201 Queens Avenue, Suite 700 Toll Free: 1 866 294-5446 Board of Directors’ Meeting...

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

Board of Directors’ Meeting Wednesday, September 25, 2013

2:00 to 5:00 pm Lions Head Hospital, Boardroom

AGENDA Item Agenda Item Lead Decision/

Information Time

1. Call to Order Chair 2:00-2:05 2. Declaration of Conflict of Interest Chair 2:05-2:10 3. Approval of Agenda Chair Decision 2:10-2:15 4. 4.1 4.2 4.3 4.4 4.5 4.6 4.7

Consent Agenda Items Approval of Minutes: Board of Directors- July 24, 2013

2013/14 Quarter 1 Broader Public Sector Accountability Act Attestation 2012/13 Fourth Quarter Health Service Provider Reports Governance Review Task Force Minutes – May 22, 2013 Board to Board Reference Group Minutes – January 16, 2013 Board to Board Reference Group Minutes – March 20, 2013 Senior Leadership Report M Barrett/M Brintnell/K Gillis/L Johnson/ /ME Khan

Chair M Barrett M Brintnell Committee Chair Committee Chair Committee Chair Senior Leadership

Decision Decision Information Information Information Information Information

2:15-2:30

5. 5.1

Presentations 2013/14 Quarter 1 Report on Performance

M Brintnell/ N Robinson

Information

2:30-3:00

6. 6.1 6.2 6.3 6.4 6.5

Agenda Items for Decision 2013-15 Ministry LHIN Performance Agreement 2013/14 Priorities for Investment Funding 2013-14 Wait Time Strategy Allocation Plan Hospital Service Accountability Agreement (H-SAA)- Six Month Extension Governance Policies A-9 and A-11

M Barrett M Brintnell M Brintnell M Brintnell Committee Chair

Decision Decision Decision Decision Decision

3:00-4:00

7. 7.1A 7.1B

Agenda Items for Information Access to Care Update Adult Day Program Redesign

K Gillis K Gillis

Information Information

4:00-4:20

8. 8.1 8.2

Governance Board Chair Report Board Director Reports

Chair Directors

Information Information

4:25-4:40

9. New Business Chair Discussion 4:40-4:50 10. Closed Session ( if required) Chair Decision 4:50-5:00 11. Date and Location of Next Meeting

Wednesday, October 23, 2013,Stratford General Hospital, E1-609B • Board Meeting – 2:00 p.m. – 5:00 p.m.

12. Adjournment Chair 5:00

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

Board of Directors’ Meeting Minutes (draft)

Wednesday, July 24, 2013 2:00 pm to 5:00 pm

Listowel Memorial Hospital Outpatient Building Basement Auditorium, 255 Elizabeth Street East

Present: Jeff Low, Board Chair

Ron Bolton, Vice Chair Ron Lipsett, Secretary Gerry Moss, Board Director Aniko Varpalotai, Board Director

Staff: Michael Barrett, Chief Executive Officer

Kelly Gillis, Senior Director, System Design & Integration Mary Ellen Khan, Director, Communications & Community Engagement

Marilyn Robbins, Executive Office Assistant (Recorder) Regrets: Barbara West-Bartley, Board Director

Andrew Chunilall, Board Director 1. Call to Order – Welcome and Introductions

The Chair called the meeting to order at 2 pm. There was quorum and two members of the public were in attendance for parts of the meeting.

2. Declaration of Conflict of Interest There was no declaration of conflict of interest.

3. Approval of Agenda

MOVED BY: Aniko Varpalotai SECONDED BY: Gerry Moss THAT the Board of Directors’ meeting agenda for July 24, 2013 be approved as presented. A closed session will be held.

CARRIED

Agenda Item 4.1

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

4. Consent Agenda Items The Physiotherapy Update Report (Item 4.4) was removed from the consent agenda and added to Section 6 – Agenda Items for Information/Discussion. MOVED BY: Ron Bolton SECONDED BY: AnikoVarpalotai THAT the consent agenda items be received and approved as circulated in the agenda package.

CARRIED

5. Agenda Items for Decision

5.1 Governance Review Task Force and Terms of Reference MOVED BY: Aniko Varpalotai SECONDED BY: Ron Lipsett THAT The South West LHIN Board of Directors approve the recommendation to combine the Governance Review Task Force and Community Nominations Committee into the newly formed Governance and Nominations Committee.

and

THAT the South West LHIN Board of Directors approve the Terms of Reference for the Governance and Nominations Committee as recommended to the Board by the Governance Review Task Force.

CARRIED Discussion: Task Force Chair, Aniko Varpalotai reported that the Governance Review Task Force met earlier in the day and were recommending one minor revision to the Terms of Reference document being considered, that section 5 include a reference to governance policy A-11 Community Nominations Process.

5.2 Integration – London Middlesex Enhanced Mental Health Crisis and Case Management Service MOVED BY: Ron Bolton SECONDED BY: Gerry Moss

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THAT the South West Local Health Integration Network (LHIN) Board of Directors does not wish to issue an integration decision regarding the proposed integration of London Middlesex Enhanced Crisis Service as proposed by Mission Services London, SEARCH Community Mental Health Services (SEARCH), London Health Sciences Centre (LHSC), WOTCH Community Mental Health Association (WOTCH), Canadian Mental Health Association London Middlesex (CMHA-LM) and Addiction Services Thames Valley (ADSTV) in the May 30, 2013 submission to the South West LHIN.

CARRIED

Discussion: A question was asked if the reporting requirements could be enhanced to ensure the board understands the success/impact of this initiative. The board heard that performance measurement in this area is still in development and that the partners will continue to work on the evaluation plan to go with the model. ACTION: Board Chair to issue a letter of congratulations with a request for a report on the integrations impact on clients and the system due back to the board in one year.

5.3 2013/13 Hospital Service Accountability Agreement (HSAA) MOVED BY: Ron Lipsett SECONDED BY: Gerry Moss THAT the South West Local Health Integration Network Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the Hospital Service Accountability Agreement 2013/14 Amending Agreement covering the period April 1, 2013 to September 30, 2013 with the South Bruce Grey Health Centre and Grey Bruce Health Services.

CARRIED Discussion: Staff reminded the board that this is an extension of the 2010 H-SAA Agreement with the two outstanding agreements being presented today as negotiations on each have concluded. These H-SAA extensions will expire on September 30th, 2013. A new H-SAA template is now being negotiated with the Ontario Hospital Association (OHA).

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6. Agenda Items for Information/ Discussion

(Item 4.4) Physiotherapy Update Report In view of recent media reports and today’s board development presentation from the Long Term Care Homes Network Council, the board requested additional dialogue to confirm that changes to physiotherapy will provide for better service for patients/clients/residents. The board heard that these changes will ensure accountability as payment for physio will shift from OHIP billings to funding being provided directly to health service providers. 6.1 2013/14 Priorities for Investment Plan A written briefing had been circulated in the meeting materials. Staff reported that all funds have been announced in the budget but the details have not yet been confirmed by the Ministry. Staff committed to providing clear communication and transparency to all providers regarding these investments. Staff aim to bring the plan to the September meeting anticipating funding letters to arrive in August. 6.2 Oxford Hospitals Joint Services Planning Update Staff referenced the report circulated in the meeting materials noting that there has been a change in the project timelines as compared to the charter that was initially approved by the South West LHIN Board of Directors. The charter had identified that governance recommendations should be identified in Phase 1 of the project for implementation in Phase 2. As there was not sufficient time in Phase 1 to develop governance recommendations, the expectation is that in Phase 2 a plan will be developed to move forward with a focus on achieving initial implementation steps, establishing momentum and trust amongst the partners. The desired outcome is that some voluntary integration will occur. In response to a request for an update on the situation with CCC/rehab beds for the Oxford hospitals staff reported that Tillsonburg and Ingersoll are engaged and financial pieces are being worked through. The meetings held since the last report to the board have been generally positive with quite a bit of work being accomplished. Staff are scheduled to attend a joint session with the boards of Tillsonburg and Ingersoll in September to provide an overview of the integration legislation. Implementation is currently on target for 2014/2015. 6.3 Integration Overview Staff provided a presentation on Integration in the South West LHIN centred around the Local Health System Integration Act (LHSIA, 2006). The presentation highlighted different types of integration and the South West LHIN’s criteria for integration.

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201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll-free: 1 866 294-5446 www.southwestlhin.on.ca The board considered the level at which integrations need to come to the board table. It was

suggested that the criteria for defining integration could be further detailed with specific criteria for what requires a board decision. A draft integration policy currently sits on the website but has not been finalized. Staff confirmed that it aligns to the legislation and does serve to inform HSPs about integration. It was suggested that the development of a more specific definition of integration could have a positive albeit minor impact on staff workload. The board considered LHIN autonomy versus system consistency and agreed that a consistent LHIN-wide interpretation of LHSIA would be preferred. Staff did confirm that the criteria for integration presented did initially come from another LHIN. The board briefly considered the $50K cost savings threshold outlined in the criteria with staff confirming that integrations to date have typically resulted in better service rather than cost savings. ACTION: Staff to bring the draft integration policy to the board for consideration at a future meeting. In considering the different types of integration staff emphasized that the goal is always for voluntary (or HSP initiated) integration and that even in instances where integration is facilitated it requires partners to sign-off. The board briefly discussed the appropriateness of issuing negative motions in support of voluntary integrations. No better means of documenting integration was identified. The board is interested in HSPs receiving on-going communication regarding their role in integration, and success factors for integration. Staff responded that the topic will be part of the program for the Board-to-Board IHSP Engagements scheduled for the fall. The presentations, the wallet card, and perhaps a one-pager on integration would be good take-aways for all upcoming Board-to-Board Engagements. The board also indicated an interest in furthering the integration discussion at either a generative session or board development event. 6.4 Draft Value for Money Assessment Framework The board received the report circulated in the meeting materials. This report came as a result of discussions at the board development event in April as a desired tool to monitor/evaluate the overall impact of investments on the system. It was suggested that the next step involve working a small test-case with readily available data through the assessment framework and bring the results to the board to illustrate its function and provide opportunity for feedback.

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Staff reported that this process would differ from the LHINs existing evaluation process in that it would involve greater detail in every area with additional information, data and documentation being required to allow for a more in-depth analysis of system impact. Concerns expressed included the labour required on behalf of both HSP and LHIN staff, and the importance of ensuring HSPs are comfortable that the goal is to evaluate system impact rather than to look too deeply into operational details. It was agreed that a guiding principle be to not make reporting more onerous for all involved and staff cautioned that different investments will require different amounts and types of data with sophisticated analysis not currently possible for all initiatives.

The board also heard that the newly implemented Project Management Office (PMO) will assist in providing the board with additional information on initiatives and will assist in this value for money exercise.

ACTION: Staff will identify and develop a test case for the assessment tool with the results to be presented for the board’s consideration at a future meeting.

7. Governance 7.1 Board Chair Report See below. 7.2 Board Director Reports

• Ron Lipsett delivered remarks at the June 27 annual meeting of the South East Grey Health Centre and reported being impressed with the discussion around models for primary care and rural.

• Aniko Varpalotai attended the opening of the St. Joseph’s Southwest Centre for Forensic Mental Health Care on June 14.

• Aniko Varpalotai, Gerry Moss and Jeff Low attended the Ministry’s Accountability and Governance Initiative (AGI) in Toronto on July 15. Gerry reported it was a good opportunity to talk to other LHIN board members and identified the Central West LHIN as a resource on generative discussions.

• Jeff Low, Board Chair reported that he would attend a July 30 meeting with the Minister and Grey Bruce Health Services regarding the Markdale Hospital and reported on a recent meeting with the LHSC CEO and their learning model.

8. New Business No new business was tabled.

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9. Closed Session MOVED BY: Ron Bolton SECONDED BY: Gerry Moss THAT the Board of Directors move into a closed session at 4:15 pm pursuant to s. 9(5)(a)and (g) of the Local Health System Integration Act, 2006.

CARRIED MOVED BY: Aniko Varpalotai SECONDED BY: Ron Bolton THAT the South West LHIN Board of Directors rise from closed session at 4:55 pm.

CARRIED The board chair reported that personnel and financial matters were discussed.

10. Date and Location of Next Meeting The next Board of Directors meeting will be held on Wednesday, September 25, 2013 at the Lion’s Head Hospital, 22 Moore Street, Lions Head. The meeting is scheduled from 2:00 pm to 5:00 pm.

11. Adjournment The meeting was adjourned by Gerry Moss at 4:56 pm.

APPROVED: _____________________________

Jeff Low, Board Chair SOUTH WEST LHIN

Date: ________________________

_____________________________ Ron Lipsett, SECRETARY

SOUTH WEST LHIN

Date: ________________________

ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act,

2010 (BPSAA)

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Agenda Item 4.2

TO: The South West LHIN Board (the “Board”) FROM: Michael Barrett, CEO, South West LHIN Date: September 25, 2013 RE: 2013/14, Quarter1, April 1, 2013 to June 30, 2013 On behalf of the South West LHIN I attest to:

• the completion and accuracy of reports required of the LHIN, pursuant to section 5 of the BPSAA, on the use of consultants;

• the LHIN’s compliance with the prohibition, in section 4 of the BPSAA, on engaging lobbyist services using public funds;

• the LHIN’s compliance with all of its obligations under applicable directives issued by the Management Board of Cabinet;

• the LHIN’s compliance with its obligations under the Memorandum of Understanding with the Ministry of Health and Long-Term Care; and

• the LHIN’s compliance with its obligations under the Ministry LHIN Accountability Agreement/Ministry LHIN Performance Agreement in effect,

during the Applicable Period. In making this attestation, I have exercised care and diligence that would reasonably be expected of a Chief Executive Officer in these circumstances, including making due inquiries of LHIN staff that have knowledge of these matters. I further certify that any material exceptions to this attestation are documented in the attached Schedule A. Dated at London, Ontario this September 25, 2013. Michael Barrett, CEO South West Local Health Integration Network I certify that this attestation has been approved by the board of the South West LHIN on September 25, 2013 Jeff Low, Board Chair South West Local Health Integration Network September 25, 2013

ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act,

2010 (BPSAA)

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Agenda Item 4.2

SCHEDULE A

South West Local Health Integration Network For the Applicable Period: 2013/14, Quarter 1, April 1, 2013 to June 30, 2013

1. MEMORANDUM OF UNDERSTANDING Non-Compliance. The LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs’ obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLPA. The LHIN is in the process of resolving this accidental breach.

2. MINISTRY LHIN ACCOUNTABILITY AGREEMENT/MINISTRY LHIN PERFORMANCE AGREEMENT

o No known exceptions

3. COMPLETION AND ACCURACY OF REPORTS REQUIRED PURSUANT TO SECTION 5 OF THE BPSAA


4. PROHIBITION ON ENGAGING LOBBYIST SERVICES USING PUBLIC FUNDS PURSUANT TO SECTION


5. COMPLIANCE WITH APPLICABLE DIRECTIVES ISSUED BY MANAGEMENT BOARD OF CABINET

o No known exceptions a. OPS PROCUREMENT DIRECTIVE b. OPS TRAVEL, MEAL AND HOSPITALITY EXPENSES DIRECTIVE c. OPS PERQUISITES DIRECTIVE

of 2

Report to the Board of Directors 2012/13 Fourth Quarter Reports - Health Service Providers

Meeting Date: September 25, 2013 Submitted by: Mark Brintnell, Senior Director, Performance and Accountability Scott Chambers, Team Lead, Finance Submitted to: Board of Directors Board Committee Purpose: Information Decision

Purpose The purpose of this report is to bring forward highlights from the assessment of the South West LHIN hospital and community sector health service provider (HSP) 2012/13 fourth quarter (Q4) reports submitted in June 2013. Hospitals Highlights: • It is important to note that the Total Margin represents hospital operations only and does not

represent a hospital’s bottom-line financial position (explained in Appendix 1) • Three hospitals ended the 2012/13 fiscal year in a deficit position: Listowel Memorial (LMH),

Tillsonburg District Memorial (TDMH), and Wingham and District (WDH). LMH and WDH deficits are small and both hospitals are expected to return to a balanced position in 2013/14.

• TDMH’s deficit position was permitted through a balanced budget waiver provided for in their H-SAA. TDMH is continuing to work on a performance improvement plan to return to a balanced budget and has sufficient working capital to compensate for the deficit position on hospital operations. TDMH is also part of the Oxford Hospitals Joint Services Planning process examining opportunities to provide services differently between the Oxford hospital partners.

• The London Health Sciences Centre (LHSC) ended the year with a total margin surplus equivalent to 3.6% of total revenue. It is important to note that LHSC is seeing a gradual reduction in its base funding allocation as a direct result of Health System Funding Reform (HSFR).

• The year-end total margin result for St. Joseph’s Health Care, London is just over two percent of total revenue. SJHC, London is also seeing a reduced funding allocation through HSFR.

• The surplus reported by St. Thomas Elgin General Hospital (STEGH) is primarily related to additional funding provided to STEGH through the Provincial Working Funds Deficit Initiative aimed at assisting hospitals improve their working capital position. This is not an operational surplus and will be used to improve the hospital’s cash flow/balance sheet.

Appendix 1 - Hospital year-end total margin, working funds and current ratio results.

Agenda Item 4.3

of 2

• Wait times for cataract surgery are increasing but this was anticipated as overall provincial volume available has been reduced.

• Although improvement gains have been made compared to the previous year, Hip and knee total joint replacement wait times are trending higher.

• Overall, ALC numbers remain constant with some hospitals above expected and some below. • MRI wait times are trending higher due to increased demand and more complex diagnostics

specialty work being performed in the London hospitals. Appendix 2 – Hospital indicator performance targets and actual results Community Sector Highlights: • Overall, the community sector ended the fiscal year with a surplus position. Any surplus position

will be identified within the reconciliation and settlement process and returned to the provincial treasury.

• We had a mix of balanced/surplus positions and deficit positions. This is not uncommon as the community sector historically has managed operations across different funds types (i.e. sources of revenue) as LHIN revenue is usually not the only source of funds a HSP receives. HSPs are required to use other fund types to off-set any deficit position against LHIN funding.

• Many of the surplus positions are a result of staff vacancies and/or programs that were started late or delayed.

• Service activity and performance results were maintained within defined corridors per the Multi-Sector Service Accountability Agreements. Given the sheer number of HSPs and service categories/performance indicators, it is difficult to present the results in the report.

Appendix 3 – Community Sector 2012/13 Q4 Surplus/Deficit results Appendix 4 - South West Community Care Access Centre financial position and performance indicators and results Attachments: Appendix 1 Appendix 2 Appendix 3 Appendix 4

Appendix 1

2012/2013 Fourth Quarter Report - Financial Performance Indicators - H-SAA Compliance to Performance Standard

Hospital TOTAL Fund Type 1 REVENUE Total Margin

Ratio: Total Margin as % of Revenue

Working Capital Current Ratio

Actual Yearend Actual Yearend Actual Yearend Actual Yearend Actual YearendAlexandra Hospital (Ingersoll) 17,828,141 170,117 0.92% Yes 427,266 1.2 YesAlexandra Marine & General Hospital 22,368,337 0 0.00% Yes -1,426,333 0.6 YesClinton Public Hospital 11,048,559 77,161 0.70% Yes 942,755 1.7 YesFour Counties Health Services 10,595,117 712,990 6.34% Yes 3,864,083 3.6 YesGrey Bruce Health Services 162,952,557 3,059,150 1.82% Yes 13,319,232 1.5 YesHanover & District Hospital 17,388,115 773,772 4.45% Yes 2,735,662 2.5 YesListowel Memorial Hospital* 19,793,055 -62,949 -0.32% No 1,067,708 1.4 YesLondon Health Sciences Centre 1,062,104,000 40,818,000 3.62% Yes 103,895,598 1.6 YesSeaforth Community Hospital 8,677,462 59,044 0.68% Yes -307,099 0.9 YesSouth Bruce Grey Health Center 43,164,964 96,216 0.22% Yes 2,670,466 1.6 YesSouth Huron Hospital Assoc. (Exeter) 10,394,463 187,075 1.80% Yes -37,754 1.0 YesSt Joseph's Health Care, London 341,984,843 8,585,602 2.14% Yes 37,329,757 1.6 YesSt. Marys Memorial Hospital 9,627,601 63,069 0.65% Yes 1,357,321 2.7 YesSt. Thomas Elgin General Hospital 91,121,177 8,119,208 8.91% Yes -6,969,640 0.4 YesStratford General Hospital 89,826,751 471,683 0.48% Yes -10,149,183 0.5 YesStrathroy Middlesex General Hospital 35,439,200 724,979 2.01% Yes 1,361,586 1.4 YesTillsonburg District Memorial Hospital* 25,446,944 -355,880 -1.37% Yes 8,100,398 2.5 YesWingham & District Hospital* 17,776,298 -90,952 -0.51% No 1,373,900 1.8 YesWoodstock General Hospital 79,903,262 342,431 0.39% Yes 5,210,751 1.4 YesWoodstock Private Hospital 1,127,051 60,870 5.40% Yes 16,988 1.2 YesTotal 2,078,567,897 63,811,586 164,783,462*Hospital will use working capital to off-set deficit position

Definitions

TOTAL Fund Type 1 REVENUE

Total Margin:

Working CapitalCurrent Ratio Current ratio is the ratio of current assets divided by current liabilities

On Target

On Target

This is the total revenue to support hospital operations (Fund Type 2 supports community services and Fund Type 3 captures other services, e.g. service Veterans Services supported by the federal government)

Surplus/(deficit) all Fund Types excluding building amortization and amortization of related donations and grants, interest on long term liabilities, and unrealized gains and losses (exlusion applies to all three Fund Types)

Working capital is determined by subtracting current liabilities from current assets.

