112
OPERATIONS IMPROVEMENT ADVISORY SERVICES Review of the Champlain Community Care Access Centre August 25, 2009 FINAL

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Page 1: Reviewo ftheC hamplainC ommunityC are AccessC entre · This report is made by KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent

OPERATIONS IMPROVEMENT

ADVISORY SERVICES

Review�of�the�Champlain�Community�Care�

Access�Centre

August 25, 2009

FINAL

Page 2: Reviewo ftheC hamplainC ommunityC are AccessC entre · This report is made by KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent

This report is made by KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent

firms affiliated with KPMG International, a Swiss cooperative.

© 2009 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms

affiliated with KPMG International, a Swiss cooperative. All rights reserved. Printed in Canada.

Executive Summary 1

Background 6

Methodology 10

Overview of Findings 12

Governance and Leadership 13

Infrastructure and Supports 18

Stakeholder Relations 25

Contract Management 35

Financial Management 39

Case Management 42

Improvement Plan 48

Appendix A – Interview List 58

Appendix B – CCAC Organizational Chart and Selected

Comparisons 59

Appendix C – Leading Practices 62

Appendix D - Conceptual Model 92

Appendix E -CCAC Planning Day High-Level Resulta 104

Table�of�Contents�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 1�

Executive�Summary�KPMG�LLP�was�engaged�by�Champlain�Local�Health�Integration�Network�(LHIN)�to�conduct�an�

external�collaborative�review�of�Champlain�Community�Care�Access�Centre�(CCAC).��The�stated�

objective�was�a�shared�understanding�of�individual,�organizational�and�system�level�expectations�and�

needs�to�optimally�meet�the�current�and�evolving�mandate,�within�the�context�of�available�resources.��

Champlain�CCAC�is�the�second�largest�health�service�provider�in�the�LHIN�and�has�an�annual�budget�

of�approximately�$170�million.��In�January�2007,�Champlain�CCAC�was�created�by�the�amalgamation�

of�four�different�CCACs�with�different�community�environments,�organizational�cultures,�practices�and�

procedures.���As�a�relatively�new�organization,�there�are�many�challenges�associated�with�

amalgamation.��Each�constituent�organization�had�different�community�environments,�organizational�

cultures,�IT�systems,�practices�and�procedures.�Champlain�CCAC�has�struggled�to�move�forward�as�

successfully�as�some�of�its�peers�mainly�due�to�the�lack�of�consistent�leadership�and�governance.���

Given�the�recent�announcement�by�Minister�Caplan�related�to�quality�and�transparency�in�home�care,�

the�Board�of�Directors�of�the�Champlain�Local�Health�Integration�Network�supports�a�collaborative�

review�of�the�Champlain�Community�Care�Access�Centre�that�will�position�the�CCAC�who�assume�a�

leadership�role�in�the�LHIN’s�integration�agenda�and�will�foster�optimal�delivery�of�community�care.���

Background

Governance�and�leadership�are�key�drivers�of�organizational�performance.�Since�amalgamation,�

Champlain�CCAC�has�had�a�significant�turnover�at�both�the�senior�leadership�and�Board�of�Directors�

levels,�during�a�time�when�consistent�leadership�and�governance�would�have�eased�some�of�the�

challenges�associated�with�amalgamation.��Champlain�CCAC�has�had�three�Executive�Directors�and�

three�Board�Chairs,�both�permanent�and�interim�since�January�2007.��It�is�important�to�note�that�while�

other�CCACs�faced�similar�challenges�with�respect�to�amalgamation,�those�with�constant�leadership�

throughout�this�period�of�time�have�been�able�to�move�the�organization�forward�more�rapidly.�����

At�the�same�time,�Champlain�CCAC�has�shown�financial�surpluses�in�2007-2008�and�was�on�track�to�

record�another�financial�surplus�for�2008-2009�until�certain�interventions�were�undertaken.��These�

surpluses�reflected�financial�management�challenges�within�the�organization.�With�the�expanded�

mandate�announced�in�December�2008�and�added�funding�for�additional�capacity�and�new�programs,�

the�CCAC�needs�to�meet�its�budget�and�the�community’s�growing�demand�for�services�in�a�cost-

effective�manner.��In�order�to�begin�addressing�some�of�the�challenges�associated�with�the�financial�

surplus,�the�CCAC�had�undertaken�a�Finance�and�Information�Review�prior�to�the�commencement�of�

this�review.��The�CCAC�has�begun�to�implement�some�of�the�recommendations�of�that�review.�With�

the�appointment�of�a�new�CFO�on�June�10,�2009,�the�recommendations�of�the�Finance�and�

Information�Review�and�this�review�can�be�more�effectively�implemented.��This�should�help�to�move�

the�CCAC�towards�a�dynamic,�forward�looking�organization�that�ties�its�strategy�and�operations�

together.���

Approach

KPMG’s�methodology�investigated�a�number�of�dimensions�including�the�organization,�performance�

metrics�and�indicators�and�change�management�to�address�the�many�factors�that�affect�the�business�

of�the�CCAC.�KPMG�began�with�a�quick�broad�based�review�of�the�CCAC’s�service�delivery�model,�

which�allowed�for�the�identification�and�prioritization�of�key�issues�and�enabled�the�project�to�then�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 2�

focus�on�those�areas�requiring�the�most�attention.�As�requested�in�the�RFP,�the�review�initially�

focused�on�the�following�areas�

• Finance;�

• Contract�Management;�and,�

• Case�Management.�

However,�it�is�noted�that�there�are�many�factors�that�influence�the�operations�of�the�CCAC�and�these�

three�areas�do�not�operate�in�isolation.��As�the�review�progressed,�it�became�apparent�that�there�were�

additional�areas�of�focus�that�needed�analysis�in�order�to�conduct�a�more�thorough�external�review.��

These�include�Infrastructure�and�Supports,�Leadership�and�Governance�and�Stakeholder�Relations.�

A�large�number�of�internal�and�external�stakeholders�were�identified,�whose�input�into�the�review�

would�be�constructive�and�potentially�valuable.��CCACs�are�in�the�unique�position�in�that�they�are�the�

only�healthcare�organizations�that�are�aligned�with�the�LHINs’�geographic�boundaries.��The�CCAC�is�

also�the�one�organization�that�interfaces�with�all�types�of�healthcare�providers�including�acute,�

primary,�long-term�care,�continuing�care,�community�and�others�that�fall�outside�the�traditional�

“healthcare”�sphere.��Given�this�unique�position,�it�is�integral�that�the�CCAC�have�strong�partnerships�

across�all�levels�of�care�and�at�all�levels�from�Board,�senior�management�to�front-line.���

Due�to�the�importance�of�stakeholder�relations�for�the�CCAC,�over�150�individuals�participated�in�focus�

groups,�were�interviewed�individually�or�provided�written�feedback.��The�individuals�represented�a�

wide�range�of�organizations�including�hospitals,�long-term�care�facilities,�contracted�service�providers,�

community�support�agencies,�municipalities�and�clients.��A�list�of�the�organizations�involved�can�be�

found�in�Appendix�A.��

Findings

The�health�care�environment�is�changing�and�is�becoming�more�data�driven,�with�an�appreciation�of�

the�power�that�information�can�provide.��During�the�review,�it�became�apparent�that�Champlain�CCAC�

has�had�a�limited�focus�on�having�the�data�necessary�to�justify�decisions�and�manage�the�organization�

effectively.��This�has�caused�a�number�of�internal�and�external�challenges.��The�board�and�senior�

leadership�had�insufficient�financial�and�operational�information�needed�to�evaluate�the�performance�

of�the�CCAC.��Many�managers�at�many�levels�within�the�CCAC�have�not�used�data�in�the�past�to�drive�

practices�and�monitor�performance�and�the�CCAC�lacked�the�ability�to�provide�quality�information�to�

external�stakeholders.��This�had�led�some�CCAC�healthcare�partners�to�question�the�role�and�activities�

of�the�CCAC.�

Good�data�and�ability�to�share�information�across�stakeholders�is�paramount�to�the�success�of�the�

CCAC�moving�forward.��As�it�stands�now,�it�is�difficult�for�the�CCAC�to�support�or�dispute�comments�

with�regards�to�the�service�that�it�provides.���

The�limited�use�of�data�and�information�and�coordinated�project�management�has�not�allowed�for�

efficient�implementation�and�evaluation�of�programs�and�services.�Moving�forward,�Champlain�CCAC�

has�recognized�the�importance�of�effective�decision�support�throughout�a�number�of�areas�and�has�

begun�to�utilize�data�and�information�to�enhance�the�considerable�work�done�internally�to�develop�a�

conceptual�case�management�model�designed�to�meet�the�current�and�expanding�mandate.��The�

proposed�model�is�based�on�a�population�health�model�and�the�CCAC�hopes�to�analyse�its�existing�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 3�

client�data�to�better�stratify�clients�to�provide�case�management�that�is�more�focused�on�the�needs�of�

the�client�groups.�

Recommendations

Recommendations�are�organized�into�six�groups:�Infrastructure�and�Supports;�Governance�and�

Leadership;�Stakeholder�Relations;�Contract�Management;�Finance�and�Case�Management.��The�

recommendations�address�the�issues�identified�in�the�organizational�assessment�and�the�project�

deliverables�outlined�in�the�RFP.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 4�

Governance and Leadership

Recommendation #1 Immediately�develop�a�comprehensive�performance�management�and�

measurement�system�to�support�the�board’s�responsibility�to�ensure�

organizational�quality�in�all�areas�including�client�care,�management�

performance,�financial�performance,�external�relations�as�well�as�the�

board’s�own�performance�and�that�the�organization’s�strategic�plan�is�

connected�to�annual�operating�performance.��

Recommendation #2 Immediately�develop�and�implement�strategies�to�assist�front-line�staff�

members�to�understand�the�CCAC’s�vision�and�mandate�and�the�role�that�

they�play�in�helping�the�CCAC�to�achieve�its�organizational�goals.���

Recommendation #3 Continually�develop�and�evaluate�its�leadership�practices�and�tools�and�

implement�leading�practices.�

Infrastructure and Supports

Recommendation #4 Enhance�Decision�Support�efforts�at�Champlain�CCAC�through�the�

development�of�a�comprehensive�Data�Management�and�Reporting�

Framework�and�skill�development.�

Recommendation #5 Develop�and�implement�a�more�robust�Change�Management�Plan.�

Recommendation #6 Implement�a�Project�Management�Strategy.�

Recommendation #7 Develop�and�implement�a�more�enhanced�communications�strategy�and�

plan.�

Stakeholder Relations

Recommendation #8� Develop�and�implement�a�robust,�coordinated�stakeholder�engagement�

strategy�for�all�stakeholders,�including�the�key�messages,�timelines,�roles,�

accountabilities�and�metrics�necessary�for�each�stakeholder�for�evaluation.��

The�stakeholder�engagement�strategy�should�enhance�the�integration�role,�

build�stronger�partnerships�and�clarify�the�roles�and�responsibilities�of�all�

stakeholders.��The�definition�of�success�including�outcomes�and�

performance�metrics�will�be�developed�in�collaboration�with�the�

stakeholders.���

Contract Management

Recommendation #9� Develop�and�implement�a�formal�Service�Provider�Agency�Relationship�

Management�Process.�

Finance

Recommendation #10� Improve�planning�processes�so�that�the�budget�planning�translates�the�

Strategic�Plan’s�directions�into�Organizational�Business�Plans.�

Recommendation #11� Build�capacity�of�the�Finance�department�to�provide�information�and�data�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 5�

that�is�dynamic,�forward�looking�and�tied�to�strategy�and�objectives.��

Recommendation #12� Enhance�the�relationship�and�build�trust�between�the�CCAC�and�LHIN�with�

regards�to�financial�and�operational�information.�

Case Management

Recommendation #13� Meet�with�internal�and�external�stakeholders�collectively,�sectorally,�

individually�and�within�specific�geographies�to�build�understanding�and�

enhancement�of�the�new�model�and�identify�the�processes�required�to�

transition�to�a�new�case�management�model.�

Recommendation #14� Work�with�all�stakeholders�to�identify�and�implement�“quick�wins”�to�

address�current�situations.�

Recommendation #15� Ensure�equitable�access�to�services�across�the�region.�

Recommendation #16� Integrate�systems�and�share�information�electronically.�

Recommendation #17� Take�ownership�of�the�role�of�system�navigator.�

The�recommendations�contained�in�this�report�should�allow�the�CCAC�to�strengthen�its�operations�

and�relationships�so�it�can�more�effectively�manage�its�core�business.��While�the�recommendations�

are�straightforward�some�will�take�a�considerable�amount�of�time�and�effort�by�the�CCAC�and�external�

partners�to�be�effectively�implemented.��Once�the�CCAC�has�a�stronger�handle�on�its�current�

operations,�they�will�be�able�to�utilize�data�and�information�more�successfully�to�enhance�stakeholder�

relations�and�collaboratively�develop�programs�and�processes�that�will�allow�the�CCAC�to�productively�

meet�its�expanded�mandate.���

��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 6�

Background�

Introduction

KPMG�LLP�was�engaged�by�Champlain�Local�Health�Integration�Network�(LHIN)�to�conduct�an�

external�collaborative�review�of�Champlain�Community�Care�Access�Centre�(CCAC).��The�stated�

objective�was�a�shared�understanding�of�individual,�organizational�and�system�level�expectations�and�

needs�to�optimally�meet�the�current�and�evolving�mandate,�within�the�context�of�available�resources.��

Given�the�recent�announcement�by�Minister�Caplan�related�to�quality�and�transparency�in�home�care,�

the�Board�of�Directors�of�the�Champlain�Local�Health�Integration�Network�supports�a�collaborative�

review�of�the�Champlain�Community�Care�Access�Centre�that�will�position�the�CCAC�who�assume�a�

leadership�role�in�the�LHIN’s�integration�agenda�and�will�foster�optimal�delivery�of�community�care.���

Champlain CCAC

Champlain�CCAC�connects�residents�with�care�at�home�and�in�the�community.��They�provide�access�

to�and�case�management�of�government�funded�home�and�community�services�and�long-term-care�

homes.��The�CCAC�also�provides�information�about�local�community�support�agencies�and�can�link�

individuals�to�these�agencies�to�arrange�service.��Champlain�CCAC�serves�approximately�25,000�

residents�on�any�given�day,�and�services�close�to�55,000�clients�annually�across�the�Champlain�Local�

Health�Integration�Network�(LHIN).��The�geographic�area�spans�a�large�section�of�eastern�Ontario�from�

the�communities�of�Renfrew�County�in�the�west,�all�of�Ottawa�in�the�middle,�plus�the�Eastern�

Counties�and�parts�of�Lanark-Leeds-Granville.��As�noted�on�the�Champlain�LHIN�website,�the�

population�is�20%�Francophone�and�approximately�14%�of�the�population�is�a�visible�minority,�with�

most�living�in�Ottawa.�The�geographic�and�population�diversity�variability�provides�strengths�yet�poses�

challenges�to�planning�and�delivery�of�health�services.���

Champlain�CCAC�is�the�second�largest�health�service�provider�in�the�LHIN�and�has�an�annual�budget�

of�approximately�$170�million.��There�is�one�head�office�and�ten�branch�offices�serving�the�population.�

Champlain�CCAC�provides�services�to�a�large�population�across�over�a�varied�geographical�area.�The�

area�is�projected�to�have�a�13%�increase,�over�2005�levels,�in�the�number�of�elderly�residents�by�

2010.��While�this�increase�is�comparable�to�the�provincial�average,�those�over�the�age�of�65�are�the�

greatest�users�of�CCAC�services�and�this�increase�will�have�an�effect�on�the�CCAC’s�ability�to�provide�

services.�

Champlain�CCAC�has�approximately�550�staff�throughout�the�region.��The�staff�allocations�are�in�line�

with�other�CCACs�that�are�a�similar�size�and�cover�a�comparable�geography,�such�as�South�West�

CCAC,�Central�East�CCAC,�Central�CCAC�and�Hamilton�Niagara�Haldimand�Brant�CCAC.��Selected�

comparisons�between�CCACs�such�as�administration�ratios�and�cost�per�service,�as�well�as�an�

organizational�chart�can�be�located�in�Appendix�B.�Overall�comparison�metrics�show�Champlain�CCAC�

to�be�mostly�aligned�with�comparator�CCACs.����

There�are�currently�six�(6)�board�members�on�the�Champlain�CCAC�Board.��All�members�on�the�board�

were�appointed�by�Order-In-Council.��As�of�April�1,�2009,�all�CCACs�are�now�governed�by�community�

boards�and�the�Champlain�CCAC�has�begun�the�process�to�recruit�additional�members.��The�board�of�

Champlain�CCAC�is�looking�to�increase�its�membership�by�an�additional�three�to�six�members.��The�

board�is�comprised�of�members�from�across�the�region�and�meetings�are�held�monthly.�

Champlain�CCAC�works�in�partnership�with�their�contracted�service�providers�and:�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 7�

• 20�hospitals;�

• 68�community�support�service�agencies;�

• 26�mental�health�and�community�addictions�service�agencies;��

• 8�community�health�centres;��

• 23�resource�centres�and,��

• Approximately�1,240�family�physicians�and�1,450�specialists�in�active�practice�in�the�area.�

In�January�2007,�Champlain�CCAC�was�created�through�the�amalgamation�of�four�different�CCACs�

with�different�community�environments,�organizational�cultures,�IT�systems,�practices�and�

procedures.��As�a�relatively�new�organization,�there�are�many�challenges�associated�with�the�

amalgamation.��CCACs�with�the�same�IT�systems�were�using�the�software�in�inconsistent�ways.��In�

addition�to�the�amalgamation�challenges,�a�number�of�provincial�initiatives�are�underway�which�aim�to�

streamline�processes�and�technologies�across�all�CCACs.���Champlain�CCAC�has�worked�to�overcome�

some�of�the�challenges�associated�with�amalgamation�as�well�as�a�significant�turnover�at�both�the�

senior�management�and�Board�level,�including�three�Executive�Directors�and�three�Board�Chairs.���

Champlain�CCAC�is�currently�in�the�process�of�standardizing�many�processes,�systems,�policies�and�

procedures�and�developing�new�tools�to�provide�effective�and�consistent�case�management�to�CCAC�

clients.��As�with�other�CCACs�in�Ontario,�there�are�currently�still�some�processes�that�have�not�yet�

been�standardized.��This�has�created�some�confusion�and�frustration�with�healthcare�partners�and�

case�management�staff,�as�clients�in�different�regions�may�receive�different�services.�

Champlain�CCAC�had�a�significant�turnover�at�both�the�senior�management�and�Board�level�during�a�

time�when�consistent�leadership�would�have�eased�some�of�the�challenges�associated�with�

amalgamation.�At�the�time�of�writing�this�report,�the�CFO�position�had�recently�been�filled�and�the�

senior�leadership�team�is�now�in�place.��In�addition�to�the�leadership�challenges�at�the�senior�level,�the�

changes�to�management�personnel�and�structures�caused�uncertainty�and�concern�with�staff�

members�located�in�offices�outside�of�Ottawa.���

Champlain�CCAC�implemented�CHRIS�(the�Client�Health�and�Related�Information�System,�a�provincial�

system�which�will�be�common�to�all�14�CCACs�over�the�next�few�years)�in�all�but�the�former�Ottawa�

offices�in�fall�of�2008.��The�implementation�of�CHRIS�in�the�Ottawa�offices�occurred�in�May�2009.�The�

implementation�of�CHRIS�should�help�to�move�the�organization�forward,�however�in�order�to�

implement�CHRIS�many�system�and�process�changes�were�required�which�has�created�a�strain�on�

the�organization.��Prior�to�the�fall�2008,�there�were�two�different�IT�systems�in�place�at�the�

predecessor�CCACs�(PMI�and�OASIS).��There�were�also�multiple�versions�of�PMI�in�place.�This�

created�challenges�in�amalgamating�data�and�providing�true�comparisons�across�the�various�areas�of�

Champlain.����It�was�noted�after�the�implementation�of�CHRIS�that�several�challenges�associated�with�

maintaining�the�multiple�legacy�systems�had�disappeared�and�information�could�now�be�accessed�and�

utilized�more�effectively�and�efficiently.��They�are�now�in�the�process�of�developing�reports�and�

improving�data�quality.�����

A�lot�of�effort�has�been�made�towards�standardization,�which�is�the�first�step�in�bringing�together�

different�organizations.�Champlain�has�been�making�a�significant�effort�to�provide�staff�with�multiple�

tools,�such�as�standardized�desktops,�a�new�VOIP�phone�system�which�will�allow�for�easy�access�to�

all�offices,�moving�from�9�to�2�collective�agreements,�standard�contracts�and�service�provider�

packages,�to�allow�them�to�communicate�and�share�consistent�information.�The�results�of�these�and�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 8�

other�standardization�initiatives�provide�Champlain�with�a�strong�foundation�that�it�should�be�able�to�

build�upon.�At�the�same�time,�Champlain�CCAC�has�shown�financial�surpluses�in�the�past�fiscal�years�

and�was�on�track�to�another�financial�surplus�for�2008-2009�until�interventions�were�undertaken.��The�

surpluses�raised�concerns�around�the�financial�systems’�ability�to�monitor�expenditures.�With�the�

expanded�mandate�announced�in�December�2008�and�added�funding�for�additional�capacity�and�new�

programs,�the�CCAC�needs�to�meet�its�budget�and�the�community’s�growing�demand�for�services�in�a�

cost-effective�manner.���

Drivers of the Review

The�review�was�intended�to�provide�a�shared�understanding�of�the�individual,�organizational�and�

system�level�expectations�and�needs�in�order�to�optimally�meet�the�current�and�evolving�mandate,�

within�available�resources.��The�objectives�of�the�review�were�as�follows:�

• To�establish�a�common�and�detailed�understanding�of�the�new�mandate�of�the�CCAC�across�the�

system�including�definitions�and�expectations�based�on�client�needs;�

• To�determine�what�LHIN�and�system�support�will�be�required�to�actualize�the�opportunity�in�this�

expanded�role;�

• To�determine�the�factors�which�led�to�the�CCAC’s�financial�surplus�and�recommend�strategies�to�

strengthen�the�capacity�of�the�CCAC�to�accurately�forecast�expenditures�and�titrate�services�

accordingly;�

• To�create�a�shared�understanding�of�the�contribution�of�case�management�in�relation�to�

international�and�Ontario�models�to�identify�opportunities�to�leverage�case�management�as�a�

system�integrating�force.��This�will�consider�possible�changes�to�effectively�and�efficiently�meet�

the�new�mandate�of�the�CCAC�going�forward;�

• To�examine�the�contract�management�function�of�the�CCAC,�and�to�identify�what�changes�might�

contribute�to�meeting�the�growing�mandate�of�the�CCAC;�

• To�determine�what�data�is�currently�collected�and�reported�by�the�CCAC�to�monitor�client�and�

stakeholder�needs,�and�to�identify�how�the�data�can�be�used�by�CCAC�and�the�LHIN�to�address�

system�issues.��Missing�data�opportunities�will�be�explored;�

• To�use�the�review�as�an�opportunity�to�identify�what�other�activities�or�innovative�practices�would�

more�effectively�meet�the�increasing�needs�of�clients�and�health�system�service�providers;�and,�

• To�make�recommendations�and�develop�short�and�long�term�action�plans�to�address�the�findings�

of�the�review.���

The�LHIN�and�the�CCAC�developed�guiding�principles�for�the�review�around�the�following�values:�

- Future-focused;�

- Accountable;�

- Collaborative;�

- Transparent;�

- Objective;�

- Integrative;�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 9�

- Thorough;�and�

- Efficient.�

KPMG’s�methodology�and�approach�to�the�review,�which�is�discussed�in�the�following�chapter,�was�

designed�to�meet�the�values�identified�above.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 10�

Methodology�KPMG’s�methodology�investigated�a�number�of�dimensions�including�the�organization,�performance�

metrics�and�indicators�and�change�management�to�address�the�many�factors�that�affect�the�business�

of�the�CCAC.�We�began�with�a�quick�broad�based�review�of�the�CCAC’s�service�delivery�model,�which�

allowed�us�to�identify�and�prioritize�key�issues�and�enabled�the�project�to�then�focus�on�those�areas�

requiring�the�most�attention.�As�requested�in�RFP,�KPMG�initially�focused�on�the�following�areas:�

• Financial�Management;�

• Contract�Management;�and�

• Case�Management.�

However,�it�is�noted�that�there�are�many�factors�that�influence�the�operations�of�the�CCAC�and�these�

three�areas�do�not�operate�in�isolation.��As�the�review�progressed�it�became�apparent�that�there�were�

additional�areas�of�focus�that�needed�to�be�analysed�in�order�to�conduct�a�thorough�external�review,�

such�as�governance�and�leadership,�decision�support,�project�management,�communications,�change�

management�and�stakeholder�engagement.�These�additional�areas�are�discussed�further�in�the�report.���

KPMG’s�review�consisted�of�the�following�activities:�

• Met�with�Champlain�LHIN�and�Champlain�CCAC�representatives�to�review�the�work�plan,�agree�

on�the�approach,�work�schedule�work,�and�determine�the�organizations�and�agencies�for�

interviews�and�focus�groups,�sites�to�visit�and�the�information�to�gather�(see�Appendix�A�for�a�list�

of�organizations�interviewed);�

• Met�with�each�of��the�members�of�the�CCAC’s�Board�of�Directors�and�reviewed�the�minutes�of�all�

board�meetings,��

• Met�with�each�member�of�the�senior�leadership�team�to�review�their�functional�responsibilities�

and�operating�plans.�

• Reviewed�and�analysed�the�policies,�procedures�and�processes�as�they�currently�exist�at�

Champlain�CCAC;�

• Gathered�information�from�various�other�comparative�CCACs�and�organizations�in�other�

jurisdictions,�to�the�extent�available,�in�order�to�perform�a�comparative�review�of�practices�and�

identify�leading�practices�(see�Appendix�C�for�leading�practice�analysis);�

• Assessed�the�strengths�and�opportunities�for�improvement�of�the�Champlain�CCAC�based�on�the�

information�gathered�and�assessed�‘gaps’�that�may�exist�as�a�result�of�the�review;�

• Worked�with�a�Peer�Advisory�Panel�with�representatives�from�three�(3)�similar�CCACs�and�the�

Vancouver�Coastal�Health�Authority�to�analyse�the�information,�learn�from�their�experiences,�and�

develop�recommendations�for�consideration;�

• Conducted�a�series�of�workshops�with�internal�and�external�stakeholders�to�engage�

representatives�of�key�stakeholders�across�the�LHIN�geography�to�address�the�result�the�data�

gathering,�analysis�and�recommendations;�and�

• Reported�findings�and�recommendations�based�on�analysis.�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 11�

CCACs�play�a�pivotal�role�in�supporting�and�advancing�the�LHIN�mandate�to�lead�the�evolution�of�

health�care�in�Ontario:�moving�from�a�collection�of�services�that�are�often�uncoordinated�to�a�true�

health�care�system.��The�relationships�that�CCAC’s�have�with�their�wide�range�of�partners�and�

stakeholders�are�a�key�enabler�for�the�achievement�of�an�integrated�health�system.��Accordingly,�it�

was�important�to�include�many�representatives�of�external�partners�within�this�review�as�they�play�a�

key�role�not�only�in�the�CCACs�ability�to�meet�its�current�and�expanded�mandate,�but�also�in�

supporting�the�transition�to�an�integrated�health�care�system�and�the�provision�of�inter-professional�

care.�

The�original�scope�of�this�review�did�not�allow�for�a�detailed�analysis�of�functions�outside�of�the�three�

specified�in�the�RFP�(Finance,�Contract�Management�and�Case�Management).��However,�it�was�noted�

early�in�the�process�through�document�review�and�stakeholder�feedback�that�areas�such�as�

infrastructure,�governance�and�leadership�needed�to�be�addressed�at�a�high-level�in�order�to�move�the�

CCAC�forward.��This�was�further�confirmed�with�the�LHIN�management�that�issues�identified�in�these�

areas�would�be�included�in�the�review.����

As�requested�by�the�LHIN�in�an�addendum�to�the�original�RFP,�KPMG�met�with�a�small�number�of�

clients�in�order�to�gain�an�understanding�from�the�client’s�perspective�on�the�strengths�and�challenges�

of�Champlain�CCAC.�At�the�time�the�LHIN�issued�the�proposal,�it�was�anticipated�that�results�from�a�

standardized�provincial�CCAC�client�survey�would�be�available�for�analysis.�It�became�apparent�during�

the�early�stages�of�the�review�that�this�provincially�driven�initiative�would�not�be�completed�in�time�to�

provide�input�into�this�report.��In�order�to�understand�the�strengths�and�challenges�from�a�client’s�

perspective,�KPMG�met�with�approximately�30�clients�either�individually�or�in�focus�groups.��It�is�

important�to�recognize�that�this�is�a�very�small�percentage�of�clients�and�they�were�not�randomly�

selected�so�the�views�provided�can�not�accurately�represent�the�performance�of�the�organization.��

However,�common�themes�and�issues�that�surfaced�were�validated�against�other�information�

obtained�in�the�review�and�incorporated�into�the�analysis.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 12�

Overview�of�Findings�During�the�review�it�became�apparent�that�a�number�of�issues�and�challenges�Champlain�CCAC�was�

facing�were�as�a�result�of�communication�challenges,�a�lack�of�understanding�of�the�CCAC’s�mandate,�

and�limited�use�of�data�to�dispute�or�support�claims�by�various�stakeholders.��Champlain�CCAC�has�

been�slower�to�move�forward�as�some�of�its�peers�mainly�due�to�leadership�turnover�facing�the�

organization�as�it�tried�to�overcome�the�many�challenges�associated�with�amalgamation.���

Based�on�the�review�of�the�Champlain�CCAC,�through�interviews,�focus�groups�and�data�gathering�

with�many�CCAC�staff�and�management�and�external�stakeholders,�there�is�a�need�for�the�CCAC�to�

focus�on�improving�the�following�areas:�

• Governance�and�Leadership;�

• Infrastructure�Improvements�and�Supports;�

• Stakeholder�Engagement;�

• Contract�Management;�

• Financial�Management;�and�

• Case�Management.�

Each�area�is�discussed�in�detail�in�the�upcoming�sections.�Included�in�Infrastructure�Improvements�

and�Supports�are�aspects�that�cross�all�boundaries�of�the�CCAC�such�as:�data�management/decision�

support;�communications;�change�management;�and�project�management.��Findings,�implications�and�

recommendations�associated�with�each�of�the�areas�of�focus�are�discussed�in�the�following�sections.��

In�order�to�reduce�duplication�when�themes�occurred�in�more�than�one�area,�each�is�discussed�in�the�

area�where�it�was�most�appropriate.�

The�recommendations�contained�in�this�report�are�intended�to�allow�the�CCAC�to�strengthen�its�

operations�and�relationships�so�it�can�more�effectively�manage�its�core�business.�Focuses�on�

leadership�and�decision�support�are�critical�to�create�an�effective�foundation�for�organizational�

success.�While�the�recommendations�are�straightforward�some�will�take�a�considerable�amount�of�

time�and�effort�by�the�CCAC�and�external�partners�to�be�effectively�implemented.��Once�the�CCAC�

has�a�stronger�handle�on�its�current�operations,�they�will�be�able�to�utilize�data�and�information�more�

successfully�to�enhance�stakeholder�relations�and�collaboratively�develop�programs�and�processes�

that�will�allow�the�CCAC�to�productively�meet�its�expanded�mandate.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 13�

Governance�and�Leadership�Governance�and�leadership�are�key�drivers�of�organizational�performance.�Champlain�CCAC�has�had�

significant�turnover�at�both�the�senior�leadership�and�Board�level�during�a�time�when�consistent�

leadership�would�have�eased�some�of�the�challenges�associated�with�amalgamation.��Governance�and�

leadership�are�discussed�first�because�of�their�importance�to�overall�organizational�success.�����

Governance

CCAC�Boards�of�Directors�have�the�same�responsibilities�of�the�boards�of�directors�of�other�not-for-

profit�corporations.��Key�for�all�boards�is�the�responsibility�for�not�only�setting�the�strategic�direction�

for�the�corporation�but�also�monitoring�the�organization’s�progress�on�achieving�its�goals.��The�board�

does�so�by:�

• Selecting,�supervising�and�evaluating�its�Chief�Executive�Officer;�

• Ensuring�organizational�quality�in�all�areas�including�client�care,�management�performance,�

financial�performance,�external�relations�as�well�as�the�board’s�own�performance;�and,��

• Ensuring�that�the�performance�management�and�measurement�system�connects�the�strategic�

plan�to�annual�operating�performance.�

The�CEO�is�appointed�by,�reports�to�and�is�accountable�to�the�Board.��The�Board�is�responsible�for�

supervising�the�CEO.��Board�responsibilities�include�selection,�overseeing�annual�objective�setting,�

identifying�learning�and�development�plans,�and�being�prepared�for�the�succession�of�the�incumbent.��

An�evaluation�or�appraisal�process�is�critical�for�the�board�to�discharge�its�overall�responsibility�as�

supervisor�of�the�CEO.�In�setting�up�a�CEO�performance�appraisal�process�the�Board�needs�to�pay�

particular�attention�to�the�skills�that�are�required�by�a�CEO�in�a�complex�and�large�organization.��

Several�CCACs�across�the�province�are�organizations�with�annual�budgets�over�$150�million�dollars�

and�the�skills�required�to�manage�such�an�organization�are�different�then�pre-amalgamation.��The�

Board�needs�to�ensure�that�the�proper�foundations�are�in�place�to�support�the�CEO�and�enhance�

development.�Evidence�of�a�CEO�robust�performance�measurement�process�based�upon�

organizational�metrics�was�not�found�at�the�CCAC�and�this�needs�to�be�developed�by�the�board�in�

order�for�it�to�fulfill�its�responsibility.��

The�board’s�own�performance�is�dependent�upon�the�skills,�experience�and�qualities�of�the�individual�

directors�who�are�members�of�the�board.��Skills�refer�to�the�area�of�expertise�or�knowledge�that�an�

individual�board�member�possesses�such�as�financial�literacy.��Experience�in�governance,�health�care�

or�system�integration�is�important�for�the�CCAC’s�board�to�be�effective.��The�CCAC’s�board�should�

also�reflect�the�diversity�of�the�community�the�CCAC�serves�with�respect�to�demography,�geography,�

culture/ethnicity�and�gender.��Given�the�end�of�the�Order�In�Council�era�for�CCAC�boards,�Champlain�

CCAC’s�board�has�an�opportunity�to�build�its�own�capacity�to�govern�the�CCAC�with�the�change�to�

becoming�a�community�board.��KPMG�reviewed�all�board�minutes,�including�in-camera�minutes,�from�

amalgamation�to�April�2009.��There�is�no�evidence�in�the�board�minutes�that�the�board�had�vigourously�

evaluated�its�current�skill�capacity�and�gaps�as�it�develops�recruitment�plans�and�strategies�for�new�

community�boards.��However,�during�the�course�of�the�review,�the�board�held�a�retreat�in�April�2009�

to�discuss�their�performance�and�skill�capacity.��Capacity�enhancement�will�be�achieved�through�the�

strategic�recruitment�of�individuals�possessing�the�necessary�skills�qualifications�and�attributes�as�well�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 14�

as�through�the�establishment�of�its�own�governance�development�program.��The�Board�also�needs�to�

evaluate�its�own�performance�on�a�regular�basis.���

The�board�is�responsible�for�the�establishment�of�a�strategic�plan�and�exercising�oversight�of�the�

implementation�of�the�plan�through�its�monitoring�of�the�CCAC’s�operations.��Accordingly,�the�

organization’s�performance�management�program�and�measurement�system�must�connect�the�

strategic�plan�to�the�CCAC’s�annual�operating�plan�and�ongoing�performance.�Metrics�need�to�be�

developed�and�implemented�so�the�board�can�routinely�monitor�how�effectively�the�CCAC�is�

performing.�There�was�no�evidence�that�the�board�has�adopted�a�plan�for�monitoring�the�

implementation�of�the�strategic�plan.�

As�noted�later�in�this�report,�the�focus�of�the�finance�department�was�purely�transactional.��Important�

trending�and�tracking�information�was�not�provided�or�analysed.��The�senior�leadership�team�and�

board�lacked�the�information�that�they�needed�in�order�to�make�strategic�decisions�with�regards�to�the�

organization.��Since�amalgamation,�the�board�has�been�provided�with�basic�financial�information�that�

does�not�look�at�trending�or�provide�detailed�analysis�with�regards�to�variance.��They�have�not�been�

provided�with�the�client�service�information�that�they�would�need�to�make�the�necessary�board�

decisions.���There�is�no�evidence�that�the�Board�has�requested�such�analysis�from�the�CCAC�

leadership.���

Monitoring�progress�on�achievement�of�the�entire�operating�plan�(not�just�the�improvement�activities)�

is�a�key�responsibility�of�the�board�of�directors.��Balanced�Scorecards�were�developed�initially�to�

ensure�that�corporations�considered�a�range�of�performance�indicators.��Leading�indicators�help�

predict�how�the�organization�will�do�in�the�future.�At�the�May�meeting�of�the�board,�leadership�

brought�forward�a�proposed�“Balanced�Score�Card”�to�assist�the�board�to�monitor�the�organization’s�

performance�and�to�promote�the�importance�of�not�only�data�but�in�linking�and�aligning�the�day-to-day�

operations�with�the�strategic�focus�of�the�organization.��The�draft�scorecard�is�a�positive�first�step�in�

providing�the�board�with�the�information�that�it�requires�to�measure�the�performance�of�the�CCAC.���

The�metrics�of�the�scorecard�support�the�achievement�of�the�client�service�objectives.�Whether�or�not�

the�CCAC�uses�a�balanced�scorecard�approach,�the�board�needs�a�simple�reporting�system�to�monitor�

overall�organization�performance.�The�accountability�agreement�between�the�LHIN�and�the�CCAC�

provides�the�framework�for�CCACs�to�report�to�government.��These�include�commitments�concerning�

CCAC�performance.��The�framework�sets�out�four�performance�domains�that�are�consistent�with�the�

balanced�scorecard�approach.��There�are�a�number�of�performance�indicators�and�service�

requirements�that�are�set�in�the�accountability�agreement.��The�CCAC’s�board�through�its�

performance�measurement�system�will�need�to�pay�attention�to�these�performance�indicators�such�

as,�performance�targets,�case�manager�visits�face-to-face,�service�activity�volumes,�individuals�served,�

proportion�of�budget�spent�on�case�management�and�proportion�of�budget�spent�on�direct�care.�The�

scorecard�is�based�on�the�client�outcomes�and�measures�that�Champlain�CCAC�wants�to�achieve�and�

the�objectives�and�metrics�in�the�other�quadrants�support�achievement�of�the�client�service�

objectives.�The�board�and�leadership�team�will�need�to�work�with�the�scorecard�to�fully�utilize�this�

important�performance�management�tool.��

Leadership

Champlain�CCAC�has�had�a�significant�turnover�at�the�senior�leadership�level�during�a�time�when�

consistent�leadership�would�have�eased�some�of�the�challenges�associated�with�amalgamation.��

While�four�members�of�the�senior�leadership�team�are�longer-term�employees�their�tenure�in�their�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 15�

current�roles�is�relatively�short�(Chief�Executive�Officer�and�Senior�Directors,�Client�Services,�

Performance�Management�and�Accountability�and�Strategic�Planning�and�Integration).��The�senior�

leadership�team�has�only�been�working�together�as�a�team�for�a�short�period�of�time,�as�the�role�of�

the�CFO�was�filled�in�June�2009.��The�positions�of�Senior�Director�of�Client�Services�and�Strategic�

Planning�Integration�were�filled�in�January�2009.��In�order�for�the�organization�to�move�forward,�the�

senior�leadership�team�need�to�effectively�work�together.��As�it�is�a�relatively�new�team,�increased�

effort�needs�to�occur�so�the�leadership�team�is�strengthened.��Without�a�strong�leadership�team,�the�

organization�will�have�difficulty�achieving�its�mandate.��Champlain�CCAC�implemented�a�leadership�

development�program�for�its�middle�managers�in�September�2007.��Most�managers�are�in�Year�One�

of�this�multi-year�initiative�which�should�help�to�strengthen�the�larger�management�team.��

As�is�the�case�at�the�onset�of�most�amalgamations,�many�staff�members�especially�in�areas�outside�

of�Ottawa,�do�not�always�feel�included�in�the�larger�organization.�Senior�leadership�and�management�

are�perceived�as�being�focused�on�Ottawa,�as�perceived�by�some�staff�and�service�provider�agencies.��

Many�expressed�a�desire�to�have�senior�leaders�seen�in�the�field,�where�the�issues�and�challenges�

are.�Some�staff�who�report�centrally�but�are�located�outside�of�Ottawa�feel�separate�from�both�the�

organization�and�the�branch.��The�CCAC’s�vision�and�role�are�not�yet�well�understood�at�all�levels�of�

the�organization.�A�consistent�vision�and�mission�for�all�14�CCACs�was�adopted�in�early�2009�and�

introduced�along�with�the�brand�in�March�2009.��There�is�still�considerable�work�to�be�done�to�assist�

staff�to�adopt�and�live�the�new�vision�and�mission.�Lack�of�understanding�of�vision�and�role�may�result�

in�inconsistency�of�approach�by�front-line�staff�members.��There�is�a�need�to�develop�management�

structures�and�communication�strategies�not�only�to�support�all�staff�but�to�effectively�support�staff�

members�who�report�centrally,�but�reside�in�branch�offices.�Staff�and�Service�Provider�Agencies�(SPA)�

noted�that�information�isn’t�always�clearly�disseminated�across�the�organization�which�leads�to�

confusion�about�the�CCAC�services�processes.�“Staff�conversations”�or�staff�meetings�occur�four�

times�annually,�with�additional�sessions�as�needed,�where�senior�leadership�visit�each�branch�to�

communicate�key�messages,�however�branches�where�a�senior�team�was�located�prior�to�

amalgamation�have�experienced�a�loss�of�daily�presence.����In�support�of�assisting�front-line�staff�to�

understand�the�CCAC’s�vision�and�mandate�and�the�role�that�they�play�in�helping�the�CCAC�achieve�its�

goals��senior�leaders�should�more�regularly�visit�branch�offices�as�part�of�a�more�comprehensive�staff�

engagement�and�communication�strategy.��

High�performing�organizations�develop�and�use�processes�and�tools�that�aid�their�effectiveness.��

Without�rigorous�attention�to�tools�and�processes,�an�organization’s�effectiveness�is�compromised.��

The�review�found�limited�management�tools,�action�plans,�meeting�notes,�metrics,�and�regular�

decision�support�analysis�and�reports�for�senior�leadership.���

In�June�2009,�CCAC�leadership�brought�to�the�board�its�2009/2010�operating�plan.��The�plan�linked�

current�improvement�activities�to�the�organization’s�strategic�goals.��It�attempted�to�identify�

performance�indicators�for�the�changes�that�it�was�planning�to�initiate.��The�plan�could�be�enhanced�by�

identifying�the�clients�or�groups�of�clients�to�whom�the�CCAC�would�be�providing�services,�the�level�

or�amounts�of�the�services,�the�types�of�services�and�the�cost�of�these�services.���This�information�

along�with�the�activities�being�undertaken�to�help�the�organization�achieve�its�strategic�goals�should�

be�included�in�the�annual�operating�plan.���

Recommendations

In�order�to�address�the�above�leadership�and�governance�concerns,�it�is�recommended�that�the�CCAC�

senior�leadership:�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 16�

Recommendation #1 Immediately�develop�a�comprehensive�performance�management�and�

measurement�system�to�support�the�board’s�responsibility�to�ensure�

organizational�quality�in�all�areas�including�client�care,�management�

performance,�financial�performance,�external�relations�as�well�as�the�

board’s�own�performance�and�that�the�organization’s�strategic�plan�is�

connected�to�annual�operating�performance��

Recommendation #2 Immediately�develop�and�implement�strategies�to�assist�front-line�staff�

members�to�understand�the�CCAC’s�vision�and�mandate�and�the�role�that�

they�play�in�helping�the�CCAC�to�achieve�its�organizational�goals.���

Recommendation #3 Continually�develop�and�evaluate�its�leadership�practices�and�tools�and�

implement�leading�practices.�

These�recommendations�are�discussed�in�more�detail�below.�

Recommendation #1�-�Immediately�develop�a�comprehensive�performance�management�and�

measurement�system�to�support�the�board’s�responsibility�to�ensure�organizational�quality�in�all�areas�

including�client�care,�management�performance,�financial�performance,�external�relations�as�well�as�

the�board’s�own�performance�and�that�the�organization’s�strategic�plan�is�connected�to�its�annual�

operating�performance.�

Ensuring�organizational�quality�begins�with�having�the�processes�and�tools�to�measure�organizational�

performance.��Organizational�performance�is�measured�with�respect�to:�

• Level�and�quality�of�services�delivered�within�the�approved�budget;�

• The�progress�made�on�achieving�the�strategic�goals;�

• Cost-effective�administration�of�human�and�financial�resources;�

• Effective�relationships�with�the�CCAC’s�many�stakeholders;�and��

• Effective�governance�processes�including�board�and�CEO�evaluation�

Other�CCACs�provide�their�Board�with�a�“dashboard”�or�summary�of�Key�Performance�Indicators�that�

include�targets�and�trends.�The�CCAC�and�Board�should�build�on�the�good�work�that�has�resulted�in�a�

balanced�scorecard�developed�by�Champlain�CCAC.��Both�parties�should�identify�any�key�performance�

indicators�that�may�be�missing�from�the�balanced�scorecard�that�has�been�developed.��The�Champlain�

CCAC�may�wish�to�review�other�balanced�scorecards�currently�in�use�at�other�CCACs,�such�as�Central�

CCAC,�to�identify�any�other�metrics�that�would�provide�information�with�regards�to�the�performance�

of�the�organization.�The�key�performance�indicators�in�the�balanced�scorecard�effectively�monitor�the�

CCAC’s�performance.��The�key�performance�indicators�need�to�be�based�first�on�the�client�outcomes�

and�measures�that�the�CCAC�wants�to�achieve.��The�objectives�and�metrics�in�the�other�quadrants�will�

then�support�the�achievement�of�the�client�service�objectives.��The�CCAC�senior�leadership�should�

report�on�each�indicator�monthly�with�past�and�project�data�to�clarify�trends.���

Recommendation #2�-�Immediately�develop�and�implement�strategies�to�assist�front-line�staff�

members�understand�the�CCAC’s�vision�and�mandate�and�the�role�that�they�play�in�helping�the�CCAC�

to�achieve�its�organizational�goals.�

The�indicators�that�the�board�monitors�are�“roll-up”�measures�that�represent�a�more�holistic�

assessment�of�the�CCAC’s�overall�performance.���Reporting�to�and�for�middle�managers�and�front-line�

staff�members�requires�“drilling�down”�into�the�indicator�in�order�for�each�group�of�staff�and�each�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 17�

individual�staff�member�to�understand�the�role�that�they�play�within�the�organization.��It�will�be�

important�to�develop�performance�metrics�that�all�staff�are�monitored�on�that�link�directly�to�the�

strategic�plan.��Staff�should�then�have�a�greater�understanding�of�how�the�every�day�activities�of�

Champlain�CCAC�are�important�and�integrated�into�the�strategic�direction�of�the�organization.���

The�successful�implementation�of�this�recommendation�will�be�measured�by�an�increase�staff�

satisfaction�and�engagement,�staff�knowledge,�adherence�to�vision�and�behaviours�throughout�the�

organization.����

Recommendation #3 –�Continually�develop�and�evaluate�its�leadership�practices�and�tools�and�

implement�leading�practices.�

Most�of�the�current�senior�directors�have�only�worked�together�for�a�short�time.��It�takes�time�to�build�

an�effective�“team”.��A�strong�leadership�team�in�the�organization�is�essential�to�achieving�its�

mandate.��A�strong�leadership�team�uses�tools�and�best�practices�that�facilitate�its�work.��An�

organization�with�leaders�and�managers�who�are�an�inspiration�to�staff�usually�results�in�employees�

following�because�they�believe�in�what�the�leader�or�manager�is�doing�and�they�try�to�help�the�

organization�achieve�its�goals.�Champlain�CCAC�needs�to�find�ways�to�inspire�employees,�such�as�

coaching�and�motivating�them�to�succeed�as�they�are�integral�parts�of�the�CCAC.�When�employees�

feel�engaged,�the�will�be�more�willing�to�share�ideas�and�work�towards�improving�processes.�An�

effective�leader�needs�to�be�an�effective�communicator.�Managers�that�regularly�share�information�

effectively�are�deemed�trustworthy�by�employees.�Employees�feel�little�loyalty�or�trust�towards�a�

manager�who�does�not�readily�and�effectively�give�out�information.���

Leadership�also�needs�to�develop�processes�and�structures�so�staff�feel�heard�and�have�a�connection�

to�the�office�where�they�reside�as�well�as�strengthen�its�current�management�team.��Managers�

should�create�a�climate�that�encourages�new�ideas�and�employee�input�to�enhance�morale.�����

Continuous�evaluation�of�both�the�senior�leadership�team’s�current�practices�and�the�team’s�skill�

development�requirements�should�be�led�by�the�Senior�Director�Human�Resources�and�Organizational�

Development.��The�review�of�leadership�team�leading�practices�should�be�informed�by�the�practices�

and�experiences�of�other�leadership�teams�at�other�CCACs�and�healthcare�partners.���Opportunities�

for�whole�team�development�such�as�the�need�for�team�building�should�be�led�by�the�CEO.���

Outcomes�to�the�successful�implementation�of�this�recommendation�will�be�a�marked�increase�in�

staff�knowledge;�adherence�to�vision;�and�behaviours.��It�should�also�result�in�an�increase�in�staff�

satisfaction�and�engagement�that�should�lead�to�staff�taking�more�ownership�in�their�position,�

translating�into�a�higher�level�of�customer�service.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 18�

Infrastructure�and�Supports�As�stated�in�the�Methodology�Section�of�this�report,�there�are�many�factors�that�influence�the�

operations�of�the�CCAC�and�financial,�contract�and�case�management,�do�not�operate�in�isolation.��The�

areas�that�have�been�grouped�into�this�section�are�more�focused�on�the�organizational�structure�and�

supports�that�are�required�to�run�an�effective�organization.�The�areas�included�within�Infrastructure�

and�Supports�are:��

• Decision�support;��

• Change�management;�

• Project�management;�and,�

• Communications.�

They�are�reported�on�at�this�stage�of�the�report�because�of�their�importance�to�overall�organizational�

effectiveness�and�improvement.��These�areas�are�critical�to�the�Champlain�CCAC�meeting�its�

mandate.�The�recommendations�for�all�areas�follow�the�discussion�on�findings.��

Decision Support

The�health�care�environment�is�changing�and�is�becoming�more�data�driven�with�an�appreciation�of�

the�power�that�the�information�can�provide.��During�the�review,�it�became�apparent�that�Champlain�

CCAC�has:�

• Had�a�limited�focus�on�decision�support;�

• “Snapshot”�data�and�does�not�identify�trends;�

• Lacks�consistent�use�of�information�to�inform�management�decisions;�

• Relies�heavily�on�a�high�number�of�ad-hoc�reports;�and,�

• Little�or�no�set�targets�and�accountabilities�for�achieving�targets.��

The�implications�are�not�only�that�it�is�difficult�to�measure�and�monitor�the�organization’s�performance�

in�the�absence�of�a�set�of�indicators,�but�also�that�it�is�difficult�to�set�reasonable�targets�in�the�absence�

of�historical�trending�data.��Accordingly,�data�is�not�being�turned�into�information.��

Most�managers�at�many�levels�within�the�organization�have�apparently�not�used�data�in�the�past�to�

drive�practices�and�monitor�performance.���The�decision�support�resources�within�the�organization�

have�multiple�foci,�including�quality,�and�have�not�had�the�time�to�learn�the�technical�skills�necessary�

to�pull�the�required�data,�or�educate�management�and�staff�on�what�information�can�be�provided�and�

how�the�data�can�be�utilized.��Prior�to�the�implementation�of�CHRIS,�valuable�data�was�residing�in�

multiple�systems,�which�made�data�integration�and�comparison�more�challenging�and�time�

consuming.��Data�quality�was�an�issue.��At�the�time�of�writing�this�report,�the�role�of�Manager�of�

Quality�has�been�filled�thereby�allowing�the�Decision�Support�Manager�to�focus�solely�on�decision�

support.��The�implementation�of�CHRIS�and�focus�on�decision�support�has�allowed�this�area�within�

the�CCAC�to�begin�providing�more�effective�decision�support�to�the�organization�as�well�as�educating�

management�and�staff�on�what�information�can�be�provided�and�how�this�information�can�be�used�to�

drive�behaviour�and�monitor�performance.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 19�

Change Management

CCACs�have�gone�through�a�considerable�number�of�major�changes�in�the�past�few�years�with�

amalgamation,�implementation�of�CHRIS,�and�the�ever�evolving�provincial�mandate.��Feedback�from�

staff�identified�a�high�degree�of�“change�fatigue”.��Some�of�this�fatigue�was�anecdotally�reflected�as:��

• Perceived�ineffective�communication�between�management�and�staff.��Staff�members�report�that�

when�they�are��overwhelmed�with�emails�they�tend�to�ignore�them;�

• Perceptions�by�some�staff�re�lack�of�training�follow-up�and�feedback�on�evaluations�on�change�

initiatives;�

• Sense�of�being�overworked;�

• Staff�are�stressed;�

• Heightened�sensitivity;�

• “Staff�vs.�Management”�attitude;�

• Perceptions�of�workload�imbalance;��

• Isolation�of�some�teams�i.e.�hospital,�satellite�offices;�

• Staff�are�tired�of�change�-�looking�for�relief;�

• Feeling�that�change�adds�more�work�and�the�old�way�was�better;�and,�

• Inconsistent�practices�-�done�intentionally�by�some�people.��

In�order�to�address�the�number�of�changes�that�have�been�underway�and�to�avoid�change�induced�

fatigue,�it�is�important�that�Champlain�CCAC�follow�leading�practices�when�developing�a�change�

management�strategy�and�plan.��Using�leading�practices,�such�as�aligning�commonly�used�change�

management�activities�like�communications,�coaching,�training,�sponsorship,�and�resistance�

management�with�the�change�goal�or�objectives,�the�chance�of�change�success�will�significantly�

increase.��As�improvement�plans�unfold,�it�will�be�important�to�assess�the�risks�associated�with�the�

change�and�design�tactics�to�address�those�risks.��In�addition,�incentives�and�performance�

management�systems�need�to�be�designed�to�meet�and�support�the�change.��This�enables�business�

leaders�to�effectively�sponsor�the�change�and�equip�the�managers�and�supervisors�to�be�effective�

change�leaders.�The�focus�on�change�management�should�become�a�standing�item�on�the�leadership�

team�agenda.���

Project Management

There�are�many�projects�ongoing�at�the�CCAC�and�the�CCAC�has�experienced�some�success�in�its�

project�management�efforts.��Currently,�the�methodologies�used�are�not�consistently�applied�across�

the�organization�and�the�project�work�is�not�always�well�coordinated.��In�the�absence�of�strong�

decision�support�as�noted�above,�project�managers�are�challenged�to�effectively�monitor,�manage�and�

evaluate�their�work.��Projects�could�be�more�successfully�implemented�if�support�was�provided�in�two�

ways.��Firstly,�through�better�coordination�of�the�organization’s�project�work�such�as�the�leadership�

that�was�provided�by�the�CCAC’s�Project�Steering�Committee�from�time�to�time.��Secondly,�through�

the�provision�of�project�management�expert�resources�including�tools,�templates,�project�data�and�

support�for�conceptualization�to�get�through�the�process�of�project�management.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 20�

Communications

Several�Staff�and�managers,�mostly�in�offices�outside�Ottawa,�noted�a�sense�of�disconnection�with�

the�overall�organization.��Many�internal�stakeholders�felt�that�communication�was�either�too�much�or�

not�targeted�and�focused�enough�to�allow�them�to�filter�the�key�messages.��Messages�that�are�not�

clearly�articulated�or�consistently�given�generate�confusion�and�distrust�which�results�in�reinforcement�

of�the�status�quo�as�changes�in�processes�outlined�in�the�message�may�not�be�implemented�

successfully.��It�was�also�consistently�reported�that�there�is�limited�communication�between�

departments�within�the�CCAC.��External�stakeholders�also�expressed�similar�frustration�with�the�

CCAC’s�communications.�

It�will�be�important�as�the�CCAC�roles�out�its�branding�and�other�initiatives�to�focus�on�the�importance�

of�developing�a�stronger�sense�of�“team”�with�the�staff�members�in�these�offices.��Leading�CCACs�

indicated�that�while�they�still�struggled�with�the�fine�balance�between�“too�much”�and�“not�enough”�

communication,�they�constantly�integrated�their�strategic�plan�to�the�day-to-day�operations�discussed�

within�the�communications.���

Recommendations

In�order�to�address�the�above�infrastructure�and�supports�concerns�it�is�recommended�that�the�CCAC:�

Recommendation #4 Enhance�Decision�Support�efforts�at�Champlain�CCAC�through�the�

development�of�a�comprehensive�Data�Management�and�Reporting�

Framework�and�skill�development.�

Recommendation #5 Develop�and�implement�a�more�robust�Change�Management�Plan.�

Recommendation #6 Implement�a�Project�Management�Strategy.�

Recommendation #7 Develop�and�implement�a�more�enhanced�communications�strategy�and�

plan.�

These�recommendations�to�address�the�above�infrastructure�and�supports�concerns�can�not�be�

implemented�in�isolation�as�they�are�the�vehicles�which�will�help�Champlain�CCAC�achieve�its�

strategic�and�operational�objectives.�

Recommendation #4�-�Enhance�Decision�Support�efforts�at�Champlain�CCAC�through�the�

development�of�a�comprehensive�Data�Management�and�Reporting�Framework�and�skill�development�

In�order�to�implement�the�recommendations�in�the�Governance�and�Leadership�section�of�this�report,�

Champlain�CCAC�needs�to�develop�a�framework�that:��

• �Enables�the�Board�to�ensure�that�the�CCAC�is�accountable;��

• �Supports�all�monitoring�and�improvement�activities;��

• �Enables�senior�leadership�to�focus�on�utilization�and�trending�as�opposed�to�“snapshot”�reporting;��

• �Provides�all�levels�of�the�organization�with�the�clinical�and�financial�information�necessary�for�each�

person�to�perform�optimally�in�their�position;�and�

• Provides�shared�data�across�community�partners�and�service�providers.��

The�framework�will:�

• Build�the�capacity�of�the�organization;��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 21�

• Help�the�board�meet�its�responsibility�to�monitor�organizational�performance;��

• Assist�the�senior�leaders�and�managers�with�their�work�to�improve�organizational�performance;��

• Support�the�case�management�team�with�the�management�of�services�and�supports�the�

management�of�services�with�external�partners�to�build�confidence�in�the�CCAC’s�processes.���

It�will�help�the�CCAC�develop�a�focus�on�performance�management�with�development�plans�in�place�

that�include�targets�and�plans�to�meet�or�exceed�targets�regularly�reviewed�with�management.���

Consideration�should�be�given�to�building�Champlain’s�framework�on�the�work�that�has�been�done�by�

other�CCACs�such�as�Central�CCAC.�

Other�CCAC’s�who�have�strong�decision�support�capabilities�have�worked�diligently�to�build�the�

capacities�and�skills�necessary�within�the�department.�The�skills�required�for�a�strong�decision�support�

team�are�both�technical�and�analytical.��It�is�a�balance�between�individuals�with�technical�backgrounds�

who�can�write�reports�and�those�with�the�analytical�mind�who�understand�the�organization�and�the�

data.��Decision�support�staff�must�have�the�ability�to�ask�the�right�questions�from�the�person�

requesting�the�report�to�clearly�understand�what�is�being�requested.��In�many�cases,�decision�support�

works�in�collaboration�with�other�areas�of�the�CCAC�to�build�and�enhance�the�analytic�capabilities�of�

the�other�departments.��Many�spend�time�teaching�case�managers�and�management�staff�how�to�use�

the�data�and�information�that�is�presented�in�the�reports�and�integrate�it�into�their�daily�operations�and�

performance.���

Good�data�and�ability�to�share�information�across�stakeholders�is�paramount�to�the�success�of�the�

CCAC�moving�forward.��As�it�stands�now,�it�is�difficult�for�the�CCAC�to�support�or�dispute�comments�

with�regards�to�the�service�that�it�provides.��For�instance,�a�hospital�may�perceive�that�discharges�are�

being�delayed�by�CCAC�processes.��A�CCAC�with�a�strong�decision�support�function�would�be�able�to�

provide�the�hospital�with�information�and�analysis,�such�as�number�of�discharges�per�day,�length�of�

time�between�referral�and�discharge,�reasons�for�delayed�discharge.��The�data�could�be�further�refined�

to�document�variances�such�as�by�hospital�ward,�time�of�year,�or�type�of�service.���This�would�enable�

productive�and�transparent�working�relationships�with�healthcare�partners.�

Given�the�important�need�of�a�strong�decision�support�function,�the�CCAC�should�consider�ways�to�

increase�the�number�of�resources�within�this�function.��The�area�currently�has�three�(3)�full�time�

equivalent�(FTE)�resources�while�other�comparable�CCACs�have�between�3�and�5�FTE�resources.��As�

part�of�the�talent�management�strategy�that�the�CCAC�is�developing�across�the�organization�it�will�be�

important�for�the�CCAC�to�first�investigate�whether�the�skills�exist�within�internal�resources�and�what�

effect,�if�any,�moving�that�resource�would�have�on�an�existing�area.��If�the�required�technical�and�

analytical�skills�do�not�currently�exist�internally,�the�CCAC�will�need�to�consider�whether�monies�can�

be�reallocated�to�allow�for�an�additional�external�resource.��In�addition,�the�CCAC�needs�to�evaluate�

whether�these�extra�positions�would�be�permanently�required�moving�forward�or�whether�they�would�

be�needed�for�a�shorter,�more�focused�period�of�time.��For�example,�a�resource�may�be�required�to�

help�with�the�remainder�of�the�CHRIS�transformation�and�the�development�and�implementation�of�a�

new�case�management�model�as�it�has�the�potential�to�impact�the�procurement�strategy�and�

partnerships�with�stakeholders�moving�forward.���

Enhancing�the�decision�support�function�of�the�CCAC�should�help�client�services�staff�provide�more�

efficient�services�and�supports�to�CCAC�clients.��For�instance,�more�detailed�analysis�on�the�specific�

resources�and�services�that�a�particular�client�group�requires�could�assist�the�CCAC�in�more�

effectively�planning�and�utilizing�community�resources.�The�decision�support�function�within�the�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 22�

CCAC�will�also�provide�valuable�input�into�the�development�of�Memorandums�of�Understanding�

(MOUs)�with�external�healthcare�providers�and�provide�data�and�information�to�effectively�monitor�and�

strengthen�stakeholder�relationships�(discussed�in�the�section�on�Stakeholder�Engagement).�This�

should�help�the�CCAC�to�improve�and�enhance�trust�across�the�many�stakeholders�and�share�

knowledge�that�should�help�all�stakeholders�to�integrate�and�improve�access�to�healthcare�services�

and�supports�for�Champlain�residents.��Decision�support�should�also�develop�prioritization�tools�for�

data�requests�and�change�the�focus�of�the�reports�from�distributed�data�to�managing�information.��

Outcomes:�The�successful�implementation�of�this�recommendation�will�be�measured�by�an�increase�

in�the�usefulness,�timeliness�and�quality�of�the�reports�provided�and�external�partners�will�express�

greater�confidence�in�the�CCAC’s�reporting.���It�will�also�be�measured�by�evidence�of�standard�reports�

and�decisions�linked�to�data.���

Recommendation #5�-�Develop�and�implement�a�more�robust�Change�Management�Plan��

CCACs�have�gone�through�a�considerable�number�of�major�changes�in�the�past�few�years�with�

amalgamation,�implementation�of�CHRIS,�and�the�ever�evolving�provincial�mandate.��In�order�to�

address�the�number�of�changes�that�have�been�underway�and�to�avoid�change�fatigue,�it�is�important�

that�Champlain�CCAC�follow�leading�practices�when�developing�a�change�management�strategy�and�

plan.���An�effective�change�management�plan�and�strategy�will�also�assist�the�CCAC�when�

implementing�the�new�case�management�model�as�discussed�later�in�this�document.��Leading�

practices�within�change�management�instil�desire,�develop�knowledge,�foster�the�ability�and�reinforce�

the�change.��The�change�strategy�should�be�developed�in�close�collaboration�with�the�Project�

Management�function�(discussed�below)�which�synthesizes�various�change�inputs�into�an�integrated�

roadmap�containing�not�only�all�change�management�dimensions�but�also�all�interdependent�initiatives�

in�play.��A�discussion�on�leading�practices�in�change�management�can�be�found�in�Appendix�C.�

The�recommendations�made�in�this�report�will�require�a�substantial�amount�of�change�within�the�

Champlain�CCAC.�While�the�CCAC�has�some�change�management�processes�in�place,�they�could�be�

more�effective.��A�more�robust�change�management�plan�will�make�the�connection�between�the�

strategic�objectives�and�the�operational�plans.�While�closely�aligned�to�project�management,�not�all�

changes�are�necessarily�related�to�individual�projects�as�it�is�about�changing�how�people�work.��This,�

along�with�other�recommendations�contained�in�the�report�should�allow�the�CCAC�to�achieve�its�

strategic�and�operational�objectives.��

While�these�changes�will�improve�many�of�the�workload�and�process�concerns,�there�is�a�high�

probability�that�even�positive�change�will�feel�overwhelming�to�staff.�A�systematic�change�strategy�

will�help�to�address�these�concerns�so�that�the�recommended�changes�are�not�viewed�as�just�another�

burden.���

The�successful�implementation�of�this�recommendation�will�be�measured�by�an�increase�in�job�

satisfaction�as�reported�in�the�Employee�Engagement�Survey.��It�will�also�be�measured�through�

adoption�of�new�practices�and�increases�in�client�and�healthcare�partner�satisfaction.��

Recommendation #6�-�Implement�a�Project�Management�Strategy��

It�was�noted�that�the�CCAC�does�not�have�a�single�point�of�focus�within�the�organization�that�has�the�

knowledge�of�the�overall�picture�with�respect�to�the�multiple�projects�that�are�ongoing�within�

Champlain�CCAC.�As�part�of�the�implementation�of�a�Project�Management�Strategy,�there�would�be�a�

single�point�of�contact�to�manage�the�plans�and�resources�needed�to�implement�the�multiple�projects.��

This�function�would�provide�the�resources�needed�to�complete�tools�and�templates,�conceptualization�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 23�

to�get�through�the�process�of�project�management�and�the�knowledge�of�the�interdependencies�of�

the�projects�that�are�underway�within�the�CCAC.��In�addition,�this�function�would�provide�

management�training�in�project�management�to�project�managers�within�the�organization.���

The�skills�required�for�this�project�management�resource�would�include�expertise�in�project�

management,�the�ability�to�coach�and�mentor�project�managers,�and�to�facilitate�cross-functional�

teams.��Project�management�is�more�than�the�ability�to�complete�a�project�charter.��It�is�the�ability�to�

understand�and�mitigate�the�risks�and�threats�to�the�project’s�success,�as�well�as�the�need�to�ensure�

the�controls,�policies�and�procedures�are�adequate�for�the�complexity�of�the�projects.��It�is�also�

necessary�that�the�project�management�office�provide�objective�feedback�to�assist�with�decision�

making�for�the�selection�and�establishment�of�projects�as�well�as�project�senior�leadership�with�real�

time�objective�data�that�can�assist�with�proactive�decision�making�to�help�mitigate�any�issues�and�

challenges�that�arise�and�provide�a�perspective�to�project�managers�on�the�progress�of�their�projects.���

The�project�management�resource�would�not�replace�the�Project�Steering�Committee�that�has�been�in�

place�from�time-to-time.��However,�the�role�of�the�committee�would�now�be�more�focused�on�the�

review�and�approval�of�projects.��The�committee�would�look�at�all�projects�from�a�strategic�viewpoint�

to�ensure�the�projects�moved�the�strategy�forward.��The�committee�would�develop�the�prioritization�

criteria�for�all�projects,�including�the�ones�that�may�arise�after�the�annual�plan�has�been�developed.�

The�composition�of�this�Committee�is�mainly�the�senior�leadership�and�Champlain�CCAC�should�

review�the�membership�to�see�if�additional�skills�and�perspectives�are�required.��This�forum�should�be�

used�to�determine�the�appropriate�allocation�of�resources�for�projects�across�the�organization.�The�

committee�would�also�be�a�forum�where�project�managers�would�regularly�bring�forward�information�

regarding�the�status�of�the�projects�including�budget,�milestones,�issues�and�risks�associated�with�the�

project.��The�committee�would�review�each�project�at�each�phase�to�make�sure�that�it�was�aligned�

with�all�parts�of�the�business�to�which�it�needed�to�be�aligned.��The�committee�would�also�evaluate�

projects�at�various�stages�and�determine�whether�the�projects�should�proceed�forward�to�the�next�

stage�or�should�be�redesigned�or�stopped.��The�committee�will�need�to�establish�a�regular�meeting�

and�project�reporting�schedule�to�effectively�meet�its�mandate.�

The�successful�implementation�of�this�recommendation�will�be�measured�by�an�increase�in�the�

number�of�successfully�completed�projects�that�are�on-time,�on-budget�and�produce�effective�results,�

more�timely�completion�of�the�projects�and�a�higher�level�of�job�satisfaction�expressed�by�project�

managers.���

Recommendation #7�-�Develop�and�implement�a�more�enhanced�communications�strategy�and�plan�

Several�staff�and�management,�mostly�in�offices�outside�of�Ottawa,�noted�a�sense�of�disconnection�

with�the�overall�organization.��The�CCAC’s�communication�plan�should�be�developed�with�the�goal�of�

developing�a�stronger�sense�of�“team”�with�the�staff�members�in�these�offices.��Where�staff�report�

to�management�in�Ottawa,�Champlain�CCAC�may�wish�to�consider�implementing�a�matrix-type�

reporting�structure�that�allows�for�the�individual�staff�members�to�be�more�closely�integrated�into�the�

office�where�they�work.��Champlain�staff�also�indicated�that�staff�meetings�did�not�appear�to�be�well�

attended�and�messages�seemed�unclear.�Senior�leadership�need�to�more�regularly�rotate�through�

main�branch�offices.��Processes�and�structures�need�to�be�enhanced�in�order�for�staff�members�to�

feel�heard�and�to�have�a�connection�to�the�office�where�they�reside.�

In�order�for�the�CCAC�to�be�at�the�forefront�of�change�in�the�Champlain�LHIN�it�requires�robust�

communications�strategies.���In�addition�to�day�to�day�internal�and�external�communication�activities�

the�organization’s�improvement�projects�and�change�management�strategies�need�to�be�supported�by�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 24�

detailed�communications�plans.�While�Champlain�CCAC�does�have�communication�plans�in�place,�it�is�

apparent�from�staff�focus�groups�and�surveys�received�that�these�plans�need�to�be�reviewed�and�

evaluated.��The�plans�must�be�targeted�to�the�specific�groups�that�need�to�receive�the�relevant�

information.��Effective�communications�plans�will�not�only�encourage�dialogue�and�exchange�of�ideas�

but�also�set�the�balance�between�“too�much”�and�“not�enough”�communication.��In�addition,�the�

plans�need�to�be�developed�in�collaboration�with�the�change�management�plan�discussed�above�and�

stakeholder�engagement�strategy�discussed�in�the�section�on�Stakeholder�Engagement.�The�plans�

must�link�the�strategic�objectives�to�the�operational�plans.��

The�successful�implementation�of�this�recommendation�can�be�measured�by�monthly�“pulse”�

surveys,�monthly�team�meetings�with�feedback�rolled�up�to�senior�leadership.�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 25�

Stakeholder�Relations�CCACs�are�in�the�unique�position�as�the�only�healthcare�organization�that�is�aligned�with�the�LHINs’�

geographic�boundaries.��It�is�also�the�one�organization�that�interfaces�with�all�types�of�healthcare�

providers�including�acute,�primary,�long-term�care,�continuing�care�community�and�others�that�fall�

outside�the�traditional�“healthcare”�sphere.��Given�this�unique�position,�it�is�integral�that�the�CCAC�

have�strong�partnerships�across�all�levels�of�care�and�at�all�levels�from�governance�to�senior�

management�to�front-line�worker.���

The�analysis�associated�with�this�particular�category�is�more�qualitative�in�nature.��Where�possible,�

documentation�that�supported�the�strength�or�weakness�of�the�relationship�was�provided�in�

confidence�to�the�consultants.�Only�common�themes�are�included�in�this�section.��The�themes�

identified�in�this�report�reflect�the�concerns�and�issues�raised�by�a�majority�of�stakeholders.��Issues�or�

comments�that�were�not�replicated�by�others�have�not�been�included�in�the�analysis.���

Over�150�individuals�participated�in�focus�groups,�were�interviewed�individually�or�provided�written�

feedback.��The�individuals�represented�a�number�of�organizations�including�hospitals,�long-term�care�

facilities,�contracted�service�providers,�community�support�agencies,�municipalities�and�clients.��A�list�

of�the�organizations�involved�can�be�found�in�Appendix�A.��

Given�the�diversity�of�stakeholders�that�were�interviewed,�stakeholders�have�been�grouped�into�five�

separate�groups:��Health�Care�Providers�(hospitals,�community�support�services,�long�term�care�

facilities�and�physicians),�Clients,�Staff,�Franco-Ontarians,�LHIN�and�Others.�Contracted�Service�

Providers�are�discussed�within�the�Contract�Management�section�of�this�chapter.���While�there�are�

many�themes�that�are�common�to�all�stakeholders,�there�are�some�that�are�unique�to�the�perspective�

of�the�various�groups.���

Common�themes�identified�by�all�stakeholders�are�as�follows:�

• Lack�of�understanding�of�CCAC’s�mandate,�vision,�roles�and�accountabilities;��

• Limited�communication�with�regards�to�services�available,�the�criteria�to�receive�CCAC�services�

and�the�various�programs�available�to�the�CCAC�(e.g.�Stay-at-Home,�Wait-at-Home);�

• �Perception�that�information�provided�among�all�partners�is�not�always�appropriate�or�up-to-date;�

• �Inconsistency�across�case�managers�in�services�that�can�be�provided;�and�

• �Lack�of�data�provided�to�support�decision�making�at�partner�organizations.�

The�following�discussion�presents�the�concerns�and�issues�raised�by�various�stakeholders.��Analysis�

of�the�information�indicates�a�need�for�the�CCAC�to�improve�communications,�clarity�of�mandates,�

data�and�accountabilities.��There�is�also�a�need�for�collaborative�planning�between�organizations.��In�

many�cases�the�relationships�with�external�partners�at�the�senior�level�were�much�stronger�than�those�

between�front-line�staff.��Also�for�the�most�part�the�relationships�among�staff�in�organizations�in�areas�

outside�of�Ottawa�appeared�to�be�stronger�than�amongst�the�staff�in�organizations�in�Ottawa.��

Health Care Providers

The�category�of�Health�Care�Providers�includes�hospitals�and�physicians,�community�support�service�

agencies�and�long-term�care�facilities.�Many�health�care�providers�noted�that�they�were�unclear�of�

what�services�the�CCAC�could�provide�to�clients�and�where�boundaries�existed�when�roles�between�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 26�

healthcare�partners�potentially�overlapped.��Many�also�perceived�the�mandates�of�the�separate�

organizations�as�being�inconsistent�with�one�another�and�noted�that�often�the�focus�on�the�individual�

receiving�care�was�forgotten.��

Healthcare�providers�noted�that�the�multiple�systems�and�processes�in�place�at�each�provider�led�to�a�

heavy�reliance�on�paper�processes.��The�processes�are�not�as�efficient�as�they�could�be�and�

information�faxed�between�organizations�can�often�be�difficult�to�read�which�leads�to�a�number�of�

steps�required�to�verify.��They�also�note�that�often�information�isn’t�as�complete�or�as�up-to-date�as�

necessary�to�make�the�most�effective�decisions.���

Hospitals

The�majority�of�hospitals�noted�a�frustration�with�the�level�of�access�that�they�have�to�the�CCAC.��In�

some�cases�they�do�not�understand�why�their�hospital�volumes�are�not�enough�to�warrant�a�dedicated�

case�manager.��Many�do�note�that�access�to�services�seems�dependent�on�the�case�manager�

assigned�to�the�hospital�or�area.��In�hospitals�with�multiple�case�managers�they�note�a�difference�in�

the�amount�of�services�that�they�seem�able�to�secure�based�on�the�individual�case�manager.��Others�

note�an�issue�with�the�hours�of�case�management�service�that�are�provided.��Some�expressed�

frustration�with�what�they�perceive�is�inflexibility�surrounding�the�closure�between�12�and�1�for�lunch�

or�the�availability�of�extended�hours�to�meet�their�volumes.��They�would�like�to�see�case�managers�

more�responsive�and�flexible�with�hours�to�meet�the�needs�of�the�hospital�with�regards�to�the�daily�

volume.��The�CCAC�is�working�towards�providing�more�dedicated�case�managers�in�the�hospitals’�

emergency�departments�throughout�Champlain,�whose�volumes�warrant�a�position.��However,�it�is�

currently�unclear�to�the�hospitals�what�volumes�are�necessary�to�have�this�position.��

A�number�of�hospitals�were�concerned�with�the�availability�of�services,�skilled�service�provider�staff�in�

the�community�or�that�the�individual�would�receive�care�in�the�medically�appropriate�time�frame.��

Many�are�unsure�that�the�agency�staff�in�the�community�are�knowledgeable�about�the�complexity�of�

some�patients�and�the�most�appropriate�care�plan.�With�no�data�to�either�support�or�dispute�these�

concerns,�some�hospital�staff�members�have�created�work-arounds�to�provide�the�individuals�with�

care�and�request�that�the�individual�return�to�hospital�to�receive�follow-up�care.���

Many�physicians�and�some�hospital�staff�indicated�that�they�are�not�aware�of�the�process�and�

resources�available�in�the�various�communities�within�Champlain�LHIN.�Many�noted�that�if�they�

believed�an�individual�would�not�qualify�for�CCAC�services�they�would�not�refer�and�were�unaware�of�

the�information�and�referral�services�that�are�available�at�the�CCAC.�Those�physicians�that�do�not�refer�

may�spend�additional�time�in�navigating�the�system�in�order�to�determine�the�services�and�resources�

that�are�available�or�may�request�the�individual�come�back�to�an�institution�to�receive�care�placing�

additional�burdens�on�the�institution.�

The�CCAC�has�implemented�a�new�website�and�310-CCAC�to�provide�information�and�referral�

services�and�expand�its�role�as�system�navigator.��These�are�relatively�new�programs�and�the�long-

term�success�will�need�to�be�evaluated.��Due�to�some�historical�challenges�and�the�preconceived�

reputation�of�the�CCAC�in�various�areas�of�Champlain,�the�CCAC�may�have�difficulty�in�quickly�

addressing�these�concerns.��It�will�be�important�for�the�CCAC�moving�forward�to�provide�data�that�

shows�the�hospital�partners�data�such�as�“time�from�referral�to�action”,�“number�of�referrals�by�time,�

day�and�hospital�location”,�“delays�in�discharges�as�a�result�of�CCAC”,�to�inform�and�build�the�

confidence�of�the�hospital�staff�and�physicians.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 27�

Community Support Services

Community�support�service�(CSS)�agencies�noted�a�difficulty�in�feeling�like�a�valued�member�of�the�

care�team.��Quite�often�the�services�provided�by�a�CSS�are�more�frequent�than�the�CCAC�services�

and�the�interactions�with�the�staff�or�volunteers�provide�information�that�can�be�used�to�monitor�the�

status�of�an�individual�client.��While�the�staff�in�CSS�agencies�may�not�be�regulated�health�

professionals,�they�are�familiar�enough�with�the�individual�to�know�when�the�condition�is�changing�and�

if�it�warrants�follow-up�by�the�CCAC.��

Some�CSS�agencies�also�noted�that�they�have�seen�a�noticeable�drop�in�referrals�to�programs�such�as�

adult-day�over�the�past�number�of�years.��A�number�of�agencies�indicated�that�they�used�to�regularly�

receive�3�to�5�referrals�a�day�and�they�were�now�receiving�3�to�5�referrals�a�week.��The�reasons�

behind�the�drop�have�never�been�fully�understood,�evaluated�or�communicated.��The�CSS�agencies�

occasionally�notice�a�brief�increase�in�the�number�of�referrals�after�they�initiate�communication�with�

the�CCAC�identifying�the�issue�but�note�they�return�to�lower�levels�after�a�short�period�of�time.��They�

believed�the�CCAC�staff�didn’t�properly�understand�what�programs�they�offered�and�the�number�of�

spaces�they�had�available.��Many�agencies�indicated�that�they�had�spaces�available�in�some�of�their�

programs�and�could�not�understand�why�they�were�not�receiving�referrals�from�the�CCAC�when�the�

apparent�lack�of�services�and�resources�provided�in�the�community�was�making�headlines.���

Long-Term Care

Long-term�care�facilities�noted�a�difficulty�with�variance�between�the�information�they�were�provided�

by�the�CCAC�and�the�status�of�the�individual�when�they�were�admitted.��Many�facilities�indicated�that�

information�was�incomplete�or�appeared�to�be�contradictory�to�the�actual�status�of�the�individual.��

They�believed�this�has�led�to�residents�being�admitted�to�an�inappropriate�facility�or�area�within�a�

facility.��It�causes�strain�on�their�staff�as�they�may�not�be�appropriately�trained�for�certain�conditions�

and�the�individual�may�put�other�residents�at�risk�as�the�facility�is�not�properly�equipped�to�handle�the�

condition�(e.g.,�secure�facilities�for�dementia�residents).���

It�was�also�interesting�to�note�the�dichotomy�between�hospitals�and�long-term�care�facilities�in�their�

perception�of�which�individual�gets�“priority”.��The�perception�from�the�hospitals�is�that�clients�waiting�

in�the�community�receive�priority,�while�others�perceive�that�hospital�patients�are�getting�faster�

access�to�long-term�care�beds.��In�the�absence�of�data�it�is�difficult�for�the�CCAC�to�dispel�these�

perceptions�and�communicate�where�the�people�are�coming�from.��The�CCAC�did�have�limited�data�to�

indicate�that�it�was�approximately�50-50.���This�data�is�not�routinely�presented�to�partners.��It�is�also�

important�to�note�that�the�long-term�care�providers�reported�that�clients�who�were�admitted�directly�

from�hospital,�while�usually�more�frail�upon�admission�to�the�facility�are�generally�healthier�and�more�

independent�within�a�few�months�than�those�who�are�admitted�directly�from�the�community.��Many�

long-term�care�providers�indicated�that�they�felt�a�number�of�residents�admitted�directly�from�hospital�

could�remain�independent�in�the�community�if�they�had�access�to�transitional�or�convalescent�care�

upon�hospital�discharge.��Lack�of�data�leads�to�distrust�between�partners�and�inefficient�use�of�

healthcare�resources.��

As�part�of�the�recommended�stakeholder�engagement�strategy�discussed�in�more�detail�later�in�this�

section,�it�will�be�important�for�the�CCAC�to�work�with�the�hospitals,�long-term�care�providers�and�the�

LHIN�to�analyse�this�data�to�see�what�possible�gaps�there�are�in�services�and�what�mitigation�

strategies�can�be�implemented�to�reduce�the�overall�strain�on�the�healthcare�system.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 28�

Franco-Ontarian population

A�focus�group�with�stakeholders�who�provide�services�to�the�Franco-Ontarian�population�within�the�

Champlain�region�was�held�to�discuss�French�language�health�services�and�the�issues�that�may�be�

unique�to�this�population.���

Many�of�the�concerns�addressed�above�are�similar�to�the�ones�expressed�with�those�who�provide�

services�to�Franco-Ontarians.��However,�additional�concerns�were�expressed�by�this�stakeholder�

group�that�relate�specifically�to�the�ability�to�plan�for�and�receive�services�in�French.��Providers�to�this�

population�perceived�themselves�as�an�“after-thought”�when�it�came�to�the�development�of�the�

CCAC�strategy�and�feel�removed�from�the�decision�making�process.���

There�is�a�perception�that�there�are�limited�services�available�to�Franco-Ontarians�and�a�lack�of�

francophone�resources�that�can�provide�services�to�individuals�in�the�community.��A�significant�

proportion�of�this�population�live�in�the�eastern�part�of�the�LHIN.��Service�providers�did�note�that�they�

had�more�difficulty�in�recruiting�resources�in�this�particular�area�(discussed�within�the�Contract�

Management�section�of�this�report).��There�is�limited�data�that�clearly�articulates�whether�this�

perception�is�reality.���As�mentioned�in�the�Case�Management�section,�the�CCAC�needs�to�work�in�

collaboration�with�all�healthcare�partners�that�develop�initiatives�which�meet�the�needs�of�this�

population.������

Clients

Champlain�CCAC�is�involved�in�the�provincial�client�survey�initiative�which�is�currently�under�

development.��At�the�beginning�of�the�project�it�was�hoped�that�the�results�of�this�third�party�client�

satisfaction�survey�could�be�used�to�inform�the�review.��However,�the�survey�was�not�complete�at�the�

time�of�writing�this�report�and�the�results�are�not�included�in�this�analysis.��Champlain�clients�have�not�

provided�formal�feedback�since�prior�to�amalgamation�so�previous�client�satisfaction�surveys�would�be�

more�than�three�years�old�and�were�not�analysed�during�this�review.���

In�order�to�understand�the�CCAC’s�strengths�and�challenges�from�a�client’s�perspective,�focus�groups�

and�interviews�were�held�with�approximately�30�clients�or�their�family�care-givers�across�Champlain.��

Focus�groups�were�conducted�in�Pembroke,�Ottawa,�Cornwall�and�Hawkesbury.��The�focus�group�in�

Hawkesbury�was�conducted�in�French�and�the�facilitator�who�is�fluent�in�French�also�attended�the�

other�three�focus�groups.��Interviews�were�conducted�in�the�preferred�language�of�the�client.���

Other�CCACs,�including�those�that�are�participating�in�the�provincial�initiative�have�implemented�

additional�tools�that�they�use�to�collect�client�feedback�on�a�regular�basis.��This�information�becomes�

one�part�of�a�balanced�scorecard.��In�the�absence�of�a�large�random�survey�it�is�difficult�to�analyse�

client�satisfaction�levels�and�to�determine�trends�across�the�region.���

One�of�the�drivers�of�this�review�was�the�perception�that�some�stakeholders�held�that�there�were�

issues�with�the�level�and�amount�of�service�that�clients�were�receiving.�Based�on�the�analysis�of�the�

information�provided�by�the�CCAC,�the�CCAC,�along�with�the�contracted�service�providers�track�

occurrences�and�monitor�the�resolution�of�issues�on�a�regular�basis.��There�is�however,�limited�

evidence�that�this�information�is�fed�back�either�to�the�organization,�client�or�case�management�staff�

member�who�initiated�the�claim.�Of�the�clients�who�were�interviewed�in�the�context�of�this�report�

many�had�contacted�the�LHIN�to�voice�a�concern�over�the�service�that�they�or�a�family�member�was�

receiving.��It�is�important�to�note�that�when�asked�if�they�voiced�their�concern�to�their�CCAC�case�

manager,�the�majority�indicated�that�they�had�not.��When�asked�why�they�did�not�let�the�CCAC�know,�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 29�

many�indicated�that�they�“probably�should�have”.��While�not�all�cases�require�CCAC�case�manager�

intervention,�clients�should�be�made�aware�that�if�the�issue�is�not�resolved�directly�with�the�service�

provider�or�the�service�provider�agency�the�concern�should�be�referred�to�the�CCAC�for�resolution.���

Very�few�clients�interviewed�noted�a�concern�with�the�number�of�service�provider�agencies�providing�

their�care�or�service.��While�the�majority�of�clients�interviewed�individually�or�in�focus�groups�did�have�

a�single�agency�providing�the�same�type�of�services�(e.g.�Agency�X�provided�nursing�care�and�Agency�

Y�provided�Personal�Support,�where�X�and�Y�may�not�be�the�same),�those�that�received�care�from�

multiple�agencies�expressed�concern�more�over�the�consistency�of�care�versus�the�consistency�of�

agency.���

Clients�and�caregivers�repeatedly�identified�the�need�for�access�to�more�“every�day”�services�

required�and�not�solely�those�that�are�classified�as�Activities�of�Daily�Living.��While�providing�these�

services�is�outside�of�the�CCAC’s�mandate,�its�role�as�system�navigator�can�link�individuals�to�services�

that�are�beyond�“healthcare”.��The�limits�and�amount�of�services�available�are�not�clearly�understood�

by�clients�and�their�caregivers�and�communication�around�why�services�are�no�longer�being�provided�

may�not�always�be�clear.��Clients�and�caregivers�are�looking�for�more�flexibility�with�the�hours�and�

types�of�services,�which�may�not�be�feasible�within�the�mandate.��The�CCAC�could�be�an�effective�

partner�in�advocating�for�this�type�of�change.�As�part�of�the�development�of�the�new�case�

management�model�discussed�later,�there�may�be�an�opportunity�to�utilize�data�more�effectively�to�

see�what�services�specific�client�groups�require�so�services�can�be�more�appropriately�tailored.��In�

addition,�expanding�the�role�to�include�system�navigation�may�provide�the�flexibility�in�services�that�

clients�require.���

Clients�also�voiced�their�frustration�with�the�need�to�tell�“their�story”�to�a�multitude�of�people�involved�

in�their�care.��While�this�is�not�unique�to�Champlain,�other�CCACs�have�started�to�electronically�share�

information�between�providers�in�an�attempt�to�reduce�this�burden.��Clients�also�noted�that�the�

information�held�by�the�CCAC�did�not�always�appear�to�be�effectively�communicated�between�case�

management�staff.��As�clients�moved�between�case�managers,�either�as�periodic�case�load�

restructuring�or�between�hospital�and�community,�they�felt�they�needed�to�repeat�some�basic�

information�to�the�new�case�manager�that�was�not�related�to�change�in�status.��They�felt�the�history�

was�being�lost�and�they�needed�to�start�from�the�beginning�each�time�they�were�assigned�a�new�case�

manager.��

Many�clients�noted�that�while�they�appreciated�the�ability�to�receive�services�at�a�clinic�location,�since�

it�gave�them�more�control�over�their�day,�at�times�they�would�like�the�choice�to�receive�services�in�

their�home.��For�instance,�a�client�just�released�from�hospital�may�wish�to�receive�the�initial�services�

at�home�while�they�recuperate�and�then�switch�to�a�clinic�setting�once�they�are�more�fully�recovered.��

One�client�noted�that�the�first�few�weeks�after�discharge�were�very�difficult�and�the�requirement�to�

get�to�a�clinic�for�services�was�very�draining�and�challenging�as�the�client�relied�heavily�on�caregivers�

to�drive�due�to�the�medication�restrictions.��Once�the�client’s�strength�improved�the�client�preferred�to�

receive�services�at�the�clinic.��These�comments�reflect�the�general�wish�of�clients�to�feel�their�

personal�needs�are�heard.��

Many�clients�did�indicate�that�they�had�a�positive�relationship�with�their�case�manager�and�felt�that�

many�case�managers�went�out�of�their�way�to�identify�services�available.��However,�some�indicated�

that�they�had�minimal�contact�with�their�case�manager,�especially�as�services�were�being�changed.��

The�lack�of�communication�caused�frustration�and�a�lack�of�trust�with�the�CCAC.��A�few�caregivers�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 30�

noted�that�they�did�not�feel�as�a�trusted�member�of�the�care�team,�yet�felt�they�were�relied�upon�

heavily�to�provide�services.���

While�these�observations�were�obtained�from�a�small�sample�of�approximately�30�clients�and�

caregivers,�it�is�worthwhile�to�consider�how�the�“customer”�experiences�the�CCAC.��A�common�

theme�across�all�facets�of�this�review�was�the�communication�and�processes�are�often�not�well�

aligned.��This�can�contribute�to�the�client�experiences�reported�back.����

Staff and Management

During�this�review�we�had�the�opportunity�to�meet�with�several�staff�members�at�focus�groups�held�in�

three�different�CCAC�branch�offices.��Three�focus�groups�were�held�with�front-line�staff�members�and�

one�with�middle�management�staff�members.��In�addition,�a�voluntary�questionnaire�was�

electronically�distributed�to�CCAC�employees�to�provide�an�opportunity�for�any�staff�member�to�have�

input.��While�there�was�not�a�significant�number�of�responses�from�the�questionnaire,�the�responses�

received�did�provided�constructive�feedback�and�were�congruent�with�what�was�heard�during�the�

staff�and�management�focus�groups.���

Staff�indicated�that�different�processes�still�existed�throughout�Champlain.��While�some�of�the�

processes�are�as�a�result�of�the�variation�in�services�available�in�the�particular�areas,�many�noted�that�

processes�could�be�improved.��Some�felt�that�processes�were�developed�without�an�understanding�of�

the�geographic�implications�that�are�perceived�to�exist.��They�feel�that�they�are�not�included�in�process�

design�discussions�and�process�development.��Although�a�number�of�staff�were�involved�in�process�

design�discussions,�some�indicated�they�felt�the�processes�were�already�determined�and�their�input�

was�cosmetic.�The�staff�who�reside�outside�Ottawa�see�the�processes�that�have�been�developed�as�

very�focused�on�Ottawa.��Management�involved�in�the�process�design�indicated�that�actually�

processes�that�had�been�in�place�in�the�CCAC�offices�outside�of�Ottawa�were�implemented�

throughout�the�organization.��These�different�perceptions�reflect�the�ongoing�divisions�across�the�4�

previous�organizations.��

Staff�also�indicated�that�the�roles�and�responsibilities�are�perceived�to�vary�across�Champlain.��Team�

Assistants�did�not�perceive�their�roles�as�being�consistent�across�Champlain.��Case�Managers�felt�that�

case�loads�varied�across�the�region�and�administrative�pressures�kept�them�from�doing�their�role�

effectively.��With�the�roll�out�of�the�new�case�management�model�discussed�later,�it�will�be�important�

to�establish�the�standard�case�load�ranges�based�on�client�group�characteristics.��In�the�meantime,�

with�the�enhancement�of�decision�support�noted�earlier,�managers�need�to�receive�the�clinical�and�

financial�data�and�address�concerns�and�any�variations�accordingly.���The�variations�in�practices�

reported�by�staff�are�consistent�with�the�perceptions�of�clients�and�external�partners.���

LHIN

The�LHIN�and�the�CCAC�have�a�unique�relationship�in�that�they�are�the�only�two�organizations�that�

share�the�same�geography.��Both�organizations�are�relatively�new�and�there�is�a�need�to�more�

thoroughly�understand�the�pressures�faced�by�each�organization�and�strategies�to�work�more�

collaboratively�to�address�these�pressures.��Financial�and�service�information�provided�to�the�LHIN�

from�the�CCAC�over�the�past�few�years�has�not�given�the�LHIN�confidence�that�the�CCAC�leadership�

is�effectively�managing�the�organization.��Parties�indicate�that�they�are�providing�each�organization�the�

necessary�information�but�some�clarification�is�needed�as�to�whether�this�information�is�complete�and�

fulsome.��In�the�past,�some�information�provided�has�not�been�reliable.�Over�time�there�has�been�an�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 31�

erosion�of�trust�on�both�sides,�resulting�from�various�issues�that�led�to�this�review.��Both�the�LHIN�

and�the�CCAC�need�to�build�a�strong�partnership�in�order�to�advance�the�shared�goal�of�increasing�the�

level�and�scope�of�integration�of�the�healthcare�system.��As�the�parties�move�forward�they�will�need�

to�work�collaboratively�on�the�improvement�plan.����

Others

This�category�includes�school�boards,�the�City�of�Ottawa�as�well�as�a�diverse�group�of�stakeholders�

and�condition�advocacy�organizations.��There�are�several�agencies�and�organizations�outside�of�the�

traditional�healthcare�domain�that�interact�with�the�CCAC�on�a�regular�basis�and�also�provide�services,�

support�and/or�information�to�CCAC�clients.���

Many�of�these�agencies�feel�that�the�services�they�provide�are�not�valued�by�the�CCAC,�as�they�fall�

outside�the�traditional�“healthcare”�domain.��Several�of�these�organizations�provide�information�and�

education�to�individuals�with�certain�conditions�and�would�like�to�be�considered�as�a�valuable�and�

trusted�source�of�information.�In�addition,�they�may�have�access�to�certain�services�that�could�be�

utilized�and�would�enhance�the�“healthcare”�services�that�an�individual�is�receiving.��Many�of�these�

services�include�assistance�with�activities�that�would�not�be�considered�activities�of�daily�living�which�

clients�indicated�they�may�be�interested�in�receiving�such�as�transportation�and�recreation.�����

Recommendation

Many�of�the�concerns�addressed�by�stakeholders�are�as�a�result�of�communication�challenges,�a�lack�

of�understanding�the�CCAC’s�mandate,�and�limited�data�provided�to�build�confidence�in�the�services�

provided�by�Champlain�CCAC.��

In�order�to�address�the�concerns�of�the�stakeholders�and�enhance�and�strengthen�partnerships�it�is�

recommended�that�the�CCAC:��

Recommendation #8� Develop�and�implement�a�robust,�coordinated�stakeholder�engagement�

strategy�for�all�stakeholders,�including�the�key�messages,�timelines,�roles,�

accountabilities�and�metrics�necessary�for�each�stakeholder�for�evaluation.���

The�stakeholder�engagement�strategy�should�enhance�the�integration�role,�

build�stronger�partnerships�and�clarify�the�roles�and�responsibilities�of�all�

stakeholders.���

The�definition�of�success�including�outcomes�and�performance�metrics�will�

be�developed�in�collaboration�with�the�stakeholders.���

The�implementation�of�the�robust,�coordinated�stakeholder�engagement�strategy,�discussed�in�detail�

below,�will�help�Champlain�CCAC�achieve�its�strategic�and�operational�objectives.���

Recommendation #8�-�Develop�and�implement�a�robust,�coordinated�stakeholder�engagement�

strategy�for�all�stakeholders,�including�key�messages,�timelines,�roles,�accountabilities�and�metrics�for�

evaluation.����

Due�to�the�unique�integration�role�of�the�CCAC,�it�is�important�for�the�CCAC�to�develop�a�robust�

stakeholder�engagement�strategy�that�focuses�on�the�individual�strategies�required�for�enhancing�the�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 32�

partnerships�and�relationships�with�each�stakeholder.��It�is�important�to�note�that�while�part�of�the�

stakeholder�engagement�strategy�includes�a�communication�plan�and�strategy�it�is�much�more�

detailed.��There�is�a�need�for�the�stakeholder�engagement�strategy�to�have�separate�internal�and�

external�strategies.���

The�stakeholder�engagement�plan�is�aligned�with�the�management�accountabilities�across�the�

organization.��The�resource�is�used�to�influence�and�develop�relationships�with�the�numerous�

stakeholders�who�interact�with�the�CCAC.��For�each�stakeholder�or�groups�of�stakeholders�the�key�

messages�are�clearly�articulated�and�the�data�that�is�needed�to�support�the�key�messages�is�

identified,�collected�and�monitored.��Key�messages�are�drafted�to�identify�and�address�partners�

“points�of�pressure”�as�well�as�how�day-to-day�operations�support�the�CCAC’s�Strategic�Plan.�

Many�stakeholders�still�noted�that�they�were�often�unclear�about�the�mandate�of�the�CCAC�as�well�as�

the�boundaries�between�organizations,�especially�when�these�organizations�fall�outside�the�traditional�

healthcare�environment.��The�Stakeholder�Engagement�Strategy�should�also�clearly�outline�the�role�

and�mandate�of�the�CCAC�and�how�all�organizations�work�collaboratively�to�achieve�the�mandate.��

Many�healthcare�partners�noted�that�the�role�and�mandate�of�the�CCAC�is�not�clear.��Many�feel�

confused�with�regards�to�what�services�the�CCAC�can�offer�and�navigate.��As�part�of�the�strategy,�the�

CCAC�must�clearly�define�and�communicate�its�current�mandate,�roles�and�boundaries�and�ensure�its�

proper�understanding�among�all�stakeholders.�In�addition,�as�the�mandate�is�expanded,�the�CCAC�

needs�to�make�sure�the�communication�with�its�providers�is�clear�and�all�understand�the�roles�and�

expectations�of�all�stakeholders.�The�CCAC�needs�to�build�on�its�branding�and�other�initiatives�to�

define�and�communicate�its�current�and�expanding�mandate�and�work�with�these�stakeholders�to�

develop�clearly�defined�roles�and�responsibilities�and�the�interfaces�required�to�make�sharing�clients�

and�information�more�seamless.���

Better�communication�is�required�between�CCAC�and�health�providers.��Improved�communication�

does�not�mean�higher�volumes�of�information�transmitted�or�more�meetings,�but�more�targeted�and�

efficient�communication.��Healthcare�partners,�including�physicians,�may�not�be�aware�of�scope�of�

services�available�in�the�community�and�may�not�refer�to�the�CCAC�if�they�do�not�think�the�individual�

would�“meet�the�criteria”�for�CCAC�services.��In�some�cases�it�was�noted�that�healthcare�partners�

have�stopped�referring�individuals�for�CCAC�services�and�instead�directing�the�individual�to�return�to�

the�hospital�for�follow-up�care�as�they�lack�trust�that�the�referral�will�be�addressed�in�a�medically�

appropriate�manner.��It�is�important�that�the�engagement�plan�address�key�messages�such�as�the�

scope�of�services�available�(including�system�navigation)�and�the�expected�access�and�times�

associated�with�receiving�services.��Doing�so�may�address�some�issues�identified�by�providers�and�

help�to�build�trust�within�the�system.��In�addition,�the�plan�should�identify�the�data�required�to�build�

and�enhance�the�relationships�between�partners�and�help�to�develop�a�view�of�information�required�to�

provide�a�common�and�shared�view�of�the�client.��In�this�case,�the�key�messages�would�be�supported�

by�data�such�as,�CCAC�services,�utilization�patterns,�client�demographics,�timelines�and�referrals.��This�

should�help�to�make�the�process�more�transparent�and�work�towards�developing�a�common�

understanding�of�the�organization’s�strengths�and�challenges.��

Some�CCACs�have�developed�MOUs�with�their�healthcare�providers�as�part�of�their�stakeholder�

engagement�strategy.��The�MOUs�outline�performance�metrics�and�information�which�is�shared�

between�partners�on�a�pre-determined�basis.��Utilizing�the�information�that�each�provider�has�with�

regards�to�the�individual�client�more�effectively�can�build�trust�within�the�circle�of�care.��The�data�also�

helps�to�build�joint�programs�and�interfaces�between�organizations�and�will�inform�the�CCAC�and�its�

partners�as�they�move�forward�with�the�development�of�the�new�processes�in�support�of�the�new�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 33�

case�management�model�that�is�discussed�later.��The�data�can�also�be�utilized�by�the�LHIN�and�other�

partners�to�identify�where�services�in�the�Champlain�region�need�to�be�developed�or�enhanced.�This�

should�facilitate�integration�within�the�LHIN.��

As�part�of�the�stakeholder�engagement�strategy�it�will�be�important�to�work�collaboratively�with�client�

services,�contract�management�and�partners�to�develop�an�engagement�strategy�that�focuses�on�the�

client.��Part�of�this�strategy�will�include�outlining�how�to�enhance�and�improve�the�customer�

experience�with�the�entire�system.��Part�of�this�may�include�developing�what�common,�shared�

information�on�the�client�is�required�by�each�organization�to�provide�an�enhanced�customer�

experience.��It�will�also�include�identifying�the�processes�and�procedures�that�may�need�to�be�

redesigned�or�enhanced�in�order�to�improve�relations�with�this�stakeholder.���

It�will�also�provide�a�process�to�work�collaboratively�with�healthcare�partners�to�implement�innovative�

programs�such�as�systems,�programs�designed�to�reduce�alternate�level�of�care�days�that�are�

currently�in�use�in�other�jurisdictions�which�may�reduce�health�system�challenges.��Communication�

should�include�exchanging�ideas�as�well�as�the�opportunity�to�debate�these�ideas.����

The�stakeholder�engagement�strategy�will�also�include�performance�indicators�and�metrics�as�they�

relate�to�each�stakeholder�group.��These�metrics�will�include�ways�to�evaluate�the�relationship�and�the�

data�will�assist�each�stakeholder�to�assess�where�relationships�need�to�be�enhanced�and�

strengthened.�Metrics�need�to�be�focused�service�metrics�and�not�based�on�“number�of�meetings�

held”.�The�definition�of�success�will�be�a�collaborative�process�between�the�CCAC�and�each�

stakeholder.��It�will�be�important�for�the�CCAC�to�work�in�collaboration�with�each�partner�identified�in�

the�strategy�to�develop�the�service�metrics,�reports�and�communication�strategies�required�to�

effectively�build�stronger�relationships.��Data�should�be�shared�between�all�parties�as�it�should�assist�

in�strengthening�the�understanding�that�each�partner�has�of�the�other’s�environment.��As�an�example,�

there�may�be�data�that�could�be�shared�with�the�CCAC�by�LTC�facilities�with�regards�to�any�change�in�

health�status�of�residents�admitted�from�community�or�hospital�after�a�period�of�time.��If�after�regular�

monitoring,�the�perception�that�is�held�now�is�verified�(i.e.�residents�directly�admitted�from�hospital�

are�generally�healthier�and�more�independent�after�a�few�months�in�a�LTC�facility�than�those�admitted�

from�community),�the�CCAC�can�use�the�information�and�develop�programs�in�collaboration�with�other�

healthcare�partners�to�develop�solutions�that�would�provide�care�for�these�individuals�in�other�settings�

in�order�to�discharge�from�hospital�and�possibly�delay�admission�to�LTC�facilities.��

Given�the�strategic�importance�of�stakeholder�engagement�for�the�CCAC�and�the�need�to�develop�and�

enhance�relationships�with�a�number�of�providers�and�build�on�its�role�within�Communities�of�Care�

and�communities�of�practice,�the�CCAC�should�consider�allocating�an�additional�resource�(1�FTE)�to�

focus�on�stakeholder�engagement,�in�addition�to�the�one�senior�position�currently�in�place.��This�

position�would�report�to�the�Director�of�Strategic�Planning�and�Integration.��The�additional�resource�

would�allow�the�CCAC�a�broader�reach�and�enable�Champlain�CCAC�to�develop�more�focused�

relationships.���The�CCAC�needs�to�evaluate�the�skills�required�for�this�role�and�determine�whether�the�

skills�and�resource�exist�internally�and�what�impact�an�internal�movement�may�have�on�the�

organization.��It�is�important�that�this�resource�possess�the�community�engagement�and�facilitation�

skills�required�to�engage�and�mobilize�a�team�to�identify�the�issues�and�challenges�faced�by�healthcare�

partners�and�facilitate�possible�solutions.����

The�successful�implementation�of�this�recommendation�will�be�measured�by�the�improvements�and�

increases�in�client�and�stakeholder�satisfaction�rates�as�identified�by�surveys�and�face-to-face�

feedback�and�on�a�stakeholder�scorecard.��Plans�should�also�assign�robust�responsibility�to�key�CCAC�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 34�

staff�to�maintain�relationships.��Regular�status�updates�should�be�provided�into�the�organizational�

stakeholder�scorecard.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 35�

Contract�Management�One�of�the�benefits�of�this�review�was�the�opportunity�for�an�independent�third�party�to�meet�with�

Service�Provider�Agencies�(SPA).��While�many�SPAs�indicated�that�they�had�a�relatively�strong�

relationship�with�the�CCAC�senior�leadership,�they�did�acknowledge�that�this�review�gave�them�an�

opportunity�to�raise�issues�that�they�may�not�feel�completely�comfortable�addressing�directly�with�the�

CCAC.���

The�CCAC�has�contracted�with�14�service�providers�(including�medical�supplies�and�equipment)�to�

provide�services�throughout�the�Champlain�region.�The�CCACs�on�the�Peer�Advisory�Panel�noted�that�

this�relatively�small�number�may�be�both�a�benefit�and�a�challenge.��The�small�number�should�allow�

the�CCAC�to�build�stronger�relationships�with�the�providers�and�the�staff�in�the�region�but�also�a�

challenge�in�covering�any�resource�shortages.���

In�order�to�work�more�effectively�with�its�service�providers,�Champlain�CCAC�has�implemented�the�

Service�Provider�Scorecard�that�was�developed�provincially,�in�the�past�few�months.��The�scorecard�

has�helped�Champlain�CCAC�to�monitor�client�issues�and�concerns�and�possible�gaps�in�client�care�

plans.��The�scorecard�also�helps�to�monitor�SPA�performance�and�allows�both�the�CCAC�and�the�SPAs�

to�track�and�trend�their�performance.��At�the�time�of�writing�this�report,�it�appears�as�though�the�

information�provided�and�monitored�is�shared�only�between�those�responsible�for�contracting�at�the�

CCAC�and�the�SPAs.��It�does�not�appear�to�be�summarized�and�shared�with�other�healthcare�partners,�

LHIN�or�CCAC�client�service�staff.��The�service�provider�scorecard�also�allows�the�CCAC�and�SPAs�to�

monitor�refusals�and�the�respective�reasons�as�well�as�the�number�of�times�an�agency�“closes”,�the�

reasons�behind�the�closures�and�any�gaps�in�care�plans.��There�is�limited�evidence�that�the�CCAC�has�

transparent�plans�in�place�to�reward�good�performance�or�manage�poor�performance�by�a�SPA.��

However,�the�data�provided�by�the�scorecards�should�allow�the�contract�management�staff�within�the�

CCAC�to�work�more�effectively�with�its�SPA�partners.���

As�part�of�the�review,�it�was�noted�by�a�number�of�stakeholders�that�there�is�a�perceived�shortage�of�

health�human�resources�in�the�Champlain�region.��A�number�of�SPAs�noted�that�historically�the�CCAC�

has�expected�the�SPAs�to�quickly�recruit�and�train�resources�to�meet�fluctuations�in�demand�or�to�use�

funds�at�year-end�and�then�reduce�headcount�when�volumes�change.��This�continuous�up�and�down�

makes�it�difficult�for�SPAs�to�retain�quality�human�resources�and�makes�SPA�management�reluctant�to�

increase�headcount�in�order�to�meet�what�may�be�short-term�increases�in�demand.��A�number�of�

SPAs�noted�that�there�are�some�areas�within�Champlain�where�recruiting�is�somewhat�more�difficult�

(such�as�the�more�easterly�and�westerly�parts)�which�may�be�due�to�the�limited�population�that�live�in�

those�rural�areas.��However,�there�was�more�than�one�SPA�who�indicated�that�they�felt�they�could�

hire�more�staff�and�had�a�list�of�potential�recruits,�however�the�SPA�was�reluctant�to�hire�based�on�

past�practices�in�which�they�were�expected�to�decrease�headcount�within�a�short�time�frame.��This�

past�practice�makes�SPAs�nervous�and�more�likely�to�maintain�a�lower�headcount�so�they�do�not�have�

to�be�continually�laying�off�staff�members.���

The�shortage�of�health�human�resources�is�not�unique�to�the�Champlain�region.��As�part�of�the�review,�

SPAs�who�had�contracts�with�multiple�CCACs�in�Ontario�were�contacted�to�understand�whether�the�

perceived�challenges�in�the�Champlain�region�existed�elsewhere�in�the�province.��For�the�most�part,�

these�providers�did�note�that�many�areas�of�the�province�face�a�shortage�of�health�human�resources�

in�community�care.��A�few�did�note�that�over�the�past�few�years�they�have�noticed�more�difficulty�in�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 36�

recruiting�in�the�easterly�and�westerly�“tips”�of�the�Champlain�region.��They�did�not�have�a�clear�

understanding�as�to�why�recruiting�was�more�difficult�in�these�areas.����

Many�SPAs�noted�that�the�relationship�between�the�SPA�and�the�CCAC�was�not�a�true�partnership.��

While�there�is�a�need�for�a�contractual�relationship,�once�the�contracts�have�been�negotiated,�each�

party�must�work�together�in�a�partnership�as�both�organizations�“share”�the�individual�clients.��Some�

SPAs�noted�that�relationships�were�stronger�at�the�more�senior�management�level,�however�they�still�

were�not�able�to�openly�discuss�certain�issues�and�frustrations.��A�number�of�providers�sent�evidence�

that�issues�and�concerns�were�not�adequately�addressed�or�understood.��The�majority�of�SPAs�

indicated�that�a�“command�and�control”�relationship�existed�between�the�case�managers�and�front�

line�staff�which�made�front-line�staff�feel�not�valued�as�part�of�the�care�team.��For�instance,�some�

case�managers�still�request�services�for�a�specific�time�or�tell�the�provider�staff�that�reports�must�be�

verbally�received.��Both�of�these�requests�are�in�conflict�with�the�processes�that�are�in�place�and�with�

the�contractual�obligations�of�the�service�providers.��This�reflects�both�a�cultural�attitude�among�case�

managers�as�well�as�a�lack�of�organizational�knowledge�dissemination.��

A�number�of�SPAs�believe�that�they�are�held�to�a�different�standard�then�the�CCAC�holds�its�own�

staff.��In�a�number�of�examples�provided,�service�providers�were�not�told�of�changes�to�CCAC�staff�or�

told�of�process�changes�without�sufficient�time�to�implement.��However,�many�indicated�that�they�are�

required�to�inform�the�CCAC�regularly�of�any�changes�to�staff�or�processes.��This�type�of�behaviour�

has�contributed�to�the�perception�amongst�providers�that�they�do�not�have�a�partnership�with�the�

CCAC��It�also�caused�a�number�of�issues�which�they�felt�would�have�been�easily�mitigated�or�avoided�

if�the�communication�was�forthcoming�and�timely.��

SPAs�and�CCAC�staff�noted�that�the�communication�between�the�client�services�staff�and�those�

responsible�for�monitoring�the�contract�appears�to�be�limited�and�infrequent.��This�appears�to�be�

contributing�to�the�variable�relations�with�service�providers.�Client�services�staff�noted�that�they�didn’t�

always�feel�they�received�a�response�to�the�issues�and�concerns�raised,�so�may�neglect�to�follow�up�

on�future�concerns.��SPAs�noted�that�when�they�identified�issues�between�front-line�staff�and�client�

services�staff,�they�did�not�often�perceive�that�the�issues�were�mitigated.��Formal�meetings�that�are�

currently�in�place�with�the�CCAC�and�SPAs,�often�do�not�involve�client�services�staff.��At�other�

CCACs,�client�services�staff�often�play�an�important�role�in�these�meetings.��Champlain�CCAC�is�

currently�investigating�the�possibility�of�restructuring�the�meetings�to�include�client�services�staff�and�

to�have�them�play�a�more�definitive�role.���

SPA�staff,�as�with�CCAC�staff,�noted�that�there�appears�to�be�a�variety�of�processes�in�place�across�

the�region.��The�lack�of�uniformity�and�integration�across�the�region�can�make�it�challenging�for�front-

line�staff�as�the�boundaries�they�are�assigned�may�not�be�inline�with�the�various�offices.�The�

processes�that�they�have�to�go�through�shouldn’t�vary�significantly�by�location.���

Recommendation

Based�on�the�observations,�implications,�and�considerations�we�recommend�that�the�CCAC�develop�

plans�for�the�following:��

Recommendation #9� Develop�and�implement�a�formal�Service�Provider�Agency�Relationship�

Management�Process�

This�recommendation�is�discussed�in�more�detail�below.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 37�

Recommendation #9�-Develop�and�implement�a�formal�Service�Provider�Agency�Relationship�

Management�Process�

The�supplier�relationship�management�process�is�where�the�CCAC�works�with�and�evaluates�the�SPA�

according�to�pre-defined�performance�metrics�in�order�to�determine�if�the�SPA�is�meeting,�exceeding�

or�not�meeting�the�CCAC’s�requirements.��This�includes�building�on�the�service�provider�scorecards�

that�are�currently�in�use�and�developing�a�formal�process�with�respect�to�this�initiative.��

The�service�provider�scorecard�allows�the�CCAC�to�build�a�formal�process�in�collaboration�with�the�

SPAs�to�review�the�performance�of�the�providers.��This�formal�process�should�include�a�plan�for�

periodic�audits�to�ensure�SPAs�are�providing�accurate�information.��The�information�on�the�scorecard�

should�also�be�analysed�and�trended�to�build�a�history�of�the�SPA’s�performance�and�to�see�changes�

in�performance�results.�It�is�important�that�scorecards�also�include�client�perspective�and�feedback�to�

ensure�client�satisfaction.�This�information�should�be�shared�amongst�all�stakeholders,�including�the�

CCAC’s�Client�Services�division.�This�gives�both�the�CCAC�and�the�SPAs�the�opportunity�to�identify�

mitigation�strategies�that�need�to�be�implemented�to�address�and�monitor�any�trends�that�are�not�

headed�in�the�desired�direction.����

The�formal�process�also�includes�regular�communication�opportunities�for�both�CCAC�and�SPA�to�

identify�any�issues�and�challenges�that�need�to�be�addressed�and�the�associated�resolutions.��A�

formal�escalation�process�will�not�only�identify�issues�that�have�been�raised�by�a�stakeholder�but�will�

also�detail�the�possible�consequences�for�sub-standard�performance�over�a�long�period�of�time.��Given�

the�limited�data�available,�it�is�not�possible�to�identify�how�frequently�this�occurs�now.�It�will�also�be�

important�to�review�the�participants�in�the�CCAC/SPA�meetings�as�well�as�their�respective�roles�

during�these�meetings.��Currently�these�meetings�are�initiated�and�attended�by�contract�management�

staff�with�little�client�service�representation.��It�is�important�to�structure�the�meetings�to�build�and�

enhance�the�relationship�between�client�service�staff�and�service�providers.��The�CCAC�and�SPAs�may�

wish�to�evaluate�the�current�organization�of�these�meetings�and�enhance�the�profile�of�client�services�

at�these�meetings.��The�CCAC�has�recognized�this�and�has�begun�to�involve�client�services�in�a�more�

meaningful�way�in�these�meetings,�in�collaboration�with�SPAs.���

Managing�the�supplier�relationship�effectively�also�requires�the�CCAC�and�SPAs�to�work�more�in�

partnership�at�all�levels�of�the�organizations.��While�many�SPAs�acknowledged�a�good�relationship�at�

the�senior�leadership�level,�it�was�noted�that�there�are�still�improvements�that�can�occur�at�all�levels�of�

the�organization.���It�was�noted�during�several�interactions�with�multiple�SPAs�that�they�are�still�

identifying�issues�where�client�service�staff�members�are�making�requests�that�are�not�in�compliance�

with�the�contract�process�and�that�they�have�a�“command�and�control”�relationship�with�the�provider�

agencies.��There�needs�to�be�a�formal�process�in�place�where�these�issues�are�addressed�and�

monitored�on�a�regular�basis.��Information�is�shared�not�only�with�the�client�services�front-line�staff�

members�but�also�with�their�supervisors�in�order�for�the�issue�to�be�dealt�with�through�the�

performance�management�process.���

The�strength�of�the�supplier�relationship�depends�on�how�areas�within�the�CCAC�effectively�work�with�

one�another�in�order�to�identify�issues�and�concerns.��It�was�noted�during�staff�focus�groups�and�

survey�submissions�that�some�client�service�staff�members�do�not�identify�issues�to�contract�

management�as�they�feel�the�issue�is�never�resolved.��In�the�absence�of�data�to�prove�or�disprove�a�

concern�a�single�issue�may�become�a�myth.��For�example,�one�instance�where�a�particular�SPA�may�

not�be�able�to�provide�a�requested�service�may�develop�into�the�view�that�the�SPA�never�provides�a�

particular�type�of�service.��Again,�a�similar�process�needs�to�be�in�place�where�the�issues�are�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 38�

addressed�and�monitored�on�a�regular�basis�and�the�resolutions�are�shared�with�client�services�staff.��

It�will�be�important�to�ensure�that�any�formal�issues�resolution�process�that�is�put�in�place�does�not�

create�a�“culture�of�blame”�but�is�instead�implemented�where�both�sides�feel�that�the�process�is�

focused�on�the�clients�and�helps�the�organizations�work�towards�overall�improvement�in�the�system.��

The�information�summarized�on�the�scorecards�should�be�shared�with�client�services�on�a�regular�

basis�so�they�have�better�understanding�of�the�contracts�and�the�SPAs’�performance.��The�information�

provided�on�the�scorecards�will�provide�the�basis�for�discussion�at�regular�management�meetings�of�

client�services�and�contract�management�where�issues�and�resolutions�will�be�discussed.���It�will�be�

important�to�also�track�and�monitor�issues�that�are�identified�by�SPAs�with�client�services�staff�and�

include�within�the�performance�measurement�process�at�the�CCAC.���

The�CCAC�provides�services�to�more�than�25,000�clients�on�any�given�day�and�close�to�55,000�clients�

annually,�hence�some�issues�associated�with�service�are�bound�to�arise.��Contract�Management�

should�track�and�trend�the�themes�of�the�issues�as�well�as�the�occurrence�rates�and�share�these�

findings�with�client�services,�management,�the�SPAs�and�the�LHIN.��As�themes�are�identified,�

education�and�communication�strategies�can�be�developed�to�address�and�mitigate�the�issues�and�

improve�the�system.��

Sharing�this�information�with�the�LHIN�should�help�to�build�trust�that�the�CCAC�is�effectively�

monitoring�and�working�in�partnership�with�SPAs�to�address�and�resolve�the�issues�and�concerns�that�

will�arise.��It�will�also�help�all�parties�to�develop�innovative�and�flexible�solutions�that�will�meet�the�

needs�of�the�Champlain�residents.���

As�part�of�the�formal�Service�Provide�Agency�Relationship�Management�process�there�needs�to�be�

measurable�outcomes�and�evaluation�processes�in�place�so�all�parties�can�monitor�the�strength�of�the�

partnerships�and�develop�ways�to�enhance�the�relationship.��The�CCAC�and�SPAs�will�need�to�work�in�

collaboration�to�define�success�and�develop�the�outcomes�and�performance�metrics�such�as,�number�

of�issues�identified,�time�to�resolution/mitigation,�client�satisfaction�and�satisfaction�of�front-line�staff�

(SPA�and�CCAC),�against�which�all�parties�will�be�measured.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 39�

Financial�Management�Prior�to�the�commencement�of�this�review,�the�CCAC�had�undertaken�a�Finance�and�Information�

Review.��The�CCAC�has�begun�to�implement�some�of�the�recommendations�of�that�review.�With�the�

appointment�of�a�new�CFO�on�June�10,�2009,�the�recommendations�of�the�Finance�and�Information�

Review�and�this�review�can�be�more�effectively�implemented.��The�CFO�position�has�been�vacant�for�

a�number�of�months.��The�person�who�held�the�position�at�amalgamation�became�acting-CEO�shortly�

after�amalgamation�prior�to�leaving�the�organization.��Another�person�held�the�role�for�only�a�few�

months.��This�vacancy�left�the�senior�leadership�team�with�limited�strategic�financial�information.��In�

addition�the�multiple�IT�systems�in�place�made�it�more�difficult�to�gather,�compare�and�utilize�the�

historical�information�required�for�trending.���

One�of�the�drivers�for�the�review�was�the�surpluses�that�the�CCAC�has�recorded�in�2007-2008�fiscal�

year�and�was�on�track�to�record�again�this�last�fiscal�year,�prior�to�corrective�action.��As�was�discussed�

in�the�section�on�Contract�Management,�part�of�the�reason�for�the�surplus�is�the�difficulty�that�some�

service�providers�have�in�recruiting�and�retaining�skilled�staff�due�to�resource�health�human�resource�

shortages�in�some�areas�of�Champlain.��However,�this�is�not�the�sole�reason�for�the�surplus�and�some�

of�the�surplus�can�be�attributed�to�the�limited�forecasting�expertise�and�ability�of�Champlain�CCAC.��

There�is�limited�evidence�that�utilization�data�was�effectively�linked�to�budget�and�that�historical�

trending�data�was�used�to�monitor�where�the�organization�stood�at�any�given�time.��The�vacancy�of�

the�CFO�has�hindered�the�organization�as�it�lacked�the�focused�strategic�leadership�required.���

It�is�not�apparent�that�the�finance�department�of�the�CCAC�has�implemented�leading�practices�that�

move�the�finance�area�within�the�CCAC�towards�a�dynamic,�forward�looking�organization�that�ties�its�

strategy�and�operations�together.��The�finance�department�should�facilitate�business�decision�and�

support�through�analysis�and�insight�rather�than�compilation.��KPMG�reviewed�the�monthly�financial�

statements�presented�to�the�Board�and�noted�that�much�of�the�strategic�financial�information�and�

analysis�required�was�not�available.��Much�of�the�focus�of�the�finance�department�has�been�purely�

transactional�and�important�trending�and�tracking�information�was�not�provided�or�analysed.��High-

level�data�on�whether�individual�line�items�were�over�or�under�budget�was�presented�without�detailed�

analysis�that�would�identify�month-over-month�and�year-over-year�trends�and�the�supporting�plans�

required�to�mitigate�any�issues.��As�a�result,�reporting�to�the�board�and�senior�leadership�has�had�

limited�trending�and/or�analysis�to�provide�meaningful�insight�into�results.���

Having�limited�formal�forecasting�processes�in�place�has�also�created�difficulty�in�predicting�the�

financial�position�of�the�CCAC�at�any�given�time�with�the�result�that�the�LHIN�questions�the�accuracy�

of�the�information�provided�by�the�CCAC.��The�senior�leadership�team�and�board�lacked�the�

information�that�they�needed�in�order�to�make�strategic�decisions�with�regards�to�the�organization.�

The�limited�forecasting�capacity�also�limited�the�senior�leadership�team’s�ability�to�develop�effective,�

proactive�plans,�such�as�implementing�programs�that�offer�access�to�additional�hours�and�services,�

which�could�affect�the�financial�position�of�the�CCAC.��

The�CCAC�is�currently�implementing�a�plan�to�provide�detailed�budget�information�to�middle�

managers.��This�is�an�important�first�step�in�linking�individual�managers’�performance�to�overall�

organizational�performance�and�will�result�in�an�increased�level�of�accountability�throughout�the�CCAC.��

Decentralized�budget�reporting�and�monitoring�will�also�be�the�basis�for�future�operating�plan�and�

budget�development.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 40�

Leading�practices�in�budgeting�and�forecasting�need�to�be�in�place�to�move�the�organization�forward�

and�to�build�the�trust�and�relationship�between�the�CCAC�and�the�LHIN�as�its�funder.�Leading�

practices�can�be�found�in�Appendix�C.��

Recommendations

Based�on�the�observations,�implications�and�considerations�above,�we�recommend�that�the�CCAC�

take�action�in�the�following�areas:��

Recommendation #10� Improve�planning�processes�so�that�the�budget�planning�translates�the�

Strategic�Plan’s�directions�into�Organizational�Business�Plans.�

Recommendation #11� Build�capacity�of�the�Finance�department�to�provide�information�and�data�

that�is�dynamic,�forward�looking�and�tied�to�strategy�and�objectives.��

Recommendation #12� Enhance�the�relationship�and�build�trust�between�the�CCAC�and�LHIN�with�

regards�to�financial�and�operational�information.�

These�recommendations�are�discussed�in�more�detail�below.��

Recommendation #10�-�Improve�planning�processes�so�that�the�budget�planning�translates�the�

Strategic�Plan’s�directions�into�Organizational�Business�Plans�

The�Strategic�Plan�defines�the�longer�term�business�targets�for�the�CCAC�and�sets�the�framework�for�

operational�planning.��The�annual�budgeting�process�should�translate�the�strategic�plan�into�the�

operational�business�department�targets.��These�targets�are�the�starting�point�for�target�setting�during�

the�annual�budgeting�process.��Collaborative�Target�Setting�is�a�method�to�help�ensure�that�plans,�

budgets�and�forecasts�are�valid�and�achievable�by�creating�a�process�where�targets�are�agreed�

between�management�and�the�operating�units�(at�all�levels�of�the�organization).��It�is�important�to�set�

targets�collaboratively�to�help�ensure�that�plans,�budgets�and�forecasts�are�valid�and�achievable�by�

creating�a�process�where�targets�are�accepted�by�all�levels�of�management.��The�management�and�

departments�consider�themselves�as�the�owners�of�the�plan�and�their�performance�is�then�measured�

based�on�meeting�the�targets.��The�plan�is�facilitated�by�Finance.�Finance�supports�business�by�

providing�budget�templates,�education,�leadership�and�direction�to�facilitate�the�budgeting�process.���

The�targets�for�improvement�should�be�reviewed�by�the�senior�leadership�team�monthly.��

Recommendation #11�-�Build�capacity�of�the�Finance�department�to�provide�information�and�data�

that�is�dynamic,�forward�looking�and�tied�to�strategy�and�objectives�

Forecasting�is�predictive�analysis�performed�to�provide�insight�into�anticipated�short-term�business�

performance.��It�is�a�periodic�update�to�the�budget�that�reflects�changes�and�impacts�actually�being�

experienced.��It�is�important�for�Champlain�CCAC�to�improve�its�financial�forecasting�capabilities�so�

services�can�be�consistently�provided.��For�example,�Champlain�CCAC�wants�to�avoid�increasing�

services�one�month�and�then�needing�to�remove�them�the�next�to�meet�targets.��These�results�may�

force�changes�in�strategies,�priorities�and�resource�allocations�to�improve�the�forecast�on�a�regular�

basis.��It�is�recommended�that�the�CCAC�implement�rolling�forecasts,�which�shifts�planning�away�

from�historic�budgeting�and�forecasting�to�move�it�toward�a�continuous�predictive�modelling�method.���

Finance�must�work�in�close�collaboration�with�all�departments,�especially�client�services�and�contract�

management,�to�develop�one�rolling�forecast�that�looks�forward�between�12�and�24�months.��The�

forecasts�need�to�be�regularly�maintained,�shared�and�transparent�for�all�internal�and�external�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 41�

stakeholders.��Collaborative�input�is�required�across�the�organization�through�embedding�into�

operational�planning.��

The�development�of�a�dynamic,�forward�looking�finance�area�will�allow�the�CCAC�to�set�more�realistic�

targets�and�monitor�performance.��It�will�also�allow�Finance�to�collaborate�with�other�areas�in�the�

CCAC�to�proactively�identify�where�the�development�of�plans�may�be�required�to�balance�to�targets.��

Once�Finance�has�started�to�produce�dynamic�information�and�is�working�collaboratively�with�

management�to�enhance�their�understanding�of�the�data�capabilities,�it�will�be�important�to�hold�

management�accountable�for�accuracy.��Having�accurate�metrics�built�into�accountabilities�and�

performance�will�help�not�only�to�increase�their�importance�throughout�the�organization,�it�should�help�

to�reduce�the�gaps�between�targets�and�actual�as�they�are�continuously�analysed�and�initiatives�and�

action�required�are�identified.���

Outcomes�of�a�successful�implementation�of�this�recommendation�are�more�reliable�reports�and�

strategic�forecasts.��

Recommendation #12�-�Enhance�Relationship�and�build�trust�between�the�CCAC�and�LHIN�with�

regards�to�financial�information�

Currently,�the�LHIN�questions�the�accuracy�of�the�financial�information�and�forecasts�that�it�has�

received�from�the�CCAC�provide�accurate�information�with�regards�to�the�financial�state�of�the�CCAC.��

The�financial�information�provided�to�the�LHIN�in�the�past�did�not�give�the�LHIN�the�confidence�that�

senior�leadership�understood�the�financial�position�of�the�CCAC�at�any�given�time.���

The�LHIN�has�noted�that�since�the�new�CFO�started�at�the�organization�the�latest�financial�statements�

and�analysis�provided�to�the�LHIN�have�been�significantly�improved.�The�new�CFO�has�a�challenge�

ahead�to�provide�more�detailed�financial�and�statistical�information�and�through�doing�so�increase�the�

LHIN’s�level�of�trust�of�the�CCAC.���

Implementing�the�recommendations�discussed�above�should�aid�the�CCAC�in�establishing�and�

maintaining�a�relationship�of�trust�with�the�LHIN.��Other�CCACs�who�report�a�strong�relationship�with�

their�LHIN�counterparts,�indicate�that�they�meet�with�the�LHIN�early�and�often�to�discuss�the�status�of�

the�CCAC’s�operating�plans�and�financial�position.��In�addition,�when�deficit�or�surplus�positions�are�

identified�these�are�discussed�early�with�the�LHIN�and�plans�to�address�the�situation�are�presented�

and�monitored�on�a�regular�basis.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 42�

Case�Management�The�case�management�model�at�Champlain�CCAC�is�similar�to�a�number�of�CCACs�across�the�

province.��There�are�few�teams�who�specialize�in�certain�areas�such�as�acute,�palliative�care�and�

paediatrics.��Other�case�managers�monitor�longer-term�clients.�The�organizational�structure�of�case�

management�is�also�similar�in�that�most�case�managers�report�to�a�manager�responsible�for�a�

geographic�area.��Those�in�the�specialized�teams�report�to�a�manager�who�is�responsible�for�the�

specialty�across�Champlain.��The�average�caseloads�of�case�managers�at�Champlain�CCAC�are�

comparable�to�their�peers�in�other�regions�of�the�province,�although�they�do�vary�by�region.�However,�

it�is�not�possible�to�compare�a�single�number�without�knowing�the�details�around�each�case�load.��

Other�CCACs�manage�and�monitor�case�loads�by�identifying�and�stratifying�the�client�characteristics�

on�a�regular�basis.��Champlain�CCAC�is�beginning�to�identify�the�data�and�information�required�to�allow�

them�to�provide�management�and�case�managers�with�this�information.��This�will�become�more�

detailed�and�refined�as�case�managers�and�management�become�more�comfortable�with�the�

information.���

Champlain�CCAC�has�undertaken�considerable�work�internally�to�develop�a�conceptual�case�

management�model�designed�to�meet�the�current�and�expanding�mandate.��Client�Services�leadership�

at�the�CCAC�have�researched�a�variety�of�models,�including�those�employed�by�other�jurisdictions�to�

develop�a�conceptual�model�that�has�the�potential�to�meet�the�needs�of�all�Champlain�residents.��The�

model�is�based�on�a�population�health�model�that�is�similar�to�models�that�have�been�used�or�are�

under�development�at�other�CCACs.��The�CCAC�hopes�to�analyse�its�existing�client�data�to�better�

stratify�clients�to�provide�case�management�that�is�more�focused�on�the�needs�of�particular�client�

groups.��It�will�now�be�important�to�enhance�and�validate�the�model�with�both�the�healthcare�partners�

in�the�various�communities�of�care�and�with�the�CCAC’s�middle�management�and�front-line�staff�

members�to�see�how�the�model�needs�to�be�modified�in�order�to�address�any�local�challenges.��

Highlights�of�the�draft�conceptual�model�are�provided�in�Appendix�D.���

There�is�considerable�experience�among�case�managers�at�the�CCAC.��Many�staff�have�a�good�

understanding�of�the�services�available�in�their�communities�and�have�developed�strong�relationships�

with�providers�and�partners�in�their�area.��While�this�is�a�considerable�strength,�some�staff�may�be�

firmly�entrenched�in�past�practices�and�cultures�which�may�pose�a�challenge�when�implementing�

changes.��The�CCAC�has�the�opportunity�to�build�on�this�expertise�when�developing�the�new�model�

and�considering�solutions�for�new�integrative�opportunities.����

While�the�implementation�of�the�new�model�is�close�to�a�year�and�a�half�or�two�years�away,�it�is�

important�for�the�CCAC�to�address�current�issues�immediately.��It�was�noted�that�the�case�managers�

at�the�Champlain�CCAC�fall�along�a�continuum�of�service�broker�to�service�navigator.��This�is�similar�to�

other�CCACs�as�historical�fluctuations�in�mandate�and�service�offerings�may�make�it�difficult�for�case�

managers�to�trust�an�expansion�in�their�role.��The�range�of�case�management�practices�causes�

frustration�for�the�providers�and�partners�as�mentioned�earlier.���

It�was�noted�on�more�than�one�occasion�that�case�managers�with�a�nursing�background�often�“nurse”�

the�client�versus�“case�manage”.��It�was�also�noted�that�the�client�may�undergo�multiple�

“assessments”�as�they�may�be�assessed�by�hospital�staff,�CCAC�staff�and�SPA�staff�as�there�is�a�lack�

of�trust�amongst�partners.���

Staff�believe�that�there�are�limited�policies�and�procedures�in�place�and�a�lack�of�consistent�application�

of�services�and�focus�across�all�staff.��This�has�also�been�identified�by�external�stakeholders�about�the�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 43�

lack�of�consistency�in�how�CCAC�front-line�staff�interpret�the�policies�and�procedures�can�negatively�

affect�the�organization’s�credibility.��There�is�a�perception�that�processes�in�use�vary�across�the�

organization.���

Recommendations

Based�on�the�observations,�implications�and�considerations,�it�is�recommended�that�CCAC�undertake�

the�following:�

Recommendation #13� Meet�with�internal�and�external�stakeholders�collectively,�sectorally,�

individually�and�within�specific�geographies�to�build�understanding�and�

enhancement�of�the�new�model�and�identify�the�processes�required�to�

transition�to�a�new�case�management�model.�

Recommendation #14� Work�with�all�stakeholders�to�identify�and�implement�“quick�wins”�to�

address�current�situations�and�challenges,�

Recommendation #15� Ensure�equitable�access�to�services�across�the�region.�

Recommendation #16� Integrate�systems�and�share�information�electronically.�

Recommendation #17� Take�ownership�of�the�role�of�system�navigator.�

Further�discussions�regarding�the�recommendations�are�below.�

Recommendation #13�-�Meet�with�internal�and�external�stakeholders�collectively,�sectorally,�

individually�and�within�specific�geographies�to�build�understanding�and�enhancement�of�the�new�

model�and�identify�the�processes�required�to�transition�to�a�new�case�management�model.�

The�successful�implementation�of�the�new�model�will�be�dependent�on�many�stakeholders�both�

internal�and�external.��It�has�the�potential�to�change�the�way�the�CCAC�works�in�partnership�with�

SPAs,�community�support�services,�and�others.��It�will�be�important�to�work�collaboratively�with�

external�partners�to�develop�and�implement�cross-organization�business�processes�and�protocols�for�

sharing�information�that�will�be�required�to�move�the�model�forward.��In�addition�it�will�be�important�to�

develop�internal�processes�across�areas�within�the�CCAC�as�this�model�may�affect�the�current�

processes�such�as�service�ordering,�billing�and�the�procurement�strategy�of�the�CCAC.���

As�part�of�this�review,�the�CCAC�presented�the�conceptual�model�to�a�variety�of�stakeholders,�

beginning�the�collaboration�required�to�successfully�develop�and�implement�such�a�model.��The�CCAC�

also�presented�the�model�to�a�small�number�of�healthcare�partners�and�service�providers.�The�CCAC�

has�begun�to�develop�a�more�detailed�stakeholder�engagement�strategy�with�regards�to�the�case�

management�model�and�will�be�scheduling�a�series�of�sessions�with�stakeholders�from�across�

Champlain�to�further�develop�and�refine�the�model.��It�is�important�that�the�new�model�continues�to�

be�developed�collaboratively.�

An�outcome�of�success�implementation�of�this�recommendation�will�be�a�model�that�is�aligned�with�

the�new�mandate�and�where�all�partners�understand�and�are�aligned�with�the�new�model.���

Recommendation #14�-�Work�with�all�stakeholders�to�identify�and�implement�“quick�wins”�to�

address�current�situations�and�challenges.�

It�is�important�to�realize�that�the�implementation�of�the�new�case�management�model,�while�

necessary�to�move�the�CCAC�forward�to�meet�the�evolving�mandate,�may�take�up�to�two�years�to�

fully�implement.��There�are�changes�to�current�processes�and�relationships�that�need�to�reviewed�and�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 44�

enhanced�immediately.��As�a�result�of�the�development�of�the�conceptual�case�management�model,�

the�CCAC�has�begun�to�hold�more�cross-functional�meetings�with�representation�from�a�number�of�

internal�departments�and�external�stakeholders�to�further�develop�the�model.�At�the�time�of�writing�

this�report,�some�processes�have�been�identified�and�are�being�further�investigated�with�the�potential�

for�redesign.��For�instance,�report�requirements�are�being�reviewed�to�see�what�information�is�

required�and�can�be�redesigned�or�modified�to�improve�the�processes�and�reports�and�how�the�

information�that�can�more�effectively�be�shared�and�utilized.���Improvements�to�case�management�

processes�could�also�be�feasibly�rolled�out�this�year.���

Another�example�of�a�“quick�win”�would�be�collaboration�between�SPAs,�healthcare�partners�and�the�

CCAC�to�provide�educational�opportunities�which�should�provide�a�better�service�to�clients.��CCAC�

needs�to�work�in�collaboration�with�its�SPAs�and�healthcare�partners�within�the�LHIN�to�look�at�flexible�

and�innovative�options�to�provide�education�and�knowledge�to�all�those�involved�in�the�care�of�

complex�patients.���The�CCAC�could�work�with�its�hospital�partners,�who�provide�expertise�in�

particular�areas,�to�offer�education�and�specialized�sessions�that�are�currently�available�to�hospital�staff�

to�the�SPA�staff�and�CCAC�staff�who�provide�care�to�similar�clients.��For�instance,�CHEO�or�others�

may�be�willing�to�open�their�education�sessions�to�SPA�staff�and�CCAC�case�managers�who�provide�

care�to�children�in�the�Champlain�region.��This�would�also�help�CCAC�staff�to�acquire�the�required�

skills�to�assess�whether�the�programs�are�being�effectively�delivered.��Details�of�these�sessions�

would�need�to�be�determined�in�collaboration�with�all�partners�to�ensure�sessions�are�optimal.��

Other�examples�of�“quick�wins”�are�programs�that�have�recently�been�implemented�in�other�CCACs�

which�help�to�address�the�alternate�level�of�care�issues�that�have�been�causing�the�health�system�a�

variety�of�challenges.��One�particular�program�is�“Home�First”�which�was�developed�in�the�

Mississauga�Halton�LHIN�in�collaboration�with�the�CCAC�and�its�hospital�partners�and�is�in�the�process�

of�being�tailored�to�a�number�of�others,�including�Toronto�Central�CCAC.��This�program�works�in�

collaboration�with�the�CCAC,�hospitals,�physicians,�supportive�housing�providers�and�others�in�the�

community�to�enhance�the�services�that�are�available�to�allow�an�individual�to�leave�the�hospital�and�

be�supported�elsewhere,�such�as�home�or�convalescent�care,�while�they�recover,�wait�or�are�

assessed�for�a�lower�level�of�care.���

At�the�time�of�writing�this�report,�the�CCAC�was�in�the�process�of�increasing�its�business�hours,�

which�should�begin�to�address�the�frustration�noted�by�a�number�of�stakeholders�with�the�CCAC’s�

business�hours.�In�addition�it�was�deploying�case�management�staff�dedicated�to�the�emergency�

department�in�a�number�of�hospitals.��The�CCAC�will�need�to�work�with�its�hospital�partners�to�

determine�where�and�when�additional�dedicated�resources�are�required.���It�was�noted�in�several�

discussions�with�hospitals�that�they�felt�discharges�to�community�care,�with�the�changes�in�their�

patient�population�were�being�delayed�by�existing�case�management�practices,�processes�and�hours.��

It�is�a�delicate�balance�and�may�not�necessarily�need�to�be�consistent�across�Champlain�as�the�

hospital�partners�and�community�support�services�are�quite�varied.��In�some�cases,�onsite�support�

may�be�required�outside�the�traditional�business�hours�to�deal�with�partners’�needs�while�in�others�

there�may�be�a�need�to�enhance�the�types�of�services�that�are�provided�(e.g.�Geriatric�Emergency�

Medicine,�Aging�in�Place�Project).����

In�all�“quick�wins”�it�will�be�important�for�the�CCAC�and�partners�involved�to�collect�and�monitor�data�

on�a�consistent�basis�in�order�to�analyse�whether�the�change�or�program�has�been�effective�in�

achieving�its�desired�outcome.��This�information�can�then�be�used�to�modify�or�make�enhancements�

to�the�program�to�more�effectively�meet�the�needs�of�Champlain�residents.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 45�

Outcomes�of�this�recommendation�should�be�the�development�of�joint�projects�with�other�partners,�

including�those�outside�traditional�healthcare�that�aim�to�enhance�services�available.��Improvements�in�

internal�processes�should�also�be�tracked.�In�addition,�each�project�should�include�an�evaluation�

component�that�identifies�the�outcomes�and�benefits�both�for�the�clients�and�for�the�system.��

Recommendation #15�-�Ensure�equitable�access�to�services�across�the�region.�

Champlain�CCAC�needs�to�work�with�the�service�providers�across�the�region�to�ensure�consistent�

standards�of�service�in�all�areas,�where�possible.��In�some�cases�it�may�be�necessary�to�provide�

additional�care�in�a�clinic�in�order�to�maximize�the�availability�of�health�human�resources.��The�CCAC�is�

investigating�whether�services,�other�than�nursing,�could�also�effectively�be�provided�in�a�clinic�

setting.��Other�CCACs�have�noted�that�the�quality�of�care�and�services�provided�in�clinics�increases�for�

certain�conditions,�such�as�wound�care,�as�the�service�is�being�provided�in�a�contained�environment.�

They�also�note�a�reduction�in�the�amount�of�supplies�wasted�when�service�is�provided�in�a�clinic�

setting.��It�would�be�important�for�the�CCAC�to�track�and�monitor�the�outcomes�for�Champlain�

residents�to�evaluate�the�clinics�make�the�necessary�changes�that�enhance�services.���

The�CCAC�must�unify�internal�processes�and�ensure�that�all�areas�within�the�CCAC�adopt�them.��

Effective�improvement�teams�use�state�of�the�art�management�tools�and�processes�and�are�

continually�looking�for�ways�to�improve�their�work.���For�example,�the�CCAC�uses�the�tool�“Value�

Stream�Mapping”�to�examine�its�processes.��However,�there�are�many�types�of�process�mapping�that�

differ�by�level�of�detail.��Value�Stream�Process�Maps�shows�where�‘value’�is,�and�is�not,�delivered�and�

contain�useful�other�information�designed�to�trigger�quality�improvement�activities.��For�

implementation�of�the�CCAC’s�new�case�management�model,�consideration�should�be�given�to�

learning�how�to�plot�Workflow�Process�Maps�which�show�who�does�what,�with�what�tool�or�form�as�

well�as�the�process’s�relationship�to�other�concurrent�lines�of�activity.���

The�CCAC�should�look�to�replace�manual�processes�with�electronic�and�online�processes�wherever�

possible�with�the�goal�of�streamlining�and�unifying�processes�across�the�CCAC.��This�will�also�help�

with�communication�between�SPAs�and�the�CCAC�as�the�information�would�be�provided�in�an�

electronic�format�and�should�improve�accuracy�and�reduce�interactions�needed�to�verify�information.���

Where�processes�affect�external�partners,�they�should�be�designed�in�collaboration�with�the�partner�in�

order�for�the�new�process�to�be�effectively�implemented�with�minimal�disruptions.��In�addition,�

extensive�communication�and�evaluation,�both�internally�and�externally,�on�new�practices�must�

accompany�these�changes.��

As�the�new�case�management�model�discussed�below�is�developed�and�implemented,�it�will�be�

important�to�involve�the�SPAs�as�their�role�has�the�potential�to�change�significantly.��The�model�also�

has�the�potential�to�affect�the�procurement�strategy�that�needs�to�be�developed�moving�forward�so�

the�collaboration�of�SPAs�with�the�development�will�be�paramount.���

In�addition�to�standard�processes�across�the�CCAC,�and�the�future�model,�it�is�also�important�to�look�

at�the�services�that�are�currently�being�provided�within�each�of�the�communities�of�care�within�the�

LHIN.��Some�CCAC�processes�may�need�to�be�customized�to�reflect�the�unique�nature�of�each�

community�of�care.��As�such,�this�is�an�opportunity�to�work�with�SPAs�across�Champlain�to�determine�

how�best�services�can�be�provided�in�each�area�in�the�region.���This�may�require�examination�of�

innovative�partnerships�with�hospitals,�instituting�clinics�which�offer�more�than�nursing�services,�or�

partnering�with�community�support�services�for�transportation�to�a�more�urban�setting�to�address�

health�human�resource�availability�challenges.���

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 46�

The�CCAC�should�also�work�with�community�support�services�to�build�and�enhance�capacity�within�

the�Communities�of�Care�identified�by�the�LHIN.��There�may�be�opportunities�where�care�can�be�

provided�by�community�support�services�in�collaboration�with�SPAs�and�the�CCAC�to�enhance�the�

level�of�care�that�individuals�receive.��The�CCAC�should�also�collaborate�with�other�social�service�

agencies,�municipal�services�or�supports�outside�traditional�healthcare�that�may�be�able�to�build�

capacity�within�certain�communities.�

An�outcome�to�monitor�should�be�a�clear�listing�of�CCAC�programs�and�services�available�across�the�

LHIN.�

Recommendation #16�-�Integrate�systems�and�share�information�electronically.���

Many�current�processes�should�be�enhanced�or�modified�to�increase�information�sharing�capabilities�

among�organizations.�With�the�implementation�of�CHRIS,�Champlain�CCAC�should�strive�to�adopt�

more�eHealth�practices�that�would�allow�more�efficient�sharing�of�information�and�less�dependency�

on�paper.��CCAC�should�adopt�the�same�information�gathering�and�managing�processes�across�the�

region.��Clients�across�the�province�often�comment�on�the�requirement�to�repeat�their�“story”�to�a�

variety�of�providers.��This�creates�frustration�as�clients�don’t�understand�why�the�information�is�not�

shared.��There�is�a�need�not�only�to�share�information�more�freely�between�care�providers�within�the�

client’s�circle�of�care�but�to�trust�the�information�provided�by�those�partners.���For�instance,�staff�

members�with�CSS�agencies�and�SPAs�can�provide�CCAC�staff�with�unique�perspectives�as�they�

typically�have�more�regular�interactions�with�individuals�and�are�key�team�members�in�the�continuum�

of�care.��This�is�consistent�with�the�direction�the�CCAC�is�taking�with�the�new�case�management�

model.���

Some�CCACs�have�implemented�an�eReferral�process�in�collaboration�with�hospitals�which�allows�for�

easy�sharing�of�client�information�and�reduces�the�interactions�required�to�verify�information.��The�

information�is�automatically�uploaded�into�the�CCAC�system�which�reduces�the�data�entry�necessary�

to�begin�a�referral�and�reduces�the�possibility�of�errors.��It�also�reduces�the�number�of�incomplete�

referrals�being�submitted�to�the�CCAC�as�the�healthcare�provider�is�required�to�complete�all�agreed�

upon�fields�prior�to�submission.��The�processes�involved�have�been�reviewed�and�redesigned�to�

ensure�that�the�information�received�is�the�information�that�is�required.��The�forms�were�not�simply�

automated�but�were�collaboratively�reviewed�and�modified�where�necessary.��

Others�have�implemented�a�Resource�Matching�and�Referral�System�across�a�variety�of�healthcare�

providers�such�as�hospitals,�long-term�care�providers�and�community�support�services.��This�system�

requests�certain�information�and�then�matches�the�person�to�the�appropriate�resources�available�in�

the�community�and�identifies�the�associated�wait�times�with�resources�to�allow�the�CCAC�and�

providers�to�develop�a�care�plan�while�the�individual�waits�for�specific�resources.��The�Resource�

Matching�and�Referral�System�in�place�at�Toronto�Central�CCAC�was�built�on�a�network�that�was�in�

place�for�rehabilitation�institutions�and�has�been�modified�to�include�other�healthcare�providers�

including�long-term�care�homes�and�community�support�services�agencies.��The�collaboration�required�

to�develop�the�common�information�requirements�and�interactions�can�be�a�very�detailed�process.��

The�CCAC�and�healthcare�providers�in�the�Champlain�LHIN�should�look�to�build�on�the�work�that�has�

been�completed�and�implemented�in�other�CCACs.���

Outcomes�include�evidence�of�increased�electronic�data�sharing�and�evidence�that�case�managers�are�

accepting�and�using�the�information�provide�by�service�providers,�hospitals�and�community�support�

services�more�effectively�to�make�decisions.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 47�

Recommendation #17�-�CCAC�to�take�ownership�of�its�role�as�navigator.�

Champlain�CCAC�must�target�individuals�in�the�most�vulnerable�sectors�in�society,�such�as�the�frail�

elderly,�to�ensure�that�they�are�provided�with�the�access�they�need�to�services�that�enable�them�to�

live�in�the�community�for�as�long�as�possible.�The�conceptual�model�that�has�been�developed�should�

help�the�CCAC�to�enhance�the�case�management�it�provides�to�its�various�client�groups.��The�model�

groups�clients�based�upon�condition�complexity.��The�system�navigation�role�connecting�clients�with�

not�only�CCAC�services�but�those�that�are�provided�by�other�care�partners�in�the�community�will�be�

very�important.��However,�it�is�important�that�the�CCAC�begin�developing�and�implementing�

processes�that�are�aligned�with�the�new�model�now�in�order�to�more�effectively�meet�the�needs�of�

the�clients�today.��The�new�model�also�recognizes�there�is�a�range�of�case�management�functions�and�

other�organizations�may�fulfill�a�variety�of�these�functions�depending�on�the�client�populations.���

With�the�aging�population�it�is�becoming�apparent�that�there�are�certain�services�that�a�client�may�

require�that�fall�outside�the�traditional�CCAC�services�and�healthcare�services�that�will�keep�them�

living�independently�in�the�community.��For�instance�there�may�be�certain�recreational�programs�that�

are�provided�by�municipalities�within�the�LHIN�which�would�be�of�benefit�for�CCAC�clients.��There�

may�also�be�CSS�agencies�or�others�that�can�provide�transportation�or�support�with�instrumental�

activities�of�daily�living.��It�will�be�important�to�provide�data�to�all�providers�that�highlight�the�services�

CCAC�clients�are�receiving�that�fall�outside�the�traditional�healthcare�sphere�and�monitor�the�client’s�

status�accordingly.��This�should�help�build�trust�with�healthcare�partners�and�others�that�the�CCAC�has�

expertise�in�system�navigation�and�is�aware�of�the�multitude�of�services�that�may�be�available�in�the�

various�communities.��It�will�be�important�for�case�managers�to�include�all�types�of�services�that�could�

provide�benefits�to�clients,�including�those�outside�healthcare,�to�be�seen�by�all�organizations�as�

having�a�strengthened�role�in�system�navigation�and�be�viewed�as�the�trusted�resource�on�all�

community�services�available.�

In�addition,�several�community�support�agencies�noted�that�some�of�their�programs�have�unused�

capacity.��Other�long-term�care�facilities�noted�that�they�had�beds�available�that�could�be�used�as�

transition�or�convalescent�beds�where�individuals�are�occupying�hospital�beds�while�waiting�either�for�

services�to�be�available�in�the�community�or�long-term�care.��The�CCAC,�the�LHIN�and�the�long-term�

care�facilities�need�to�work�in�collaboration�to�determine�the�resources�required�to�best�meet�the�

needs�of�the�Champlain�residents.��

Outcomes�include�evidence�of�care�plans�that�link�clients�to�a�broad�range�of�appropriate�services.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 48�

Improvement�Plan�As�requested�in�the�RFP,�KPMG�is�providing�recommended�short�and�long�term�action�plans�to�

address�the�findings�of�this�review.�As�the�review�neared�completion�Champlain�CCAC’s�senior�

leadership�team�held�a�planning�retreat�to�update�their�operating�plans�and�priorities�to�move�the�

organization�forward�in�the�current�fiscal�year.��

During�this�review�the�CCAC�was�provided�with�the�interim�report�and�subsequent�sessions�were�

held�with�the�senior�leadership�team�to�communicate�the�findings�of�the�report.��It�was�understood�

the�CCAC�would�use�this�information�to�develop�their�updated�operating�plan;�however�they�were�not�

privy�to�the�level�of�detail�contained�in�this�report.�KPMG�received�the�high-level�results�of�this�

planning�session,�which�has�been�included�as�Appendix�E.��The�document�in�the�Appendix�still�

requires�detailed�targets�and�metrics�which�will�be�used�for�evaluation.��While�it�is�recognized�that�the�

organization�has�other�activities�and�priorities,�which�are�included�in�the�planning�session�document,�

the�following�table�outlines�KPMG’s�recommendations,�priorities�and�accountabilities�required�to�

address�the�issues�identified�in�this�report.���

Priorities�are�categorized�in�the�following�way:�

• High�–�to�be�started�immediately�and�completed/finalized�within�6�months�(by�January�31,�2010)�

• Medium�–�to�be�started�and�completed/finalized�within�the�next�12�months�(by�August�31,�2010)�

• Low�–�to�be�started�and�completed/finalized�within�the�next�12�–�24�months�(by�August�31,�2011)�

Some�“Medium”�and�“Low”�priority�recommendations�may�require�additional�lead�time�so�the�CCAC�

may�wish�to�begin�planning�and�development�for�these�recommendations�when�resources�are�

available.���

It�is�important�to�note�that�the�many�of�these�recommendations�can�not�be�developed�and�

implemented�in�isolation�from�other�areas�within�the�CCAC.��Additionally,�several�recommendations�

need�to�be�developed�and�implemented�in�close�collaboration�with�external�partners.��A�number�of�

senior�leaders�within�the�CCAC�may�be�accountable�for�some�aspects�of�each�recommendation�as�

has�been�noted�in�the�Accountability�column�of�the�chart.��The�senior�leader�with�the�ultimate�

accountability�for�the�recommendation�being�implemented�has�been�identified�by�an�asterisk�“*”.�It�is�

expected�that�the�CCAC�senior�leadership�team�will�create�a�more�detailed�workplan�for�each�of�the�

items�described�below.�It�will�also�be�important�that�the�LHIN�and�CCAC�review�progress�against�plan�

on�a�monthly�basis.��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 49�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

Governance and Leadership

1 Immediately develop a comprehensive performance management and measurement system to support the board’s responsibility to ensure organizational quality in all areas including client care, management performance, financial performance, external relations as well as the board’s own performance and that the organziation’s strategic plan is connected to annual operating performance.

� Build�on�Balanced�Scorecard�developed�by�Champlain�CCAC�

� Review�Balanced�Score�cards�in�use�by�other�CCACs�

� Identify�Key�Performance�Indicators�that�may�be�added�

� Develop�“dashboard”�or�summary�of�Key�Performance�Indicators�that�include�targets�and�trends�

� Implement��a�schedule�for�senior�leadership�to�reporting�to�the�Board�with�respect�to�organizational�performance��

� Develop�a�robust�CEO�performance�review�program�that�is�linked�to�organizational�performance���

� Enhance�Board�performance�review�program�

� Assess�Board�skills�capacity�and�bring�board�to�full�complement�of�individuals�and�full�range�of�skills��

� Mandatory�orientation�e.g.�governance�training�

Targets / Outcomes:��

� Balanced�Scorecard�/�Dashboard�developed��

� Board�approves�comprehensive�Balanced�Scorecard�at�September�meeting��

� Formalized�CEO�evaluation�program�linked�to�organizational�performance��

� Formal�Board�performance�review�program��

� Board�at�full�complement�

High�(January�31,�2010)�

Board�*�

CEO�

2 Immediately develop and implement strategies to assist front-line staff members to understand the CCAC’s vision and mandate and the role that they play in helping the CCAC to achieve its organizational goals.

� Develop�performance�metrics�that�are�aligned�with�CCAC’s�

vision�and�mandate�

� Manage�CCAC�management�staff�performance�on�these�

metrics�

� Manage�CCAC�front-line�staff�performance�on�these�metrics�

Targets / Outcomes:��

� Increase�staff�satisfaction�and�engagement�as�measured�by�next�employee�engagement�survey��

� Increase�staff�knowledge,�adherence�to�vision�and�behaviours�throughout�the�organization�(as�demonstrated�in�client,�service�provider,�partner�and�management�feedback)��

� Revisions�to�management�and�front-line�staff�performance�management�program�to�include�organizational�benchmarks�(in�line�with�balanced�scorecard)��

See�also�recommendation�7�Develop and implement a more enhanced communications strategy and plan�

High�(January�31,�2010)�

CEO�*�

HROD�

SPI�/�Communications�

Client�Services�

PMA�

Finance�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 50�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

3 Continually develop and evaluate its leadership practices and tools and implement leading practices.

� Review�all�current�leadership�practices�and�business�procedures�

i.e.�senior�leadership�team�meeting�record�keeping�and�follow-

up�mechanisms;�planning�practices�and�timelines;�senior�

leadership�team�performance�appraisal�system�

� Refine�and�implement�formalized�Talent�Management�Strategy�

and�Plan�

Targets / Outcomes:��

� Increased�incidence�of�achieving�individual��performance�targets��

� Stakeholders�express�higher�levels�of�confidence�in�CCAC�

senior�leadership��

� Marked�increase�in�staff�knowledge��

� Adherence�to�vision�and�behaviours��

� Staff�taking�more�ownership�in�their�position�and�can�translate�

into�higher�level�of�customer�service�that�meets�benchmark�of�

other�CCACs�in�client�satisfaction���

� Formalized�Talent�Management�Strategy�and�Plan�in�place�

Medium�(August�31,�2010)�

HROD�*�

CEO�

Infrastructure and Supports

4 Enhance Decision Support efforts at Champlain CCAC through the development of a comprehensive Data Management and Reporting Framework and skill development

� Review�frameworks�developed�by�other�CCACs�to�build�

framework�for�Champlain�CCAC�

� Identify�skills�and�resource�capacity�required�for�decision�

support.��Identify�whether�skills�and�resources�exist�internally�

and�if�not�determine�how�funds�can�be�reallocated�to�allow�for�

additional�resources�required�

� Develop�prioritization�tools�for�data�requests�

� Work�collaboratively�with�management�to�change�focus�of�

reports�from�distributed�data�to�managing�information�

� Develop/access�training�programs�for�managers�to�increase�

their�level�of�unserstanding�of�performance�management�and��

use�of�the�CCAC’s�metrics�

Targets / Outcomes:��

� Data�Management�reporting�framework�is�developed��

� Training�on�framework�completed�by�all�management�staff�

� Required�skills�identified�and�plan�in�place�to�build�capacity�

(utilize�Talent�Management�Strategy)�

� Increase�in�the�usefulness,�timeliness�and�quality�of�reports�

provided�

� External�partners�will�express�greater�confidence�in�CCAC’s�

reporting��

� Evidence�of�standard�reports�and�decision�linked�to�data�

High�(January�31,�2010)�

PMA�*�

HROD�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 51�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

5 Develop and implement a more robust Change Management Plan

� Investigate�leading�change�management�practices�(Appendix�C)�

� Adopt�those�leading�practices�that�are�best�suited�to�the�CCAC�

� Ensure�that�all�project�leaders�are�trained�in�and�utilize�the�

CCAC’s�adopted�change�management�practices.���

Targets / Outcomes:��

� Adoption�of�Formal�Change�Management�Strategy�and�Plan�

� Increase�in�job�satisfaction�and�employee�engagement�as�

measured�in�the�Employee�Engagement�Survey;�adoption�of�

new�practices;��

� Increases�in�client�and�healthcare�partner�satisfaction�

High�(January�31,�2010)�

CEO�*�

SPI�/�Communications��

HROD�

6 Implement a Project Management Strategy

� Identify�project�management�skills�and�resources�required�for�

project�management�function�

� Identify�whether�internal�resource�could�fulfill�function�or�

whether�monies�will�need�to�be�reallocated�to�fill�PMO�with�

external�resource�(1�FTE)�

� Develop�project�management�tools�and�templates�as�well�as�

project�management�training�for�project�managers�within�

organization�

� Formalize�Project�Steering�Committee�membership,�roles,�

responsibilities�and�regular�meeting�dates�

� Develop�project�prioritization�criteria�

� Develop�monthly�Project�/�Portfolio�Status�Report�

Targets / Outcomes:��

� Development�and�launch�of�Project�Management�Strategy��

� New�Terms�of�Reference�for�Project�Steering�Committee�

developed��

� Increase�in�the�number�of�successfully�completed�projects�that�

are�on-time,�on-budget�and�produce�effective�results��

� Evidence�that�management�decisions�informed�by�Project�/�

Portfolio�Status�Report�

� More�timely�completion�of�projects��

� Higher�level�of�job�satisfaction�expressed�by�project�managers�

High�(January�31,�2010)�

SPI�*�

CEO�

7 Develop and implement a more enhanced communications strategy and plan

� Review�current�communication�plans�and�identify�opportunities�

for�enhancement�

� Identify�and�develop�key�messages�and�communication�plans�

required�for��all�improvement�projects�and�change�management�

strategies�

� Implement�regular�rotation�schedule�for�senior�leadership�in�

branch�offices�

Targets / Outcomes:

� Enhanced�Communications�Strategy�and�Plan�in�place�

� Monthly�“pulse”�surveys��

� Monthly�team�meetings�with�feedback�rolled�up�to�senior�

leadership�

� Continue�quarterly�staff�conversations�with�key�messages�

High�(January�31,�2010)�

SPI�/�Communications�*�

CEO�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 52�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

Stakeholder Relations

8 Develop a robust stakeholder engagement strategy for all stakeholders, including key messages, timelines, roles, accountabilities and metrics for evaluation. The stakeholder engagement strategy should enhance the integration role, build stronger partnerships and clarify the roles and responsibilities of all stakeholders. The definition of success including outcomes and performance metrics will be developed in collaboration with the stakeholders.

� Map�the�CCAC’s�current�relationship�with�each�of�its�key�

stakholders.��Determine�whether�or�not�the�currrent�relationship�

serves�to�result�in�effective�client�outcomes.���Where�

appropriate�develop�relationship�improvement�plans�on�a�

stakeholder�by�stakeholder�basis.���

� Identify�Stakeholders�to�be�included�in�engagement�plan�

(internal�and�external);�role�on�project�or�as�partner;�interests;�

expectations�of�project�outcomes;�key�representatives;�

engagement�approach;�key�messages,�performance�metrics�

and�indicators;�timelines�and�channels�in�collaboration�with�

client�services,�contract�management�and�external�partners�

� Identify�additional�resouce�(1�FTE)�to�focus�on�stakeholder�

engagement,�including�skills�and�resources�required�

� Identify�performance�metrics�and�information�to�be�shared��monthly�between�the�CCAC�and�each�stakeholder�or�stakeholder�group�(see�also�Recommendation�#2)�

� Implement�MOUs�with�key�stakeholders�

� Outline�how�to�enhance�and�improve�customer�experience�with�entire�system;�develop�common,�shared�information�standards�and�identify�processes�and�procedures�that�may�need�to�be�enhanced�or�redesigned�

Targets / Outcomes:

� Identify�Stakeholders�to�be�included�in�the�strategy�

� Performance�metrics�and�information�identified�in�collaboration�with�stakeholders�

� Improvements�and�increases�in�client�and�stakeholder�satisfaction�rates�as�identified�by�surveys�and�face-to-face�feedback�and�on�stakeholder�scorecard�

� Assign�robust�responsibility�for�developing�and�maintaining�relationships�

� Regular�status�updates�provided�into�organizational�stakeholder�scorecard�

High�(January�31,�2010)�

SPI�*�

CEO�

Board�

Client�Services�

PMA�

Finance�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 53�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

Contract Management

9 Develop and implement a formal Service Provide Agency Relationship Management Process

� Develop�process�to�analyse�and�trend�information�that�is�

provided�on�SPA�scorecards;�include�periodic�audits�to�validate�

information��

� Enhance�scorecards�to�include�client�satisfaction�results�and�

develop�process�to�share�information�among�stakeholders�

(including�client�services)�when�client�satisfaction�survey�in�

place�

� Develop�regular�communication�proctocols�and�opportunities�for�

CCAC�contract�and�client�services�staff�and�SPA�to�identify�

issues�and�challenges�that�need�to�be�addressed;�develop�

agendas,�roles�and�responsibilities�and�as�well�as�timelines,�

meeting�minutes,�feedback�and�evaluation�mechanisms�

� Develop�formal�process�for�issues�escalation�and�resolution�

� Develop�measurable�outcomes�and�evaluation�processes,�

supported�by�monthly�standard�reports,��so�all�parties�can�

monitor�the�strength�of�the�partnerships�and�develop�ways�to�

enhance�the�relationship�

Targets / Outcomes:

� Process�to�analyse�and�trend�scorecard��

� Formal�issues�escalation�and�resolution�process��

� Review�of�communication�protocols�and�improvement�plan�developed��

� Improvements�in�relationship�with�contracted�service�provider�agencies�at�levels�of�the�organizations�(as�measured�through�confidential�survey)�

High�(January�31,�2010)�

PMA�*�

Client�Services�*�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 54�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

Finance

10 Improve planning processes so that the budget planning translates the Strategic Plan’s directions into Organizational Business Plans

� Translate�Strategic�Plan�directions�into�operational�business�plan�targets

� Create�collaborative�processes�where�targets�are�developed�and�agreed�between�management�and�departmetns�of�the�CCAC

Targets / Outcomes:

� Balanced�scorecard�in�place�

� Plans�aligned�with�one�another�

� Staff�and�management�have�more�ownership�of�budgets�

� Plans,�budgets�and�forecasts�are�valid�and�achievable

High�(January�31,�2010)�

Finance�*�

Client�Services�

SPI�

PMA�

11 Build capacity of the Finance department to provide information and data that is dynamic, forward looking and tied to strategy and objectives

� Develop�and�implement�rolling�forecasts�in�collaboration�with�all�departments,�especially�client�services�and�contract�management�

� Regularly�maintain�forecasts�and�share�information�with�LHIN

� Develop�accurate�and�appropriate�metrics�and�build�into�management�accountabilities�and�performance

Targets / Outcomes:

� New�forecasting�methodology�in�place�

� Plans,�budgets�and�forecasts�are�reliable,�valid�and�achievable�

� Services�can�be�more�consistently�provided�

� Develop�a�continuous�predictive�modelling�method

� Balanced�budget

High�(January�31,�2010)�

Finance�*�

PMA�

12 Enhance the relationship and build trust between the CCAC and LHIN with regards to financial and operational information

� Enhance�the�level�of�detail�provided�to�LHIN�with�regards�to�financial�and�operational�information

� Work�proactively�with�LHIN�to�discuss�status�of�operating�plans�and�financial�position�and�monitor�plans�required�to�address�any�identified�situations�

Targets / Outcomes:

� Enhanced�relationship�between�CCAC�and�LHIN

High�(January�31,�2010)�

Finance�*�

CEO�

Case Management

13 Meet with internal and external stakeholders collectively, sectorally, individually and within specific geographies to build understanding and enhancement of the new model and identify the processes required to transition to a new case management model

� Continue�to�meet�with�stakeholders�to�collaboratively�develop�

and�enhance�conceptual�model�

� Identify�processes�and�procedures�that�have�the�potential�to�

change�with�the�implementation�of�the�new�model�and�

collaboratively�develop�transition�strategies�

Targets / Outcomes:

� Discussions�with�all�partners�are�completed��

� Model�aligned�with�new�mandate�

� All�partners�understand�and�are�aligned�with�new�model�

Medium�(by�August�31,�2010)�

Client�Services�*�

SPI�

PMA�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 55�

# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

14 Work with all stakeholders to identify and implement “quick wins” to address current situations and challenges

� Identify�cross-organizational�operational�processes�and�

procedures�that�could�be�redesigned�and�enhanced�and�begin�to�

collaboratively�develop�improvements�

� Outline�how�to�enhance�and�improve�customer�experience�with�entire�system;�develop�common,�shared�information�standards�and�identify�processes�and�procedures�that�may�need�to�be�enhanced�or�redesigned�

� Work�with�healthcare�partners�to�identify�educational�

opportunities�required�and�collaborative�educational�sessions�

that�could�be�provided�

� Investigate�other�programs�and�leading�practices�that�are�

currently�being�rolled�out�in�other�CCACs�and�modify�to�meet�

needs�of�Champlain�stakeholders�(e.g.�Home�First)�

� Meet�with�healthcare�partners�to�address�where�resources�are�

required�for�identified�improvements�/�strategic�opportunities;�

collect�and�monitor�data�to�analyse�whether�change�or�program�

has�been�effective�in�achieving�its�desired�outcome�

Targets / Outcomes:

� Development�of�joint�projects�with�other�partners�(including�

those�outside�traditional�healthcare)��

� Implement�programs�such�as�Home�First�in�selected�pilot�

hospitals�

� Improvements�in�internal�processes��

� Evaluation�component�that�identifies�outcomes�and�benefits�for�

both�clients�and�the�system�

High�(January�31,�2010)�

Client�Services�*�

SPI�

PMA�

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# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

15 Ensure equitable access to services across the region

� Work�collaboratively�with�healthcare�and�other�partners�to�

develop,�implement�and�monitor�consistent�standards�of�service�

� Develop�and�implement�solutions�that�maximize�availability�of�

health�human�resources�and�track�and�monitor�any�program�

implementation�to�identify�outcomes�and�required�changes�

� Work�collaboratively�with�community�support�services�and�other�

partners�to�enhance�capacity�within�communities�of�care�

� Create�collaborative�human�resources�recruitment�and�

deployment�plan�with�SPAs�

� Unify�internal�operational�processes;�ensure�all�areas�within�CCAC�adopt�processes�

� Replace�manual�processes�with�electronic�and�online�processes�wherever�possible�with�the�goal�of�streamlining�and�unifying�processes�across�the�CCAC�

� Work�with�service�provider�agencies,�healthcare�partners�and�LHIN�to�determine�how�best�services�can�be�provided�in�each�area�/�community�of�care�

Targets / Outcomes:

� Clear�listing�of�programs�and�services�available�across�the�LHIN;��

� Service�level�metrics�are�in�line�with�comparable�CCACs�and�

meet�the�needs�of�clients�

� Work�in�collaboration�with�community�support�services�to�

develop�referral�targets�and�report�on�trends�monthly�

� Clarification�of�variances�in�access�to�service�across�Communities�of�Care�

� Plan�in�place�to�develop�equitable�access�to�services�across�all�

Communities�of�Care�

� Standardized�operational�processes�

� Improved�client�and�service�provide�satisfaction;��

� Identification�of�collaborative�partnerships�required�to�provide�services�

� Clarification�of�variances�in�access�to�service�across�Communities�of�Care��

� Plan�in�place�to�develop�equitable�access�to�services�across�all�

Communities�of�Care�

Medium�(by�August�31,�2010)�

Client�Services�*�

PMA�*�

IT/IS�

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# RECOMMENDATIONS PRIORITY ACCOUNTABILITY

16 Integrate systems and share information electronically

� Identify�processes�that�can�be�enhanced�or�modified�to�increase�

information�sharing�capabilities�across�organizations�

� Work�collaboratively�with�healthcare�partners�to�identify�

common�information�data�requirements�

� Investigate�other�programs/processes�that�are�in�place�at�other�

CCACs�(e.g.�eReferral,�Resource�Matching�and�Referral)�and�

work�with�Champlain�LHIN�to�develop�implementation�plan�

Targets / Outcomes:

� Identify�programs/processes�in�place�at�other�CCACs�that�can�

be�implemented�at�Champlain�CCAC�

� Develop�implementation�plans�for�the�identified�programs�/�

processes�

� Evidence�of�increased�electronic�data�sharing;��

� Evidence�that�case�managers�are�accepting�and�using�

information�provided�by�service�providers,�hospitals�and�

community�support�services�more�effectively�to�make�decisions�

Low�(by�August�31,�2011)�

Client�Services�*�

PMA�

HROD/IT/IS�

17 Take ownership of the role of system navigator

� Identify�roles�and�responsbilities�of�healthcare�partners�(within�

existing�service�delivery�model�and�new�model)�and�develop�

processes�and�procedures�in�collaboration�with�partners�

� Work�collaboratively�with�other�partners�and�LHIN�to�identify�

which�programs�could�benefit�Champlain�residents�(e.g.�

municipal�recreation�programs)�

� Undertake�baseline�audit�of�care�plans��

Targets / Outcomes:

� Evidence�of�care�plans�that�link�clients�to�a�broad�range�of�

appropriate�services�

� Adherence�to�CCAC�vision�and�behaviours��

� Staff�taking�more�ownership�in�their�position�and�can�translate�

into�higher�level�of�customer�service�and�meets�benchmark�of�

other�CCACs�in�client�satisfaction�

Medium�(by�August�31,�2010)�

Client�Services�*�

PMA�

SPI�

CEO�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 58�

Appendix�A�–�Interview�List�The�following�organizations�participated�in�interviews�and�/�or�focus�groups:�

ORGANIZATION ORGANIZATION

CCAC Service Provider Agencies

CCAC Senior Leadership Access Health Care

CCAC Management Bayshore Health Care

CCAC Staff (Pembroke, Ottawa, Cornwall) Carefor Health and Community Services

CCAC Board Comcare Health Services

LHIN Communicare

LHIN Senior Leadership Medigas

LHIN Board Mulvihill Drug Mart Ltd.

