Salaries & Wages 2,351,480 1,670,614 2,299,810 51,670 1Subtotal (Salaries & Wages) 2,351,480 1,670,614 2,299,810 51,670 Employee Benefits

2.1 HOOPP * 178,240 149,958 194,958 (16,718) 22.2 Other Benefits 386,115 273,876 386,142 (27)

Subtotal (Employee Benefits) 564,355 423,834 581,100 (16,745)Transport & Communication

3.1 Staff Travel 35,000 16,981 26,021 8,979 33.2 Governance Travel 12,000 6,766 12,165 (165)3.3 Communication 70,000 35,021 51,765 18,235 3.4 Other - - - -

Subtotal (Transport & Communication) 117,000 58,768 89,951 27,049 Services

4.1 Accomodation 275,000 234,161 277,561 (2,561)4.2 Advertising incl. website 25,000 2,387 24,387 613 4.3 Banking - 43 43 (43)4.5 Consulting Fees 85,000 66,024 104,024 (19,024) 54.7 Governance Per Diems 140,000 118,308 140,308 (308)4.8 Insurance - Operations only 5,000 5,000 5,000 - 4.9 LSSO Shared Costs 300,000 225,000 300,000 -

4.10 Other Meeting Expenses 70,000 36,757 62,957 7,043 6

4.11 Other Governance Costs (mtgs, prof Liab Ins) 55,000 53,852 76,852 (21,852) 74.12 Printing & Translation 25,000 30,202 44,302 (19,302) 84.13 Staff Development 55,000 18,199 26,911 28,089 9

Other Services* 25,000 29,552 - 25,000 10Subtotal (Services) 1,060,000 819,485 1,062,345 (2,345) Supplies & Equipment

5.1 IT Equipment * 15,000 12,910 13,710 1,290 5.2 Office Supplies & Purchased Equipment 51,402 36,386 53,963 (2,561)

Other Services & Equipment 15,000 20,991 20,990 (5,990) 11Subtotal (Supplies & Equipment) 81,402 70,287 88,663 (7,261)

6.1 Capital Assets Purchased 85,000 112,368 137,368 (52,368) 11Amortization - - - - Subtotal (Capital Assets Purchased) 85,000 112,368 137,368 (52,368)

TOTAL BUDGET for 2008-9 4,259,237 3,155,356 4,259,237 -

e-Health 425,000 80,002 425,000 - Aboriginal Community Engagement 10,000 - 10,000 - ED Lead 75,000 35,000 75,000 - Capital Funding 190,000 - 190,000 Total Special Programs 700,000 115,002 700,000 -

Central Local Health Integration Network

Q3 - FORECASTED REQUIREMENTS FOR FISCAL 2008-9based on December 31, 2008 actuals

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Notes for variances noted above (under and over- spending)1 Various vacancies led to savings2 HOOPP costs greater than budgeted3 more meetings in house led to Travel savings4 revised BB plans led to savings5 Organization re-design Consultant costs6 More meetings in house 7 Governance Toolkit, meeting and printing costs8 CAPS, SNAGA and Annual Report costs higher than anticipated9 Staff attending fewer and less costly training sessions

10 Expenses charged back to various programs11 Expanded premises and related equipment costlier than original budget plans

Other Notes on Special ProjectsAging at Home costs not recorded as a separate LHIN item as no specific funding was provided in 2008-9ER/ALC funding was not yet received as at December 31, 2008Capital Funding is for the 2008-9 and the 2009-10 fiscal years; carryover will be permitted

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

December 23, 2008 Memorandum

To: CEOs/Executive Directors/Administrators of Central LHIN Health Service Providers From: Hy Eliasoph, Chief Executive Officer Re: Central LHIN Health Service Needs Assessment and Gap Analysis Project and the Integrated