Appendix 2 9/17/2013

2012/2013 Q4 Report ‐ Person Experience Accountability Indicators

Hospital

Performance Target

2012/13 Performance

Performance Target

2012/13 Performance

Performance Target

2012/13 Performance

Performance Target

2012/13 Performance

Performance Target

2012/13 Performance

Performance Target 12/13

2012/13 Performance

Alexandra Hospital (Ingersoll) 21.60 10.40 YES 4.10 4.00 YES 3.70 3.70 YES n/a n/a 18.5 8.15 YESAlexandra Marine & General Hospital n/a n/a n/a n/a n/a 22.9 24.44 YESClinton Public Hospital 5.70 5.9 YES 3.70 3.60 YES 2.20 2.10 YES n/a n/a 13.3 17.18 NOFour Counties Health Services n/a n/a n/a n/a n/a 14.5 30.76 NOGrey Bruce Health Services 10.00 9.60 YES 5.00 4.90 YES 2.90 2.90 YES 41.00 38.00 YES n/a 14 10.68 YESHanover & District Hospital n/a n/a n/a n/a n/a 17.3 10.18 YESListowel Memorial Hospital n/a n/a n/a n/a n/a 9.5 0.86 YESLondon Health Sciences Centre 29.00 29.80 YES 7.80 7.90 YES 5.50 6.00 YES 70.00 73.00 YES 45.00 38.00 YES 9.15 8.85 YESSeaforth Community Hospital 9.90 7.00 YES 4.00 3.50 YES 2.00 2.00 YES n/a n/a 1 0.52 YESSouth Bruce Grey Health Center 7.00 7.40 YES 4.80 5.20 YES 2.60 2.60 YES n/a n/a 15 15.87 YESSouth Huron Hospital Assoc. (Exeter) n/a n/a n/a n/a n/a 15 8.15 YESSt Joseph's Health Care, London n/a n/a n/a 60.00 43.00 YES n/a n/aSt. Marys Memorial Hospital 7.80 8.00 YES 5.60 5.30 YES 2.50 2.40 YES n/a n/a 16.8 24.98 NOSt. Thomas Elgin General Hospital 8.00 7.2 YES 5.30 5.00 YES 3.20 2.90 YES 50.00 51.00 YES n/a 15.8 6.35 YESStratford General Hospital 12.50 16.40 NO 6.60 6.80 YES 4.70 4.90 YES 66.00 52.00 YES n/a 6.7 8.36 NOStrathroy Middlesex General Hospital 13.40 10.20 YES 6.20 5.90 YES 4.00 4.00 YES 43.00 55.00 NO n/a 14.5 14.54 YESTillsonburg District Memorial Hospital 24.60 24.6 YES 5.00 4.90 YES 2.50 2.50 YES 33.00 n/a 17.8 9.42 YESWingham & District Hospital n/a n/a n/a n/a n/a 9.5 5.01 YESWoodstock General Hospital 8.90 11.9 NO 5.30 5.90 YES 3.80 3.90 YES 46.00 29.00 YES n/a 15 12.21 YESWoodstock Private Hospital n/a n/a n/a n/a n/a n/a n/a

Hospital

Target 2012/13 Performance Target 2012/13

Performance Target 2012/13 Performance Target 2012/13

Performance Target 2012/13 Performance

Alexandra Hospital (Ingersoll) 90.00 91.00 YES n/a n/a n/a n/aAlexandra Marine & General Hospital n/a n/a n/a n/a 15.00 14.00 YESClinton Public Hospital 115.00 164.00 NO n/a n/a n/a n/aFour Counties Health Services n/a n/a n/a n/a n/aGrey Bruce Health Services 85.00 120.00 NO 130.00 86.00 YES 166.00 111.00 YES 63.00 41.00 YES 18.00 11.00 YESHanover & District Hospital n/a n/a n/a n/a n/aListowel Memorial Hospital n/a n/a n/a n/a n/aLondon Health Sciences Centre n/a 182.00 161.00 YES 182.00 196.00 NO 78.00 98.00 NO 28.00 21.00 YESSeaforth Community Hospital n/a n/a n/a n/a n/aSouth Bruce Grey Health Center n/a n/a n/a n/a 11.00 7.00 YESSouth Huron Hospital Assoc. (Exeter) n/a n/a n/a n/a n/aSt Joseph's Health Care, London 120.00 160.00 NO n/a n/a 76.00 87.00 NO 35.00 23.00 YESSt. Marys Memorial Hospital n/a n/a n/a n/a n/aSt. Thomas Elgin General Hospital 86.00 80.00 YES 90.00 181.00 NO 90.00 191.00 NO n/a 25.00 22.00 YESStratford General Hospital 86.00 64.00 YES 178.00 195.00 NO 182.00 207.00 NO 20.00 14.00 YES 11.00 10.00 YESStrathroy Middlesex General Hospital 104.00 113.00 YES 178.00 277.00 NO 182.00 277.00 NO n/a 11.00 10.00 YESTillsonburg District Memorial Hospital 86.00 86.00 YES n/a n/a n/a 15.00 20.00 NOWingham & District Hospital n/a n/a n/a n/a n/aWoodstock General Hospital 72.00 62.00 YES 178.00 293.00 NO 182.00 352.00 NO 30.00 35.00 YES 25.00 38.00 NOWoodstock Private Hospital n/a n/a n/a n/a n/aNote: the results listed above are for the full fiscal year and will not necessarily match the Report on Performance results which capture monthly data.Note: this table is produced to track H-SAA compliance by quarter and at yearend; the Report on Performance provides month by month data used for gauging performance trends - see the South West LHIN web site Report on Performance ToolNote: hospital performance indicators that do not meet the target number are still 'on target' for HSAA compliance purposes if the actual performance is within the performance corridor

Percentage ALC Days - Closed Cases

On Target

On Target

90th Percentile ER LOS for Admitted Patients

On Target

90th Percentile ER LOS for Non-admitted Complex Patients

On Target

90th Percentile ER LOS for Non-admitted Minor /

Uncomplicated Patients

On Target

90th Percentile Wait Times for Cataract Surgery

On Target

90th Percentile Wait Times for Hip

Replacement Surgery

On Target

90th Percentile Wait Times for Knee Replacement

Surgery

90th Percentile Wait Times for MRI Scan

On Target

90th Percentile Wait Times for CT Scan

On Target

90th Percentile Wait Times for Cancer Surgery

On Target

90th Percentile Wait Times for Cardiac Surgery

On Target

Appendix 3: Community Sector 2012/13 Q4 Surplus/ (Deficit)

HSP Name Total Fund Type 2 Revenue

Fund Type 2 Surplus / (Deficit)

Fund Type 2 Position

Surplus / (Deficit) as a % of

Fund Type 2 Revenue

Comments

Addiction Services Of Thames Valley 2,767,306 505,656 Surplus 18.3% NP Vacancies in telemedicineAlexandra Hospital 1,313,806 - Balanced 0.0%Alexandra Marine and General Hospital 1,720,693 - Balanced 0.0%Alzheimer Society of Elgin - St. Thomas 425,861 - Balanced 0.0%Alzheimer Society of Grey-Bruce 504,287 - Balanced 0.0%Alzheimer Society of Huron County Inc. 384,198 - Balanced 0.0%Alzheimer Society of London and Middlesex 716,573 - Balanced 0.0%Alzheimer Society of Oxford 720,550 - Balanced 0.0%Alzheimer Society of Perth County 489,833 - Balanced 0.0%Blue Water Rest Home Inc 122,629 75 Surplus 0.1%Boys' and Girls' Club of London 1,299,229 (1,733) Deficit -0.1% Deficit funded with Fund Type 3Canadian Mental Health Association, Elgin Branch Q4 Report not submittedCanadian Mental Health Association, Grey Bruce Branch 2,092,176 19,517 Surplus 0.9%Canadian Mental Health Association, Huron Perth Branch 2,356,918 (2,733) Deficit -0.1%Canadian Mental Health Association, London-Middlesex Branch 2,691,554 52,138 Surplus 1.9%Canadian Mental Health Association, Oxford County 3,417,859 (84,387) Deficit -2.5%Can-Voice Consumer/Survivor Community Support Services 331,558 (175) Deficit -0.1%Central Community Health Centre 2,903,417 360,071 Surplus 12.4% Salary savings, equipment purchase capitalizedCheshire Homes Of London And Inc. 11,028,962 302,904 Surplus 2.7%Chippewas Of Nawash Unceded First Nation 107,158 (2,798) Deficit -2.6%Choices For Change Alcohol, Drug And Gambling Counselling Centre 1,845,841 414,016 Surplus 22.4% NP Vacancies in telemedicineCommunity Health Services - Canadian Red Cross And Woodstock Branch 1,266,880 196,696 Surplus 15.5% New program not completely phased inCorporation of the City of London (Dearness Home) 605,388 - Balanced 0.0%Corporation of the City of St. Thomas - Valleyview Home 577,971 (31,937) Deficit -5.5% Deficit funded with Fund Type 3Corporation of the County of Elgin 337,419 47,552 Surplus 14.1% New program not completely phased inCouncil for London Seniors 43,008 (1,836) Deficit -4.3% Deficit funded with Fund Type 3Craigwiel Gardens 291,190 (5,664) Deficit -1.9%Crest Support Services (Meadowcrest) Inc. 1,488,037 5,663 Surplus 0.4%Dale Brain Injury Services Inc. 4,636,421 - Balanced 0.0%Domestic Abuse Services Oxford Q4 Report not submittedFamily Service Thames Valley Q4 Report not submittedFamily Services Perth Huron 283,019 - Balanced 0.0%Four Counties Health Services 442,854 5,532 Surplus 1.2%G & B House 452,441 - Balanced 0.0%Governing Council of the Salvation Army in Canada (The) Q4 Report not submittedGrey Bruce Health Services 4,074,776 172,641 Surplus 4.2% Staff vacanciesHome And Community Support Services Of Grey-Bruce 4,518,791 14,753 Surplus 0.3%Hopegreybruce Mental Health And Addictions Services 5,887,494 273,743 Surplus 4.6% NP Vacancies in telemedicine (filled in May 2013); staff vacancieHuron Hospice Volunteer Service 68,754 (279) Deficit -0.4%Hutton House Association for Adults with Disabilities 393,221 - Balanced 0.0%Ingersoll Services for Seniors 437,200 (3,276) Deficit -0.7%Kiikeewanniikaan Healing Lodge (Munsee-Delaware First Nation) 481,951 (39,535) Deficit -8.2% Deficit funded with Fund Type 3Knollcrest Lodge Limited 576,647 - Balanced 0.0%London Health Sciences Centre 4,452,468 1,168,109 Surplus 26.2% New program not completely phased inLondon Intercommunity Health Centre 5,965,005 29,163 Surplus 0.5%London Regional Aids Hospice And O/A John Gordon Home 520,407 6,111 Surplus 1.2%McCormick Home for the Aged (Women's Christian Association) 2,023,119 8,675 Surplus 0.4%Meals On Wheels London 1,416,228 (41,845) Deficit -3.0% Deficit funded with Fund Type 3Mission Services Of London 2,782,913 - Balanced 0.0%Mornington And Ellice And Milverton Wheels To Meals 10,503 (249) Deficit -2.4%North Perth Community Hospice Inc. 84,493 (191) Deficit -0.2%One Care Home and Community Support Services 6,780,352 (1) Deficit 0.0%Oneida Nation Of The Thames 429,255 - Balanced 0.0%Over 55 (London) Inc. 80,705 - Balanced 0.0%Oxford Self-Help Network 158,047 - Balanced 0.0%Participation House Support Services - London And Area 3,093,880 0 Surplus 0.0%Participation Lodge - Grey Bruce 2,573,470 (47,866) Deficit -1.9% Deficit resulting from costs of strike during fiscal year.Phoenix Survivors, Perth County 176,885 7,663 Surplus 4.3% New program not completely phased inPsychiatric Survivors Network Of Elgin 171,967 3 Surplus 0.0%Ritz Lutheran Villa 343,579 - Balanced 0.0%Search Community Mental Health Services 1,193,160 (9,731) Deficit -0.8%Sherwood Forest (Trinity) Housing Corporation 370,137 (1,399) Deficit -0.4%South East Grey CHC 2,822,272 51,973 Surplus 1.8%South West CCAC 187,062,156 30,829 Surplus 0.0%Southwest Ontario Aboriginal Health Access Centre 801,017 3,956 Surplus 0.5%Spruce Lodge Home For The Aged 725,938 0 Surplus 0.0%St. Joseph - Hospice of London Inc. 1,198,177 203,835 Surplus 17.0% Surplus is from hospice integration funding.St. Joseph's Health Care - CMHA 5,131,064 (0) Deficit 0.0%St. Joseph's Health Care - Parkwood Hospital Pain & Symptom Mgt 992,231 (6,253) Deficit -0.6%St. Joseph's Health Care London - Third Age Outreach Program 232,610 (6,690) Deficit -2.9% Reduced Fund Type 2 funding (Parkwood Hospital)St. Mary's And Area Home Support Services 493,014 256 Surplus 0.1%St. Marys And Area Mobility Service 223,426 - Balanced 0.0%Stratford General Hospital 3,592,531 94,585 Surplus 2.6%The Canadian Hearing Society - London Region 235,116 (10,024) Deficit -4.3% Reduced Fund Type 2 funding (United Way)The Canadian National Institute For The Blind - Ont Div - London 719,830 3,324 Surplus 0.5%The Governing Council Of Salvation Army Canada - London Village 594,424 75,040 Surplus 12.6%Tillsonburg And District Multi-Service Centre 1,498,321 - Balanced 0.0%

Appendix 3: Community Sector 2012/13 Q4 Surplus/ (Deficit)

HSP Name Total Fund Type 2 Revenue

Fund Type 2 Surplus / (Deficit)

Fund Type 2 Position

Surplus / (Deficit) as a % of

Fund Type 2 Revenue

Comments

Turning Point Q4 Report not submittedVictorian Order Of Nurses - Oxford Branch 1,128,271 - Balanced 0.0%Victorian Order Of Nurses - Perth-Huron Branch 1,393,579 - Balanced 0.0%Victorian Order Of Nurses For Canada - Ontario Branch Grey-Bruce 2,033,536 - Balanced 0.0%Victorian Order Of Nurses For Canada - Ontario Branch Middlesex 5,775,011 65,005 Surplus 1.1%Violence Against Women Services, Elgin County 125,371 - Balanced 0.0%West Elgin Community Health Centre 4,322,581 28,725 Surplus 0.7%Western Ontario Therapeutic Community Hostel 9,369,229 324,789 Surplus 3.5% New program not completely phased inWomen'S Shelter, Second Stage Housing And Counselling Services Of Huron 64,400 - Balanced 0.0%Woodstock and Area Community Health Centre 3,018,738 44,513 Surplus 1.5%Woodstock General Hospital 419,105 - Balanced 0.0%

Total 330,702,391 4,218,910

Appendix 4

South West CCAC Specific Performance Indicators 2012/13

Target Q4 Performance

Performance Standard Target Q4

PerformancePerformance

Standard Target Q4 Performance

Performance Standard Target Q4

PerformancePerformance

Standard25 23 23 - 28 YES 3951 5308 3793 - 4109 YES 5 7 4 - 6 NO 79% 85% >=75% YES

On Target

Clients placed in LTCH with MAPLe scores high and very high as a

proportion of total clients placed

On Target

Wait Time 2. 90th percentile wait time from Community setting to Community Home

Care Services

On Target

Clients with MAPLe scores high and very high living in the community supported

by CCAC

On Target

Wait Time 1. 90th Percentile from Hospital Discharge to Service Initiation

(Hospital Clients)

1


South West LHIN Board to Board Reference Group March 20, 2013 - Teleconference

Minutes

(approved by the group on July 17, 2013) Present: Jeff Low, South West LHIN (Chair)

Ruthe Anne Conyngham, London Health Sciences Centre Craig Curran, Grey Bruce Health Services Marcella Grail, St. Joseph’s Health Care, London Mary Lapaine, South West Community Care Access Centre Ron Lipsett, South West LHIN Philip McMillan, Alzheimer Society, Huron County Leslie Showers, Huron Perth Healthcare Alliance Diane Sullivan, Southwest Ontario Aboriginal Health Access Centre Aniko Varpalotai, South West LHIN

Staff: Kelly Gillis, Senior Director, Planning, Integration & Community Engagement Mary Ellen Khan, Manager, Communications & Customer Service Marilyn Robbins (Recorder)

Regrets: Susan Estabrooks, WOTCH Community Mental Health Services

Brian Milne, Grey County Social Services Maria Sinosic, Participation House Support Services Daniel Rasokas, Tillsonburg District Memorial Hospital

1.0 PREAMBLE

Minutes of a meeting of the South West LHIN Board to Board Reference Group held via teleconference on Wednesday, March 20, 2013.

CALL TO ORDER

Ron Lipsett called the meeting to order at 9:02 am. Jeff Low would be joining the meeting later.

AGENDA The agenda consists of approving the minutes of January 16, 2013 and a review of the IHSP Communications Plan – Board Governors.

Agenda item 4.6

2


APPROVAL OF MINUTES MOVED BY: Mary Lapaine SECONDED BY: Marcella Grail TO approve the minutes of the January 16, 2013 meeting of the South West LHIN Board to Board Reference Group.

CARRIED

2.0 INTEGRATED HEALTH SERVICE PLAN (IHSP) COMMUNICATION PLAN Kelly Gillis, Senior Director, Planning, Integration & Community Engagement began the review of the IHSP Communications Plan with support from Mary Ellen Khan, Manager, Communications & Customer Service. Phase 1 – Webinars with HSP administrators and another with HSP governors are being scheduled for late April/early May. The governors webinar would be an evening event lasting for about 20 minutes the purpose being to begin to familiarize governors with the IHSP and related support materials including a testimonial piece that members are encourages to participate in. Jeff Low joined at 9:10 am. Some confirmed having received and reviewed the IHSP materials already distributed. Phase 2 – Develop a presentation consisting of five to ten slides with supporting materials to be reviewed at individual HSP governance meetings. Volunteers to pilot the presentation in early May were sought. A LHIN governor would be expected to attend for support. Phase 3 – The LHIN Board would host a series of regional meetings for all members of HSP boards to attend for a cross-LHIN governance dialogue on the role of governance in the IHSP and health system transformation. No comments/concerns offered. Mary Lapaine (CCAC), Philip McMillan (Alzheimer Society – Huron) and Leslie Showers (HPHA) volunteered to provide video testimonials to support phase 1. ACTION: LHIN Staff to coordinate scripting (as needed) and filming of testimonials by Mary Lapaine, Philip McMillan and Leslie Showers.

3


ACTION: Leslie Showers to contact her Chair about piloting phase 2 at the April 4th or May 2nd meeting of the HPHA Board of Directors. ACTION: LHIN staff will forward the finalized phase 2 slides and materials to the Board to Board Reference Group as available. The group discussed the time required to complete phase 2 at the HSP Board level with CCAC offering that they spent 1.5 hours discussing the IHSP following a presentation from staff on the subject. The CCAC discussion was reported to be good but that some skepticism was expressed about different barriers to progress – funding uncertainty and the role of physicians. The CCAC suggested that their organizational direction is consistent with the 3-year direction of the IHSP. ACTION: Phase 3 – regional meetings will be further discussed at the July 17th meeting of the Board to Board Reference Group. Staff confirmed that all HSP board members will be encouraged to attend, broad participation is desired. There was some discussion about the timing of the Phase 1 webinars in order to set the groundwork for the Phase 2 pilot. Staff confirmed that sector-level materials are being developed for distribution in the coming weeks and that governors should ensure their staff are discussing. 3.0 NEXT MEETING DATES

The group is scheduled for a face to face meeting on Wednesday, July 17 at the Stratford General Hospital – the agenda will include a review of the June 6 Quality Symposium and a preview of the agenda for the fall governance sessions. 4.0 ADJOURNMENT The meeting adjourned at 9:35 am.

APPROVED: _____________________________ Jeff Low, CHAIR

SOUTH WEST LHIN

Date: ______________________

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Report to the Board of Directors Senior Leadership Report

Meeting Date:

September 25, 2013

Submitted By:

Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, System Design and Integration Mark Brintnell, Senior Director, Performance and Accountability Mary Ellen Khan, Director, Communications & Community Engagement Lisa Johnson, Controller & Manager of Corporate Services

Submitted To:

Board of Directors Board Committee

Purpose: Information Decision Health Links Update

In early December 2012, the Minister of Health and Long Term Care announced the Health Links initiative. At that time, 19 early adopter Health Links were announced with one, the Huron Perth Health Link, in the South West LHIN. The intent is to spread Health Links across the whole province. Health Links are to encompass geographies that represent usual patient flow patterns between local care providers such as primary care, acute care, and community services. During February and March, we engaged our health service providers to determine what the geographies of our health links would be. We based our discussions on Patient Network geographies identified by ICES and landed on six Health Links for the South West LHIN which are identified below. The LHIN is taking a coordinating and enabling role, working with the evolving Health Links to support a local approach to planning and engagement. We are also working to establish a South West LHIN Health Link Steering Committee comprised of Health Link Leads and other regional representatives. Each Health Link will be supported by a LHIN Primary Care Co-Lead. All six Health Link areas are in various states of readiness. At the same time, the LHIN is working with the its Primary Care Lead and the South West Primary Care Network to develop a more comprehensive approach to primary care engagement through the establishment of local primary care networks in alignment with the South West Primary Care Network and local Health Link Steering committees.

1. Huron Perth Health Link: Funding to support the business plan has just been received, so this Health Link will be moving forward to implementation. The steering committee is actively recruiting a project manager to begin to move this Health Link forward. The long lag time between business case approval and funding has slowed progress but we anticipate implementation will move forward as planned now.

Agenda Item 4.7

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A LHIN/OMA physician engagement took place this past spring to provide an opportunity to introduce Health Links to the broader physician community and gather input and recommendations from the physician perspective to inform the process going forward. 2. London/Middlesex Health Link: The London Health Link Steering committee resubmitted their readiness assessment at the beginning of the summer. By mid-summer, we received notice that the London Health Link Readiness Assessment will be approved. We continue to wait for official confirmation from the ministry and funding to move forward to the business planning phase. During the business planning phase, the London Health Link will develop a spread plan to expand to Middlesex The steering committee is in the process of selecting a consultant to be ready to move forward quickly. The Health Link has been working with LHSC to align stakeholder engagements for the Health Link and LHSC’s “high 5” initiative engagements to ensure collaboration no duplication of effort occurs between these two initiatives aimed at a similar population. A LHIN/OMA physician engagement also took place this past spring in London. 3 & 4. Grey Bruce Health Links: The ICES analysis identified two Health Links for Grey and Bruce Counties and discussions with local health care providers supported this direction, however it is recognized that many Health Service Providers service both the north and south areas of the two Counties. To avoid duplication of effort, the two groups are working closely together in the development of their Readiness Assessments. A LHIN/OMA physician engagement also took place this past spring in Owen Sound. Both Health Links have adopted a co-lead model. In the north, the Owen Sound Family Health Team and Grey Bruce Health Services are the co-leads and in the south, the Brockton Family Health Team and South Bruce Grey Health Centre are the co-lead organizations. The groups are working with their collaborating partners to complete their readiness assessments in October. 5. Elgin Health Link: Local health care providers have met several times over the summer to discuss an Elgin Health Link. The group is developing a terms of reference for a Health Link Steering committee. To date, a Lead organization has not been identified. Different models are being discussed. A joint LHIN/OMA physician engagement on Health Links is taking place October 9, 2013 in Elgin County to further explore options in Elgin County. 6. Oxford Health Link: Oxford County health service providers and physicians are in the very early stages of health link development. A small group of Health Service Providers are planning to meet this fall to begin discussions. A lead organization has not been identified. A joint LHIN/OMA physician engagement on Health Links is taking place November 19, 2013 in Oxford County to further explore options.

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Physiotherapy Reform Update In April 2013, the Ontario government announced that on August 1, 2013 physiotherapy (PT) reform will come into effect. Why? • Expenditures growing disproportionately to demand and demographics • Costs for in-home PT services through DPCs have increased from $12 million in 2007 to a

projected $81 million in 2013 and $100 million in 2014 • Utilization of OHIP funded PT in Long-Term Care Homes has increased 130% and in-home

services has increased 600% from 2005 to 2011 • Four companies were responsible for two-thirds of all PT billings • Group exercise classes were being billed as PT and on a per-person basis • PT services not well defined by current regulation (time-limited and goal-oriented versus

maintenance and activation) • Inequity in access • Need for changes supported by Dr. Walker, Dr. Sinhaand, Drummond reports How? • PT will no longer be an OHIP insured service and will now be directly funded by the MOHLTC and

through the LHINs allowing more care in community settings, in patients’ homes, and in long-term care homes

• There are five streams of services impacted by the changes: Exercise/Falls Prevention Classes, In-Home PT, LTCH PT & Exercise/Falls Prevention Classes, PT Clinics, Primary Care

• These changes will not affect PT services provided in hospitals • Eligibility for publicly-funded PT is not changing • There is no set limit on PT services: Patients will receive as many PT sessions as determined to

be necessary by their physiotherapist in order for them to recover. • The budget for PT, exercise and falls prevention classes is increasing: The old, inefficient system

overspent the budget. Under the new system, the budget will increase from $146 million to $156 million annually, and twice as many Ontarians will get the care they need in the community.

• These reforms are supported by the Ontario Physiotherapy Association Injunction: On July 25, 2013, an application for judicial review was brought forward by members of the Designated Physiotherapy Clinics Association. The Divisional Court ordered that the Regulation which de-insures PT services from OHIP was suspended from coming into effect on August 1, 2013 until August 21, 2013 when the matter was to be heard by a panel of three judges of the Court. On August 21 at the Divisional Court, the application was dismissed. As a result, the regulation that had been temporarily suspended by order of the court on July 26 is in force, and the ministry has moved forward with changes that will improve access to PT and exercise programs for Ontarians.

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South West LHIN Status Update: Group Exercise and Falls Prevention Classes Exercise & falls prevention classes are now provided through certified staff and volunteers at retirement homes by community support service (CSS) organizations and will no longer be provided by the PT companies • 61 replacement class locations in Retirement Homes have been identified in the South West LHIN

• 55 class locations will have classes running • 6 are still awaiting communication or are considered “on hold” as they negotiate class

times and MOUs with the CSS providers • 5 locations have declined to implement LHIN funded classes and have pursued private pay

options • The LHIN is working with CSS providers to enhance existing classes in the community and look at

new locations to ensure there is access to these services for more seniors across the LHIN • These services are fully funded and will be offered free of charge to seniors - services will be

offered in multiple locations at multiple times during the week for 48 weeks a year CCAC In-Home PT • CCAC is now the single point of access for all in-home PT and will be responsible for all

assessments and eligibility determinations • 100% of retirement homes or other congregate settings have been engaged in outreach • 2,471 individuals to date have been identified in the South West LHIN to have been receiving

OHIP funding PT services. Of the clients that have been assessed approximately half have been identified to continue to receive PT services.

• The South West CCAC is on track for implementation; clients fall into 1 of 4 streams • One-on-one PT • Exercise and falls prevention only • Combination of PT and exercise and falls prevention • Does not require or declines services

PT and Exercise in Long-Term Care (LTC) Homes • LTC homes now receive funding directly to manage the PT needs of their resident on a one-on-

one basis and for exercise/activation • 77 of 78 LTC homes in the South West LHIN have confirmed that contracts are in place with PT

providers and that the homes are directly paying for those services • 1 LTC home is still finalizing a contract with a PT provider PT Clinics • Publicly funded PT Clinic funding is to provide support for the delivery of PT to eligible persons

referred to specific PT clinics by a physician or nurse practitioner • Eligible persons are those: aged 65 and older; aged 19 or younger; recently discharged as an

inpatient of a hospital and in need of PT that is directly connected with the condition for which the person was hospitalized; eligible for funding of services under the Ontario Disability Support or Ontario Works programs

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• The MOHLTC has signed agreements with the three OHIP funded PT clinics in our LHIN and they are now operating under the new terms which means that they now have a direct funding and accountability relationship to the MOHLTC and are no longer billing OHIP for services provided.

• The MOHLTC received 68 applications to provide publicly funded services in the South West LHIN • Applicants were required to identify the total number of “episodes of care” that they believed they

could provide. An “episode of care” encompasses all of the PT visits required to accomplish the clinical goal of an individual client referred for a specific problem.

• The South West LHIN will be funded for 8,039 new episodes of care per year. Decisions will be made on allocation of these episodes of care to ensure equity of distribution of publicly funded PT services across the LHIN.

• The MOHLTC is currently reviewing the applications. The summary of their review is expected to be received by the LHIN on September 18, 2013.

• LHIN staff will review the applications, using a tool based on the LHIN decision making framework and agreed to by all LHINs. The LHIN review is to be completed and submitted to the ministry by October 4, 2013.