Healthcare Providers (Hospitals, CHCs, CSS, LTCs, CTC)

Ontario Medical Supply

Almonte General Hospital Paramed Home Health Care

Arnprior and District Memorial Hospital Saint Elizabeth Health Care

Bruyere Continuing Care Red Cross

Carleton Place & District Memorial Hospital VHA (COTA)

Children’s Hospital of Eastern Ontario We Care Home Health Services

Coalition of Ottawa Community Support Services

Other

Community Health Centres in Champlain City of Ottawa Parks and Recreation

Community Support Services in Eastern Counties and Renfrew County

School Boards in Champlain

Cornwall General Hospital Clients

Hawkesbury & District General Hospital

Kemptville District Hospital

Montfort Hospital

Ottawa Children’s Treatment Centre

Queensway Carleton Hospital

Renfrew Victoria Hospital

The Ottawa Hospital

Winchester District Memorial Hospital

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 59�

Appendix�B�–�CCAC�Organizational�Chart�and�Selected�Comparisons��

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 60�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 61�

CCAC Cost per Individual Served 2007/08 FY

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000

Erie S

T. Cla

ir

South

Wes

t

Wate

rloo

Wellin

gton

Hamilton

Niagar

a H...

Centra

l Wes

t

Miss

issau

ga H

alto

n

Toron

to C

entra

l

Centra

l

Centra

l East

South

East

Champl

ain

North S

imco

e M

uskok

a

North E

ast

North W

es

CCAC

Co

st

pe

r In

div

idu

al

Se

rve

d (

$)

$0$500$1,000$1,500$2,000$2,500$3,000$3,500$4,000

Average Cost per Contracted Out Expense per Hour of

Care

$0.00

$10.00

$20.00

$30.00

$40.00

$50.00

$60.00

2006/2007YE 2007/2008YE 2008/2009Q3

Fiscal Year

Av

era

ge

Co

st

($)

SW LHIN

NHNHB

Central

Central East

Champlain

CCAC Proportion of Case Management to Admin and

Support Staff

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

South

West

HNHB Central Central

East

Champlain

CCAC

Perc

en

t (%

)

Other

Case Mgmt

Admin & Support

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 62�

Appendix�C�–�Leading�Practices�

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63© 2009�KPMG�LLP,�a�Canadian�LLP�and�a�member�firm�of�the�KPMG�network�of�independent�member�firms�affiliated�with�KPMG�International,�

a�Swiss�cooperative.�All�rights�reserved.�Printed�in�Canada.�KPMG�and�the�KPMG�logo�are�registered�trademarks�of�KPMG�International,�a�Swiss�cooperative.

Champlain CCAC – Leading Practice: Finance

Leading Practice

Budgeting translates Strategic Plan targets into Organizational Business Plans.• Annual�stake�in�the�ground�defines�aspiration�business�targets�and�sets�framework�for�operational�and�regulatory�

planning.��

• These�targets�would�be�the�starting�point�for�the�collaborative�target�setting�process�for�Corporate�and�the�

Operating�Units�for�the�annual�budget

• Collaborative�Target�Setting�is�a�method�to�help�ensure�that�plans,�budgets�and�forecasts�are�valid�and�achievable�

by�creating�a�process�where�targets�are�agreed�between�Corporate and�the�operating�units�(at�all levels�of�the�

organization)

• The�management�and�organizational�units�consider�themselves�as�the�owners�of�the�plan;�Finance�is�considered�

as�the�facilitator�of�the�plan.�Finance�supports�business�by�providing�budget�templates,�and�leadership�and�

direction�to�facilitate�the�budgeting�process.

• Close�to�80%�of�top�performance�organizations�have�managers�accountable�for�budget�and�forecast�accuracy�

Use of standardized Planning and Simulation software tools that supports all aspects of the planning cycle.• Typical�cycle�time�6-8�weeks�

• Budget�Calendar�with�critical�path�and�defined�roles�and�responsibilities

• Budget�supported�by�web-based�tool�that�allows�for�planning�and�simulation

• Planning�responsibilities�are�communicated�and�understood�well�in�advance�and�ingrained�within�the�business�

operations

• Budgets�should�relate�to�comprehensive�set�of�revenue�and�expense�drivers.

• Finance�education�and�training�sessions�for�the�business�stakeholders�(i.e.�partnering�with�the�business�)

Limited�formal�forecasting�process�in�place�has�created�a�difficulty�in�predicting�financial�position�of�the�CCAC�at�

any�given�time.�Challenges�seem�to�exist�in�gathering�the�data�and�analysing discrepancies�which�has�led�to�

several�work-arounds including�requiring�Service�Providers�to�submit�an�estimate�of�the�bill�one�day�prior�to�the�bill�

submission.�

Issue/Challenge

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64© 2009�KPMG�LLP,�a�Canadian�LLP�and�a�member�firm�of�the�KPMG�network�of�independent�member�firms�affiliated�with�KPMG�International,�

a�Swiss�cooperative.�All�rights�reserved.�Printed�in�Canada.�KPMG�and�the�KPMG�logo�are�registered�trademarks�of�KPMG�International,�a�Swiss�cooperative.

Champlain CCAC – Leading Practice: Finance

Leading Practice

Forecasting

• Forecasting�is�predictive�analysis�performed�to�provide�insight�into�anticipated�short-term�business�performance.�It�

is�a�periodic�update�to�the�budget�(and�the�Strategic�Plan)�that reflects�changes�and�impacts�actually�being�

experienced�in�the�marketplace,�The�actual�results�being�experienced�in�the�marketplace�force�changes�in�

strategies,�priorities�and�resource�allocation�,�Forecasting�is�typically�made�up�of�revenue�and�expense�outlooks�

(and�often�extends�further�to�the�balance�sheet�and�cash�flow)

• Rolling�forecasts:�A�forecasting�method�that�shifts�planning�away�from�historic�budgeting�and�forecasting�and�

moves�it�toward�a�continuous�predictive�modelling method.

• Executives�are�directed�to�find�new�strategies�and�tactics�to�improve�forecast�each�quarter

Limited�formal�forecasting�process�in�place�has�created�a�difficulty�in�predicting�financial�position�of�the�CCAC�at�

any�given�time.�Challenges�seem�to�exist�in�gathering�the�data�and�analysing discrepancies�which�has�led�to�

several�work-arounds including�requiring�Service�Providers�to�submit�an�estimate�of�the�bill�one�day�prior�to�the�bill�

submission.�

Issue/Challenge

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65© 2009�KPMG�LLP,�a�Canadian�LLP�and�a�member�firm�of�the�KPMG�network�of�independent�member�firms�affiliated�with�KPMG�International,�

a�Swiss�cooperative.�All�rights�reserved.�Printed�in�Canada.�KPMG�and�the�KPMG�logo�are�registered�trademarks�of�KPMG�International,�a�Swiss�cooperative.

Champlain CCAC – Leading Practice: Finance

Leading PracticeOperations and Finance work together to develop one forecast, normally in leading practice organizations this is a 12-24 month rolling forecast.

• Forecast�used�for�course�correction�for�the�business

• Leading�finance�departments�have�individuals�dedicated�to�budgeting�and�forecasting

• Forecast�is�consolidated�using�an�integrated�planning�and�simulation�tool

• Forecast�is�based�on�key�business�drivers

• The�rolling�forecast�looks�beyond�the�normal�12�month�calendar�on�an�ongoing�basis

• Gap�between�target�and�‘business�as�normal’ is�analysed�and�closed�by�identifying�initiatives�/�management�action�required

• Extensive�use�of�business�drivers�to�convert�existing�operational�plans�into�rolling�financial�forecasts�using�relationships.��

Organizations�can�not�get�trapped�into�the�detail

• Rolling�forecasts�are�regularly�maintained,�shared�and�transparent.��Collaborative�input�is�required�across�the�organization�

through�embedding�into�operational�planning

• Emphasis�of�the�rolling�forecast�should�be�on�accuracy�(‘closest�to�the�pin’)

Top performing organizations tend to evaluate their managers on forecast accuracy (50% more then other the other companies). Forecast accuracy metric built into accountabilities and performance

• Speed�and�agility�are�critical.��Forecasts�should�be�completed�within�3�days�after�each�period.�Strike�a�balance�between�time�

invested�and�Forecasting�precision

• Link�Forecasts�to�the�Planning�and�Budgeting�cycle—furthermore,�Forecasts�should�be�directly�linked�to�the�closing�and�

reporting�processes�

• Create�and�maintain�a�well-documented,�well�communicated�Forecasting�process.�Build�quality control�mechanisms�into�this�

process�(to�evaluate�the�effectiveness�of�the�Forecasting�process,�etc.)

• Strive�for�continual�reduction�in�cycle-time�of�the�Forecasting�process.�Develop�an�ongoing�Forecasting�process�

improvement�program

• Simplify�the�Forecasting�model�by�reducing�the�number�of�items�comprising�the�Forecast

• Develop�and�maintain�a�standard�Forecasting�calendar

• Use�Forecasting-specific�software�tools�integrated�into�the�ERP�system�to�support�the�Forecasting�process

• Standardized�planning,�forecasting�and�reporting�templates

• Workflow�automation�within�planning,�forecasting�and�reporting.

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Champlain CCAC – Leading Practice: Finance

• Finance�facilitates�business�decision�and�support,�

through�analysis�and�insight,�rather�than�compilation

• Clearly�defined�and�communicated�Financial�Planning�

&�Analysis�organization�that�is�future�focused�and�can�

proactively�help�the�internal�client�organization�

understand�financial�implications�of�performance�and�

decisions�from�a�internal�client�business�perspective.�

• Dashboard�style�reporting�metrics�are�incorporated�

into�monthly�management�reporting.

• Information�and�data�that�is�dynamic,�forward�looking�

and�tied�to�strategy�and�objectives

• Finance�split�into�the�following�3�streams�with�the�

following�objectives�and�activities:

• Controllership�- Primary�responsibility�is�to�

efficiently�produce�relevant�timely�and�materially�

accurate�financial�information�for�management�

and�third�parties.

• Financial�Planning�&�Analysis�- Proactively�help�

the�organization�understand�financial�implications�

of�performance�and�decisions�for�the�CCAC.

• Financial�Systems�&�Information�– Work�towards�

Finance’s�vision�and�strategy�for�finance�systems�

and�technology�infrastructure,�as�well�as�support�

process�changes�and�enhancements�in�finance.�

Focus�of�the�Finance�department�is�mainly�

transactional�in�nature.�Reporting�to�the�Board�has�

limited�trending�and/or�analysis�to�provide�

meaningful�insight�into�results.

Leading PracticeIssue/Challenge

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Champlain CCAC – Leading Practice: Finance

Typical�CFO�Accountabilities:

• Develop�and�maintain�a�long�term�finance�strategy�

aligned�to�business�strategy�for�the�organization.

• Driving�functional�excellence,�setting�standards�and�

developing�KPIs�for�risk�management�and�decision�

support,�including:

• Running�an�efficient�cost�effective�finance�

function�where�high�levels�of�customer�

satisfaction�are�achieved�continuously

• Supporting�the�business�by�providing�insightful�

real�time�information�and�analysis

• Influencing�investors�and�other�stakeholders�

• Maintain�regulatory�compliance�with�relevant�

external�stakeholders

• Deliver�on�commitments,�to�budgets�and�forecasts�

in�line�with�investor�expectations

• Create�an�environment�where�skilled�people�are�

motivated�and�committed�to�the�achievement�of�the�

business�objectives

• Create�an�environment�of�continuous�improvement�

and�the�development�of�strategic�initiatives

There�is�no�CFO�and�this�position�has�been�vacant�

for�a�number�of�months.�Prior�to�the�vacancy�the�

role�was�filled�by�two�different�people.�The�first�to�

hold�the�role�after�amalgamation�was�also�Acting�

ED�for�a�period�of�time�and�the�second�held�the�role�

for�only�a�few�months.

Leading PracticeIssue/Challenge

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Champlain CCAC – Leading Practice: Contract Management

Supplier�Relationship�Management:

• Supplier�Relationship�Management�is�the�process�by�which�the�buying�organization�works�with�and�evaluates�each�

supplier�according�to�a�pre-defined�performance�metrics�in�order�to�determine�if�the�supplier�is�meeting,�

exceeding,�or�not�meeting�the�buying�organization’s�service�requirements�

• The�relationship�management�process�also�involves�identifying�and�giving�rewards�to�the�supplier�

meeting/exceeding�performance�metrics,�as�well�as�penalties�for�not�meeting�those�metrics.�

• There�should�be�weekly,�monthly,�or�quarterly�reporting,�both�measurement�and�exception,�shared�between�buyer�

and�supplier.

• Pre-established�corrective�action�should�be�taken�if�the�supplier�is consistently�not�meeting�performance�metrics.�

• Performance�should�be�tracked�to�obtain�a�history�of�the�supplier’s�performance.�

• Managing�supplier�relationships�enables�both�the�buyer�and�the�supplier�to�identify�potential�savings,�quality�

enhancements�and�service�level�improvements

Process�entails�3�core�elements:

• A�communication�process�establish�with�suppliers�to�manage�the�relationship�and�incorporate�feedback�(in�both�

directions)

• A�supplier�“scorecard”

• A�set�of�tools�and�templates�including�representative�scorecards for�different�types�or�sizes�of�suppliers,�tracking�

tools,�reporting�tools,�training�and�reference�materials,�etc.�

Leading Practice

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Champlain CCAC – Leading Practice: Contract Management

Key�elements�of�the�process�would�include:

• Establish�plan�for�discussing�performance�against�scorecard�dimensions�suppliers�– and�building�action�plans�to�

improve�in�key�areas

• Scorecards�should�be�initiated�with�large�suppliers�and�those�with�standing�agreements�or�recurring�business�–

simpler�versions�can�be�used�with�smaller�suppliers

• Incorporate�into�tender�process�an�evaluation�criteria�that�incorporates�historical�supplier�performance�based�upon�

scorecard�data�that�is�tracked�and�kept�up�to�date

Steps�required:

• Categorize�the�Supply�Base�(i.e.�financial�strength,�capabilities/core�competencies,�mutual�interests�etc.)

• Development�of�Mutual�Business�Goals�(MBG’s)

• Create�A�Model�to�Track�Performance

• Create�a�Weighted�Supplier�Scorecard

• Drive�Continuous�Improvement

Leading Practice

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Champlain CCAC – Leading Practice: Contract Management

• Regular�communication�with�the�Business�Owner�(in�this�case�

Client�Services)�– need�to�obtain�info�from�the�Business�Owner�

to�ensure�contract�terms�are�being�met.�

• Business�owner�have�ownership�of�the�contract�(in�this�case�

Client�Services)�– they�have�better�visibility�to�manage�the�

contract�and�performance.�The�role�of�Contract�Management�is�

to�provide�the�business�owners�with�the��

tools/templates/education/support�&�facilitation.�

• Regular�monthly�meetings�between�Client�Services�and�

Contract�Management�to�discuss�issues�and�resolution.�

However,�Client�Services�is�able�to�approach�Contract�

Management�if�any�there�are�any�immediate�concerns/issues.

• Each�Contract�Manager�is�responsible�for�a�specific�area�(i.e.�

Nursing)

Limited�internal�communication�between�

Contract�Management�and�Client�Services�

with�regards�to�issues�and�resolution.�Client�

Services�are�still�making�requests�of�the�

providers�which�are�no�longer�included�in�the�

contract�(e.g.�time�specific�referrals�and�

requiring�telephone�updates)

• Ideal�relationship�would�be�for�vendors�to�have�as�much�

information�as�possible.�This�requires�regular�communication.�

• Leading�practice�would�be�to�work�with�them�and�not�against�

them.�Vendors�can�bring�a�lot�of�value�if�they�are�engaged�in�the�

right�way.

• Regular�evaluation�of�Providers�(i.e.�Scorecards)

Limited�regular�communication�with�service�

provider.�Although�at�the�time�of�writing,�it�

was�noted�that�weekly�teleconferences�have�

now�been�initiated.

Leading PracticeIssue/Challenge

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Champlain CCAC – Leading Practice: Contract Management

• Scorecards�are�customized�based�on�discipline�to�ensure�

relevancy�(i.e.�Nursing)

• Formal�process�in�place�to�review�scorecards.

• Periodic�audits�to�ensure�suppliers�are�providing�accurate�

information.�

• Scorecards�should�include�client�perspective/feedback�as�well�

to�ensure�client�satisfaction.

• Formal�escalation�process�in�place�to�address�issues�(i.e.�Client�

Services�to�inform�Contract�Mgmt,�establishment�of�Plan�to�

Improve�for�Service�Provider,�possible�consequences�for�sub-

standard�performance�for�a�long�period�of�time,�potential�

penalties:�a)�financial�b)�disqualifying�from�future�work�c)�

cancellation�of�contracts�– terms�to�be�included�in�the�contract)�

• Rewards�– financial�incentives�/�recognitions

Although�quarterly�reports�from�Service�

Providers�on�how�they�are�meeting�standards�

as�outlined�in�the�contract�are�being�received,�

there�is�a�limited�formal�process�in�place�to�

review�the�quarterly�reports�or�determine�

actions�to�be�taken�based�on�results.�Minimal�

plans�in�place�to�manage�poor�Service�

Provider�performance.�Service�providers�are�

not�rewarded�or�penalized�based�on�

performance.

Leading PracticeIssue/Challenge

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Champlain CCAC – Leading Practice: Contract Management

Service�Providers�are�now�providing�‘estimate’ of�bill�

prior�to�submitting�the�bill�to�assist�the�CCAC�in�

forecasting�its�volume�as�there�appear�to�be�

difficulties�with�the�forecasting�process�and�systems�

currently�in�place.�In�addition�there�appears�to�limited�

data�on�“Not�Seen�Not�Found” available�for�analysis.

• Team�relationship�– on�going�dialogue�and�sharing�of�

information

Relationship�with�Service�Provider�is�not�a�

partnership.�Service�Provider�feels�as�though�the�

CCAC�“holds�the�contract�over�their�head”

• Analysis�of�historical�information/stats�– to�determine�

seasonality�

• Demographic�forecasting�

• More�information�provided�to�vendors�

• Provide�forecasts�/�or�existing�year�volumes

The�CCAC�does�not�provide�adequate�information�to�

the�Service�Providers�to�enable�them�to�plan�for�

resource�requirements�effectively�(e.g.�weekend�

requirements�determined�on�late�Friday�afternoon)

• Point�person�within�Service�Provider�who�deals�

specifically�with�Champlain�CCAC�– to�ensure�any�issues�

raised�are�resolved�in�a�timely�manner�and�there�is�

accountability�within�the�Service�Provider�organization�

Based�on�our�analysis�while�challenges�exist�with�a�

shortage�of�health�human�resources�this�in�not�the�

sole�reason�for�the�initial�surplus.�While�there�are�

shortages�in�health�human�resources�across�the�

province,�some�providers�have�indicated�they�can�

recruit�staff�but�based�on�historical�experience�are�

not�willing�to�“ramp-up” to�meet�current�demand�in�

case�they�are�required�to�“ramp-down” in�future�

months.�

Leading PracticeIssue/Challenge

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Champlain CCAC – Leading Practices: Case Management

Case managers generally act as:�M

•Broker, arranger and coordinator, who identifies and coordinates services.

•A gatekeeper, who contains costs and monitors resource allocation M

•An evaluator, who assures that case management goals are attained

Role�of�Case�Manager�

within�the�System

Assessment�should�at�least�include�the�following�components:�Personal�Data,�Health�

Status/Age,�Advanced�Directives�Status,�Emotional�Status,�Cognitive�Functioning,�

Functional�Status,�Cultural�Issues,�Patient�Support�System,�Caregiver�Support�System,�

Financial�Status,�Vocational�Status/Potential,��Community�Reintegration,�and,�Home�&�

Community�Environment

Assessment

All�criteria�should�be�developed�for�the�overall�purpose�of�coordination�of�quality�health�

care�services,�reduction�of�service�fragmentation,�enhancement�of�quality�of�life,�and�the�

appropriate�use�of�health�care�resources.

Screening

Case�Management�is�designed�to�obtain�the�best�and�most�appropriate�treatment�for�

patients.�Instead�of�discouraging�consumption�of�medical�or�social�services,�it�encourages�

the�most�effective�use�of�health�care�or�social�services�and�dollars.��It�involves�collaborative�

work�with�other�professionals�to�maintain�a�team-oriented�approach,�incorporating�the�

client�and�family�in�care�decision�making.

Definition

Reassessment�is�an�ongoing�process,�with�a�formal�reassessment�conducted�at�prescribed�

intervals�and�whenever�there�is�a�significant�change�in�the�patient’s�health,�abilities,�living�

situation,�family�involvement,�etc.�Reassessment�should�include�evaluation�of�the�type�and�

intensity�of�case�management�services�required,�with�changes�made�to�the�treatment�plan�

accordingly.

Reassessment

Leading PracticeArea

Source:��http://www.sswlhc.org/docs/swbest-practices.pdf

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Champlain CCAC – Leading Practices: Case Management

Development of Case Management Treatment Plan:

• Case�manager�explains�process�to�patients�and�family�members/significant�others�

• Case�manager�develops�options�to�present�to�patients�and�family�members/significant�others�

• Case�manager�then�helps�patients�and�family�members/significant�others�review�advantages�

and�disadvantages�to�each�option.�

• Together,�Case�Manager,�patient,�and�family/significant�others�formulate�an�individualized�

effective�case�management�treatment�plan�and�implementation�strategies.

• Plan�will�identify�patient’s�strengths�and�support�systems�and�utilize�them�in�implementation�

strategies.

Collaboration:

• Case�Manager�will�collaborate�with�patients,�family�members/significant�others�and�

interdisciplinary�team�members�on�implementation�of�the�plan�and will�keep�team�members�

informed�about�progress�toward�goals,�obstacles,�and�changes�to�the�plan.

Continuum of Care:

• Case�Management�is�provided�across�the�continuum�of�care.�Case�Managers�regularly�follow�

patients�from�community�to�inpatient�to�ambulatory�to�community�settings�and�adapt�the�case�

management�treatment�plan�as�the�patient’s�needs�change.�Reevaluation,�planning,�and�

referrals�as�appropriate�are�required�to�ensure�continuity�of�care.

Intervention�

Methods/

Options

Leading PracticeArea

Source:�http://www.sswlhc.org/docs/swbest-practices.pdf

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Champlain CCAC – Leading Practices: Case Management

Documentation

• Case�Management�Plans�of�care�are�developed�and�documented�in�the�patient’s�medical�record�

and�located��strategically�for�access�and�notice�by�all�relevant and�authorized�health�

professionals�involved�in�a�patient’s�care.

• Case�Managers�will�document�the�patient’s�understanding�and�acceptance�of�the�Case�

Management�plan�developed.

• Case�Manager�documentation�focuses�on�new�and�pertinent�information�relevant�to�the�

current/proposed�course�of�treatment�or�future�planning.

• Case�Management�and�all�Medical�Record�Documentation�are�confidential�in�nature�and�should�

be�treated�accordingly.

Documentation

Leading PracticeArea

Source:�http://www.sswlhc.org/docs/swbest-practices.pdf

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Champlain CCAC – Leading Practices: Case Management

Measurement of Outcomes –

• For�each�problem,�issue,�or�concern�identified,�the�Case�Management�treatment�plan�will�have�observable�

and�measurable�goals�for�each�problem,�issue�or�concern�identified�and�expected�outcomes.�

• Progress�toward�goals�will�be�periodically�measured�by�the�case�manager�in�collaboration�with�the�patient,�

family�member/significant�others�and�team�members.�Based�on�the�outcomes�and�progress,�changes�will�be�

made�to�the�plan�as�needed.�

• Outcomes�measurements�should�include�the�following:

•Problem Resolution

- Identified�individual�patient�care�plan�goals�met�(%�met,�%�not�met,�%�partially�met)

- Patient�adherence�to�treatment�(measured�by�increase�in�attendance�at�planned�treatment�sessions,�

treatments,�doctor’s�appointments,�etc.,�or,�decrease�in�unplanned�treatments�or�procedures�such�as�

visits�to�the�ER)

- Change�in�health�status�– measured�by�clinical�laboratory�values�or�other�physiological�testing

- Change�in�Patient�functional�status/degree�of�disability

- Change�in�patient�behavior- increase�in�self-management�activities

•Utilization Management

- Cost�of�services�provided�(when�available)

- Utilization�of�resources�as�measured�by�length�of�hospital�stay, hospital�readmissions,�ER�visits,�home�

health�visits,�etc.

- Appropriateness�of�level�of�service�(were�patient�needs�matched�with�appropriate�provider�services)

•Client Satisfaction

- Patient�satisfaction�questionnaires�and�Patient-perceived�quality�of�life�

Quality of Care Indication (Outcomes)

Leading PracticeArea

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Champlain CCAC – Leading Practices: Case Management

Disengagement�or�shift�in�the�mechanisms�for�achieving�client��goals.

• The�dynamic�nature�of�the�client’s�state�or�journey�necessitates�movement�to�alternate�

settings,�care�and�roles.

• A�redefinition�of�the�client/case�manager�relationship�in�the�evolution�of�the�client’s�

journey�toward�meeting�his/her�goals.