Health Services Plan 2010/11 – 2012/13 Dear Colleagues: The Central LHIN Health Service Needs Assessment and Gap Analysis Project report from KPMG is now available on our website. The report is one component of the Project which also included:

a) the delivery to the LHIN of extensive interactive databases and information regarding functional and geographical needs within the LHIN

b) a priority framework that can be adopted by the LHIN to assist it in setting short, medium and long-term priorities

c) extensive engagement with our health providers through key interviews and focus groups The Health Service Needs Assessment and Gap Analysis process and the data collected through the project will serve as the backbone of the LHIN’s Integrated Health Services Plan 2010/11 to 2012/13. We will provide more detail about that process early in the New Year but it will include:

a) continued engagement with our health service providers and broader community b) linkages to the Ministry of Health and Long Term Care’s strategic plan and priorities c) utilization of a priority framework to analyze information from Health Service Needs Assessment and

Gap Analysis and other data sources in order to identify LHIN priorities We will be looking to volunteers from our Health Service Providers to participate on a Steering Committee to provide oversight for the development of the IHSP in mid-January. Our IHSP needs to be produced by autumn 2009 and we are hoping to have priorities defined by the spring. Central LHIN Staff are currently working to summarize the content of the Health Service Needs Assessment & Gaps Analysis project into user-friendly fact sheets, based on planning-areas that can be shared with members of your staff or the general public. Once complete, the material will be available online. If you are interested in accessing additional data elements such as maps, demographic breakdown or inventory of providers, a request form is available on our website. Thank you for your continued support.

http://www.centrallhin.on.ca/page.aspx?id=5568

http://www.centrallhin.on.ca/page.aspx?id=5568

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APPENDIX 13.0


December 18, 2008 Carrie Hayward Director LHIN Liaison Branch Ministry of Health and Long-Term Care Hepburn Block, 5th Flr 80 Grosvenor St Toronto ON M7A1R3 Dear Ms. Hayward: Re: Dialysis Program at Humber River Regional Hospital The purpose of this letter is to seek your assistance in resolving issues associated with the Dialysis Program at Humber River Regional Hospital (HRRH) funded by the Ministry’s Priority Programs Unit. According to the Hospital, following extensive negotiations and discussions with Ginette Daigle and other staff of Ministry’s Priority Programs Unit, the hospital was authorized to perform additional Level III Acute Hemodialysis procedures in 2007-08. This was confirmed at a meeting held with Ministry, LHIN and Hospital representatives on September 17, 2008 (see attached minutes). As a result of performing these additional procedures, the hospital incurred a cost of $1.8 M. On December 18, 2008, the Ministry’s Priority Programs Unit advised Central LHIN that the Ministry was willing to provide funding based on a ratio of 88:12 for level II and level III procedures. This would lead to funding in 2007/08 of $1.2M instead of $1.8M claim submitted by the Hospital. We would like to highlight several issues resulting from the Ministry decision to impose an 88%:12% ratio retroactively:

1. The hospital was authorized by the Ministry to perform higher volume III procedures because of the delay in approval to award construction of the 17-station expansion in the HRRH dialysis unit. The hospital was asked to treat patients as in-patients since the dialysis unit would not be available.

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- 2 - Dialysis Program at Humber River Regional Hospital (HRRH)

2

Also, due to an outbreak in ICU and the medical units the dialysis patients were treated for an extended period in isolation, for their protection, resulting in a 1:1 nurse:patient ratio. Since the Ministry did not communicate to the LHIN or the hospital the requirement to comply with the 88:12 ratio, the hospital was operating on the basis that funding would be provided based on the circumstances under which they were operating. The gap in funding resulting from the Ministry’s decision is $0.6M.for 2007-08.

2. The hospital continued to perform additional volumes in 2008-09, pending

confirmation of volumes by the Ministry. Since only one quarter of the fiscal year is remaining in 2008-09, the imposition of the 88:12 ratio requirement without advance notice to the hospital will generate a deficit of $0.3 M for 08/09.

3. The Ministry and the LHIN agreed on the need for an additional dialysis satellite

unit at the Humber site to meet growing future demands. However, the hospital has elected not to submit an expansion proposal at this time due to Ministry’s decision to not reimburse costs incurred to deliver volumes in 2007-08 and 2008-09.

4. Finally, the hospital is planning to reduce their current service levels to eliminate

future deficits by aligning costs incurred with Ministry funding under the 88:12 direction. The result will be that the hospital plans to reduce the current volume of 306 patients to a level that will match the 88/12 ratio. This will occur by not accepting any new patients requiring dialysis and through attrition.