Primary Care PT: Community Health Centres (CHC), Family Health Teams (FHT), Nurse Practitioner Lead Clinics (NPLC) and Aboriginal Health Access Centres (AHAC) • Currently there is limited integration of PT into Family Health Care settings with 1 CHC in the

South West LHIN currently employing physiotherapists. A total of $2,000,000 has been allocated across the province. LHIN level allocations have not been determined

• This initiative will provide program-based PT in primary care settings • A call for applications to CHCs, FHTs, NPLCs and AHACs was released on June 26, 2013 with a

submission date to the ministry of July 23, 2013 • 16 applications were received from South West LHIN providers (1 CHC, 14 FHTs and 1 NPLC) • LHIN staff scored the applications and submitted results to the ministry on September 13, 2013. • Each application will be scored out of a total of 100 with the following breakdown - ministry review

/80 and LHIN review /20 • Final application approval date is not currently known. French Language Services Took Kit The Erie St. Clair and South West LHINs have a number of Health Service Providers (HSPs) that are identified or designated to provide their services in French. Other LHIN-funded HSPs must also be responsive to the needs of the Francophone population as part of their clientele. As a result, there is a need to reinforce good practices related to the delivery of quality services in French and to provide HSPs with information and tools to support them in the delivery of French language services. The French Language Toolkit was developed to provide an overview on a variety of subjects related to the delivery of services in French. Each section was conceived with the intent of providing useful information and practical tools to make delivery of services in French as easy as possible. The toolkit includes basic information on the Francophone community, active offer of French language services, implementation of French language services, human resources, training, translation and interpretation, supporting legislation and thehealthline.ca. A list of additional resources is also included. The Toolkit also contains some flyers and fact sheets produced by outside organizations to

http://thehealthline.ca/

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complement the information provided and items such as badges, lanyards and signs to promote delivery of services in French. Please find below the link to the FLS Toolkit http://southwestlhin.on.ca/Page.aspx?id=8884 The Toolkit is being made available to all HSPs in the ESC and South West LHINs and is also being shared with French Language Coordinators across the province. Communications Media Relations July media coverage included:

• 5 stories on the use of clot busting drugs at London Health Sciences Centre and St. Thomas General Hospital

• 2 stories on a “living wage” for Personal Support Workers • An article on the funding of a new Markdale hospital • An article on new beds coming to Grey-Bruce Health Services • An article on obstetrics in Hanover • An article on obstetrics in Woodstock • An article on using physician assistants in the emergency departments at South Bruce Grey

Health Centre • An article on the criminal charges against a staff member at a long-term care home • An article on the Alzheimer’s awareness event held by Grey Bruce Health Services • An article on 2 large donations to London Health Sciences Foundation

August media coverage included:

• 4 stories on the funding of a new Markdale hospital • 4 stories on Saugeen Memorial Hospital, including capital projects • 2 stories on a C-Difficile outbreak at University Hospital • 2 stories on a mental health response teams in Grey-Bruce • An article on changes to hydrotherapy at St. Joseph’s hospital • An article on mammography at Kincardine • An article on non-emergency patient transfers • An article on the staff assault at Grey Gables • An article on using physician assistants in the emergency departments at South Bruce Grey

Health Centre • An article on changes to physiotherapy programs • An article on layoffs at Ritz-Lutheran Villa • An article on Hospice issues in Grey-Bruce • An article on possible lab closure at the St. Thomas Elgin General Hospital • An article on senior management team changes at the St. Thomas Elgin General Hospital

http://southwestlhin.on.ca/Page.aspx?id=8884

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Website & Social Media Tracking

July and August activity included: • Twitter – 130 Tweets from the July Board meeting and promotion of the Minister Medal for

Quality and Board to Board Engagement Sessions this fall. • Facebook – 8 posts promoting the Minister’s Medal, exercise and falls prevention classes,

cross-promotion of our YouTube channel o 237 friends/likes

• YouTube – 30,389 channel views so far at the end of August. o 2 videos in July from the Long-Term Care Homes Network Forum

Health Service Provider Survey Development of the HSP surveys is proceeding. Questions for both the Administer and Governor versions are being finalized and creation of the survey tool is underway. The survey tool will be ready for review/testing in October. The tool will be piloted with 5-6 HSPs to ensure language and functionality is effective. Timing for distribution is mid-November, following the IHSP board-to-board engagements. This timing is ideal as the survey includes a few questions about our engagement of HSPs with the IHSP. Organizational structure The Board is aware that the South West LHIN organizational structure is being updated. We are moving to a matrix structure that is intended to provide our teams and individuals with greater role

Q4 Q1 Q2 January February March April May June July August

Web Visitors 4,686 4,182 5,428 5,612 4,278 3,849 3,212 3,666

Unique Visitors 2,738 2,439 3,168 3,050 2,316 2,181 1.833 2,189 Page Views 11,676 11,132 13,912 15,096 11,685 10,255 8,562 9,793

My Page Subscribers

1,049 1,052 1,060 1,052 1,086 1,122 1,139 1,150

Social Twitter

Followers 2,747 2,817 2,875 2,939 2,982 3,039 3,103 3,169

Tweets (7,256 to date)

36 25 27 18 33 130 19 20

Facebook Friends

(“Likes”)

219 222 226 230 237 237 240 242

Facebook Posts

8 6 4 3 3 6 5 3

New Videos 4 3 4 9 11 2 0 YouTube Views

(300+ videos) 26,490 26,498 27,083 27,998 28,499 29,287 29,918 30,389

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clarity, and better position the organization to achieve the strategic directions and initiatives of our IHSP. The matrix consists of “functional teams” and “portfolio teams”. We have been working with many of our staff (including Team Leads and Portfolio Leads) over the last several months to solicit input and to ensure the successful implementation of our updated structure. On September 9th, all staff were provided with an update on our progress. The next step in the implementation journey is to fully develop and support our portfolio teams. The LHIN has recently contracted a consulting firm, specializing in executive and team coaching, who we are bringing on board to assist in the process. Over the coming months the consultant will provide coaching to both our portfolio teams and our senior leadership team. On September 23rd, the consulting firm will facilitate a ½ day “Team Development Kick-off Event”; one of many team sessions that will occur over the next six months. Getting our portfolio teams and matrix structure fully functional is important and the engagement of the consultant will be another opportunity to provide our teams and individuals with greater role clarity, and better position the organization to achieve our strategic directions and our Human Resources Strategy. Information on our updated organizational structure has been shared with all of our health service providers, and is posted on our website.

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Report to the Board of Directors South West LHIN 2013/14 Quarter 1 Report on Performance

Meeting Date:

September 25, 2013

Submitted By:

Mark Brintnell, Senior Director, Performance and Accountability Nicole Robinson, Team Lead, Performance Improvement

Submitted To:


Purpose: Information Decision Purpose The South West LHIN Report on Performance Scorecard is designed to provide insight into how our local health system is performing according to identified metrics aligned to the strategic objectives outlined in the LHIN’s 2013-16 Integrated Health Service Plan (IHSP). The Report on Performance Scorecard will be communicated quarterly to the Board in the months of September, December, March and June. Background The Quarter 1 2013/14 Report on Performance Scorecard is attached. The scorecard shows progress against our Big Dots, 12 outcome indicators, and four key driver measures. The scorecard was recently redesigned to reflect the new IHSP Strategy Map with an aim to present alignment of indicators to strategies and overall progress to the Big Dots. In addition, a standardized Interventions Report has been developed to highlight actions aligned to each outcome indicator being undertaken that are having an impact on performance results. Only interventions with primary alignment to the noted indicators and those that are either in implementation or will be within the next quarter were included. The Report on Performance e-tool remains available monthly tracking over 60 metrics. The e-tool shows comparative and drill-down information at the provincial, LHIN and HSP levels. The e-tool is available on the LHIN’s website and will be a feature of the LHIN’s communications and engagement over the coming months to ensure HSPs utilize the information presented in the tool. Next Steps As shared with the LHIN Board, South West LHIN staff has developed a robust Performance Improvement Framework that will help to enable focused improvement in collaboration with provider partners. We are currently working to improve performance in key areas through application of this approach.

Agenda Item 5.1

Increase the communication between health care providers through SPIRE.

Baseline: 54% Current: 446/824 organizations

Increase providers using Clinical Connect.

Baseline: 0% Current: 0/1446 organizations

Increase organizations using the ‘Regional Integrated Decision Support System’ (2013-14).

Baseline: 0 active organizations Current: 0/21 active organizations

Increase the proportion of key initiatives (P4R, BSO, ATC, P4Q) meeting LHIN Experience Based Design criteria.

Baseline: 0 Current: 16/24 criteria met by early adopter programs

Improve access to family health care

1. Reduce wait time to specialist from family health care

Coming Soon Baseline: 000

Current:

Target: 000

2. Reduce rate of ER visits best managed elsewhere (per 1,000 population aged 1-74)

Baseline: 13.3

Current: 13.7

Target: 000

3. Increase percent of discharge summaries sent from hospital to community care provider within 48 hours

Baseline: 23.0

Current: 49.3

Target: 000

Improve coordination and transitions of care for those most dependent on health services

1. Reduce ER revisit rates within 7 days (per total unscheduled emergency visits)

Baseline: 15.6

Current: 14.6

Target: 000

2. Reduce hospital readmission rate within 30 days for selected CMGs (per discharges for selected CMGs)

Baseline: 15.8

Current: 17.5

Target: 000

3. Increase percent of clients seeing family health care provider within 7 days of discharge (from hospital)

Baseline: 40.5

Current: 40.5

Target: 000

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Drive safety through evidence-based practice

1. Reduce rate of ER visits resulting from falls (per 100,000 population aged 65 and over)

Baseline: 1431

Current: 1333

Target: 000

2. Reduce pressure ulcer related hospitalizations (percent of all discharges)

Baseline: 0.47

Current: 0.55

Target: 000

3. Reduce hospital acquired infection rates (c diff) (per 1,000 patient days)

Baseline: 0.27

Current: 0.21

Target: 000

REPORT ON PERFORMANCE SCORECARD FIRST QUARTER, 2013-14

The BIG DOTS this quarter:

1. Increasing the availability of family health care – Our goal is to increase the percent of clients seeing their family health care provider within 7 days of discharge from hospital.

Data coming soon*

2. Reducing emergency room visits – Our goal is to save 15,000 revisits to the emergency department within 7 days.

Data coming soon*

3. Increasing availability and access to community supports for people – Our goal is to reduce 17,000 days spent in hospital over the next 3 years.

Data coming soon*

Increase the value of our health care system for the people we serve

1. Increase timeliness of diagnostic services (percent within target)

Baseline: 70.3

Current: 70.2

Target: 000

2. Reduce LHIN cost variance (HBAM hospitals) for acute/day surgery and ER (actual/expected costs)

Baseline: 1.0/1.0

Current: 1.0/1.1

Target: 000

3. Reduce ALC rate (per total inpatient days)

Baseline: 11.4

Current: 11.4

Target: 000

South West LHIN Ontario

*We will begin tracking and quantifying progress from Q1 2013/14 onwards.

South West LHIN Report on Performance Scorecard Interventions Q - Scorecard Indicator Latest

Result Progress? Key Current South West LHIN Interventions Targeting Improvement

Improve Access to Family Healthcare *Reduce wait time to specialist from family health care

Coming Soon

Coming Soon

South West LHIN Integrated Orthopaedic Improvement & Capacity Plan – focused on improvement of key quality, patient experience and performance indicators.

Reduce rate of ER visits best managed elsewhere (per 1,000 population aged 1-74)

13.7 No change No specific interventions at this time.

Increase percent of discharge summaries sent from hospital to community care provider within 48 hours

49.3 Improved SPIRE – focused on establishing Electronic Medical Records (EMRs) connections between community family health care and hospitals. Access to Care (Home First) - Focused on identification and screening for potential high needs patients who frequent the ER and hospital and who require complex discharge plans.

Improve Coordination and Transitions of Care for Those Most Dependent on Health Services Reduce emergency revisits within 7 days (per total unscheduled ER visits)

14.6 Improved Behavioral Supports Ontario - Continuing to build a behavioural support system of care by implementing coordinated prevention, care and educational strategies across primary care, seniors, Mental health and addictions teams and specialist resources, Alzheimer Societies, Long Term Care homes, CCAC and other community providers. Health Links (emerging)– Will focus on providing integrated care, better supporting high needs and at risk clients in order to reduce emergency department visits, and revisits with implementation of collaborative robust care planning. Partnering for Quality – Supporting increased adoption of Advanced (Open Access) Scheduling through eHealth training and encouraging utilization of Health Quality Ontario resources. Crisis Response and Transitional Case Management (Mental Health and Substance Abuse) – Facilitating access to mental health case management services to ensure access to community based supports to reduce emergency department repeat and/or avoidable visits. (emerging) Addictions Case Managers are currently being hired to support clients living with substance abuse concerns. ED Pay for Results (emerging)– London-specific focus targeting improvement in coordination of care for the most frequent users of the emergency department.

Reduce hospital readmission rate within 30 days for selected Case Mix Groups (CMGs) (per discharges for selected CMGs)

17.5 Declined Health Links – Will focus on providing integrated care, to better support clients with high needs, living with COPD, CHF and frail seniors. The Huron Perth Health Link will begin patient care planning within the next quarter.

Increase percent of clients seeing family health care provider within 7 days of discharge (from hospital)

40.5 No change Health Links (emerging) & Access to Care - Will focus on improving transitions and continuity of care for clients who have been discharged from hospital. SPIRE – Focused on enabling the technology to allow connection of community care providers to hospitals in order to facilitate the transfer of information including discharge summaries.

Drive Safety through Evidence-based Practice

South West LHIN Report on Performance Scorecard Interventions Q - Reduce rate of ER visits resulting from falls (per 100,000 population aged 65 and older)

1333 Improved South West LHN Falls Prevention Program – Building on the program underway in Grey Bruce and in partnership with Public Health, this initiative focuses on implementing the ‘Falls Prevention Strategy’ by utilizing evidence-based tools/protocols/training to screen, identify, manage and/or refer individuals to appropriate services.

Reduce pressure ulcer related hospitalizations (percent of all discharges)

0.55 Declined South West LHIN Regional Wound Care – Focused on implementation of a sustainable wound care program across the South West LHIN.

Reduce hospital acquired infection rates (c diff) (per 1,000 patient days)

0.21 Improved Service Accountability Agreements - This indicator is included in all Hospital Service Accountability Agreements and is also included in Hospital Quality Improvement Plans.

Increase the Value of Our Health Care System for the People We Serve Increase timeliness of diagnostic services (percent within target)

70.2 No change MRI Performance Improvement Program (PIP) – Will enable enhanced monitoring of key performance indicators (access, timeliness, quality). Diagnostic Imaging Appropriateness Pilot – Intended to develop appropriateness guidelines for diagnostic services in order to support improved access to those in need. LHIN Priority Investment Allocations – Focused on improving access and timeliness of MRI diagnostic services across the South West LHIN.

Reduce LHIN cost variance (HBAM hospitals) for acute/day surgery and ER (actual/expected costs)

1.0 (acute & day

surgery) 1.1

(Emerg)

Declined No specific interventions at this time. This indicator has been identified as an opportunity area for future Local Partnership work.

Reduce ALC rate (per total inpatient days)

11.4 No change Access to Care (Assisted Living/Supportive Housing/ Adult Day Programs, Complex Continuing Care/Rehab) – Implementation of redesign recommendations to improve access to obtain the right service at the right time by the right provider. Access to Care (Home First) – Focused on spreading the implementation of the Home First philosophy across the South West LHIN including screening for potential high needs patients who frequent the emergency department and hospital and who require complex discharge plans. Behavioral Supports Ontario – Focused on continuing to build a Behavioural Support System of Care by implementing coordinated prevention, care and educational strategies across primary care, seniors Mental Health and Addictions teams and specialist resources, Alzheimer Societies, Long Term Care homes, CCAC and other community organizations. Patient Access and Flow - Focused on repatriation of patients from a higher level of care to community care in order to reduce ALC.

NOTE:

1. Interventions included in this report were limited to: a. interventions identified as having a primary alignment with the noted indicators, b. Those that are happening now(implementation) or those that will be implemented within the next quarter.

2. Progress is measured as current quarter performance over established baseline for each of the indicators noted.

Better PerformanceSouth West LHIN Board of Directors

September 25, 2013

Presented by: Mark Brintnell, Senior Director, Performance and AccountabilityNicole Robinson, Team Lead, Performance Improvement

What are we trying to achieve?

The Current State

3

Strategy Map

Report on Performance Scorecard

Focus & prioritize initiatives, align providers and improve care for patients and families

The South West LHIN Strategy – What are we trying to achieve?

Key Outcomes in the next 3 years

Our strategy is to help people live safely and independently at home

Supporting people like Anne• Living with substance

abuse, bipolar disorder, asthma, Type 2 Diabetes, COPD

Moving Forward…Our Approach

How Will We Get There?Strategy to Execution to Framework

6

Develop the StrategyPlan the Strategy

Align the Organization

Plan Operations Monitor & Learn

Test & AdaptStrategic Plan

Operating Plan/ ABP

Execution

Performance measures

Performance measures

Results

Results

Kaplan and Norton, 2008

• Strategy Map, Balanced Scorecard, Analytics Framework and Access to Data Process• Performance Dashboards, Outcome Reporting Scorecards• Portfolio Operational Monitoring & Reporting, Quarterly Strategic Review Process• Communication Strategy

Reporting, Monitoring & Accountability

• Service Accountability Agreements• Performance Management Teams (Reactive MLPA or SAA)Performance Management

• Process & Quality Improvement Tools & Frameworks (Pre‐Emptive and Proactive) • Focus on Future Expected Accountability Indicators, Enhanced Effort to impact Outcomes in Key High Impact Areas & GAPs

Process Management Through Quality

Improvement

• Evaluation Planning to Increase Impact on Outcomes by Aligning Initiatives to Outcomes

• Available Tools, Templates, Resources and Standardized Problem Solving Methodology• Capacity Building through Education and Training

Evaluation & Capacity Building

7

Key Elements

Performance ImprovementStrategy to Execution Building Blocks

Reporting, Monitoring & Accountability

88

Reporting, Monitoring

and Accountability

Performance Management

Process Management

through Quality

Improvement,


• ‘Report on Performance’ Scorecard & Performance Dashboards)

• Analytics Framework & Access to Data Process

• Initiative Performance Scorecards – Alignment of Lead to LAG outcome measures

• Monitoring of Other Key Business (Portfolio Operational Reporting)

• Internal Strategic Review Process

• Communication Strategy (Senior Leadership, Board(s), HSPs, Public)

Key Components of Our Performance Process – LHIN Level

SCORECARDSTRATEGY MAP‘ROP’

DASHBOARDS

“Strategic Progress”“The Linkages”

“Drill DownProgress”

9South West LHIN Local Health System Scorecard, Launch August 26, 2013

South West LHIN Report on Performance

Reporting, Monitoring and Accountability

Push vs. Pull• Report on Performance Scorecard will be pushed to the Board quarterly.• Intervention information will be provided for all indicators.• Additional profiles for notable changes in performance including success stories will also

be included as appropriate.• In the future – the lower level Report on Performance dashboards will be pushed

monthly to the LHIN Senior Leadership Team, and Portfolio Teams. This information will continue to be publicly posted on our website

• Anyone, from Board members to staff, will have the opportunity to pull lower level performance information through the Report on Performance e-tool.

10

Quarterly – What the Board Will See

11

Report on Performance Scorecard (system level outcomes)

+

Targeted Intervention Update (programs & initiatives)

Service Accountability Update

Proportion of sector HSPs in compliance with SAA obligations:BUDGETPERFORMANCESERVICE VOLUMES

Proportion of programs/ initiatives on:MILESTONE STATUSBUDGETPERFORMANCE

The Report on Performance Scorecard

The Report on Performance Scorecard

13

Strategy Map

Report on Performance Scorecard

IHSP 2013-16 Interventions

NEW Report on Performance Dashboard

IHSP 2013-2016 Scorecard IndicatorsKey Performance Outcomes

15

Improve Access to Family Health Care

• Reduce wait time to specialist from family health care

• Reduce ER visits best managed elsewhere

• Increase the proportion of discharge summaries received within 48 hours (hospital to community)

Improve coordination and Transitions of Care for Targeted Populations

• Reduce ER revisits• Reduce hospital readmission rates

• Increase the percent of clients seeing their family health care provider within 7 days of discharge

Drive Safety Through Evidence Based Practice

• Reduce ER visits resulting from Falls

• Reduce pressure ulcer related hospitalizations

• Reduce hospital acquired infection rates (c diff)

Increase the Value of the Health Care System for the People we Serve

• Increase timeliness of diagnostic services

• Improve LHIN HBAM cost variance (hospitals)

• Improve ALC rate

16

11. Reduce ER visits resulting from Falls12. Reduce pressure ulcer related hospitalizations

3. Reduce ER revisits within 7 days4. Increase timeliness of

diagnostic services5. Improve LHIN HBAM cost

variance (hospitals)6. Improve Alternate Level of Care

(ALC) rate

7. Reduce Readmissions to Hospital within 30 Days for Selected CMGs

8. Reduce Hospital Acquired Infection Rates (c diff)

Report on Performance Scorecard IndicatorsMapped Against Continuum of Care

1.Living in Community

2. Emergency Department

3. Acute Care/ Sub-Acute Care

1. Reduce wait time to specialist from family health care

2. Reduce Emergency (ER) visits Best Managed Elsewhere (in alternative primary care settings)

9. Increase the percent of discharge summaries sent from primary to community care providers within 48 hours

10. Increase the percent of clients seeing their family health care provider within 7 days of discharge

The Scorecard LIVE…Anne’s Story

How will IHSP 2013-16 initiatives impact people?

Anne’s Story• 66 year old female• No fixed address

How will IHSP 2013-16 initiatives impact people?

Anne’s Story• Living with substance

abuse, bipolar disorder, asthma, Type 2 Diabetes, COPD

How will IHSP initiatives impact people?Anne’s Story• Has a family healthcare

provider• Has visited the Emergency

Department 69 times in the last 12 months

Anne is admitted to hospital with exacerbation of COPD.

Experiences shortness of breath at the shelter. EMS responds and transports Anne to the ED

After multiple inhalation treatments, Anne is not responding and is referred to internal medicine for an admission consult

Anne is discharged from the hospital after and re-presents to ED 10 days later with similar complaints.

Anne’s Health Care Journey




Reduce number of revisits to ED within 7 days and revisits within 30 days for mental health and substance abuse concerns

Reduce readmissions within 30 days for COPD and other similar concerns

IHSP 2013-16 Key Scorecard Measures

Discharge summaries sent from hospital to community care within 48 hours

Increase number of clients discharged from hospital seeing family health care provider within 7 days




• SPIRE• Clinical Connect• Access to Care

e-Notification

• Health Links• Partnering

for Quality

IHSP initiatives help to improve access to care for Anne

• Access to care e-Notifications

• Mental Health & Addictions

• Transitional Case Management

• ED Frequent User• London

Intervention

• Access to Care• Assisted

Living




Our Improvement Approach to Better Performance

Performance ManagementRisk Reduction & Reactive Approach

25


and Accountability


Process Management

through Quality

Improvement


• Develop Optimized Accountability Process

• Infrastructure and Development (i.e. triggers, transitions, roles)

• Performance Management Team Implementation (i.e. Hip & Knee, Cancer, ED P4R, ALC)

• Performance Management Capacity Building

Performance Management TeamsIN ACTION

Emergency Department Pay for Results Hip and Knee PMTCancer PMTALC PMT – coming soon

Process Management throughQuality ImprovementPre-Emptive & Proactive Approach

26


and Accountability


Process Management

through Quality

Improvement

Capacity Building, and Evaluation Planning

• Infrastructure & Development(framework, triggers, transition, etc)

• GAP Analysis & Improvement Strategy in high Impact Areas (i.e. Big Dots, QBPs, Health Links)

• Process Management through Quality Improvement Implementation (i.e. KT, Orthopaedic System of Excellence)

• Process & Quality Improvement Tools, Templates, Collaborative Space

• Capacity Building

Process Management through Quality Improvement in ACTIONSouth West LHIN Patient Flow Knowledge TransferOrthopaedic System of Excellence


2727


and Accountability


Process Management

through Quality

Improvement


1. Infrastructure & Development (i.e. resource and process planning)

2. NEW Implementation – Validation, Prioritization & Evaluation for (IHSP 3 Programs & Initiatives)

3. On‐going Implementation Evaluation of Emerging Initiatives

4. Capacity Building through education, training and coaching

Implementation of Evaluation ProcessAccess to Care (all streams)IHSP 2013‐16 Strategy DevelopmentMental HealthLong‐term VentOne Number/Patient Access and FlowRegional Palliative CareIndigenous Cultural Competency (provincial)PhysiotherapyComing Soon, Health Links, Portfolio Team Programs)

Key Milestones and Timeline

2013-14 2014-15 2015-16

July Aug Sept Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Balanced Scorecard

Refine SAA Development Process

Performance Dashboard

Hip & Knee PMT

Cancer PMT

First Strategic ReportStrategic Review

Tools & Templates & Resources

Develop Evaluation Process

Repo

rting &

Accoun

tability

Performance M

anagem

ent

Evaluate/

Capacity

IHSP 3 (Validate/ Prioritize, Align)

Portfolio Specific Reporting

Process M

gmt

through QI

Performance Management Skill Building

GAP Analysis

Evaluation (All IHSP 3)

Develop PMT Approach (triggers, roles)

Re develop SAA Monitoring & Accountability Process

ALC PMT

Develop Process Mgmt (triggers,

roles)TBD Improvement Strategy *by GAPs

Knowledge Transfer Initiative)

Process Management & QI Skill Building

Evaluate on-going and EMERGING (i.e. physiotherapy, diabetes, ATC, IHSP, LTC, one number, etc)

ENABLERS & TOOLS

TBD Future PMTs *by trigger

Launch RIDSS

Align Priorities to Strategic Priorities

Analytics & data request process)

Planning for RIDSS

Target Setting (BSC)

SDI and HSP education, engagement

Transition to operations

PERF

ORMA

NCE

IMPR

OVEM

ENT

FRAM

EWOR

K

Data Review

Transition to Quality Council

Beta Test RIDSS

Analysis (Support cross portfolio functional needs, and portfolio analytics)

Education & Engagement

(SAAs)

Key Milestone

Tools & h l i

Capacity/ Skill ld

Process Development

Implementation

Thank-you!