Transition

Leading PracticeArea

Source:�http://www.sswlhc.org/docs/swbest-practices.pdf

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Champlain CCAC – Leading Practices: Guidelines to Understanding Needs of Clients

Source:�Care�Watch

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Champlain CCAC – Leading Practices: Guidelines for Home 1st

Source:�Mississauga�Halton�LHIN,�Home�First

• Conduct�initial�psycho-social�assessment.��Identify�risks�that�may�prevent�timely�

discharge�and�provide�intervention�re:��housing/social/financial/abuse�issues.��

• Messaging�to�Patient/Family�around�Home�First.��

• Initiate�referral�to�CCAC�for�Home�First�assessment

Role of Social Work/Discharge Planner

• Meets�and�communicates�with�physicians�around�the�initiative.��Physicians�require�a�

hospital�point�person�to�address�any�concerns,�challenges,�complaints�– and�to�remove�

potential�barriers�between�hospital-CCAC-pt/family.

Role of Physician

• All�patients�would�be�assessed�by�CCAC�to�go�“Home�First” prior�to�LTC�designation.�Assessment

• CCAC�CM�assesses�patient�for�in�home�services�(W@H,�regular�services�etc)�within�24�

hours�of�referral�– if�patient�not�able�to�go�home�directly�would�consider�Restore�/�

Convalescent�care

• If�there�are�no�options�for�this�patient,�CM�(with�Manager�sign�off)�will�refer�the�patient�

back�to�the�clinical�team�and�social�worker�on�the�unit�indicating�the�client�is�ALC�– LTC�

(or�CCC).��The�normal�LTC�application�process�will�be�followed�at�that�point�including�

vacancy�matching.

Role of CCAC

• In�case�the�journey�home�involves�more�than�1�step�(i.e.,�from�Slow�Stream�Rehab�to�

Restore�to�Home�then�to�LTC).

• These�situations�require�collaborative�work�to�avoid�LTC.��However�if�LTC�is�needed�the�

process�should�occur�outside�of�acute�care.

• Physician,�CCAC,�Discharge�Planners�and�Program�Team�(OT,�PT,�Nurse)�need�to�

message�consistently�to�the�patient�/Family.

• If�concerns�are�identified�around�a�complex�discharge,�an�interdisciplinary�team�family�

meeting�is�required�to�resolve�it.

Complex Discharge

Plans

Leading PracticeArea

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Champlain CCAC –Case Manager Best Practices

• Case�Managers�should�be�present�in�all�aspects�of�the�health�care�continuum:�

neighborhoods,�specialized�teams�and�hospitals.��

Points�of�Contact

• Case�manager�shall�be�knowledgeable�about�resource�availability, service�costs,�

and�budgetary�parameters�and�be�fiscally�responsible�in�carrying out�all�case�

management�functions�and�activities.��

Case�Management�

Level�of�Knowledge

• Case�manager�shall�participate�in�evaluative�and�quality�assurance�activities�

designed�to�monitor�the�appropriateness�and�effectiveness�of�both�the�service�

delivery�system�in�which�case�management�operates�as�well�as�the case�

manager’s�own�case�management�services,�and�to�otherwise�ensure�full�

professional�accountability.

Quality�Assurance

Leading PracticeArea

Sources:��� http://www.sswlhc.org/docs/swbest-practices.pdf

http://www.ncmn.ca/Content/Documents/Document.ashx?DocId=42154

http://www.hhsc.state.tx.us/about_hhsc/reports/CaseManagement_BestPractices.pdf

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Champlain CCAC – Leading Practices: Change Management

The ADKAR MODEL

Awareness�of�the�need�to�

change

Desire�to�support�and�

participate�in�the�change

Knowledge�of�how�to�change

Ability�to�implement�required�

skills�and�behaviours

Reinforcement�to�sustain�the�

change

A

D

K

A

R

� ADKAR�provides�a�framework�for�implementing�change,�and�increasing�the�likelihood�for�success,�at�the�

organizational�and�individual�level��

� The�ADKAR�model�features�five�elements,�each�one�of�which�has�to be�in�place�for�change�to�be�realized

� Developed�in�2006�after�extensive�evidence-based�research,�it�has�since�become�a�leading�practice,�as�

well�as�go-to�model�for�practitioners�in�the�field.

� ADKAR�is�based�on�the�principle�that�by�aligning�commonly�

used�change�management�activities�like�communications,�

coaching,�training,�sponsorship,�and�resistance�management�

with�the�change�goal�or�objectives,�the�chance�of�change�

success�will�significantly�increase.�

� Tactics�to�implement�change�include�(but�are�not�limited�to):

� Building Awareness:

− Develop�effective�and�targeted�communications

− Sponsor�(Lead)�the�change�at�the�right�level�in�the�

organization;�share�why�change�is�needed

− Enable�managers�and�supervisors�to�be�effective�coaches

− Provide�employees�with�ready�access�to�business�

information

1 Hiatt, Jeffrey, ADKAR: How to Implement Successful Change in Our Personal Lives and Professional Careers, ProsciLearning Centre, 2006

The ADKAR Model1

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Champlain CCAC – Leading Practices: Change Management

The ADKAR MODEL

Awareness�of�the�need�to�change

Desire�to�support�and�participate�in�

the�change

Knowledge�of�how�to�change

Ability�to�implement�required�skills�

and�behaviours

Reinforcement�to�sustain�the�

change

A

D

K

A

R

� Creating Desire:

− Enable�business�leaders�to�effectively�sponsor�the�change,�and�equip�

manager�and�supervisors�to�be�effective�change�leaders

− Assess�the�risks�associated�with�the�change�and�design�tactics�to�

address�those�risks

− Engage�employees�in�the�change�process

− Align�incentive�and�performance�management�systems�to�support�the�

change

� Developing Knowledge:

− Implement�effective�training�and�use�job�aides�that�assist�employees�in�the�learning�process

− Provide�one-on-one�coaching

− Create�user�groups�and�forums�to�share�problems�and�lessons�learned

� Fostering Ability:

− Foster��day-to-day�involvement�of�supervisors,�and�provide�access�to�subject�matter�experts

− Implement�programs�for�performance�monitoring�and�provide�hands-on�exercises�during�training

� Reinforcing Change:

− Celebrate�successes�and�give�rewards�for�successful�implementation

− Gather�feedback�from�employees,�conduct�audits,�and�develop�performance�measurement�systems�to�

identify�causes�for�low�adoption�and�implement�corrective�action

− Build�accountability�mechanisms�into�business�operations

� These�tactics�and�activities�provide�the�framework�to�implement�change

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Champlain CCAC – Leading Practices: Change Management

� Key�components�of�include�Analysis,�Engagement�

and�Delivery,�each�with�unique�elements.�

� These�have�a�logical�order�but,�in�reality,�managing�

change�is�an�iterative�process�applied�in�a�

situational�context.

� The�following�pages�provide�a�tactical�overview�of�

what’s�required�at�each�stage,�including:

− Strategic�business�question�to�be�answered

− Objective�of�each�element

− Tools�to�achieve�the�objective

Developing a Change Management Plan

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Champlain CCAC – Leading Practices: Change Management

Strategic Business Question:

Why do we need to Change, what are the

desired benefits, and how does it impact me?

Objective:

To define a compelling business case and

vision for Change as a means to engage up-

front buy-in and aligned consensus while

laying the foundation for a communications

plan with key messaging across all audiences

Tools:

•Business Case for Change Framework•Visioning the Future•KPI Profiling

Strategic Business Question:

What Organizational Risks need to be identified and managed to improve readiness for

Change?

Objective:

To develop a holistic understanding of the landscape of organizational risks for the

upcoming change across all best practices of the BCM framework

Tools:

•Stakeholder Analysis•Change Readiness Assessment •People & Organization Risk and Issues Log•Culture Surveys

Strategic Business Question:

What is our overarching strategy to prepare

the organization for Change?

Objective:

To develop a thorough roadmap in close

collaboration with the Project Management

Office (PMO) which synthesizes various

Change inputs into an integrated roadmap

containing not only all Change Management

dimensions but also all interdependent

initiatives in play. In addition, the governance

infrastructure of a Change Agent network is

set up as the execution arm.

Tools:

•Organizational Impact Analysis•Change & Communication Strategy

Analysis is about assessing the organizational risk and cultural readiness

of an Organization for Change while laying the foundation for a

compelling vision and executable Change Strategy going forward,

Business Case &

Vision for change

Change Risk Analysis

Change Strategy

Getting Started: “Analysis” and its Elements

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Champlain CCAC – Leading Practices: Change Management

Strategic Business Question:

How do I help ensure that I have galvanized

leadership consensus for the Change and how do I

mobilize them to manage their stakeholders?

Objective:

To assist leadership to be effective leaders within

the context of driving Transformational change.

Tools:

•Change Leadership Behaviors Diagnostic•Generating Leadership Alignment Events•Leading Change Workshop (Educational tool)

Strategic Business Question:

How do I manage stakeholders through the Change with a

particular emphasis on proactively mitigating behavioral

resistance?

Objective:

To mobilize the Change strategy, it is key to take the change

architecture and network and bring it to life through active

stakeholder management. The goal here is to cascade

awareness and preparation for Change throughout the

organization.

Tools:

•Stakeholder Management Framework

Engagement is about proactively

addressing and mitigating

Change resistance. This phase is

focused on engaging and

mobilizing leaders and

stakeholders through a

structured Change Network and

driving awareness, buy-in and

ownership through a series of

interventionsStakeholder Management

Change Leadership

Involvement Strategies

Strategic Business Question:

How do I get stakeholders groups involved in the ‘what’ and/or ‘how’ of the

change to develop their buy-in and gain active involvement in making it a

success?

Objective:

To develop an effective involvement strategy and plan across all stakeholder

groups and to create momentum behind the change.

Tools:

•Communication and Change Tactical Plan

Getting Involvement and Buy-In: Engagement” and its Elements

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Implement and Sustain the Change: “Delivery” and its Elements

Strategic Business Question:

Is the operating model and organization structure aligned to the strategy and does it

create an environment that positions my workforce to be successful?

Objective:

To develop a future state organization and operating model at both the macro and

micro levels that aligns the workforce to adopt and execute the business model

effectively

Tools:

• Organizational Blueprint

Strategic Business Question:

How do I measure and monitor progress to help

ensure sustainable benefits?

Objective:

To develop a measurable set of tools to drive

sustainable organizational adoption and potential

benefits realization

Tools:

• Sustainability Checklist

• Knowledge Transfer Strategy

•Management Monitoring Dashboard

Strategic Business Question:

Once I understand the impacts, how do we help position the

workforce to successfully adopt the future state business

model?

Objective:

To create a thorough workforce transition strategy which takes

into account job role impact, training as well as navigating the

knowledge, skill and ability gaps

Tools:

•HR Frameworks Assessment•Competency Frameworks Assessment•Job Impact Analysis•Training Needs Analysis•Redundancy and Transition Cost Model

•Workforce Transition Countdown Roadmap

Delivery is about moving to the

“implementation” mode of the Change

journey by preparing affected

stakeholders for the new people, process

and technology impacts of the Change.

The Change strategy in Delivery is more

pragmatic and focused on helping

ensure the workforce is being equipped

with the right tools to be positioned for

success.

Benefit Realization & SustainablePerformance

People Transition

& WorkforceEffectiveness

Organizational Integration

Champlain CCAC – Leading Practices: Change Management

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Champlain CCAC – Leading Practices: Change Management

Taking all of the practices previously discussed, a Change Management Strategy and Plan should include the following:

� Introduction:

− This�section�provides�an�overview�and�purpose�of�the�document�in addition�to�some�background�

information�for�context.�The�introduction�may�also�discuss�methodology�and�the�engagement�scope�

and�objectives.�

� Change Approach and Guiding Principles:

− This�section�outlines�the�overall�approach�to�the�change,�as�well�as�the�principles�that�will�guide�the�

change.��

− Typically,�the�change�approach�is�usually�based�on�a�series�of�activities�that�occur�in�parallel�and/or�in�

succession�and�often�focus�on�establishing�effective�organizational�change�leadership,�engaging�and�

supporting�individuals,�reducing�resistance�to�change�by�addressing�individual�and�team�concerns,�

ensuring�that�people�have�the�appropriate�tools�to�efficiently�work�within�new�processes�and�

procedures

− Guiding�principles,�by�contrast,�will�provide�the�foundation�upon�which�all�of�the�above�activities�are�

conducted.��Typical�guiding�principles�often�include�timely�and�targeted�communications,�openness�and�

transparency�of�activities,�equal�“say” for�everyone,�providing�a�variety�of�two-way�communications�

channels�to�facilitate�discussion

Developing a Better Practice Change Management Strategy and Plan

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Champlain CCAC – Leading Practices: Change Management

� Current Assessment and Conclusions

− This�section�presents�a�comprehensive�overview�of�the�current�state�of�the�organization�by�outlining�the�

degree�of�impact�the�change�will�have�on�fundamental�elements�of the�organization�(high,�medium,�or�

low).�This�often�assesses�the�impact�on�the�following�elements:

� Business Economics: The�financial�impact�of�the�Change�on�business�units�or�Departments�

� Resource Capacity: The�ability�to�adequately�resource�the�change�and�the�desired�future�state,�and�

the�capabilities�of�those�resources�to�execute�their�tasks

� Process: Business�processes,�flows�of�information�or�materials�between�individuals�or�groups.

� Roles and Responsibilities: Tasks�and�outcomes�for�which�an�individual�or�team�is�responsible.

� Technology: The�abilities�and�skills�an�individual�or�team�requires�in�order�to�perform�their�role.

� Culture: Shared�behaviors,�values�and�beliefs.

� Strategic Areas of Focus:

− This�section�identifies�detailed�change�management�strategies�to address,�and�mitigate,�each�of�the�

high-impact�areas�identified�in�the�previous�section.��These�often�include�Leveraging�Leadership,�

Building�Broad�Awareness,�and�Training�and�Learning

− The�Strategic�Areas,�in�turn,�provide�the�focus�for�tactical�change�management�plan;�tactics�are�

organized�to�align�with�each�Strategic�Area�of�Focus

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Champlain CCAC – Leading Practices: Change Management

� Detailed Strategies

− This�section�presents�the�details�of�each�Strategic�Area�of�Focus.�Specifically,�for�each�Strategic�Area�is�

outlines:

� An�overview�of�the�Strategic�Area�(i.e.,�how�and�what�it�addresses�of�the�high-risk�impact�areas

� Tactical�recommendations�that�align�with�the�Strategic�Area

� Roles�and�responsibilities�required�to�execute�on�the�recommendations

− The�linkages�between�the�impact�areas,�Strategic�Areas�of�Focus, and�Detailed�Strategies�have�been�

illustrated�at�a�high-level�as�follows:

Example High Impact Area:

Lack�of�clarity�around�Roles�

and�Responsibilities

Example Strategic Area of Focus:

Building�Understanding�of�

Roles�and�Responsibilities

Example Detailed Recommendations:

• Develop�and�disseminate�

roles�and�responsibilities

• Demonstrate�each�roles�in�the�

context�of�the�overall�

business�process

Tip! Not�all�strategies�have�to�one-to-

one�to�the�impact�areas;�one�strategy�

can�often�address�multiple�risk�areas!

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Champlain CCAC – Leading Practices: Change Management

� The Change Management Plan

− This�section�includes�the�Strategic�Areas�of�Focus,�the�Recommendations�for�each�Area�of�Focus,�as�

well�as�the�detailed�activities,�target�audience,�delivery�method,�key�messages,�delivery�date,�and�task�

owner�for�each.�

− The�Change�Management�Plan�is�usually�presented�in�table�format�to�accommodate�the�level�of�tactical�

information�and�for�ease�of�reading

� Sustainability and Performance Measurement

− This�section�outlines�the�ongoing�activities�that�will�help�sustain�the�change,�as�well�as�the�strategy�and�

the�tactics�to�measuring�the�success�of�the�change.�This�often�includes:

� Identifying�the�change�management�tactics�that�will�remain�in�operation�post�change�as�a�means�of�

reinforcing�desired�behaviours�(e.g.,�a�leadership�newsletter)

� Evaluation�Strategies�such�as�the�types�of�evaluation�that�will�take�place�(formal�feedback,�informal�

feedback,�survey�analysis,�feedback�via�managers�etc)

� Evaluation�Plan�that�outlines�the�type�of�evaluation�(i.e.�survey),�the�indicators�being�measured,�the�

evaluation�date,�and�task�owner.�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 91�

Appendix�D�–�Conceptual�Model�

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DRAFT

Conceptual Model Champlain CCAC

Developed�by�Champlain�CCAC

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Conceptual Model

• Ministry�and�LHIN�priorities�along�with�an�aging�population�will continue�to�exert�

service�and�cost�pressures.��The�aging�population�is�not�served�by�a�single�

population�but�the�system�working�together.�

• In�order�to�meet�the�needs�of�individuals�who�require�support�from�multiple�

levels�of�the�healthcare�system�and�deliver�on�these�priorities�the�Champlain�

CCAC�is�exploring�in�partnership�with�its�stakeholders:

�New�Case�Management�Models

� Innovative�models�of�service�delivery

• Goals�of�Integrated�Case�Management

�Responsibility�over�the�span�of�services�and�agencies�

�Linking�care�across/within�levels�of�health�care

�Focusing�on�improved�outcomes�for�the�client

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Conceptual Model

• Benefits�of�an�Integrated�Case�Management�model:

� Increases�continuity�of�care�between�settings

� Increases�communication�between�providers

� Enables�proactive�discharge�planning

� Reduces�redundancy�in�care

� Is�flexible�and�responsive�to�changing�care��needs

� Provides�regular�outcome/performance�monitoring

� Integrated�care�delivery�systems�designed�to�meet�the�needs�of��specific�populations�are�efficient�and�cost-effective�(Hollander�et�al,�2007)

� CM�alone�is�less�effective�than�CM�accompanied�by�integrative�network�that�involves�interdisciplinary�team�work�(Tremblay�et�al)

• Challenges

� Competition�between�organizations

� Turf�protection�and�power�issues�due�to�overlapping�roles�

� Financial�resources�and�time�to�move�towards�integration

� Encouraging�client�awareness�and�input

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Population Health Approach

• “An�approach�to�health�that�aims�to�improve�the�health�of�the�entire�

population�and�to�reduce�health�inequities�among�population�groups.”

• It�considers�the�entire�range�of�individual�and�collective�factors�and�conditions�

- and�their�interactions�- that�have�been�shown�to�be�correlated�with�health�

status” (Health�Canada�Website)

Population Health Approach

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Conceptual Model

• The�following�parameters�need�to�vary�based�on�the�client�population�being�

served:

�Range�of�Professional�Requirements

�Emphasis�on�Cost�Containment�vs.�Care�Management�

�Degree�of�Specialization

�Emphasis�on�Integration

�Type�of�Support�for�Chronic�Disease�Management

�Caseload�Size

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Range of Professional ServicesC

ase M

an

ag

er

Ro

les

SRC* Cost Service LOS Acuity Risk

Low Cost

High Cost Long Stay

Short Stay

939495

9192

PTOT

PSWSW

NursingPalliative

Low Acuity

Medium to High Acuity

Low Risk

Medium to High Risk

Other

* 91 – Acute; 92 – Rehab; 93 – Maintenance; 94 – Long Term Supportive; 95 – End of Life

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Community Population Health Framework

Chronic

Well

Complex

Acu

te, E

pis

odic

Acu

te U

nst

able Unstable

Well at Risk

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Conceptual Model

• Guiding�principles:�

�The�model�will�meet�the�needs�of�clients�as�they�change�and�move through�

the�health�care�system

�The�model�will�be�flexible�to�meet�the�needs�of�an�evolving�community�and�

health�care�system

• Key�considerations:�

�Continuity�of�primary�case�manager�(supported�by�client�services team)�is�

highest�priority�unless�otherwise�indicated

�Minimization�of�transfers

�Accessibility

�Urgency�of�response

� In-depth�or�broad�knowledge�requirements�of�1)�resources,�partners, linkages�

(system�navigation)�and�2)�disease/condition

�Efficient�and�effective�use�of�case�management�resources

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CHILD AND YOUTH:

SCHOOL

ALL LEVELS:

SERVICE PROVIDER FOCUSED

LOOKS LIKE: DEDICATED TEAM WITH

LARGE CASELOADS

PROVIDER IS PIVOTAL

(*FRAGILE CLIENTS MAY BE

MANAGED BY IN-HOME CM)

ACUTE CARE

ALL LEVELS:

SERVICE PROVIDER FOCUSED

LOOKS LIKE: DEDICATED TEAM WITH

LARGE CASELOADS

CENTRALIZED

RESOURCES: CARE PATHWAYS

PROVIDER IS PIVOTAL

CHILD AND YOUTH

IN-HOME

ALL LEVELS:

NEED FOR IN-DEPTH KNOWLEDGE,

CONTINUITY, PREVENTION,

MAINTENANCE, RESPONSIVENESS

LOOKS LIKE: DEDICATED TEAM

COMPRISED OF SUBJECT MATTER

EXPERTS CLOSE TO CLIENTS, WITH

MODERATE CASELOADS

EXPERT CM IS PIVOTAL

INTEGRATED CASELOADS

NEED FOR CONTINUITY, BROAD

KNOWLEDGE, PREVENTION, MAINTENANCE,

CHRONIC DISEASE MANAGEMENT, ACUTE AND

LTC AVOIDANCE, PLACEMENT

LOOKS LIKE: INTEGRATED TEAMS CLOSE TO

CLIENTS

EXPERT CM FOR HIGH INTENSITY NEEDS:: ABI;

MH; GA/ RISC; DEMENTIA

Other Resources:

Wait at Home, Aging at Home,

Chronic Disease Strategies

CLIENT INTENSITY

INTEGRATED CASE-

LOADS, LOW INTENSITY

NEED FOR CONTINUITY, BROAD

KNOWLEDGE, PREVENTION, MAINTENANCE,

LOOKS LIKE:•Usually single service, good degree of independence and confidence in knowledge and care management

•Integrated adult/senior caseloads, broad knowledge base

•Located in large general catchment area•Linkages horizontally (providers, community resources, I & R))•Administrative functions by

non-professional staff•Case load size: Large

SUPPORTIVE CARE

ALL LEVELS:

NEED FOR IN-DEPTH KNOWLEDGE,

CONTINUITY, PREVENTION,

MAINTENANCE, RESPONSIVENESS

LOOKS LIKE: DEDICATED TEAM

COMPRISED OF SUBJECT MATTER

EXPERTS CLOSE TO CLIENTS, WITH

MODERATE CASELOADS

EXPERT CM IS PIVOTAL

INTAKE

PLACEMENT SUPPORT TEAM

HOSPITAL/ ED CASE MANAGMENT

CHAMPLAIN

HEALTHLINE FAMILY HEALTH

TEAM CASE MANAGEMENT

PRIMARY C

ARE

CONNECTOR

INFORMATIO

N

AND REFERRAL

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Conceptual Model

• Understand�the�population�we�serve�based�on�costs,�RAI�outputs,�complexity,�diagnosis

• Develop�internal/external�engagement�strategy�to�test/refine�model

• Develop�an�implementation�plan�which�includes�evaluation/metrics

• Identify�potential�sites/partners�to�run�pilot�projects

• Identify�new�skill�sets�required�&�training/development�plan

• Outcomes�are�critical�in�demonstrating�the�value�of�case�management.�Client-related�outcome�measures�may�include:

�Cost�of�client�care

�Client’s�health�status

�Readmissions�to�hospital,�emergency�department

�Delay�admission�to�LTC

�Length�of�stay

• Client�outcome�metrics�are�very�important,�as�they�help�identify what�is�and�what�is�not�working�and�they�begin�to�form�a�basis�for�aggregate reporting.�

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• New�models�of�service�delivery

• Response�to�ED�notification

• CDPM�strategy

• Strategies�to�improve�communication

Service�Providers

• Explore�partnerships�for�clients�with�mental�health�

disorders

Canadian�Mental�

Health�Association

• Improved�linkages/referrals�with�I&R

• Increased�information�flow�for�shared�client

Community�Support�

Services

• ED�notification

• Resource�Matching�e-Referral

• Relationship�with�Intensive�CM

• Repatriation�of�placement�role

Hospitals

Working with Our Partners

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 104�

Appendix�E�–�CCAC�Planning�Day�High-Level�Results�

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 105�

SLC Planning Day, July 13, 2009

In Attendance: Sheila Bauer, Johanne Levesque, Ashley Haugh, Hannu Harinen, Paul Boissonneault, Patrice Connolly, Lynn Godding, Kim

Peterson, Penny Sands, Glenda Owns, Sophie Parisien

Items from the Board approved CCAC operating plan were ranked by members of SLC in four categories – mandatory, high, medium and low. Client Services PMA Finance/Facilities SPI/Communications HROD/IS/IT

Mandatory

• Legislated • Contractu

al • LHIN/

mandated

• Develop and implement CM Model (2 yr 09-10 – broad internal/external membership)

• ED Notification (April 2010 – 3 hospitals)

• CCAC Branding R/T proof points for C.S. (April 2010)

• Repatriate placement (external/C.S. membership– Dec ’10)

• Transitional care function (fall 2009)

• Procurement strategy (09-10 yr end)

• Contract extension (Dec ’09-june ’10)

• HSE RFP (Oct ’09-March ’10)

• CHRIS Business process alignment (lean approach)

• Alignment of TA/CM roles related to CHRIS

• • Strategic plan refresh

• Summer ’09 HSP

• Business case re direct service delivery

• Implement accessibility for Ontarians with

Disabilities Act

• Implement workplace wellness plan

• BTI refresh (firewalls, laptops and desktops)

High Priority

• High risk financial/ impact on business

• Alignment of placement guidelines

• Home First (3 acute hospitals)

• Develop, implement & integrate a decision support model (resourced appropriately)

• Client experience satisfaction survey (CEE) ¼ follow through

• Pandemic planning as part of

• Implement decentralized budget

o Implement decentralized budget reporting throughout Champlain (IT)

• Implement more sophisticated

• Strategic communications re review

• Develop and implement CCAC ED/ALC strategy

• Internal communications plan

• Develop French language services plan

• Develop & implement employment engagement action plan

• Continue to develop phase 1&2 leadership development programs (4 sessions annually)

• Complete development & fully

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 106�

Emergency Preparedness plan

• Complete the implementation of lean CHRIS process across Champlain (Lead)

forecasting system

• Budget targets • Revised BoD

financial reporting package

• Facilities master plan (short term, long term)

• Expansion project cancer centre QCH (Nov ’09)

• New Hawkesbury office

implement onboarding program (# new hires retained) o Develop, align & implement CH recruitment infrastructure & measure

o Standard CM/TA/I&R reps orientation

• CHRIS – OCR (docushare) Integration (step 1, step 2)

• Incoming fax server & process

Medium Priority

• • • Internal strategy - implementation of brand

• Develop Champlain CCAC strategic workforce plan

• Corporate learning plan

• Develop a strategy to improve union relations

• Develop tele-work model

• Deploy and train Office 2007

• CHRIS releases o 1.2.8 –eForms o 1.3 – off-line

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 107�

Low Priority • Service guidelines evaluation & follow-up

• Expand content of healthline ( careers section, LTC virtual tour, desk top resources, chronic disease resources, CSS)

• Initiate accreditation process (delayed)

o Risk management program – assessment, develop & implement

• Document management system

• Caregiver recognition awards

• Develop/implement stakeholder engagement model/plan

• Talent management strategy

• External strategy – implementation of brand

Completed • Programs new service maximums (SAH, WAH, EPSS, EOL)

• Complete the brand activation implementation

• HR/OD framework • Implement a

recognition program which supports retention

• Develop CCAC e-health strategic plan

• CHRIS deployment & date migration

• Deploy internal audio conference to reduce costs (by 50%)

• Expand web portal access to RAI in RC & EC

• Extend video conference to 3 additional sites

Items for future years operating plans

• Alignment of therapy guidelines

• Expansion of services in RC for

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 108�

OCTC

• Continue linkage with (primary care strategy) via care connector community engagement RM

• E-referrals and resource matching

• Implement therapy professional practice standards

• VAC & wound care – ensure best practice

• There will always be mandatory projects that come part way through the year from the LHIN, MOH, etc. At that time, we will have to re-

prioritize medium and lower priority items to accommodate new projects. If items are added, need to remove something else and communicate

delay.

o New projects will come to SLC first:

� projects that will impact the entire organization

� that involve more than one department

� over $100,000 (this also requires approval of the Board)

• Not only are you part of your own priorities but part of priorities from other departments – i.e., also take your time.

• The understanding is that the items in mandatory, high and medium priorities will be complete before March 31, 2010 unless indicated will be

multi-year. Low priority items will be worked on as well and may extend to next fiscal year.

• Each VP will decide who responsible for each project and who is writing project charter.

• Project charter – what it looks like. Wanda has developed one and there is also one from Central East. (discuss July 20)

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 109�

o Being sent to Paul to review and discuss at the Directors and Sr. Manager’s meeting next Monday

• Education re project management – Wanda will be resource for now.

• Need for a resource re project management – where is it coming from? (Patrice, Paul and Johanne to speak – explore options if no funding

available via LHIN)

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FINAL� ������Review�of�Champlain�Community�Care�Access�Centre� 110�

kpmg.ca�

©�2009�KPMG�LLP,�the�Canadian�member�firm�of�KPMG�International,�a�Swiss�cooperative.��All�rights�reserved.�

KPMG�and�the�KPMG�logo�are�registered�trademarks�of�KPMG�International,�a�Swiss�cooperative.