5. A recent study by the Central LHIN indicated that the rate of growth of end stage

renal failure (requiring dialysis services) in the Humber hospital catchment area is higher than the growth rate in the rest of the province. As a result, due to demographics in the area, there is a greater need for level III procedures than the provincial average of 12%. At present, the hospital is experiencing a ratio of 84% Level II to 16% Level III, a ratio that the hospital is willing to accept.

Recommendations:

1. That the Ministry accept the hospital claim for actual volumes delivered in 2007-08 since the requirement to comply with the 88:12 ratio was not communicated to the LHIN or the Hospital;

2. That the Ministry allow the hospitals to deliver planned volumes for 2008-09 by

accepting the hospital request to function within the ratio of 84:16 for 2008-09, and providing advance notice to the hospital to comply with the 88:12 ratio effective April 1, 2009 if the Ministry so wishes;

- 3 - Dialysis Program at Humber River Regional Hospital (HRRH)

3

3. That the Ministry review statistical data to determine the relevance of imposing

the 88:12 provincial average ratio in an area of high growth and demographic challenges.

The above-noted recommendations, we believe, constitute a reasonable approach to managing dialysis challenges in an area of high growth. We look forward to your response. In the interim, we have asked the hospital not to reduce services pending the outcome of Ministry decision. Yours truly,

Hy Eliasoph CEO, Central LHIN /cs (Encl.) c. Ken Morrison, Chairman of the Board of Directors

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APPENDIX 16.0

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Page 1 Briefing Note Updated: January 20, 2009

CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE Aging At Home Capacity Report

JANUARY 27, 2009

ISSUE: The Central LHIN has received a $106.5M allocation, as planned funding over a three-year period, for Aging at Home. (See Appendix A for Ministry allocation by LHIN for Aging at Home) Although the Ministry provided $263K in operating dollars to plan year one for Aging at Home, planning dollars for subsequent years have not been allocated. Central LHIN staff are required to plan according to the Aging at Home strategy and ensure materials are produced in appropriate time to support the board in its role to carry out due diligence. In addition to planning, Aging at Home requires implementation of initiatives, ongoing monitoring and performance management. Staff are preparing to present the year two plan and modified slate of year one projects to the board in January through March, 2009. PURPOSE: To capture the projected staffing requirements to carry out the Aging at Home plan given the increasing magnitude of yearly allocations. BACKGROUND:

The Aging at Home program launched in August, 2007 is the single most important initiative in which LHINs have been vested with responsibility to plan, implement and monitor. Over the three-year implementation of the program, Central LHIN will be investing more than $100M. To assist us in launching the program, Central LHIN, as all LHINs, received some initial funding ($263K) to plan the first year of the program. During the course of the year and beyond, we will be monitoring and reporting on progress in implementing these projects and in meeting the targets and metrics established for improved service delivery.

• August, 2007 Ministry announced $106.5M allocation for Central LHIN (over three years) • October, 2007 Central LHIN submitted Directional Plan • February, 2008 Central LHIN submitted Detailed Plan for Year One • November, 2008 Ministry provided direction regarding Aging at Home and Emergency Room and

Alternate Level of Care


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• November, 2008 Ministry requested submission of Emergency Room/Alternate Level of Care Overarching Plan

• November, 2008 Ministry provided template for Detailed Plan submission – Year Two

Year One plan includes 26 initiatives Year Two plan will include > 26 initiatives Enhanced focus on meeting performance targets – previously negotiated Ministry LHIN Accountability Agreements targets. Additional reporting requirements to the Ministry on a go forward basis ANALYSIS: Currently Central LHIN has allocated six FTEs to plan, implement and monitor Aging at Home. Staffing and operating funds for other planning activities have been re-directed to meet the needs of the Aging at Home initiative. Staff project that an additional 3 FTEs are required, given our current understanding of expectations for year two and three.