For more information please visit www.southwestlhin.on.ca

of 2

Report to the Board of Directors 2013-15 Ministry-LHIN Performance Agreement

Meeting Date:

September 25, 2013

Submitted By:

Michael Barrett, CEO

Submitted To:


Purpose: Information Decision Motion That the South West Local Health Integration Network Board of Directors authorize the Board Chair to execute the 2013-15 Ministry-LHIN Performance Agreement (“MLPA”) presented to this Board and attached to the minutes of this meeting provided that the execution version of the MLPA, including the performance requirements and funding allocations, are substantially the same as those presented. Background The Local Health System Integration Act, 2006 (LHSIA), the Memorandum of Understanding (MOU) and the Ministry-LHIN Performance Agreement (MLPA) are the key elements of the accountability framework between the Ministry of Health and Long-Term Care (MOHLTC) and the Local Health Integration Networks (LHINs). The MLPA identifies the MOHLTC’s key operational and funding expectations of the LHIN that are not already addressed in the LHSIA or the MOU. It recognizes that the MOHLTC and the LHIN have a joint responsibility to serve the public interest and effectively oversee the use of public funds. The Agreement reflects the LHINs’ critical role in ensuring enhanced access and quality of healthcare in a fiscally sustainable manner while acknowledging the MOHLTC’s responsibility to apply appropriate and legitimate scrutiny of fiscal management and health services delivery by the LHINs. The Agreement itself is refreshed every three years. This refresh is overseen by the Ministry-LHIN Joint Advisory Committee (JAC) which is comprised of representative leaders from both the ministry and the LHIN. The JAC held six meetings to discuss and endorse the content that forms the 2013-15 MLPA. Key Changes in Approach and Content: • The MLPA reflects Ontario’s Action Plan for Health Care and includes reference to key provincial

strategies: Health Links, Seniors Strategy, Mental Health Strategy and Health System Funding Reform. Emphasis has been placed on the need for LHINs to engage and work with the broader healthcare system, such as primary care physicians.

Agenda Item 6.1

of 2

• Streamlined to be a higher-level document that does not duplicate details contained elsewhere, such as referencing a ministry-developed policy, guideline and/or provincial standard.

• New provision to articulate LHIN role in Quality Improvement Plans. The LHIN will work to align the Quality Improvement Plan objectives and priorities of its health service providers to improve the quality of care across sectors and the healthcare system. Signal expansion of Excellent Care for All Act beyond hospital sector to primary care and community care sectors, as well as the role of LHINs in their development.

• New provision to articulate Ministry-LHIN role in service capacity planning. Both parties will work together to develop a collaborative process to support current and future service capacity planning so that decisions about local service provision will advance provincial priorities and strategies. Commitment to comprehensive service capacity planning that involves both the ministry and the LHINs; this work supports the goal of longer-term vision for health system transformation and sustainable spending.

• New provision to articulate Ministry-LHIN role in inter-agency collaboration (Schedule 1, s.4-5): • The MOHLTC will work with the following provincial health agencies to ensure they equally

consider the role of LHINs as local health system managers: • Cancer Care Ontario; • eHealth Ontario; • Health Quality Ontario; and • Ontario Agency for Health Protection and Promotion.

• The LHIN will work with the aforementioned provincial health agencies to support the fulfillment of provincial priorities and strategies. Existing accountability agreements and Memorandum of Understanding between the ministry and these agencies do not currently mention LHINs in their role as local health system managers, and there is a commitment by the ministry to help strengthen the relationship between LHINs and the aforementioned agencies.

• New provision to ensure government priorities and strategies are reflected in LHIN accountability planning submission templates, service accountability agreements and schedules with health service providers and other providers.

• In January 2013, the ministry and LHINs jointly developed a Performance Framework that reflects direction articulated in Ontario’s Action Plan for Health Care, as well as the principles in the Excellent Care for All Act (ECFAA), 2010.

Current Status The 2013-15 Ministry-LHIN Performance Agreement (MLPA) template is now available for individual LHINs to consider for approval. It should be noted that the MLPA and all associated schedules and data are draft until approved by the Minister of Health and Long-Term Care. South West LHIN staff has successfully completed negotiation of the performance schedule (attached) and concur with the latest financial schedule (attached) and are not anticipating any material changes to the current version. Next Steps The South West LHIN Board will receive a final copy of the South West LHIN MLPA once it is approved by the Minister. No further LHIN Board approval will be required as long as no substantial changes are made to the current version.

DRAFT Ministry-LHIN Performance Agreement (2013/14 - 2014/15) Page 1 of 39 May 15, 2013

MINISTRY-LHIN PERFORMANCE AGREEMENT APRIL 1, 2013 – MARCH 31, 2015

BETWEEN:

Her Majesty the Queen in right of Ontario, as represented by the Minister of Health and Long-Term Care (“MOHLTC”)

- and -

XXXX Local Health Integration Network (“LHIN”)

Introduction The Local Health System Integration Act, 2006 (LHSIA), the Memorandum of Understanding (MOU) and the Ministry-LHIN Performance Agreement (“Agreement”) are the key elements of the accountability framework between the MOHLTC and the Local Health Integration Networks (LHINs). The Agreement identifies the MOHLTC’s key operational and funding expectations of the LHIN that are not already addressed in the LHSIA or the MOU. It recognizes that the MOHLTC and the LHIN have a joint responsibility to serve the public interest and effectively oversee the use of public funds. The Agreement reflects the LHINs’ critical role in ensuring enhanced access and quality of healthcare in a fiscally sustainable manner while acknowledging the MOHLTC’s responsibility to apply appropriate and legitimate scrutiny of fiscal management and health services delivery by the LHINs. The MOHLTC has communicated provincial strategic direction that provides a vision for system change and reinforces the principles articulated in the Excellent Care for All Act, 2010. The MOHLTC and the LHINs used this vision to develop a Performance Framework focused on better patient outcomes and value for healthcare dollars. The framework includes the following shared system goals:

• Enhanced Person-Centred Care • Improved System Integration and Enhance Coordination and Transitions of Care • Implementation of Evidence-Based Practices to Drive Quality, Value and Improved

Health Outcomes • Financial Sustainability

A number of key initiatives have been introduced to transform the healthcare system and achieve the vision set forth by the MOHLTC. The LHINs will work with health services providers and other providers to enhance collaboration within and between sectors and ensure alignment with current provincial strategies, including:

• Patient-Based Funding: a new funding strategy to facilitate fiscal sustainability and person-centred care. This will impact hospital, Community Care Access Centre (CCAC), and Long-Term Care Homes (LTCH) budgets.

• Health Links: an innovative approach to enhancing coordinated care for people who


access the system frequently and at multiple entry points. • Seniors Strategy: a provincial initiative to keep seniors healthy and at home longer and

reduce pressures on hospitals and LTCHs by increasing capacity in the community. • Mental Health and Addictions Strategy: an inter-ministerial commitment to improve the

well-being of all Ontarians and create healthy, resilient communities. To further support the transformation agenda and address the demographic and fiscal challenges facing Ontario, comprehensive service capacity planning that includes both the MOHLTC and the LHINs is required. Primary Purpose of the Agreement 1. This Agreement outlines the mutual understanding between the MOHLTC and the LHIN

of their respective performance obligations in the period from April 1, 2013 to March 31, 2015 covering the 2013-2014 and 2014-2015 fiscal years. This is an accountability Agreement for the purposes of s. 18 of the LHSIA.

Principles 2. Both parties will carry out the responsibilities and obligations based on principles that

reflect:

a) Alignment with provincial priorities and strategies;

b) Sustainability of the healthcare system by maximizing the efficient and effective use of public funds;

c) Performance improvement;

d) High-quality, person-centred service delivery;

e) Consistency;

f) Consultation and collaboration among MOHLTC, LHINs, health service providers, other providers and the applicable communities;

g) Openness and transparency; and

h) Innovation, creativity and flexibility.

Definitions 3. The following terms have the following meanings in all the Schedules:

“Agreement” means this Agreement, including any schedules, and any instrument which amends this Agreement.

“Annual Business Plan” means the plan for spending the funding received by the LHIN from the MOHLTC and included in this Agreement as required by s. 18(2) (d) of the LHSIA.


"Community" has the meaning set out in s. 16(2) of the LHSIA.

“Consolidation Report” means a report that includes the LHIN’s revenues and expenditures for LHIN operations and transfer payments to health service providers, and balance sheet accounts for the LHIN. “Dedicated Service Funding” means, in respect of a specific service, the funding that must be used by the LHIN to fund the provision of the specific service. “eHealth” means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Key application areas of eHealth in Ontario include, but are not limited to: • Electronic health information systems (e.g., electronic medical records, hospital

information systems, electronic referral and scheduling systems, digital imaging and archiving systems, chronic disease management systems, laboratory information systems, drug information and ePrescribing systems)

• Electronic health information access systems (e.g., provider portals, consumer eHealth)

• Underlying enabling systems (e.g., client/provider/user registries, health information access layer)

• Remote healthcare delivery systems (e.g., telemedicine services) “eHealth Ontario” means the government agency responsible to the Minister of Health and Long-Term Care which is a corporation without share capital created and continued in Ontario Regulation 43/02 made under the Development Corporations Act. “Fiscal year” means April 1 to March 31.

"Health service provider" has the meaning set out in s. 2(1) of the LHSIA.

“Regular Report” means a report that includes a statement of the LHIN’s revenues, actual expenditures, forecasted expenditures for LHIN operations, transfer payments, an explanation of variances as required between the forecasted expenditures and revenues, and the identification of any financial and performance risks. “Schedule” means any one of and “Schedules” means any two or more of the schedules appended to this Agreement, including the following:

1. General; 2. Local Health System Program Management; 3. Long-Term Care Homes Program Specific Management 4. Funding and Allocations; 5. Local Health System Performance; and 6. Integrated Reporting.

“Service accountability agreement” means the service accountability agreement that the LHIN and a health service provider are required to enter into under s. 20 (1) of the LHSIA.


“Year-end” means the end of a fiscal year.

Accountability 4. Both parties will fulfill their performance obligations in accordance with the terms of this

Agreement. 5. Both parties will collaborate and cooperate to:

a) Facilitate the achievement of the requirements of the Agreement; b) Promote financial sustainability and efficient utilization of financial resources; c) Develop clear and achievable service and financial performance obligations and

identify risks to performance; d) Establish clear lines of communication and responsibility; and e) Work diligently to resolve issues in a proactive and timely manner.

6. The LHIN is responsible for managing its performance, the performance of the local

health system, and collaborating with other providers to support provincial goals, as set out in the Agreement and using its authority under law. The MOHLTC is responsible for collaborating with the LHIN to achieve those ends. The MOHLTC and the LHIN recognize that issues may arise in the local health system that will require joint MOHLTC-LHIN problem-solving, decision making and action.

Performance Improvement 7. Both parties will follow a proactive and responsive approach to performance

improvement based on the following principles:

a) Prudent financial management of public healthcare resources; b) Better access to high quality, person-centred services; c) Strengthened transitions in care across the entire patient journey; d) Ongoing performance improvement; e) An orientation to problem-solving; and f) A focus on relative risk of non-performance.

8. Where matters arise that could significantly affect either the LHIN or MOHLTC’s ability to

perform their obligations under this Agreement, they shall provide written notice to the other party as soon as reasonably possible (a “Performance Factor”). Notice shall include a description of any remedial action the party has taken or plans to take to remedy the issue. Receipt of notice will be acknowledged within five business days of the date of the notice.

9. Both parties agree to meet and discuss the “Performance Factor” within one calendar month of the date of the notice. During the meeting, using the principles set out in paragraph 7, the parties will discuss:

a) The causes of the Performance Factor;

b) The impact of the Performance Factor and whether it poses a “low”, “moderate” or “high” risk to achieving the obligations of the Agreement;


c) The steps in the performance improvement process to be taken to mitigate the impact of the Performance Factor; and

d) Whether revisions or amendments to a party’s performance obligations are required.

10. Where a LHIN Performance Factor is not mutually resolved, the Minister will determine the remedies to improve performance, depending on the extent, exposure or level of risk.

Next MOHLTC LHIN Agreement 11. Both Parties will enter into a new agreement under s. 18 of the LHSIA to be effective at

the end of this Agreement. If the new agreement is not signed by the Parties by April 1, 2015 this Agreement will continue in force until the new agreement is signed. Both Parties will make their best efforts to sign a new agreement as soon as they are able.

General

12. Any amendment to this Agreement will only be effective if it is in writing and executed by

the authorized representative of each party.

13. The LHIN will not assign any duty, right or interest under this Agreement without the written consent of the MOHLTC.

14. If a due date for materials falls on a weekend or on a holiday recognized by the MOHLTC, the materials are due on the next business day.

15. Each Schedule applies to the 2013-15 fiscal years, unless stated otherwise in a

Schedule. Some of the performance obligations in a Schedule may apply only to one fiscal year, as stated in that Schedule.

16. Each party will communicate with each other about matters pertaining to this Agreement through the following persons:


To the MOHLTC: Ministry of Health and Long-Term Care, Health System Accountability and Performance Division Hepburn Block, 5th Floor 80 Grosvenor Street, Toronto, ON M7A 1R3 Attention: Assistant Deputy Minister, Health System Accountability and Performance Fax: (416) 212-1859 Telephone: (416) 212-1134 With a copy to: Director, Local Health Integration Network (LHIN) Liaison Branch 80 Grosvenor St. 5th Floor, Hepburn Block Toronto, ON M7A 1R3 Fax: (416) 326-9734 Telephone: (416) 314-1864

To the LHIN: Attention: Chair Fax: () - Telephone: () - With a copy to: Attention: CEO Fax: () - Telephone: () -

Made effective this 1st day of April, 2013 by:

Her Majesty the Queen in right of Ontario, as represented by the Minister of Health and Long-Term Care:

________________________________________ The Honourable Deb Matthews Minister of Health and Long-Term Care

XXXX Local Health Integration Network

By:

________________________________________ Name Chair


SCHEDULE 1: GENERAL

Provincial Priorities and Strategies

1. The MOHLTC will establish provincial priorities and strategies for the health system and communicate these priorities to the LHINs.

2. The LHIN will:

a) Work with the MOHLTC, health service providers and other providers in the local

health system to achieve and accelerate provincial priorities and strategies. b) Work to align the Quality Improvement Plan (QIP) objectives and priorities of its

health service providers to improve the quality of care across sectors and the healthcare system.

3. Both parties will work together to develop a collaborative process to support current

and future service capacity planning so that decisions about local service provision will advance provincial priorities and strategies.

Provincial Health Agencies 4. The MOHLTC will work with the following provincial health agencies to ensure they

equally consider the role of the LHINs as local health system managers:

a) Cancer Care Ontario; b) eHealth Ontario; c) Health Quality Ontario; and d) Ontario Agency for Health Protection and Promotion.

5. The LHIN will work with the aforementioned provincial health agencies to support the

fulfillment of provincial priorities and strategies. Consistency

6. The MOHLTC will identify common issues and services for which a consistent approach

across LHINs is required. 7. The LHIN will work collaboratively with other LHINs, and in accordance with the MOU, to

ensure a consistent approach for common issues and services, including those identified by the MOHLTC in subparagraph 6(a).

Local System Coordination and Integration

8. The LHIN will work with its health service providers and other LHINs to improve

governance, coordination and integration of healthcare delivery across the continuum of care and both within and between LHINs.

Community Engagement

9. The LHIN will fulfill its community engagement requirements in accordance with the


community engagement guidelines to ensure greater clarity and transparency of process.

Information Management

10. The MOHLTC will:

a) Develop, maintain and support health data standards, communicate health data reporting requirements and standards to the LHIN and health service providers, advise/inform health service providers of reporting and data quality issues, and, inform the LHINsand health service providers of reporting timelines;

b) Consult with the LHIN to identify LHIN data/information requirements that support

data infrastructure for LHIN operational needs, and prepare data sharing agreements and / or amendments to existing agreements as required; and

c) Receive data and information from health service providers on behalf of the LHIN

and provide timely access to the appropriate data to support health system needs.

11. The LHIN will:

a) Require health service providers to submit data and information as communicated by the MOHLTC under subparagraph 8(a) to the MOHLTC, Canadian Institute for Health Information, or other third party;

b) Identify LHIN data/information requirements to support the LHIN analysis at the local

level, and work collaboratively with the MOHLTC to develop appropriate methodology, consistent data analysis and reporting; and

c) Work with health service providers to improve data quality and timeliness as

necessary.

12. Both parties will avoid duplicating data and information management infrastructure and processes, determine and prioritize data and information products, and streamline reporting requirements and timelines for the LHIN and health service providers.

Compliance Protocols


a) Retain its compliance, inspection and enforcement authorities under legislation; and

b) Inform the LHIN as soon as reasonably possible on matters related to compliance, inspection and enforcement in LTCHs and otherwise through a mutually agreeable reporting schedule.

14. The LHIN will:

a) Exercise its legislative and contractual authorities as necessary or as required under law, including conducting or requiring audits and reviews of health service providers; and


b) Inform the MOHLTC as soon as reasonably possible:

i) Of non-compliance by a health service provider with an assigned agreement, a

service accountability agreement, or legislation, that has not been resolved to the LHIN’s satisfaction; or

ii) Of a health service provider that is licenced or approved to operate a LTCH,

a) That is experiencing financial issues;

b) Where the LHIN is aware that there is risk to resident health and/or safety in a LTCH; or

c) Where the results of an audit or review conducted or required by a LHIN

identifies problems. eHealth


a) Set technical and information management standards related to eHealth and implementation / compliance timeframes for the interoperability of the health system in Ontario, including standards related to content, architecture, technology, privacy and security; and

b) Review annual LHIN Cluster eHealth plans as submitted by the LHINs.

16. The LHIN will:

a) Assist their respective LHIN Clusters to prepare an annual LHIN Cluster eHealth plan that aligns with the provincial eHealth priorities for 2013-15, to be submitted to the MOHLTC for review;

b) Include eHealth commitments in service accountability agreements requiring health

service providers to:

i) Assist the LHIN to implement provincial eHealth priorities for 2013-15;

ii) Comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security, set for health service providers by the MOHLTC or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be;

iii) Implement and use the approved provincial eHealth solutions identified in the

LHIN Cluster eHealth plan; iv) Implement technology solutions that are compatible or interoperable with the

provincial blueprint and with the LHIN Cluster eHealth plan; and


v) Include, in their annual planning submissions, plans for achieving eHealth priority initiatives, including full adoption by all hospitals of Ontario Laboratory Information System by March 2015.

17. Both parties will work together, and in conjunction with eHealth Ontario and Ontario Telemedicine Network as appropriate, to:

a) Participate in forums for the discussion of eHealth issues at a provincial level to

identify options to support the roll out of eHealth initiatives and related eHealth issues including local health system needs, challenges, and opportunities and eHealth standards, definitions, and architectural frameworks; and

b) Inform one another of significant issues or initiatives that contribute to or have an

impact on provincial or local eHealth issues, strategies or work plans. Capital 18. Both parties will:

a) Follow the November 2010 MOHLTC-LHIN Joint Review Framework for Early

Capital Planning Stages;

b) Work together during the term of this Agreement to develop a revised or updated capital planning and delivery model for the early capital planning stages informed by service capacity planning by the MOHLTC, the LHINs and other provincial health agencies;

c) Follow the MOHLTC's current Health Infrastructure Renewal Fund Guidelines; and

d) Work together to devolve the review and approval process for Own-Funds Capital

Projects from the MOHLTC to the LHIN, as appropriate. Emergency Management 19. Both parties will work together to implement the approved policy: “The LHIN Role in

Emergency Management” (August 2012). General Performance Obligations 20. The MOHLTC will provide the LHIN with, and develop as appropriate, those provincial

standards (such as operational, financial or service standards and policies, operating manuals and program eligibility), directives and guidelines that apply to health service providers, including providing the LHIN with relevant program manuals.

21. The LHIN will:

a) Require health service providers to provide services funded by the LHIN in

accordance with provincial standards, directives and guidelines provided pursuant to paragraph 20 above;


b) Provide a certificates of compliance, or attestations as the case may be, to the MOHLTC in form and substance as required by the MOHLTC;

c) Maintain the 10% reduction in executive office costs that it achieved between April 1,

2011 and March 31, 2013 against its 2010/11 budget; d) Require its hospitals and CCAC to maintain the 10% reduction that they achieved

between April 1, 2011 and March 31, 2013 against their respective 2010/11 budgets; e) Not use, nor permit its hospitals and CCAC to use, funding provided under this

Agreement to increase executive office budgeted costs during the term of this Agreement; and

f) Report on their executive costs in an attestation to the MOHLTC, and require its

hospitals and its CCAC to report on their respective executive office costs in an attestation to the MOHLTC.

22. Both parties will work together to ensure that government priorities and implementation

of provincial strategies are reflected in accountability planning submission templates, service accountability agreements and schedules with health service providers and other providers.

Annual Review and Update 23. Both Parties agree that the Schedules will be reviewed and updated annually, as

necessary to better reflect the Primary Purpose, within 120 days of a budget announcement of the Government of Ontario.


SCHEDULE 2: LOCAL HEALTH SYSTEM PROGRAM SPECIFIC MANAGEMENT

Provincial Programs 1. The MOHLTC and the LHIN will establish a coordinated and effective system for the

management of provincial programs. 2. The MOHLTC will:

a) Identify provincial programs, determine any terms and conditions, including

dedicated service funding, related to these provincial programs and communicate these to the LHIN; and

b) Establish:

(i) Roles and responsibilities related to provincial program delivery; and

(ii) Performance management, monitoring and evaluation processes.

3. The LHIN will fulfill requirements as may be identified under paragraph 2 above and

work with other LHINs to coordinate provincial program service delivery. Other MOHLTC Programs 4. If the MOHLTC establishes expectations and requirements for other programs, it will

advise the LHIN.

5. The LHIN will require health service providers that provide the specific program to provide program services in accordance with the expectations and requirements established by the MOHLTC.

Devolution 6. The MOHLTC:

a) Will determine the devolution of province-wide programs to the LHINs; b) Will consult with LHINs before identifying a Lead LHIN; and c) May specify the terms and conditions applicable to the funding and administration of

the province-wide program after its devolution. 7. The LHIN will:

a) Administer the devolved program in accordance with the ”Agreement Concerning

the Devolution of Provincial Programs”, also known as the Lead LHIN Model Agreement and any terms and conditions specified by the MOHLTC; and


b) Confirm any proposed changes to the Lead LHIN Model Agreement with the MOHLTC prior to implementation.

Community Health Centres (“CHCs”) 8. The MOHLTC will support development of QIPs by providing the required templates,

guidance and accompanying supports. 9. The LHIN will require each CHC to submit a QIP to Health Quality Ontario that is aligned

with and supports local health system priorities. Mental Health 10. The MOHLTC will:

a) Determine and advise the LHIN of the number of housing units that receive rent supplements for persons with serious mental illness and the specific agencies that receive the rent supplements for these units from the MOHLTC;

b) Determine and advise the LHIN of the required service levels for supports to housing services for persons with serious mental illness who occupy the housing units that receive rent supplements as described in subparagraph 10(a);

c) For forensic mental health services, determine and advise the LHIN of:

(i) the number and type of forensic mental health inpatient beds and the forensic case management initiatives, and the Transitional Rehabilitation Housing Programs’ numbers and models;

(ii) the designated hospitals that provide forensic mental health services; and

(iii) the required service levels for forensic mental health services; and

d) Determine and advise the LHIN of the type (adult or paediatric, inpatient, residential, day treatment or outpatient) and quantity of specialty eating disorder services, where applicable.

11. The LHIN will:

a) Fund the provision by health service providers of a combination of community mental

health services for the local health system, including services for people who have been in conflict with the criminal justice system;

b) Fund the provision by health service providers of the following services:

(i) Supports to housing services for persons who occupy the housing units that receive rent supplements at the service levels as described in subparagraph 10(b);

(ii) forensic mental health services that include forensic mental health inpatient beds, forensic case management initiatives, and the Transitional Rehabilitation


Housing Programs; and (iii) specialty eating disorder services; at the service levels as specified under paragraph 10;

c) Require health service providers, designated as psychiatric facilities under the

Mental Health Act, to provide the essential mental health services in accordance with the specific designation for that site and discuss any material changes to the service delivery models or service levels with the MOHLTC; and

d) Not make any changes to the types and/or levels of service as specified under

paragraph 10 without MOHLTC approval. Addictions 12. The MOHLTC will:

a) Determine and advise the LHIN of type and quantity of problem gambling treatment and prevention services;

b) Determine and advise the LHIN of the number of housing units that receive rent supplements for persons with problematic substance use and the specific agencies who receive the rent supplements for these units from the MOHLTC; and

c) Determine and advise the LHIN of the required service levels for supports to housing

services for persons with problematic substance use who occupy the housing units that receive rent supplements as described in paragraph 12(b).

13. The LHIN will:

a) Fund the provision by health service providers of the following services:

(i) Problem gambling treatment and prevention services as described in subparagraph 12(a);

(ii) Supports to housing services for persons who occupy the housing units that

receive rent supplements as described in subparagraph 12(c); and (iii) A combination of substance abuse treatment services for the local health system;

and

b) Not make any proposed changes to types and/or levels of service as specified under paragraph 12 without MOHLTC approval.


SCHEDULE 3: LONG-TERM CARE HOMES PROGRAM SPECIFIC MANAGEMENT

Definitions 1. Definitions below apply to Schedule 3: Long-Term Care Homes and Schedule 4:

Funding and Allocations:

“Acknowledgement and Consent Agreement” means an agreement entered into between the MOHLTC, the operator of a LTCH, and one or more lenders or secured parties, by which the MOHLTC consented to, or agreed to request a consent to, any of the following: (a) a mortgage of real property associated with the LTCH, (b) an assignment of a Development Agreement with the MOHLTC, and/or (c) an assignment of a service agreement; “Beds in Abeyance” means LTCH beds licensed or approved by the MOHLTC, for which the LTC health service provider has obtained written permission from the Director, PICB, in accordance with the LTCHA for the beds not to be available for occupancy.;

“Construction Funding Subsidy per diem” or “CFS per diem” means any per diem funding paid pursuant to a Development Agreement;

“Convalescent Care Beds” means those short-stay beds, licensed or approved under the LTCHA, that are part of a short-stay convalescent care program for which residents may be eligible for admission in accordance with regulations under the LTCHA; “Development Agreement” means an agreement between the MOHLTC and a LTC health service provider, or a proposed LTC health service provider, to develop, upgrade, retrofit or redevelop LTCH beds;

“Funding Policies” means the funding and financial management policies determined by the MOHLTC for LTCHs as the same may be amended from time to time. Funding Policies establish the rates, and amounts and envelopes of all funding provided to LTC health service providers by the MOHLTC or the LHIN, including Supplementary Funding. Funding Policies also establish the applicable conditions for funding, the funding reconciliation rules, and the form, manner and content and date for submission of reports; “Interim Beds” means those short-stay beds that are licensed or approved under the LTCHA and that fall within the definition of “interim bed” in accordance with regulations under the LTCHA;

“LTCH” means long-term care home;

“LTCH Protocol” means the document titled “Long-Term Care Homes Protocol” as prepared and amended by the MOHLTC;

“LTCHA” means the Long-Term Care Homes Act, 2007 and regulations thereunder;

“LTC health service provider” means a health service provider that is a licensee within


the meaning of s. 2(1) of the LTCHA; “Supplementary Funding” means funding for LTCH beds provided directly by the MOHLTC to LTC health service providers in accordance with applicable Funding Policies and pursuant to a funding agreement between MOHLTC and the LTC health service provider;

“service agreement” means the agreement pursuant to which funding is provided to a LTC health service provider and includes a service accountability agreement;

“service accountability agreement” means the service accountability agreement between a LHIN and a LTC health service provider required by s. 20 of the LHSIA; and “Short-Stay Respite Beds” means those short-stay beds, licensed or approved under the LTCHA, that are part of a short-stay respite care program for which residents may be eligible for admission in accordance with regulations under the LTCHA.

Funding 2. The MOHLTC will:

a) Determine and provide to the LHIN, the amount of funding that a LHIN may provide

to a LTC health service provider together with any applicable terms and conditions;

b) Determine any net projected unused funding for all LHINs that, as of September 30 in each fiscal year, has not or is projected not to be used by LTC health service providers;

c) Reallocate a share of the net projected unused funding to the LHIN if the LHIN is

projected to be overspent on its funding for the LTCH per diem rate; d) If there is net projected unused funding remaining after the reallocation, allocate to

the LHIN by December 31 of each year a share of the unused funding in proportion to the number of LTCH beds that are licensed or approved and in operation in the LHIN’s geographic area, other than (i) Beds in Abeyance and (ii) beds funded by the LHIN pursuant to paragraphs 18 and 21 of this Schedule, compared to the provincial total number of LTCH beds that are licensed or approved and in operation in the Province, other than Beds in Abeyance and beds funded by all the LHINs pursuant to paragraphs 18 and 21 of Schedule 3 to their respective Ministry LHIN Performance Agreements; and

e) At its discretion, provide Supplementary Funding.

3. The LHIN will distribute and reconcile the funding provided under paragraph 2, pursuant

to the terms of a service accountability agreement that is consistent with and requires adherence to the Funding Policies and any additional terms and conditions. For greater certainty, the LHIN may not provide any more funding to LTC health service providers than is identified in paragraph 2 above, except as provided in the Funding Policies and this Schedule.

4. If a LTC health service provider’s beds are closed or transferred to another LHIN, or if a


LTC health service provider’s licence expires, is surrendered or is revoked under the LTCHA, the residual funding for the beds provided under subparagraph 2 (a) reverts to the MOHLTC.

Construction Funding Subsidy (CFS) 5. The MOHLTC will:

a) Determine the CFS per diem and the LTC health service providers in the geographic area of the LHIN that will receive the per diem, including any conditions on the funding and the number of beds for which the LTC health service provider will receive the CFS per diem; and

b) Provide the CFS per diem to the LHIN. 6. The LHIN will provide the CFS per diem to LTC health service providers for each

approved or licensed bed that is identified in paragraph 5 and operated in accordance with the MOHLTC’s conditions of funding, applicable legislation or Development Agreement.

7. Every service accountability agreement entered into between the LHIN and the LTC

health service provider during the term of this Agreement and in the future will contain an obligation on the LHIN to provide the CFS per diem to the LTC health service provider for the length of time set out in the particular Development Agreement for the particular beds.

Assignment of LTC Service Agreement 8. Where the MOHLTC has entered into an Acknowledgement and Consent Agreement

with a LTC health service provider and one or more lenders of the LTC health service provider (Lender) prior to the proclamation of the LTCHA, the LHIN will treat the MOHLTC’s consent to assign the service agreement under the Acknowledgement and Consent Agreement as if MOHLTC had provided the consent on behalf of the LHIN.

9. Where an Acknowledgement and Consent Agreement or a Development Agreement

between the MOHLTC and the LTC health service provider provides that the MOHLTC will request the LHIN to consent to an assignment of the service agreement, to the Lender or person designated by the Lender, the LHIN will consent to the assignment of the service agreement to that person where the MOHLTC so requests, and the consent shall be subject to terms and conditions similar to those of the Acknowledgement and Consent Agreement or the Development Agreement as the case may be.

10. In addition, the LHIN will not unreasonably withhold consent requested from a Lender, or

from a receiver or receiver and manager appointed by a Lender or by a court order, to assign its or the LTC health service provider’s right, title and interest in the service agreement or any part thereof or interest therein to another party, subject to all applicable legislative requirements.

11. Where the MOHLTC


a) has entered into a Development Agreement with a LTCH health service provider or a proposed LTCH health service provider (an “Operator”);

b) has consented to the grant of a security interest to a Lender under the Development Agreement; and

c) has directed the LHIN to consent to the assignment of the Operator’s rights under a service accountability agreement,

then the LHIN,

d) Shall deliver to the Lender a commitment, in the MOHLTC’s standard form, to provide

the LHIN’s consent to the assignment of the Operator’s rights under the service accountability agreement between the Operator and the LHIN;

e) Upon the grant of a licence to the Operator in respect of the Home, and for so long as a CFS is to be paid in respect of the Home, shall consent to the grant of a security interest in the service accountability agreement between the LHIN and the Operator in respect of the Home, provided that:

1) The security interest in the service accountability agreement may only be

exercised together with the exercise of a security interest in the licence for the beds; and

2) The security interest is subject to all applicable statutory requirements and

restrictions, including s. 107 of the LTCHA and s. 2(2), 19 and 20 of the LHSIA; and

f) Shall amend s. 15.8 of the service accountability agreement in respect of the Home

to remove the following sentence: “No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor.”

Beds in Abeyance 12. The MOHLTC will review and may approve Beds in Abeyance applications in

accordance with the Beds in Abeyance policy and LTCH Protocol. 13. In the event that an application is approved, the LHIN may seek and the MOHLTC may

grant permission to temporarily use the amount of funding available as a result of any approved Beds in Abeyance applications. If the MOHLTC approves the LHIN’s request, the LHIN may use the funding in accordance with the approval, including any conditions that may attach to the approval.

Short-Stay Program Beds 14. The MOHLTC will:

a) Determine the minimum threshold for occupancy for Short-Stay Respite Beds to inform approval of these beds in accordance with the LTCH Protocol;


b) Determine the minimum number of Convalescent Care Beds and Interim Beds in the Province;

c) In consultation with the LHIN, determine the LTC health service providers that will

provide the Convalescent Care Beds and the Interim Beds and the number of those beds from the minimum number of beds determined in subparagraph (b); and

d) Set other conditions for the operation of Convalescent Care Beds and Interim Beds.

15. The LHIN will:

a) Take action as appropriate to improve the utilization of Short-Stay Respite Beds;

b) Have the ability to set, in its discretion, a threshold for occupancy of Short-Stay Respite Beds that is higher than the minimum set by the MOHLTC pursuant to subparagraph14 (a);

c) Determine which LTC health service providers will provide Short-Stay Respite Beds

within the existing licensed or approved beds of each home and the number of such beds;

d) Advise and/or make a proposal to MOHLTC about matters referred to in

subparagraph 14(c);

e) Incorporate the conditions referred to in subparagraph 14(d) in service accountability agreements;

f) At its discretion, request that the MOHLTC approve the conversion of existing

licensed or approved beds into Convalescent Care Beds additional to those identified in subparagraph14(b) in accordance with the LTCH Protocol; and

g) Provide from its allocation, all additional funding for the converted Convalescent

Care Beds approved by the MOHLTC pursuant to subparagraph 15(f) to LTC health service providers in accordance with the Funding Policies, including the additional subsidy for Convalescent Care Beds and the resident co-payment portion of the base level-of-care per diem funding.

LHIN-Requested LTCH Beds 16. In paragraphs 17 and 18 “LHIN Requested LTCH Beds” means, subject to a

determination under subparagraph 18(b), a LTCH bed funded by the LHIN out of its allocation, other than its allocation for LTCHs:

a) That would increase the bed capacity of an existing LTCH licence issued under s.99,

or an approval granted under s. 130 of the LTCHA; or

b) In the case of a development or redevelopment, that is over and above the number of LTCH beds that the MOHLTC has approved a LTC health service provider for development or redevelopment.

17. The LHIN will:


a) At its discretion, request LHIN Requested LTCH Beds; b) In its request identify (i) the number of LHIN Requested LTCH Beds requested; (ii)

the estimated amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be paid in accordance with paragraphs 3 and 6 in this Schedule; and (iii) where, subject to a determination under subparagraph 18(b), the funding will be found within the LHIN’s allocation, other than its allocation for LTCHs; and

c) Fund the LHIN Requested LTCH Beds in accordance with the Funding Policies and

paragraphs 3 and 5 of this Schedule if the LHIN’s request for LHIN Requested LTCH Beds is granted by the MOHLTC.


a) Consider the LHIN’s request for LHIN Requested LTCH Beds and decide whether to grant the request.

b) Determine the amount of funding, if any, that the MOHLTC may contribute;

c) Confirm the amount of the funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be calculated pursuant to paragraphs 2 and 5 in this Schedule; and

d) Reallocate the confirmed funding from the sources identified by the LHIN to (i) the

LHIN’s allocation for LTCH beds for all funding to be paid in accordance with paragraphs 3 and 6 of this Schedule; and (ii) the MOHLTC’s allocation for Supplementary Funding when the LHIN Requested LTCH Beds are available for occupancy.

LHIN-Requested Temporary LTCH Beds

19. In paragraphs 20 and 21, “LHIN Requested Temporary LTCH Beds” means a LTCH bed

for which the MOHLTC would issue a temporary licence in accordance with s. 111 of the LTCHA or increase the bed capacity of a temporary licence in accordance with the LTCHA, on the condition that the LTCH bed will be funded by the LHIN out of the LHIN’s allocation, which may include funding approved for temporary use under paragraph 13.

20. The LHIN will:

a) At its discretion, make a request for LHIN Requested Temporary LTCH Beds for a

term of no longer than 5 years; b) In its request identify (i) the number of LHIN Requested Temporary LTCH Beds

requested; (ii) the estimated amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be paid in accordance with paragraph 3; and (iii) where the funding will be found within the LHIN’s allocation; and


c) If the request is approved pursuant to paragraph 21, provide the funding identified in subparagraph 21(b) for the LHIN Requested Temporary LTCH Beds in accordance with the Funding Policies for the term of the temporary licence issued by the MOHLTC, including any increases in this funding and Supplementary Funding after the date the temporary licence is issued by the MOHLTC for these beds.


a) Consider the LHIN’s request for LHIN Requested Temporary LTCH Beds and decide whether to grant the request;

b) Confirm the amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and the funding paid in accordance with paragraph 3 of this Schedule.


SCHEDULE 4: FUNDING and ALLOCATIONS

Definitions 1. In this Schedule, the following terms have the following meanings:

“Annual Balanced Budget” means that, in a fiscal year, the total revenues are greater than or equal to the total expenses. Further, for the LHIN, the meaning of annual balanced budget is also subject to Public Sector Accounting Board (PSAB) rules as well as any interpretations issued by the MOHLTC in financial policies, directives or guidelines under paragraph 8. “Health Based Allocation Model (HBAM)” is a population health-based funding methodology that uses population and clinical information to inform funding allocation. “HBAM Funding” means the portion of funding allocated to a health service provider based on the results of HBAM allocation methodology. “Multi-year funding targets” means the funding targets for remaining years of the Agreement. “Operating Budget” means the budget for the LHIN’s corporate operations. “Quality Based Procedures (QBP)” means the evidence-based funding determination that uses a ‘price times volume’ methodology to calculate the funding for a targeted set of specific patient groups. “QBP Funding” means the amount allocated to a health service providers as a result of QBP analyses using QBP allocation methodology. “Transfer Payment Budget” means the budget for the LHIN’s funding of health service providers.

Funding 2. The government’s overall provincial LHIN funding allocations that have been updated

from the 2013-14 Printed Estimates to include any additional funding to July 31, 2013 and any reallocations initiated by the LHINs are set out in the following tables, in this Schedule: a) Table 1 – Statement of Overall LHIN Provincial 2013-14 Funding Allocation b) Table 1a – Statement of Overall LHIN Provincial 2013-14 Funding Allocation –

Health System Funding Reform Budget c) Table 3 – Statement of Overall LHIN Provincial 2013-14 Dedicated Service Funding

by Sector 3. The MOHLTC:

a) Will provide to the LHIN on August 20, 2013 the 2013-14 funding allocation, such

funding allocation having been updated from the 2013-14 Printed Estimates to


include any additional funding to July 31, 2013 and any reallocations initiated by the LHIN, set out in the following tables in this Schedule:

(i) Table 2 – Statement of Individual LHIN 2013-14 Funding Allocation (ii) Table 2a – Statement of Individual LHIN 2013-14 Funding Allocation – Health

System Funding Reform Budget (iii) Table 3a – Statement of Individual LHIN 2013-14 Dedicated Service Funding by

Sector

b) As the LHIN makes funding allocation decisions at the sector level throughout the year, will revise the Health Service Provider Transfer Payment Budget by Sector Initiatives allocation in Table 2 in this Schedule to the appropriate sectors;

c) May set terms and conditions for any of the funding set out in the tables in this

Schedule, including the type of funding (e.g. base or one-time), whether the funding is subject to annual adjustment, and whether and in what circumstances the funding may be recoverable from the LHIN by the MOHLTC:

d) Has determined that HBAM Funding set out in Tables 1a and 2a is subject to annual adjustment by the MOHLTC, and QBP funding set out in Tables 1a and 2a in this Schedule is subject to annual adjustment and is recoverable by the MOHLTC;

e) Will reconcile all funding provided to the LHIN under this Agreement on an annual

basis; f) Will recover funding from the LHIN if the MOHLTC has advised the LHIN that the

particular funding is recoverable; and g) May require the LHIN to carry out certain initiatives.

4. The LHIN:

a) Will allocate the funds provided by the MOHLTC for 2013-15, in accordance with the LHSIA, this Agreement and any applicable terms and conditions of which the LHIN is advised by the MOHLTC, including those set out in paragraph 3;

b) Will carry out MOHLTC-required initiatives that may include:

(i) Aboriginal Community Engagement, French Language Health Services, French Language Health Planning Entities, LHIN Shared Services Office, Diabetes Regional Coordination Centre Program, Emergency/Alternative Level of Care Performance Leeds, Emergency Department LHIN Leads and Critical Care LHIN Leads, as set out in Table 2 in this Schedule under LHIN Operating Budget – Initiatives; and

(ii) Aging At Home, Urgent Priorities Fund, ALC Investment, Behavioural Supports Ontario Project and funding for Community Investment Initiatives ($XXXM), as set out in Table 2 in this Schedule under Health Service Provider Transfer Payment Budget – Initiatives.

c) May, at its discretion, provide additional funding for the services for which Dedicated


Service Funding is identified; and

d) May, only with prior approval from the MOHLTC, reallocate unused Dedicated Service Funding to another service. If the MOHLTC does not give approval, the LHIN shall return unused Dedicated Service Funding to the MOHLTC.

Long-Term Care Homes 5. The funding allocations in Tables 1 and 2 for LTCHs are only estimates that are subject

to adjustment in accordance with the Funding Policies, including adjustments for reconciliation, Beds in Abeyance, and Construction Funding Subsidy per diem.

Annual Balanced Budget Requirements 6. The LHIN will:

a) Plan for an Annual Balanced Budget for its operations and health service provider

transfer payments; b) Achieve an Annual Balanced Budget for its operations; and c) Require health service providers who receive LHIN funding through transfer

payments to achieve an Annual Balanced Budget. Multi-Year Funding Requirements 7. The LHIN will plan and manage LHIN forecasted expenses for the LHIN’s Operating and

Transfer Payment Budgets within the multi-year funding targets set out in this schedule and the Multi-Year Funding Framework. Multi-year funding targets are to be used for planning purposes only and may be revised upward or downward at the discretion of the MOHLTC.

Financial Management Polices and Guidelines 8. The MOHLTC may develop and issue to the LHIN policies, directives and guidelines

related to financial management. 9. The LHIN will comply with all applicable legislation; including the Financial

Administration Act, any MOHLTC policies, directives and guidelines issued to the LHIN related to financial management; as well as government financial management policies; guidelines; and directives, including the following:

a) Multi-Year Funding Framework; b) Parameters for Financial Health Framework; c) Fiscal Prudence through Contingency Planning Policy; and d) Parameters for In Year and Year End Reallocations Policy.

Accounting Standards 10. The MOHLTC:


a) Will issue interpretations and modifications relating to Public Sector Accounting Board (PSAB) standards, based on advice from the Office of the Provincial Controller; and

b) May review the documentation described in paragraph 11 during regular business

hours and upon twenty-four hours notice to the LHIN. 11. The LHIN will:

a) Prepare its financial reports and statements on its Operating and health service provider Transfer Payment Budgets, including its Annual Business Plan, based on the Public Sector Accounting Board (PSAB) standards, subject to modifications and interpretations issued as per paragraph 10.

b) Maintain documentation to support all financial statements and related payment

instructions, including funding approval letters to health service providers and service accountability agreements signed between the LHIN and its health service providers.


2013-14 FundingAllocation

(000's)


(000's)

Total LHIN Operating Budget XXXX TBD

Total Health Service Provider Transfer Payments XXXX TBDOperation of LHIN XXX TBDInitiatives XXX TBDE-Health XXX TBD

Operations of Hospitals XXXX TBD

Grants to Compensate for Municipal Taxation - Public Hospitals XXXX TBDLong Term Care Homes XXXX TBDCommunity Care Access Centres XXXX TBDCommunity Support Services XXXX TBDAcquired Brain Injury XXXX TBDAssisted Living Services in Supportive Housing XXXX TBDCommunity Health Centres XXXX TBDCommunity Mental Health XXXX TBDAddictions Program XXXX TBD

Specialty Psychiatric HospitalsXXXX TBD

Grants to Compensate for Municipal Taxation - Psychiatric Hospitals XXXX TBDInitiatives XXXX TBD

Table 1: Statement of Overall LHIN Provincial 2013-14 Funding Allocation

Total Health Service Provider Transfer Payment Budget by Sector:


2013-14 Funding Allocation (000s) (1)


Total Health System Funding Reform BudgetTotal Health Service Provider Transfer Payments XXX TBD

Total Health Service Provider Transfer Payments XXX TBD

HospitalsHealth Based Allocation Model (HBAM) Funding (2) XX TBDQuality Based Procedures (QBP) Funding (3) XX TBD

Community Care Acces CentreHealth Based Allocation Model (HBAM) Funding (2) XX TBDQuality Based Procedures (QBP) Funding (3) XX TBD

1. The amounts in this table are included in Table 1 under the respective sectors.2. HBAM funding will be processed as base funding subject to annual adjustment. 3. QBP funding will be processed as base funding subject to annual adjustment and recovery.

Table 1a: Statement of Overall LHIN Provincial 2013-14 Funding Allocation - Health System Funding Reform Budget



(000s)


(000s)

Total LHIN Operating Budget XXXX TBD

Total Health Service Provider (HSP) Transfer Payments XXXX TBDOperation of LHIN XXX TBDInitiatives XXX TBDE-Health XXX TBD

XXXX TBDOperations of Hospitals XXXX TBD

Grants to compensate for Municipal Taxation - Public Hospitals XXXX TBDLong Term Care Homes XXXX TBDCommunity Care Access Centres XXXX TBDCommunity Support Services XXXX TBDAcquired Brain Injury XXXX TBDAssisted Living Services in Supportive Housing XXXX TBDCommunity Health Centres XXXX TBDCommunity Mental Health XXXX TBDAddictions Program XXXX TBDSpecialty Psychiatric Hospitals XXXX TBD

Grants to compensate for Municipal Taxation - Psychiatric Hospitals XXXX TBDInitiatives XXXX TBD

Table 2: Statement of Individual LHIN 2013-14 Funding Allocation

Total Health Service Provider Transfer Payment Budget by Sector:


Table 2a: Statement of Individual LHIN 2013-14 Funding Allocation - Health System Funding Reform Budget



Total Health System Funding Reform BudgetTotal Health Service Provider Transfer Payments XXX TBD

Total Health Service Provider Transfer Payments XXX TBD

HospitalsHealth Based Allocation Model (HBAM) Funding (2) XX TBDQuality Based Procedures (QBP) Funding (3) XX TBD

Community Care Acces CentreHealth Based Allocation Model (HBAM) Funding (2) XX TBDQuality Based Procedures (QBP) Funding (3) XX TBD

1. The amounts in this table are included in Table 2 under the respective sectors.2. HBAM funding will be processed as base funding subject to annual adjustment. 3. QBP funding will be processed as base funding subject to annual adjustment and recovery.


2013-14 Dedicated Service Funding

Allocation(000s)

Post Construction Operating Plan XXX

Uninsured Persons Services XXX

Consumer Survivor Initiatives XXX

Problem Gambling Treatment Services XXX

Programs for Pregnant or Parenting Women with Problematic Substance Use XXX

School Health Professional and Personal Support Services XXX

Compensation Under Specified Initiatives / Agreements (1) XXX

Other

1. Includes CHC physician salaries and psychiatric sessional fees for community and hospital-based agencies.

Table 3: Statement of Overall LHIN Provincial 2013-14 Dedicated Service Funding by Sector

Hospitals

Community Health Centres

Mental Health

Addictions

Community Care Access Centres

2013-14 Dedicated Service Funding

Allocation(000s)

Post Construction Operating Plan XXX

Uninsured Persons Services XXX

Consumer Survivor Initiatives XXX

Problem Gambling Treatment Services XXX

Programs for Pregnant or Parenting Women with Problematic Substance Use XXX

School Health Professional and Personal Support Services XXX

Compensation Under Specified Initiatives / Agreements (1) XXX

1. Includes CHC physician salaries and psychiatric sessional fees for community and hospital-based agencies.

Other

Table 3a: Statement of Individual LHIN 2013-14 Dedicated Service Funding by Sector

Hospitals

Community Health Centres

Mental Health

Addictions

Community Care Access Centres


SCHEDULE 5: LOCAL HEALTH SYSTEM PERFORMANCE Definitions 1. In this Schedule, the following terms have the following meanings:

“LHIN baseline” means the result at a given time for a performance indicator that provides a starting point for measuring changes in local health system performance and for establishing LHIN targets for future local health system performance; “LHIN target” means a planned result for an indicator against which actual results can be compared; “Performance indicator” means a measure of local health system performance for which a LHIN target will be set, and the LHIN will be held accountable for achieving results under the terms of this Agreement for the local health system in connection with a performance indicator;

“Provincial target” means an optimal performance result for an indicator, which may be based on expert consensus, performance achieved in other jurisdictions, or provincial expectations; “CTAS” means Canadian Emergency Department Triage and Acuity Scale; and “CMG” means Case Mix Group.