FTE Basis Total current FTE allocation 6 Projected additional FTE / allocation required

4

Total FTE allocation proposed for Aging at Home:

10

Minus Ministry FTE allocation 1 Allocation/Reallocation Required*

3

The estimated allocation required is $300K for 3 FTEs and associated overhead, community engagement costs and materials. At present the following workgroups and Advisory groups inform the Aging at Home plan for Central LHIN:

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The Planning Process

High-Level Overview of Longer Range of Activities Fall 2007: Prepare Year One Aging at Home Plan and deliverables (board in Feb, 2008) April 2008 to March 2009: Implement 26 year one projects, track progress, reallocate funds, plan year two April 2009 to March 2010: Implement > 26 year two projects, track year one and year two progress/performance, reallocate funds, plan year three, consider rolling some year one projects to health service provider base budgets (to be determined) April 2010 to March 2011: Implement ($26M) year three projects, track previous projects not in base (to be determined), reallocate funds, plan year four (reallocation of recovered project funds), consider rolling some projects into health service provider base budgets. April 2011 – March 2012: Monitor projects and new (re) allocations. Consider further transition to health service provider base budgets

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SYNTHESIS/CURRENT STATUS: Given that LHINs are young organizations many processes are in development. Aging at Home requires the development of processes and frameworks to support portfolio management for Central LHIN which translates into additional resources to build reporting infrastructure. The re-direction of resources to Aging at Home has resulted in ongoing and continuous re-prioritization of activities to ensure that general planning obligations are maintained and fulfilled. Insufficient staffing resources may contribute to turnover and staff burnout which would further jeopardize the Aging at Home plan development for Central LHIN. DELIVERABLES/IMPACT ON CARE: (How will it be measured?) n/a COMMUNITY/STAKEHOLDER CONSULTATION/RESULTS: n/a COMMUNITY/STAKEHOLDER IMPACT AS A RESULT OF THE PROPOSAL: n/a ALIGNMENT WITH IHSP: n/a DIVERSITY/EQUITY: n/a RECOMMENDATIONS: WHEREAS Central LHIN has received a $106.5 M allocation, over three years, for Aging at Home WHEREAS Central LHIN has received $100K operating dollars to fund one FTE for Emergency Room/Alternate Level of Care Performance BE IT RESOLVED THAT: “Central LHIN Staff request the additional operating funds of $300K one-time recurring from the Ministry to support Aging at Home planning and portfolio management activities”. SOURCES OF FUNDING: n/a

Appendix A Listed below is a breakdown of the Aging at Home funding:

Three Year Allocations to LHINs Local Health Integration Network (LHIN)

2007/08 Planning Funding

Initial Investment

2008/09

Planned Base

Increase 2009/10

Planned Base Increase 2010/11

Planned Three-Year

Funding

Erie St. Clair $187,000 $3,937,535 $9,785,302 $17,282,348 $31,005,184

South West $236,000 $7,005,606 $17,409,869 $30,748,507 $55,163,982

Waterloo Wellington $181,000 $4,783,520 $11,887,688 $20,995,487 $37,666,695

Hamilton Niagara Haldimand Brant $295,000 $7,638,234 $18,982,036 $33,525,196 $60,145,467

Central West $162,000 $2,737,669 $6,803,474 $12,015,982 $21,557,124

Mississauga Halton $196,000 $7,685,778 $19,100,189 $33,733,872 $60,519,839

Toronto Central $243,000 $6,194,791 $15,394,886 $27,189,738 $48,779,415

Central $263,000 $13,527,801 $33,618,398 $59,375,263 $106,521,461

Central East $288,000 $4,641,877 $11,535,688 $20,373,799 $36,551,365

South East $182,000 $2,211,479 $5,495,822 $9,706,466 $17,413,767

Champlain $246,000 $6,928,868 $17,219,166 $30,411,697 $54,559,731

North Simcoe Muskoka $161,000 $2,973,268 $7,388,969 $13,050,056 $23,412,292

North-East $202,000 $4,290,570 $10,662,643 $18,831,868 $33,785,081

North-West $158,000 $1,046,673 $1,924,956 $3,399,768 $6,371,397

Ontario Total $3,000,000 $75,603,669 $187,209,085 $330,640,046 $593,452,800

Total Funding Assistive Devices Program Funding Increase $40,000,000 Provincial Priorities $66,000,000 Allocations to LHINs $596,452,800 $702,452,800

Documents

· Central LHIN Updates Central LHIN Board of Directors Page 1 CEO Report – January 27, 2009 4 Table of Contents 1.0 Strategic Priorities