General Obligations 2. Under the Act and the Commitment to the Future of Medicare Act, the LHIN will measure

and plan to improve performance at the local level through service accountability agreements with health service providers.

Specific Obligations 3. The MOHLTC will:

a) Calculate the results for the performance indicators set out in Tables 1, 2 and 3:

b) Provide the LHIN with calculated results for the performance indicators by the release dates set out in Schedule 6, and supporting performance information as requested, such as the performance of health service providers; and

c) Provide the LHIN with technical documentation for the performance indicators set out

in Tables 1, 2 and 3, including the methodology, inclusions and exclusions.

4. The LHIN will:

a) Work to achieve the LHIN’s performance targets for the performance indicators;

b) Report quarterly on the performance of the local health system on all performance indicators; and


c) Report on the performance of the local health system on all performance indicators in the LHIN Annual Report.

Table 1: Performance Indicators

Objective: To enhance person-centred care

Expected Outcome: Persons will experience improved access to healthcare services identified below in alignment with best practices.

INDICATOR Provincial target LHIN

Baseline 2013-14

LHIN Target 2013-14

90th Percentile Emergency Room (ER) Length of Stay for Admitted Patients

8 hours

90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients

8 hours

90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients

4 hours

Percent of Priority IV Cases Completed Within Access Target for Cancer Surgery *

Priority IV: 84 days

Percent of Priority IV Cases Completed Within Access Target for Cardiac By-Pass Procedures *


Percent of Priority IV Cased Completed Within Access Target for Cataract Surgery *


Percent of Priority IV Cases Completed Within Access Targets for Hip Replacement *


Percent of Priority IV Cases Completed Within Access Target for Knee Replacement *

Priority IV : 182 days

Percent of Priority IV Cases Completed Within Access Target for MRI Scan *


Percent of Priority IV Cases Completed Within Access Target for Diagnostic CT Scan*


* The reporting for these indicators has been revised starting 2013/14. Previous Agreements included the 90th percentile wait time for these surgical and diagnostic imaging services



Objective: To improve system integration and enhance coordination of care while ensuring better transitions to various care settings.

Expected Outcome: Persons will be able to navigate the healthcare system and receive the care they need, when and where they need it.


Baseline 2013-14

LHIN Target 2013-14

Percentage of Alternate Level of Care (ALC) Days

9.46%

90th Percentile Wait Time from Community for CCAC In-Home Services – Application from Community Setting to first CCAC Service (excluding case management)

To be determined (TBD)

Wait Time from When CCAC Receives Application to Long Term Care Home to When Assessment for Eligibility is Completed *

(TBD)

* New indicator for 2013/14. The MOHLTC and the LHINs will monitor performance in 2013/14 and work together to refine quality and consistency of data. Targets will be established starting 2014/15.


Objective: To implement evidence based practice to drive quality and value and improve health outcomes

Expected Outcome: Persons will receive quality inpatient care and coordinated post-discharge care, leading to reduced readmission rates that may improve survival, quality of life and other outcomes without increasing cost.


Baseline 2013-14

LHIN Target 2013-14

Readmissions within 30 days for Selected CMGs

TBD

Repeat Unscheduled Emergency Visits within 30 days for Mental Health Conditions **

TBD

Repeat Unscheduled Emergency Visits within 30 days for Substance Abuse Conditions **

TBD

** The methodology for these indicators has been revised starting 2013/14. Results may not be comparable to the previous Agreement.


SCHEDULE 6: INTEGRATED REPORTING General Obligations 1. The MOHLTC will:

a) Provide any necessary training, instructions, materials, data, templates, forms, and guidelines to the LHIN to assist with the completion of the reports listed in Table 1; and

b) As required, develop reporting requirements relating to government priorities and

notify the LHIN of the requirements;

2. Both parties will:

a) Work together to ensure a timely flow of information, including financial records, to fulfill the reporting requirements of both parties;

b) Finalize the Annual Business Plan within 120 days of a budget announcement by the

Government of Ontario as part of the annual review set out in Schedule 1: General.


Table 1: MOHLTC and LHIN Reporting Obligations (2013/14)

Due Date Description of Item 2013/2014

APRIL April 16, 2013 MOHLTC will provide to the LHIN a Year End Report confirming the

expenditures and revenue related to its transfer payments as of March 31 of the preceding fiscal year

April 30, 2013 MOHLTC will provide to the LHIN the forms for the Year-end Consolidation Report

April 30, 2013 The LHIN will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC

April 30, 2013 The LHIN will submit to the MOHLTC an Attestation as required under the Broader Public Sector Accountability Act (BPSAA)

MAY May 13, 2013 MOHLTC will provide the LHIN with the most recent quarter of data for

indicators in Schedule 5: Local Health System Performance May 14, 2013 MOHLTC will provide to the LHIN a Year End Report with updated


May 17, 2013 The MOHLTC will provide to the LHIN for planning and reporting purposes the initial preliminary allocation for 2013-14

May 31, 2013 The LHIN will submit to the MOHLTC the year-end consolidation report using forms provided by the MOHLTC and the draft Audited Financial Statement if the signed statements are not ready by May 31 of each fiscal year to which this agreement applies

JUNE June 3, 2013 The LHIN will submit to the MOHLTC a report on performance indicators using

the forms provided by the MOHLTC On or about the 7th working day (date may depending on the IFIS GL close)

MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN’s review

June 28, 2013 The LHIN will submit to the MOHLTC Q1 Regular and Consolidation Report using the forms provided by the MOHLTC

June 28, 2013 The LHIN will submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements

June 28, 2013 The LHIN will submit to the MOHLTC a Board approved report on consultant use for the previous fiscal year using the template provided in the Minister’s Directive under the BPSAA

JULY July 31,2013 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the

forms provided by the MOHLTC July 31,2013 The LHIN will submit to the MOHLTC an Attestation as required under the

BPSAA AUGUST

August 12, 2013 The MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management

August 15, 2013 The MOHLTC will provide the preliminary approved allocation for the current fiscal year, as of July 31, 2013


Due Date Description of Item August 30, 2013 MOHLTC will provide to the LHIN the forms and information requirements for

the Multi-year Consolidation Report

SEPTEMBER September 3, 2013 The LHIN will submit to the MOHLTC a report on performance indicators using

the forms provided by the MOHLTC On or about the 7th working day (date may vary on IFIS GL close)

The MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN’s review

September 30, 2013 The LHIN will submit to the MOHLTC Q2 Regular and Consolidation Report using the forms provided by the MOHLTC

September 30, 2013 The MOHLTC will provide to the LHIN the forms and information requirements for the 2014/15 Annual Business Plan

OCTOBER October 31, 2013 (or date necessary to meet central agency reporting requirements)

The LHIN will submit to the MOHLTC a Multi-year Consolidation Report using the form provided by the MOHLTC

By October 31, 2013 The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA

October 31, 2013 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC

NOVEMBER November 12, 2013 MOHLTC will provide to the LHIN the most recent quarter of performance data

for indicators in Schedule 5: Local Health System Management DECEMBER

December 2, 2013 The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC

On or about the 7th working day (date may vary depending on the IFIS GL close)


December 31, 2013 LHIN will submit to the MOHLTC Q3 Regular and Consolidation Report including final year-end forecast using the forms provided by the MOHLTC

JANUARY January 31, 2014 MOHLTC will provide the LHIN with year-end instructions (including templates) By January 31, 2014 The LHIN will submit to the MOHLTC an Attestation required under the BPSAA January 31, 2014 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the

forms provided by the MOHLTC FEBRUARY

February 10, 2014 MOHLTC will provide the LHIN with most recent quarter of performance data for indicators in Schedule 5: Local Health System Performance

February 14, 2014 MOHLTC will provide to the LHIN the forms and requirements for the Annual Report (non-financial content)

MARCH March 3, 2014

The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC


Due Date Description of Item March 28, 2014 MOHLTC will provide to the LHIN the forms for the Annual Report (financial

content) March 31, 2014 The LHIN will submit to the MOHLTC a Draft 2014/15 Annual Business Plan

using the forms provided by the MOHLTC 2014/2015

APRIL April 15, 2014 MOHLTC will provide to the LHIN a Year End Report confirming the


April 15, 2014 The LHIN will submit to the MOHLTC Year End Reallocation Report on actual expenditures related to in-year reallocations as of March 31 of the preceding fiscal year

April 30, 2014 MOHLTC will provide to the LHIN the forms for the Year-end Consolidation Report

By April 30, 2014 The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA

April 30, 2014 The LHINs will submit to the MOHLTC a Expense Report using the forms provided by the MOHLTC

MAY May 12, 2014 The MOHLTC will provide to the LHIN the most recent quarter of performance

data for indicators in Schedule 5: Local Health System Performance May 13, 2014 MOHLTC will provide to the LHIN a Year End Report with updated

expenditures and revenue related to its transfer payments as of March 31, of the preceding fiscal year

May 16, 2014 The MOHLTC will provide to the LHIN for planning and reporting purposes the initial preliminary allocation for 2014-15

May 30, 2014 The LHIN will submit to the MOHLTC the year-end consolidation report using forms provided by the MOHLTC and the draft Audited Financial Statement if the signed statements are not ready by May 31 of each fiscal year to which this agreement applies

JUNE June 2, 2014 The LHIN will submit to the MOHLTC a report on performance indicators using

the forms provided by the MOHLTC On or about the 7th working day (date may vary depending on the IFIS GL close)

The MOHLTC will make the expenditure and revenue report available to the LHIN is APTS for the LHIN’s review

June 30, 2014 The LHIN will submit to the MOHLTC Q1 Regular and Consolidation Report using the forms provided by the MOHLTC

June 30, 2014 The LHIN will submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements

June 30, 2014 The LHIN will submit to the MOHLTC a Board approved report on consultant use for the previous fiscal year using the template provided in the Minister’s Directive under the BPSAA

JULY July 31,2014 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the

forms provided by the MOHLTC July 31,2014 The LHIN will submit to the MOHLTC an Attestation as required under the

BPSAA


Due Date Description of Item AUGUST

August 12, 2014 The MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management

August 15, 2014 The MOHLTC will provide the preliminary approved allocation for the current fiscal year, as of July 31, 2014

August 29, 2014 MOHLTC will provide to the LHIN the forms and information requirements for the Multi-year Consolidation Report

SEPTEMBER September 2, 2014 The LHIN will submit to the MOHLTC a report on performance indicators using

the forms provided by the MOHLTC On or about the 7th working day (date may vary on IFIS GL close)


September 30, 2014 The LHIN will submit to the MOHLTC Q2 Regular and Consolidation Report using the forms provided by the MOHLTC

September 30, 2014 The MOHLTC will provide to the LHIN the forms and information requirements for the 2014/15 Annual Business Plan

OCTOBER October 31, 2014 (or date necessary to meet central agency reporting requirements)

The LHIN will submit to the MOHLTC a Multi-year Consolidation Report using the form provided by the MOHLTC

By October 31, 2014 The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA

October 31, 2014 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC

NOVEMBER November 12, 2014 MOHLTC will provide to the LHIN the most recent quarter of performance data

for indicators in Schedule 5: Local Health System Management DECEMBER

December 2, 2014 The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC

On or about the 7th working day (date may vary depending on the IFIS GL close)


December 31, 2014 LHIN will submit to the MOHLTC Q3 Regular and Consolidation Report including final year-end forecast using the forms provided by the MOHLTC

JANUARY January 30, 2015 MOHLTC will provide the LHIN with year-end instructions (including templates) By January 30, 2015 The LHIN will submit to the MOHLTC an Attestation required under the BPSAA January 30, 2015 The LHINs will submit to the MOHLTC a Quarterly Expense Report using the

forms provided by the MOHLTC FEBRUARY

February 10, 2015 MOHLTC will provide the LHIN with most recent quarter of performance data for indicators in Schedule 5: Local Health System Performance


Due Date Description of Item February 13, 2015 MOHLTC will provide to the LHIN the forms and requirements for the Annual

Report (non-financial content)

MARCH March 3, 2015

The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC

March 27, 2015 MOHLTC will provide to the LHIN the forms for the Annual Report (financial content)

March 31, 2015 The LHIN will submit to the MOHLTC a Draft 2015/16 Annual Business Plan using the forms provided by the MOHLTC

Schedule 4

Total Health Service Provider Transfer Payments 2,222,624.3 TBD

E-Health TBD

Initiatives 1,591.6 TBD

Operation of LHIN 4,895.7 TBD

Total LHIN Operating Budget 2,229,111.6 TBD

Total Health Service Provider Transfer Payments Budget by Sector

Addictions Program 10,509.2 TBD

Community Mental Health 51,652.7 TBD

Community Health Centres 17,874.7 TBD

Initiatives 25,911.7 TBD

Grants to compensate for Municipal Taxation - psychiatric hospitals

TBD

Specialty Psychiatric Hospitals TBD

Assisted Living Services in Supportive Housing 17,341.2 TBD

Long Term Care Homes 309,872.8 TBD

Grants to compensate for Municipal Taxation - public hospitals

451.5 TBD

Operations of Hospitals 1,559,323.6 TBD

Acquired Brain Injury 4,634.1 TBD

Community Support Services 34,650.2 TBD

Community Care Access Centres 190,402.6 TBD

LHIN-SW

2013-14 Funding Allocation

($000's)

2014-15 Funding Allocation

($000's)

Table 2: Statement of Individual LHIN 2013-14 Funding Allocation - Updated as of August 31, 2013

Ministry-LHIN Performance Agreement (2013/14 - 2014/15) Page 1 of 2

SOUTH WEST


Objective: To enhance person-centred care

Expected Outcome: Persons will experience improved access to healthcare services identified below in alignment with best practices.


Baseline 2013-14

LHIN Target 2013-14

90th Percentile Emergency Room (ER) Length of Stay for Admitted Patients

8 hours 23.80 23.50

90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients

8 hours 6.50 6.50

90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients

4 hours 3.77 3.90

Percent of Priority IV Cases Completed Within Access Target for Cancer Surgery *

Priority IV: 84 days 91% 90%

Percent of Priority IV Cases Completed Within Access Target for Cardiac By-Pass Procedures *

Priority IV: 90 days 99.6% 90%

Percent of Priority IV Cased Completed Within Access Target for Cataract Surgery *


97% 90%

Percent of Priority IV Cases Completed Within Access Targets for Hip Replacement *


89% 90%

Percent of Priority IV Cases Completed Within Access Target for Knee Replacement *


83% 90%

Percent of Priority IV Cases Completed Within Access Target for MRI Scan *

Priority IV : 28 days 45% 60%

Percent of Priority IV Cases Completed Within Access Target for Diagnostic CT Scan*

Priority IV : 28 days 90% 90%

* The reporting for these indicators has been revised starting 2013/14. Previous Agreements included the 90th percentile wait time for these surgical and diagnostic imaging services

Ministry-LHIN Performance Agreement (2013/14 - 2014/15) Page 2 of 2


Objective: To improve system integration and enhance coordination of care while ensuring better transitions to various care settings.

Expected Outcome: Persons will be able to navigate the healthcare system and receive the care they need, when and where they need it.


Baseline 2013-14

LHIN Target 2013-14

Percentage of Alternate Level of Care (ALC) Days

9.46% 10.51% 9.46%

90th Percentile Wait Time from Community for CCAC In-Home Services – Application from Community Setting to first CCAC Service (excluding case management)

TBD 26.00 24.00

Wait Time from When CCAC Receives Application to Long Term Care Home to When Assessment for Eligibility is Completed *

TBD

* New indicator for 2013/14. The MOHLTC and the LHINs will monitor performance in 2013/14 and work together to refine quality and consistency of data. Targets will be established starting 2014/15.


Objective: To implement evidence based practice to drive quality and value and improve health outcomes

Expected Outcome: Persons will receive quality inpatient care and coordinated post-discharge care, leading to reduced readmission rates that may improve survival, quality of life and other outcomes without increasing cost.


Baseline 2013-14

LHIN Target 2013-14

Readmissions within 30 days for Selected CMGs

TBD 16.81% 15.10%

Repeat Unscheduled Emergency Visits within 30 days for Mental Health Conditions **

TBD 15.60% 15.60%

Repeat Unscheduled Emergency Visits within 30 days for Substance Abuse Conditions **

TBD 31.80% 28.60%

** The methodology for these indicators has been revised starting 2013/14. Results may not be comparable to the previous Agreement.

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Report to the Board of Directors

2013/14 Priorities for Investment Plan

Meeting Date:

September 25, 2013

Submitted By:

Michael Barrett, CEO Mark Brintnell, Senior Director, Performance and Accountability Kelly Gillis, Senior Director, System Design and Integration

Submitted To:


Purpose: Information Decision Suggested Motions THAT the South West Local Health Integration Network Board of Directors approves the allocation of up to $20,882,447 million dollars in base funding in support the 2013/14 Priorities for Investment Plan priorities. THAT the South West Local Health Integration Network Board of Directors approves the allocation of up to $7.4 million dollars in one-time funding in 2013/14 in support the 2013/14 Priorities for Investment Plan priorities. Background Following input from the LHIN Board at the June and July meetings, LHIN staff has been working with our Health Service Provider partners to develop the 2013/14 Priorities for Investment Plan. This year’s proposed Priorities for Investment (PFI) Plan continues to focus on priorities identified in the 2013-16 Integrated Health Service Plan (IHSP), the 2013/14 Annual Business Plan, and aligned to provincial priorities. Priorities addressed in this report include:

• Improve access to family health care • Improve coordination and transitions of care for targeted populations • Drive safety through evidence-based practice • Increase the value of the health care system for the people we serve

The sources of funding identified within this report: • Community Sector base funding increase - $15,781,200 (base) • Community Care Access Centre base funding increase to support a five day wait time target for

personal support services - $5,118,200 (base) • LHIN Urgent Priorities Fund - $4,538,409 (one-time)

Agenda Item 6.2

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Community Sector Base Funding Increase The new base funding increase of over $20.8 million dollars for the community sector represents a 5% funding increase. This increase is consistent with the provincial commitment to increase investment in the community over the next four years, 2013/14 being the second year of this commitment. Three provincial requirements have been stipulated:

1. A minimum of $9.4 million of the total new funding must be applied to support care in the home provided by community health service providers such as the CCAC and community support service agencies.

2. A minimum of $5,118,200 to support the South West CCAC to reduce wait times for personal support services for persons with complex needs.

3. Investments must work toward achieving the following provincial priorities: • Reducing ALC rates • Reducing the number of people readmitted to hospital or visiting the ER within 30 days

discharge of a hospital • Supporting partners of Health Links to deliver care to high needs populations including seniors

and people with complex health conditions LHIN Urgent Priorities Fund The Urgent Priorities Fund (UPF) is an annual allocation received from the Ministry of Health and Long-Term Care (MOHLTC) to focus on local priorities, government priorities, and performance improvement against set targets included in the Ministry-LHIN Performance Agreement (MLPA). The total 13/14 allocation received for the South West LHIN is $4,538,409. Our LHIN continues to only allocate the UPF as one-time dollars to ensure we maintain our flexibility to seed and incent projects and initiatives each year. Across-the-Board Community Sector Base Increase After careful consideration and detailed analysis of existing HSP funding levels and service activity, South West LHIN staff is not recommending an across-the-board base funding increase for community sector HSPs. The recommendation is based on the following factors:

• an across-the-board increase would limit capacity to target and advance community strategies and enhancements (i.e. access to care, adult day programming) already underway

• analysis of current funding levels and service activity does not point to the need for an across-the-board increase

• the LHIN would prefer to work with our community sector partners to examine and advance opportunities to support sustainability through integration (including back office integration), application of best practices, and better coordination of services

The South West LHIN recognizes operational pressures some community sector HSPs face but would prefer to see more integration, adoption of best practices and better coordination of services instead of an indiscriminate across-the-board funding increase. In support of this position, one-time funds have been identified within the PFI Plan to support this work. The LHIN will continue to monitor the long term sustainability environment through our normal reporting and monitoring channels. Engagement The LHIN committed to working through a transparent process and seek input as the plan was being developed. The following touch-points were undertaken during the PFI Plan development phase:

of 3

• meetings with each community sector (i.e. CSS/MH&A/CCAC/CHC) • meetings with HSPs involved in proposed programs and projects • meeting with Health System Leadership Council • meeting with CEO Leadership Forum (Hospital/CCAC/LHIN) • 2 open conference calls for all HSPs

The following points capture the feedback and input received:

• programs and projects appear to be building from work previously initiated • focus on outcomes and measurement appears stronger than in previous plans • human resource capacity and availability in the community may be a limiting factor in achieving

the intended outcomes per the expected timelines • some community sector HSPs believe a blended approach of across-the-board and targeted

funding is the ideal approach • some Long-Term Care Homes and Community Health Centres do not see how they directly fit

within the plan The above points of feedback and input were helpful as the LHIN continued to refine the PFI Plan. It is important to remember that the base funding is community sector based which limits its application to other sectors. Having said this, many of the programs and projects will have either a direct or indirect impact on other provider sectors and the patients/clients/residents they serve. The long-term care homes do receive annual funding increases through their per diem funding methodology. Next Steps The LHIN will be investing new base funding in 2013/14. Even though the base programs will fully spent the funds on an annualized basis, the full base amount of funds cannot be spent in 2013/14 given the timing of approvals and allocation decisions. As a result, the LHIN will have surplus amount stemming from the unused base funds that can be considered for one-time investments in 2013/14. These funds have been added into the one-time envelope in support of the one-time projects listed in the PFI Plan.

• Proposed 2013/14 PFI Plan considered by LHIN Board – September 25th • Pending approval of PFI Plan, LHIN staff to issue funding letter packages – October 11th • LHIN staff will continue to work with HSPs as implementation begins • LHIN staff will assess any further investment opportunities using the remaining funds, in-year

reallocations and/or any new funding that may be confirmed within the fiscal year Appendix 1: Recommended Community Sector Programs – Base Funding Appendix 2: Recommended Projects - One-time Funding A Program or Project Proposal exists for each item, except previous year commitments, listed in the PFI Plan. Due to the size and detail of the proposal package, individual proposals are not being included with the Board Report.

Appendix 1

2013/14 PFI Funding SummaryBase Funding 2013/14 2014/15Total community sector 5% base funding $15,781,200 $15,781,200

CCAC Maximum 5 Day Wait Time target funding $5,118,200 $5,118,200

Total $20,899,400 $20,899,400

Proposed Program Investments $15,812,416 $20,882,447

Balance $5,086,984 $16,953

One‐time FundingFunding source: Urgent Priorities Fund $4,538,409

One‐time 2013/14 community sector base funding surplus $5,086,984

Total $9,625,393

Proposed Investments $7,420,307

Balance $2,205,086

Note: The 2013/14 new base community sector funding is being fully allocated on an annualized (i.e. 12 months)

basis. Due to timing of approvals and allocation decisions, the base funding cannot be fully spent by Health Service

Providers in 2013/14 but the full base amount will be supporting services and programs effective April 1, 2014 (refer

to 2014/15 funding column details)

Note: South West LHIN staff will be bringing forward further investment recommendations to allocate the balance of

the surplus one‐time funds in the amount of $2.2M. These recommendations will come forward in Q3 2013/14

Appendix 1

2013/14 Priorities for Investment New Programs

# Program Proposal Sector Annualized Fiscal 13/14 Target Population Big Dots/Lead Lag Indicators

1Additional funding to support increased home care and five day maximum

wait time for personal support services targetCCAC $5,600,000 $7,600,000

Seniors and Adults with

Complex Needs

Increasing availability and access to

community supports for people, resulting in

7,100 more days at home

2 Home First Expansion (Parkwood, Central, Grey Bruce) CCAC $4,464,131 $1,511,538Seniors and Adults with

Complex Needs




3eShift ‐technology‐based palliative care initiative that connects an enhanced‐

skill Personal Support Worker (PSW) in the home with a registered nurse via

a web‐enabled iPhone

CCAC $662,367 $386,381Seniors and Adults with

Complex Needs




4 Palliative care service plans and caregiver relief CCAC $3,871,569 $3,676,625Seniors and Adults with

Complex Needs




5

Physiotherapy: Exercise and Falls Prevention Classes:Funding to supplement

the implementation of Exercise and Falls Prevention initiative of provincial

physiotherapy reform. Approx 270 classes in total across the LHIN serving

9,450 unique individuals across the LHIN

CSS $450,416 $301,577Seniors and Adults with

Complex Needs




6

Medically Fragile: Caregiver Relief (Overnight respite and ADP): Overnight

respite for 2 individuals 7 days/wk to reach goal to accommodate 4

individuals/wk. Day program services to support 4 individuals 5 days/wk to

reach the goal to accommodate 6 individuals/wk

CSS $580,584 $25,000


Complex Needs; People

Living with or at Risk of

Chronic Disease




7

Medically Fragile: Assisted Living: Medically Fragile individual living in hospital

with lack of appropriate alternatives for placement while continue to attend

school. Depending on housing spaces available, fund 1 or 2 Assisted Living

spaces ($125,000/space) in London

CSS $250,000 $150,000People Living with or at

Risk of Chronic Disease




8

Acquired Brain Injury: Specialized Unit in LTC home (Kensington): Leverage

opportunity of Kensington rebuild and transfer of 80 LTCH beds to London to

create specialized ABI unit in LTCH. Supplement regular LTCH per diems in

order to create specialized unit for 12 individuals with ABI who require that

level of service


Complex Needs




9

Acquired Brain Injury: Specialized ADP (Dale Brain): Leverage opportunity of

Kensington rebuild and transfer of 80 LTCH beds to London to create

specialized ABI unit in LTCH. Supplement regular LTCH per diems in order to

create specialized unit for 12 individuals with ABI who require that level of

service


Complex Needs




10

ADP Access to Care Recommendations :Costs to implement redesign

recommendation to improve access to and equity in Adult Day Program

services and enhance ADP second shift and transportation to McCormick

Home from 3 days per week to five days per week. This funding would allow

us to create a consistent client fee of $10 across the LHIN; standardize LHIN

funding for ADP; move all programs to the minimum standard of operation 3

days/week, 15 spaces/day to ensure efficiency in programs.


Complex Needs




11ADP Overnight Respite (expansion of BSO): 1 night per month per provider

was funded through BSO. Add 3 additional nights per month per provider to

reach goal of 4 nights per month per provider


Complex Needs




12

Two mental health workers will be jointly supported by four CHCs (Oxford,

Elgin, Bruce Grey areas) and the Southwestern Ontario Aboriginal Health

Access Centre to provide mental health support and system navigation to

vulnerable populations served by these agencies

CHC $250,000 $62,500

People Living with Mental

Health and Addictions

Challenges

Reducing 15,000 emergency room visits and

hospital readmissions, resulting in 10,000

more days at home

13

Access to Addiction Treatment: The Project facilitates timely access to

addiction assessment and treatment for individuals who are believed or

known to be experiencing drug abuse problems and who are charged with a

drug offense under the CDSA (Controlled Drug and Substance Act)

CMHA $504,000 $186,000



Challenges



more days at home

14Crisis Response: enhancement from last year: immediate support for

patients/ clients in current crisis CMHA $168,000 $62,000



Challenges



more days at home

Appendix 1

2013/14 Priorities for Investment New Programs

# Program Proposal Sector Annualized Fiscal 13/14 Target Population Big Dots/Lead Lag Indicators

15

Peer Support: Develop and promote training, implementation, spread, and

sustainability method for Self‐Management Program for health care

providers to assist implementation of self‐management support techniques.

Promote “Living a Healthy Life with Chronic Conditions” workshop to clients

and their caregivers as appropriate. Build system capacity for mental health

and addiction self‐management strategies (i.e. WRAP and Stanford model –

coordinating techniques where appropriate).

CMHA $84,000 $21,000



Challenges; People Living

with or at Risk of Chronic

Disease



more days at home

16

Aboriginal Population (Access to Addiction Treatment and Family Support):

The addition of two new positions to service 140 new clients is part of the

continuation of the implementation of the Aboriginal Mental Health and

Addictions Strategy.

CMHA $168,000 $84,000



Challenges



more days at home

17Francophone Population: The aim of the project is to provide the

francophone community of London‐Middlesex with telemedicine access to

French language mental health assessment and consultation services.

CMHA $84,000 $66,500



Challenges



more days at home

18

Multidisciplinary team GB 10 FTE: To strengthen the continuum of case

management services implement a multi‐disciplinary service team model

that can support serious mental illness (SMI) individuals who require

intensive case management

CMHA $840,000 $310,000



Challenges



more days at home

19

MHA Supportive Housing; A well‐resourced range of supportive housing

options for individuals with serious and moderate mental health and/or

addiction problems is necessary for meaningful community‐based support

system.

CMHA $504,000 $186,000



Challenges




20

Aboriginal Health Outreach to Grey/Bruce/Owen Sound Enhancement: The

transfer of positions from the Aboriginal Aging at Home initiative and the

initiation of new mental health transitional case workers do not provide

enough administration/operational funding for the satellite clinic to optimally

function. This request is intended to address the known administrative

shortfall and provide funding for a medical administrator.

CMHA $135,000 $56,250



Challenges



more days at home

Total $20,882,447 $15,812,416

Appendix 2

2013/14 Priorities for Investment One‐time Projects

#Project Sector Funding 13/14 Funding 14/15 Target Population Expected Outcomes

1 Cancer Surgery Wait Time Improvement Project* Hosp $156,746 Reduced wait times

2 Hip Fracture Improvement Project* Hosp $39,600Seniors and Adults with

Complex Needs Spread best practice

3 Southwestern Ontario Perinatal Capacity Assessment* Hosp $36,417 Maternal/newborn Improved planning

4 Knowledge Transfer ER Improvement* Hosp $847,003 $100,641 Reduced wait times

5Access to Care Infrastructure ‐ additional funding (primarily to replace

project surplus funding no longer available due to new recovery policy)Multi $493,430


Complex Needs




6 Access to Care Infrastructure* Multi $359,281 $146,169Seniors and Adults with

Complex Needs




7 South West LHIN Falls Strategy* CSS $135,000 $135,000Seniors and Adults with

Complex Needs



more days at home

8 Community Sector Back Office Integration* CSS $126,000 $73,500Reduced administration costs, better

reporting

9 Access to Data Strategy* Multi $60,000 Improve data capture and quality

10 London Middlesex Mental Health HSP Amalgation Costs* CMHA $1,090,000



Challenges

Increased service capacity/seamless

service/efficient operations

11 Senior Friendly Hospital Implementation* Hosp $17,000Seniors and Adults with


12Clinical Services Planning ‐ Outpatient/Ambulatory Care Realignment & Best

Practice Implementation (Cataract/Endoscopy)Hosp $231,120 $462,240



13Clinical Services Planning ‐ Stroke Capacity Assessment & Best Practice

Implementation – Acute & RehabHosp $48,600 $97,200



14 Surgical Waitlist Management ‐ Business Case Development Hosp $79,060 All Reduced wait times

15 Clinical Services Planning ‐ Demand Modeling ‐ Ortho Hosp $10,800Seniors and Adults with

Complex Needs Reduced wait times

16Additional Knee Volumes ‐ 150 total joint replacements and provision for

additional CCAC rehabilitationHosp $1,267,290


Complex Needs Reduced wait times

17 MRI Additional Volumes ‐ 2,000 hours to meet MLPA target Hosp $520,000 All Reduced wait times

18Access to Care Designated Geographic Services Hubs ‐ resources needed for

HR and Legal, Project and Change management to develop framework,

navigation strategy and work plan

CSS $100,000Seniors and Adults with

Complex Needs




19Provincial Rehab Alliance ‐ support for province wide initiative supported by

all LHIN CEOsCSS $18,000 $18,000


Complex Needs




20 Healthline Development ‐ Healthchat 2.0 Multi $90,000Enhanced health system management

capability

21 SouthwestHealthline ‐ Enhancing Access to Health Events Multi $80,000Enhanced health system management

capability

22Physiotherapy: Exercise and Falls Prevention Classes ‐ Infrastructure support

for expanded programCSS $380,250


Complex Needs



more days at home

23Acquired Brain Injury: Specialized Adult Day Program ‐ Infrastructure Support

for New ProgramCSS $365,400


Complex Needs Supports new base program startup

24 CSS Integration Projects ‐ Huron Perth HR/IT Back office CSS $135,000Reduced administration costs, better

reporting

25 CSS Integration Projects ‐ Huron Perth Care Advocate pilot CSS $105,250Seniors and Adults with

Complex Needs




26 Refresh of Mental Health and Addictions Community Capacity Report CMHA $100,000



Challenges

Improved planning; spread best practice

27 London Middlesex Crisis Centre Capacity Enhancement CMHA $100,000



Challenges

More capacity for crisis beds, screening and

transitional case management

28Transitional Employment Phase 2 ‐ One time capital to develop a Phase 2

London based Transitional and Supported Employment programCMHA $378,410



Challenges

Enhance capacity to provide vocational

employment opportunities

29Indigenous Cultural Competency (ICC) Online Training Enhancement and

Implementation Multi $50,650 $199,350

People Living with or at

Risk of Chronic Disease;



Challenges

Increased number of Ontario Health

Professionals with formal ICC Training from

200 to 2000

Total $7,420,307 $1,232,100*2012/13 commitment

South West LHIN 2013/14 Priorities for Investment Plan | South West LHIN Board Briefing

September 25, 2013 1 | P a g e

2013/14 PFI Plan – briefing on process related questions

Purpose: To share with the South West LHIN Board information in response to process related questions stemming from the 2013/14 Priorities for Investment Board Report

Responses to Questions: 1. Questions related to allocation of new base community sector funding: How many requests did we get? Who are they from? Can we see the requests like we have seen the chart of the final recommendations? How many total $ were requested?

Response: The South West LHIN did not use an external call for proposals process which makes it difficult to answer the questions as they best pertain to a call for proposal process. Instead, the South West LHIN team targeted the investments and relied on knowledge and information obtained through current program and project implementation efforts, ongoing dialogue and discussions with health service providers, and performance, financial and service activity information gleaned through our regular HSP monitoring function in order to inform the programs and projects to be recommended for inclusion in the PFI Plan.

2. Questions related to the process used to rate proposals for additional base funding: How were the proposals assessed against the provincial and IHSP foci, including proposal

prioritization and final selection? Response: - Proposals were assessed against the provincial and IHSP priorities based on strategic

alignment and fit. The goal is to ensure the recommendations are creating momentum in helping us advance the identified priorities. Many of the recommendations build upon work previously initiated.

- Each proposal followed a proposal template (attached) to capture the relevant information to assist in being clear about the investment itself but also to enable our decision-making responsibility.

- The LHIN did not conduct a proposal scoring/rating system. This approach was used in the past but with mixed results. Typically, the ratings turn out to be tight between proposal’s, rater bias plays a part and scoring/rating processes tend to take a fair amount of time to conduct.

- A long list of proposals was generated by having LHIN team members identify potential investments in keeping with the requirements identified in the June Board Report.

- The long list was reviewed by the internal Strategic Alignment Group (Senior Directors/Director and Team Leads) and Senior Leadership to ensure proposals were in keeping with current LHIN strategies, addressing performance outcome issues, and could be supported within the fiscal resources available. A few proposals were removed from the list as they were deemed to require further work by HSPs or could not be supported through these funds.



- The revised list was shared with HSPs with the opportunity to ask questions or offer comments/observations.

Were any other criteria used to help inform the selection process other than the provincial and IHSP priorities? For example, HSP willingness to look at integration options, having a healthy financial bottom-line , general cooperation with LHIN in past years on various fronts, ability to deliver on project work in the past, no funding increase last year?

Response: The LHIN did not screen each proposal against a specific set of factors as described in the question. However, indirectly these factors were part of the consideration and assessment phase. LHIN staff would not recommend a proposal if the providers were not working together, or have not been a part of the LHIN process to pursue integration or system improvements.

Was there an initial sorting process used to sort into several categories and who conducted this process?

Response: The long list was reviewed by the internal Strategic Alignment Group (Senior Directors/Director and Team Leads) and Senior Leadership to ensure proposals were in keeping with current LHIN strategies, addressing performance outcome issues, and could be supported within the fiscal resources available. A few proposals were removed from the list as they were deemed to require further work by HSPs or could not be supported through these funds.

Were some proposals of considerable merit but the funds were out of line and a negotiation process was undertaken to pare down the funds so that the revised proposal was more in line with what was considered acceptable?

Response: All proposals were developed with the fiscal year timeline in mind and based on what is needed to achieve the objectives. As a result of LHIN staff working with HSPs no proposal came in “out of line” but proposals were tweaked based on proposal deliverables and available funds.

3. Looking at this from a two year perspective: Which HPS's will now face no increase in base funding for the 2nd year in a row? Which HSP's received no increase last year, but some this year?

Response: - Approx. 30% of community sector HSPs received base funding increases in 2012/13 in

support of new or enhanced service activity. The percentage for 2013/14 is close to 25%. - Approx. 14 HSPs did not receive a base funding increase in 2012/13 but are projected to

receive a base funding increase in 2013/14. The final HSP count is subject to final negotiations between the LHIN and HSP partners as part of the final budget and funding letter approval process.

- It is important to note that base funding increases were allocated in support of new or enhanced service levels and not in support of existing service levels or existing operations.

- Health System Funding Reform is shifting how HSPs are funded to deliver programs and services. The former across-the-board increase allocation approach is no longer the



predominate means to allocate new funds into the system in order to target the goals and objectives identified provincially and locally.

South West LHIN 2013/14Priorities for Investment

South West LHIN 2013/14 Priorities for Investment 1

Note: this template is intended to capture information sufficient to decide on a slate of projects to recommend to the LHIN Board and to inform the LHIN Board report. A project proposal or charter will need to be created soon after the project is approved to allow time for the project to be completed before the fiscal year end, i.e. we will need to pull the details together quickly after Board approval in September. Project title: Project description Strategic Alignment – Identify the Integrated Health Service Plan strategic direction being advanced. Strategic Direction Improve Access to Family Health Care

Improve Coordination and Transitions of Care for Those Most Dependent on Health Services

Drive safety through evidence-based practice

Increase the value of our health care system for the people we serve Comment:

Please identify whether this is a NEW or EXISTING initiative that was identified in the Annual Business Plan Initiative (please list) *(NOTE the initiative must be implemented within this fiscal year) NEW Existing (in

ABP)



Performance – Please refer to the IHSP 3 and Annual Business Plan work already completed to identify lead and lag measures that align with the proposed Priority for Investment Initiative

Performance Indicators

List Key LAG Indicators that this initiative aligns with (i.e. % ALC Days) – NOTE Lag indicators are outcome-based, and longer-term

List Key LEAD Indicators that this initiative aligns with (i.e. Total number of ALC open cases) – more timely and current – NOTE Lead indicators are more timely and align to LAGs

List Key Process-level Indicators that this initiative aligns with -

Lag Indicators Timeline to Impact (fiscal and quarter)

Lead Indicators Timeline to Impact (fiscal and quarter)

Process Indicators

1. 1. 1.

Big Dot Alignment (not required for every project)

Increasing availability of family health care; increase in number of people seeing a family physician when needed

Reducing 15,000 emergency room visits and hospital readmissions, resulting in 10,000 more days at home; reduction in number of people returning to the emergency room within 7 days of initial visit

Increasing availability and access to community supports for people, resulting in 7,100 more days at home (less days in hospital attributed to reduced ALC Days, reduced Acute Care Length of Stay (ortho), reduced readmissions)

Comment:



Project/Program Cost: Projects – onetime funding (e.g. projects funded from Urgent Priorities Fund)

2013/14 2014/15 2016/17

$ $ $

PFI funding is onetime (not base) but multi-year commitments may be considered.

Programs (require ongoing base funding, e.g. new programs from community 5% incr.)

Sept 2013/March 31/14* 2014/15 Ongoing Base Funding**

$ $ $

Notes on cost estimate:

*Estimated cost to run the program this year; allow for late start after funding letters delivered. **Most likely the same as 2014/15, this is the cost to run the program on an annual basis Describe project/program benefits/outcomes and value for money proposition Outcomes: March 2014 Outcomes: April 2014 – March 2015

Health Service Providers Involved and LHIN Geographic Area Impacted - List Other partners to engage would include: Success Factors Risks South West LHIN staff sponsor: End.

of 2

Report to the Board of Directors South West LHIN Wait Time Strategy Allocation Plan

Meeting Date:

September 25, 2013

Submitted By:

Mark Brintnell, Senior Director, Performance and Accountability Nicole Robinson, Team Lead, Performance Improvement Harpreet Brar, Health Data & Performance Analyst

Submitted To:


Purpose: Information Decision Motion THAT the South West Local Health Integration Network Board of Directors approves the allocation of $4,825,900 in one-time funding for key diagnostic and surgical services as outlined in the South West LHIN 2013/14 Wait Time Strategy Allocation Plan Background The Ontario Wait Time Strategy (WTS) was created in 2005/06 to supplement hospital base programs and drive wait times down to provincial targets (or lower) for selected procedures and service areas in order to improve access. A wait time is the amount of time you have to wait for your surgery or exam and is measured from the time your surgery or exam is booked until the time you receive it. Wait times are now reported as the percent of priority four (less urgent) surgeries completed within access target. In 2012/13, cataracts and primary hip and knee total joint replacements were removed from the WTS allocation plan and became quality based procedures (QBPs) funded through Health System Funding Reform (HSFR). For 2013/14, the WTS allocation plan covers revision hip and knee replacements, MRI and CT scans, general surgeries, and paediatric surgeries. The South West LHIN has been allocated $4,825,900 in one-time funding for the 2013/14 fiscal year to support incremental volumes of the noted procedures. The South West LHIN is accountable for several wait time targets through the Ministry-LHIN Performance Agreement (MLPA). MLPA indicators and proposed targets for 2013/14 have recently been negotiated and are relevant indicators and performance is included as Appendix A. See attached Appendix B for full 2013/14 WTS allocation plan. In comparison to 2012/13, WTS volume allocations in 2013-14 are as follows:

• Allocations for hip and knee surgical revisions (through WTS) remain the same, although the LHIN has lost allocated volumes for primary joint replacements (funded through Quality Based Procedures). Specifically for knee replacement surgeries (revisions and primaries), the overall funded volume has been reduced by 188 procedures.

Agenda Item 6.3

of 2

• Overall diagnostic hours have been reduced with significant impact on MRI volumes. Incremental WTS MRI allocated volumes have been reduced by 2,423 hours from last years allocation of 13,558

• Allocations for general surgery reached identified organizational capacity for some procedures but volume is stable.

• Paediatric surgeries have increased overall. Process for Allocation of Wait Time Volumes in the South West LHIN 1. Allocations for Hip and Knee Revisions and Diagnostics (CT, MRI and MRI OBSP)

• Allocations for hip and knee revision surgeries were determined by considering capacity, need performance and prior year allocations. Allocations for primary joint replacement are determined and funded separately through QBPs.

• Allocations for diagnostic procedures followed the input of the South West LHIN Diagnostic Action Team. Considerations included organizational need and capacity, maintaining a similar allocation to the year prior to promote balancing of human resource considerations and organizational performance.

2. Allocations for General and Paediatric Surgery • The general surgery allocation plan was developed based on hospital capacity. Only hospitals

currently reporting through Cancer Care Ontario (CCO) Wait Time Information System (WTIS) were considered eligible for receiving incremental volume allocations.

Next Steps In order to help mitigate the impact of lost volumes for knee replacement surgeries (primaries) and MRI Scans in 2013/14, South West LHIN staff has proposed one-time investments through the Priorities for Investment Plan of an additional 2,000 MRI scans and 150 primary knee procedures. (see agenda item 6.2) Reporting and monitoring of volume completion and improvement in outcomes is already built into the existing accountability agreements and improvement interventions underway.

Appendix A 2013 Relevant MLPA Performance Indicator Provincial Target LHIN Target 2013-14 Baseline Most Recent

Quarter Available (Q1 13-14)

Percent of Priority IV Cases Completed Within Access Target for Hip Replacement Surgery (Priority IV: 182 days)

90% 90% 89% 87%

Percent of Priority IV Cases Completed Within Access Target for Knee Replacement Surgery (Priority IV: 182 days)

90% 90% 83% 77%

Percent of Priority IV Cases Completed Within Access Target for Diagnostic MRI Scan (Priority IV: 28 days)

90% 60% 45% 48%

Percent of Priority IV Cases Completed Within Access Targetfor Diagnostic CT Scan (Priority IV: 28 days)

90% 90% 90% 85%

2013/14 Wait Time Strategy Allocations - Detailed Breakdown for 2013/14 Total WTS Procedures by Hospitals

i. 2013/14 WTS Allocation for Hip and Knee Revision, CT, MRI and MRI OBSP

Base RateOne-Time

Incremental WTS Volumes

Base RateOne-Time

Incremental WTS Hours

Base (1) RateOne-Time

Incremental WTS Hours

RateOne-Time

Incremental OBSP Hours

Hip and Knee (revisions) CT MRI MRI OBSP

High Risk

663 Alexandra Marine & General Hospital 0 $8,796 0 1,950 $250 46 0 $260 0 $260 0 $ 11,500

955 Grey Bruce Health Services 9 $8,796 3 2,470 $250 239 2,080 $260 2,921 $260 16 $ 26,400 $ 59,800 $ 759,500 $ 4,200

936 London Health Sciences Centre 194 $10,776 10 20,854 $250 739 10,400 $260 5,070 $260 0 $ 107,800 $ 184,800 $ 1,318,200

946 South Bruce Grey Health Centre 0 $8,796 0 2,427 $250 203 0 $260 0 $260 0 $ 50,800

714 St Joseph's Health Care, London 0 $10,776 0 2,115 $250 203 4,160 $260 2,410 $260 105 $ 50,800 $ 27,300 $ 27,300

793 St. Thomas-Elgin General Hospital 2 $8,796 0 2,500 $250 203 0 $260 0 $260 0 $ 50,800

813 Stratford General Hospital 0 $8,796 5 2,236 $250 203 2,080 $260 367 $260 0 $ 44,000 $ 50,800 $ 95,500

814 Strathroy Middlesex General Hospital 0 $8,796 5 1,920 $250 115 0 $260 0 $260 0 $ 44,000 $ 28,800

824 Tillsonburg District Memorial Hospital 0 $8,796 0 600 $250 46 0 $260 0 $260 0 $ 11,500

890 Woodstock General Hospital 2 $8,796 2 2,223 $250 203 2,080 $260 367 $260 0 $ 17,600 $ 50,800 $ 95,500

South West LHIN Total 207 25 39,295 2,200 20,800 11,135 121 $ 239,800 $ 550,400 $ 2,296,000 $ 31,500 (1) Base MRI Hours includes 62 base OBSP high Risk MRI hours (Grey Bruce Health Services - 62 and St. Josephs, London - 0)*Note: Base notated here might not reflect the most updated base volumes

FUNDINGMRI OBSP High Risk

Faci

lity

#

Hospital

Hip & Knee (Revisions) CT MRI

ii. 2013/14 WTS Paediatric Allocations

Dental/Oral Surgery Plastic Surgery Ophthalmology Plastic Surg Ortho

Maxiofacial Surgery

Base Volumes Inpatient Rate Outpatient Rate Inpatient

VolumesOutpatient Volumes

Total Incremental Volume Base Volumes Inpatient Rate Outpatient Rate Inpatient


Total Incremental Volume Base Volumes Rate

Total Incremental

Volume

Base Volumes Funding Rate

Total Incremental

Volume

Base Volumes Rate

Total Incremental

Volume

955 Grey Bruce Health Services 0 $2,478 $1,063 0 0 0 0 $2,478 $1,063 0 30 30 0 $689 0 0 $4,688 0 0 $2,150 0 $ 31,890

676 Hanover & District Hospital 7 $2,478 $1,063 0 0 0 0 $2,478 $1,063 0 3 3 0 $689 4 0 $4,688 0 0 $2,150 4 $ 3,189 $ 2,756 $ 8,600

826 London Health Sciences Centre 297 $2,478 $1,422 0 0 0 349 $2,478 $1,422 69 0 69 180 $689 0 0 $5,671 0 0 $2,150 0 $ 170,982

793 St. Thomas-Elgin General Hospital 228 $2,478 $1,063 0 7 7 486 $2,478 $1,063 40 0 40 0 $689 0 28 $4,688 5 0 $2,150 0 $ 7,441 $ 99,120 $ 23,440

532 0 7 7 835 109 33 142 180 4 28 5 0 4 $ 7,441 $ 305,181 $ 2,756 $ 23,440 $ 8,600

Hypospadias Repair

Hospital Base Volumes Inpatient Rate Outpatient Rate Inpatient


Total Incremental Volume Base Volumes Inpatient Rate Outpatient Rate Inpatient


Total Incremental Volume Orchiopexy Hydrospadias

repair

955 Grey Bruce Health Services 3 3,167 $1,187 0 1 1 0 3,167 1,187 0 0 0 $1,187

676 Hanover & District Hospital 0 3,167 $1,187 0 0 0 0 3,167 1,187 0 0 0

826 London Health Sciences Centre 47 3,167 $1,580 0 10 10 29 3,167 1,187 10 0 10 $15,800 $31,670

793 St. Thomas-Elgin General Hospital 5 3,167 $1,187 0 0 0 0 3,167 1,187 0 0 0

55 0 11 11 29 10 0 10 $16,987 $31,670

Ventral Hernia

Base Volume Rate Total Incremental Volume Base Volume Rate Total Incremental

Volume Base Volume Rate Total Incremental Volume Base Volume In Patient Rate Out Patient Rate In Patient

VolumesOut Patient Volumes

Total Incremental

Volume Base Volume In Patient

RateOut Patient

RateIn Patient Volumes

Out Patient Volumes

Total Incremental

VolumeAnorectal Cholecystectom

yGroin Hernia Repair

Intestinal Surgery Ventral Hernia

663 Alexandra General & Marine Hospital 3 $654 0 28 $1,056 0 27 $1,110 0 0 $11,186 $591 0 0 0 3 $3,136 $1,348 0 0 0 0

955 Grey Bruce Health Services 11 $654 0 201 $1,056 0 175 $1,110 0 9 $11,186 $591 6 0 6 40 $3,136 $1,348 10 12 22 28 $67,116 $47,536

676 Hanover & District Hospital 12 $654 2 36 $1,056 11 44 $1,110 8 0 $6,619 $591 4 0 4 0 $3,136 $1,348 0 2 2 27 $1,308 $11,616 $8,880 $26,476 $2,696

936 London Health Sciences Centre 103 $839 33 491 $2,153 40 375 $1,363 0 6 $11,186 $591 0 0 0 21 $4,592 $1,352 0 0 0 73 $27,687 $86,120

946 South Grey Bruce Health Centre 1,217 $654 0 96 $1,056 0 66 $1,110 0 0 $6,619 $591 0 0 0 0 $3,136 $1,348 0 0 0 0

714 St Joseph's Health Care, London 108 $839 0 198 $1,056 0 163 $1,363 0 89 $11,186 $591 0 0 0 262 $4,592 $1,352 0 0 0 0

793 St. Thomas-Elgin General Hospital 0 $654 0 98 $1,056 0 145 $1,110 12 39 $6,619 $591 0 0 0 10 $3,136 $1,348 0 13 13 25 $13,320 $17,524

813 Stratford General Hospital 0 $654 0 0 $1,056 0 248 $1,110 20 0 $11,186 $591 0 0 0 0 $3,136 $1,348 0 20 20 40 $22,200 $26,960

814 Strathroy Middlesex General Hospital 13 $654 10 99 $1,056 31 68 $1,110 40 8 $6,619 $591 12 0 12 36 $3,136 $1,348 5 7 12 105 $6,540 $32,736 $44,400 $79,428 $25,116

824 Tillsonburg District Memorial Hospital 40 $654 0 84 $1,056 17 72 $1,110 2 0 $6,619 $591 6 0 6 31 $3,136 $1,348 5 0 5 30 $17,952 $2,220 $39,714 $15,680

889 Wingham Hospital 0 $654 0 19 $1,056 0 15 $1,110 0 0 $11,186 $591 0 0 0 95 $3,136 $1,348 0 0 0 0

890 Woodstock General Hospital 48 $654 4 131 $1,056 30 140 $1,110 5 2 $6,619 $591 6 0 6 31 $3,136 $1,348 0 7 7 52 $2,616 $31,680 $5,550 $39,714 $9,436

1,555 49 1,481 129 1,538 87 153 34 0 34 529 20 61 81 380 $38,151 $180,104 $96,570 $185,332 $97,412

Strabismar repair

All Dental procedures (including

Extractions/Restorations)

Maxofacial Surg Arthroscopy

Dental/Oral Surg

FUNDING

Grand Total Procedures By Site

Anorectal Cholecystectomy Groin Hernia Repair Intestinal Surgery

Ophthalmology SurgeryFunding

Exstraction/Restoration

Faci

lity

#

Hospital

South West LHIN Total

Faci

lity

#

Hospital


Faci

lity

#

iii. 2013/14 WTS General Surgery Allocations

Extractions/Restorations only All Dental procedures (including Extractions/Restorations)


Strabismus Repair

Orthopaedic Surgery

Arthroscopy

Orchiopexy Funding

iv. Summary of 2013/14 Funding by hospital

663 Alexandra & Marine General Hospital $0 $11,500 $0 $0 $0 $0 $11,500

955 Grey Bruce Health Services $26,400 $59,800 $759,500 $4,200 $114,700 $33,100 $997,700

676 Hanover & District Hospital $0 $0 $0 $0 $51,000 $14,600 $65,600

936 London Health Sciences Centre $107,800 $184,800 $1,318,200 $0 $113,900 $218,500 $1,943,200

946 South Bruce Grey Health Centre $0 $50,800 $0 $0 $0 $0 $50,800

714 St. Joseph's Health Care, London $0 $50,800 $626,600 $27,300 $0 $0 $704,700

793 St. Thomas-Elgin General Hospital $0 $50,800 $0 $0 $30,900 $130,100 $211,800

813 Stratford General Hospital $44,000 $50,800 $95,500 $0 $49,200 $0 $239,500

814 Strathroy Middlesex General Hospital $44,000 $28,800 $0 $0 $188,300 $0 $261,100

824 Tillsonburg District Memorial Hospital $0 $11,500 $0 $0 $75,600 $0 $87,100

889 Wingham Hospital $0 $0 $0 $0 $0 $0 $0

890 Woodstock General Hospital $17,600 $50,800 $95,500 $0 $89,000 $0 $252,900

$239,800 $550,400 $2,895,300 $31,500 $712,600 $396,300 $4,825,900

MRI MRI OBSP General Surgery

Faci

lity

#

Hospital Hip and Knee Revision CT


TOTALPaediatric Surgery

of 1

Report to the Board of Directors Hospital Service Accountability Agreement – Six Month Extension

Meeting Date: September 25, 2013 Submitted by: Mark Brintnell, Senior Director, Performance and Accountability Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion That the South West LHIN Board of Directors approves the proposed Hospital Service Accountability Agreement (H-SAA) Amending Agreement, effective as of the 1st day of October, 2013, which amends the 2008/13 H-SAA by extending its term to March 31, 2014; and That the South West LHIN Board of Directors authorizes the Board Chair and LHIN CEO to execute the H-SAA Amending Agreement on behalf of the LHIN. Purpose To seek South West LHIN Board approval to use an amending agreement template (attached) for the purpose of simply extending the current Hospital Service Accountability Agreement (H-SAA) for 6 months to complete the 2013/14 fiscal year. Essentially, the extension means the current terms and conditions are in place and the provisions set out in the 2013/14 schedules approved this past spring will prevail until March 31, 2014. The current H-SAA terms expires September 30, 2013. Current Status The provincial H-SAA Steering Committee has been working to draft a new legal agreement template that was anticipated to be available to renew the H-SAA this October. The LHIN goal is to make the new template consistent with the templates used with our community and long-term care home sector partners. Progress has been made, but a final new template is not complete. The target is to have the new template available to complete the H-SAA process effective April 1, 2014. Once new the H-SAA template is available, it will require 2/3rd majority approval of the 14 LHIN Boards before it can be used as the H-SAA agreement. Next Steps This extension will complete the 2013/14 fiscal year. South West LHIN staff does not expect any issues that will prevent the extensions from being executed by the hospitals. Work on the next agreement is already underway. The LHIN Board will be provided with regular updates on the progress of developing the new 2014/15 H-SAA.

Agenda Item 6.4

H-SAA Amending Agreement –extension to March 31, 2014 Page 1

THIS AMENDING AGREEMENT (the “Agreement”) is made as of the 1st day of October, 2013

B E T W E E N:

SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”)

AND

[Legal Name of the Hospital] (the “Hospital”)

WHEREAS the LHIN and the Hospital (together the “Parties”) entered into a hospital service accountability agreement that took effect April 1, 2008 (the “H-SAA”); AND WHEREAS pursuant to various amending agreements the term of the H-SAA has been extended to September 30, 2013; AND WHEREAS the LHIN and the Hospital have agreed to extend the H-SAA for a further six-month period with the joint intention of finalizing and executing an H-SAA for the period April 1, 2014 – March 31, 2017; NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the parties agree as follows:

1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the H-SAA. References in this Agreement to the H-SAA mean the H-SAA as amended and extended.

2.0 Amendments. 2.1 Agreed Amendments. The H-SAA is amended as set out in this Article 2.

2.2 Term. The reference to “September 30, 2013” in Article 3.2 is deleted and

replaced with “March 31, 2014”. 3.0 Effective Date. The amendments set out in Article 2 shall take effect on October

1, 2013. All other terms of the H-SAA shall remain in full force and effect. 4.0 Governing Law. This Agreement and the rights, obligations and relations of the

Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein.

5.0 Counterparts. This Agreement may be executed in any number of counterparts,

each of which will be deemed an original, but all of which together will constitute one and the same instrument.

6.0 Entire Agreement. This Agreement constitutes the entire agreement between

the Parties with respect to the subject matter contained in this Agreement and

H-SAA Amending Agreement –extension to March 31, 2014 Page 2

supersedes all prior oral or written representations and agreements.

IN WITNESS WHEREOF the Parties have executed this Agreement on the dates set out below. SOUTHWEST LOCAL HEALTH INTEGRATION NETWORK By: ________________________________ ________________________________ [Name], Chair Date

And by: ________________________________ ________________________________ [Name], CEO Date [Insert Full Legal Name of Hospital] By: _________________________________ ______________________________ [Name], Chair Date And by: _________________________________ ______________________________ [Name], CEO Date

- 1 -

Report to the Board of Directors Governance Policies A-9 and A-11

Meeting Date:

September 25, 2013

Submitted By:

Aniko Varpalotai, Governance & Nominations Committee, Chair

Submitted To:


Purpose:

Information Only Decision

The Governance & Nominations Committee met on July 24, 2013 and has since voted via electronic poll to approve the minutes of that meeting and the following recommendations to the Board contained therein. A formal motion confirming the electronic poll results will be made at the next meeting. Suggested Motion: THAT The South West LHIN Board of Directors adopt Governance Policies A-9 (Committee Structure and Responsibilities) and A-11 (Community Nominations Process) as revised and recommended by the Governance and Nominations Committee. Background: Policy A-9 has been revised to reflect the current practice of the board and ensure consistency with the by-laws and applicable legislation, see attached. Policy A-11 has been revised to ensure consistency with the current Terms of Reference for the Governance & Nominations Committee (approved July 24, 2013) and provide reference to the Board approved skills matrix (or Local Health Integration Networks Board of Directors Competency Profile) used by the Nominations Committee to identify the skills, competencies and experience needed on the board or available from a potential board candidate.

Agenda Item 6.5

Title: Committee Structure and Responsibilities

Policy Number: A-9

Approved: January 25, 2012 Approved: September 25 (pending)

Revised: November 2011 Revised: July 24, 2013

The South West LHIN By-Law No. 1 specifies the following required committee structure:

• Audit Committee • Community Nominations Committee • And any other committees prescribed by the Minister under the Local Health

System Integration Act (LHSIA) The board may establish any committees that the board may require from time to time by resolution and may delegate to any such board committee any of the powers of the board, subject to any rules and terms of reference imposed by the board. The board may also establish advisory bodies or committees as required, but they may not exercise the powers of the board. Minutes of meetings will be approved by the committee and provided to the board for acceptance. The CEO (or his/her designate) may be invited to attend meetings of board committees as a non-voting member.

Title: Community Nominations Process

Policy Number: A-11

Approved: January 25, 2012 Approved: September 25 (pending)

Revised: November 2011 Revised: July 24, 2013

As required from time to time, the South West LHIN board will through its Governance & Nominations Committee carry out a recruitment process for filling vacancies on the board of directors. As needed, the Governance & Nominations Committee will strike a sub-committee comprised of the Board Chair (ex officio) plus three directors plus a maximum of two community members to review the applications provided by the Public Appointments Secretariat, interview potential board candidates using the Board approved skills matrix (see Local Health Integration Networks Board of Directors Competency Profile attached), and recommend to the Board potential appointees to the Board. In turn, the Board will provide recommendations to the Minister of Health and Long-Term Care regarding rank placement of candidates interviewed for appointment to the board. The Governance & Nominations Committee shall:

• Give notice to the public of vacancies on the board of directors of the network; • Inform the public and the objects and role of the network; • Identify potential appointees to the board of directors of the network potential

appointees to the board of directors of the network; • Recommend to the board of directors by the network; and • Undertake any other matters required by the board.

The process is open to all residents of the LHIN catchment area and is aimed at ensuring a good cross representation of interested and skilled individuals. The Board will also advise the Minister of Health and Long-Term Care as to its preferences in qualities and values of a Board Chair. The position will be advertised in the media, and the interview process will be set up. Committee members are required to attend all interviews, as well as evaluate and advise the Ministry as to potential candidates. The Chair should advise the board of her/his succession plan within a 6 month period. Attached: Local Health Integration Networks Board of Directors Competency Profile

Rating 0123

What to look for in “fit” for a board culture that…

Kno

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Score • Achieves the proper level of engagement without overstepping roles. • Understands that authority comes from the collective not from the individual. • Acts in the best interest in the LHIN, over self-interest. • Has the confidence of the community it serves. • Demonstrates accountability to those it serves. • Ensures a risk management system is in place. • Demonstrates a culture of openness and transparency.

LHIN Weighting 6 9 8 9 6 6 7 7 9 7 6 6 6 6 6 6 6 6 9 6 6 6 6 6 9 7 4 4Total Score

Total

Local Health Integration Networks Board of Directors Competency Profile

SW LHIN Attributes

Look for: • Evidence of experience in building and sustaining community relationships. • Experience in resolving differences. • Experience in maneuvering between organizations and groups. • Experience in communicating organizational goals to others. • Experience in decision-making through community engagement. • Experience in communicating mission, vision and values to stakeholders. • Problem solving through seeking out the opinions, ideas and input of others.

Personal Attributes

Look for: • Ability to understand the perspective of others. • Experience in exercising judgment while taking risks. • Understands the difference between having the right to do something and doing the right thing. • Experience in dealing with ambiguity. • Experience and track record of consistently aligning words and actions. • Experience in a dynamic environment. • Ability to make required commitment. • Demonstrated consensus orientation. • Experience in supporting and defending contentious board decisions.

Strategic Relationships

Notes: Notes:Notes:

Look For: Geography/Equity: Membership selection for the Board will consider a variety of perspectives including an individual’s ability to discuss the rural and urban nature of our LHIN geography and comply with our commitment to cultural competence and diversity. The overall composition of the Directors should ensure a balance of perspectives and specific skills and expertise. Availability/Ability to Travel: ability and willingness to commit to the necessary time to participate in Board orientation and continuing education, Board meetings, committee meetings, retreats, community events and meeting preparation. Overall Impression: Rate the overall impression from 1-9 with 9 being most favourable.

- 1 -

Report to the Board of Directors Access to Care Update

Meeting Date:

September 25, 2013

Submitted By:

Kelly Gillis, Senior Director, System Design and Integration Sue McCutcheon, Access to Care Lead

Submitted To:


Purpose:

Information Only Decision

Purpose • To provide an update on the work and outcomes of Access to Care in the South West to date • To describe the implementation plan for the rest of fiscal 2013/14 including intended outcomes • To highlight relationship between Access to Care outcomes and funding request included as part

of the LHIN Priorities for Investment recommendations (see agenda item 6.2) Background Throughout Access to Care implementation, it is recognized that the work to strengthen community services through increased adult day and assisted living spaces, implementation of consistent eligibility criteria, as well as more opportunities for robust service plans in the home, has been instrumental in setting the stage for realignment of services to where the care need is. The cultural change evidenced by care providers consistently working together to support seniors and adults with complex needs in the community for as long as possible has shifted the possibilities for these individuals and their families. Norman and Peggy

Peggy had a stroke two years ago and is legally blind. Her husband Norman has Parkinson’s disease. Last year he went to hospital for knee replacement surgery and had a bad drug reaction. He would have waited in hospital for a place in a long-term care home, if it hadn’t been for Access to Care and the Home First approach. Thanks to the work of the hospital, the CCAC and all of the community partners, Norman was able to return home with 24-hour care for several weeks. When Norman arrived home he was greeted by an occupational therapist, a physical therapist and a nurse. A mechanical lift was brought in to support Norman to move from one place to another. Since then, Norman has made a remarkable recovery. He’s

Agenda Item 7.1a

- 2 -

now able to take walks in the neighbourhood, often accompanied by Peggy in an electric wheelchair, their neighbourhood caregiver Moe, and their two dogs and a cat. Two days a week, he attends an Adult Day Program at McCormick Home. “It took a village to get us home,” says Peggy. “It’s a partnership and it works very well. It just shows what a village can do!”

2013/14 Access to Care Implementation Update 1. Impact across the Health System

Access to Care has been implementing change since September 2011 when Home First was launched at University Hospital in London. Since then significant investment has been made by the South West LHIN to support care in the community, 5 more hospitals have implemented Home First, realignment activity began in adult day programs and assisted living, and work processes for admission to many services began to change. The outcomes presented below are only a beginning of what partners can achieve once all aspects of Access to Care are fully implemented. Other initiatives such as Partnering for Quality, Health Links, and Behavioural Support Services are also working to build a strong system of care for seniors and adults with complex needs so that they can be supported whenever possible in their homes.

232 226 246 244 235 253 249 243198 201 194

156 167 175 178 196 187221

187 183 175 181 162 160 166 169

Jul-1

1

Aug-

11

Sep-

11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb-

12

Mar

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Apr-

12

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12

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Jan-

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Feb-

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Apr-

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Aug-

13

In the 6 hospitals where Home First has been implemented the overall number of people who are waiting for care elsewhere has decreased (31%).

In hospitals where Home First has been implemented the number of people who are waiting in hospital for Long Term Care has decreased (51%).

ATC/Home First Implementation

begins

- 3 -

The number of people being supported in the community with robust service plans is increasing.

Increasing number of clients with a MAPLe score High or Very High are living in the community supported by CCAC.

A consistent high percentage of clients placed in LTC with a MAPLe score of High or Very High


begins


begins


begins

- 4 -

2. In the hospital

Home First Implementation timelines for 2013/14 • St. Joseph’s Health Centre, Parkwood launch is September 20, 2013 • Huron Perth Heath Care Alliance and Middlesex Hospital Alliance will launch later this fall. • South Bruce Grey Health Centre, Hanover and District Hospital, Alexandra Marine and General -

Goderich, South Huron Hospital Association will launch in Q4 2013/14 with Listowel Wingham Hospitals Alliance being late in March 2014.

Performance All six hospitals who have implemented home first have collaborated with the CCAC to set targets and are seeing improvements in key performance indicators. Targets have been set in each hospital for the number of alternate level of care (ALC) open cases, the percent ALC and ALC throughput. Progress is being made in all areas to maintain or achieve the desired performance. This work is having a major impact on the overall system changes noted above. Sustainability strategies are in the process of implementation: 1. Escalation to leadership at CCAC and the hospital before any individual waits in hospital for long

term care so that all discharge options have been explored and exhausted, 2. Collaborative reviews of all patients who are in hospital waiting for care elsewhere in order to

brainstorm and problem solve discharge options with complex patients, 3. Electronic identification of patients who have complex discharge planning needs (e-Screener) and

those patients who are mutual clients/patients who are in the ED and hospital (e-Notification), and 4. Incorporation of home first principles into hospital discharge planning policies. Value for Money The South West CCAC assessed the economic impact of Home First (using a similar methodology as used by the Boston Consulting Group in the Hamilton Niagara Halton Brant (HNHB) LHIN (2010)) looking at the 371 most complex patients returning home from hospital in 2012-2013. These patients received up to 24/7 care for up to four weeks. The analysis shows: The average per diem cost was $412 in the first 22 days, and $50 thereafter. Hospital per diems

are $450 (excepting London Health Sciences Centre where the per diem is $900), and LTC per diems are $108.

Although the first month of care at home was costly, community care was less costly than institutional care. The average annualized cost per patient was approximately $56,000 (total system cost

including hospital stays and LTC). The average annual cost per patient if they stayed in hospital until moving to LTC would have

been approximately $84,000. The net economic savings to the system for these 371 patients was approximately $10 million. Beyond the 371 patients, an additional 2,228 complex patients benefited from Home First during the 365-day period, receiving robust care plans to be able to go home. Of those: 1,980 of the 2,228 were still at home after a month, More than 1,100 were still at home at the end of two months, and The average cost per person was less than $55 per diem.

- 5 -

The report entitled ‘Home First One-year Impact Analysis’ is available at http://www.ccac-ont.ca/Content.aspx?EnterpriseID=2&LanguageID=1&MenuID=1512 Coordinated Access Implementation Highlights • CCAC care coordinators continue to assess patients for eligibility for the Inpatient Rehabilitation

(Rehab) program at Woodstock Hospital (WGH) and the Complex Continuing Care (CCC) program at Alexandra Hospital in Ingersoll (AH). Patients accessing the services for the 5 beds at AH and the 15 beds at WGH all meet the eligibility criteria.

• WGH, AH and CCAC staff members are currently able to meet mutual expectations on timelines for determining eligibility and organizing admission.

• Hospital and CCAC teams at WGH, Tillsonburg District Memorial Hospital (TDMH), AH and St. Thomas Elgin General Hospital (STEGH) are working to develop workflow processes for the eReferral and wait list management tool for patients needing CCC/Rehab services.

• Coordinated access using the eReferral and waitlist management tool will be implemented at STEGH (CCC and rehab), WGH (CCC and Rehab), TDMH CCC, and AH CCC in October/November 2013.

Bed Realignment of CCC/Rehab beds in Oxford, Elgin and Grey/Bruce Phase 1 Integration At the June 26, 2013 South West LHIN Board of Directors meeting, the South West LHIN Board directed South West LHIN staff to continue to engage health service providers in a facilitated integration process intended to result in the following Phase I changes with implementation targeted for fiscal 2014/15: • Increasing 10 CCC beds at Grey Bruce Health Services – Owen Sound; • Increasing 2 rehab beds at St. Thomas Elgin General Hospital (STEGH); • Decreasing 15 CCC beds at STEGH; • Decreasing 15 CCC beds in Oxford County (6 at Tillsonburg District Memorial Hospital, 9 at

Alexandra Hospital Ingersoll); and • Ensuring that the ongoing operating costs of changes to be implemented are cost neutral at the

LHIN level. South West LHIN staff and staff of hospitals involved in the facilitated integration (identified above) have been meeting regularly over July and August to finalize the integration process, establish implementation plans, confirm timing of bed changes, finalize financial details, and identify risks and potential patient impact. The hospitals also meet together on a regular basis to ensure collaborative planning between the involved hospitals. Because of the interdependencies, this interaction s critical in ensuring a stepwise, coordinated approach to engagement, communications and implementation. Each hospital is developing its own implementation plan that will provide the background for the integration decision. Hospitals will submit their integration plans to LHIN staff for review. These plans will form the basis of a facilitated integration agreement that will include terms of the bed realignment, including sequencing of funding transfers and implementation timelines. Each hospital will seek Board approval on this agreement. Once this is accomplished, a recommendation will be brought to

http://www.ccac-ont.ca/Content.aspx?EnterpriseID=2&LanguageID=1&MenuID=1512

- 6 -

the South West LHIN Board for decision. Following is the projected timeline for these critical next steps: • September 13 to17 - Hospitals submit implementation plans • September 20 - Hospitals agree on terms of the facilitated integration • October 7 - Letter of agreement approved by hospital leadership • October 22-23 - Alexandra Hospital, Tillsonburg District Memorial Hospital, St. Thomas Elgin

General Hospital and Grey Bruce Health Services Hospital Boards approve agreement • November 22 - South West LHIN Board facilitated integration decision

As the process unfolds, the South West LHIN Board of Directors will be informed of progress and risks that may arise. Financial Methodology and Planning The CCC/Rehab Bed Realignment Financial Methodology Working Group concluded its effort this summer. The working group helped to shape the funding redistribution formula that is being used for the purposes of Phase 1 realignment, but did not come to unanimous agreement on the methodology. Some group members preferred an incremental approach to providing funds for new beds. For CCC/Rehab Bed Realignment Phase 1 purposes, the bottom up approach is being used (i.e. one formula for funding the total recommended number of beds, not just the incremental number). This is consistent with the approach used to inform the June Board report and municipal engagement sessions. The financial formula will be re-examined for Phase 2 and any future funding redistribution initiatives, based on the experience gained from Phase 1, and lessons learned about the impact of Health System Funding Reform formulae and local funding shifts. Restorative Care/Convalescent Care Implementation Planning (highlights to date) Implementation planning is underway with the following actions in progress: • Create a formal South West Rehabilitative Care Council • Secure representation on the Provincial Rehabilitative Care Alliance and propose representatives

from the South West to Provincial working groups • Develop single consistent referral form for acute care to CCC/Rehab including Restorative Care • Collaborate with stakeholders regarding the shift to a ‘rehabilitative model of care’ as opportunities

arise e.g. Huron Perth Healthcare Alliance implementation of Rehab services in Seaforth 3. In the community Adult Day Program Redesign The goal of the Adult Day Program (ADP) changes are to create more equitable access to ADP services through the implementation of a consistent funding methodology and standardized client fees across the LHIN.

Since January, the South West LHIN Staff, the ADP Network and the Access to Care Co-leads have worked to co-create a standard ADP service delivery model which clearly defines client characteristics of those that should be receiving ADP services, goals of the program, core services, additional key services delivery requirements and operational standards. Work is now occurring to further detail organizational costs so that a standard client fee and funding for direct and administrative costs can be finalized. A more detailed update (item 7.1b) regarding this work is attached and will be presented at the upcoming Board of Directors meeting.

- 7 -

Building awareness and strategies to implement the hub model and designated geographic areas Access to Care staff and staff from the South West LHIN are beginning to work with the Assisted Living Providers to develop an implementation plan for Assisted Living/Supportive Housing (AL/SH) hubs and Community Support Service (CSS) designated geographic areas. Recommendations to move this direction came from the May 2012 Access to Care AL/SH/ADP Initiative Report available at http://www.southwestlhin.on.ca/Page.aspx?id=6122#ADP . To date there have been four focused conversations with CSS leaders including Ontario Community Support Association (OCSA) District A members, Assisted Living/Supportive Housing Network members, Access to Care Implementation Teams and the South West LHIN CSS Support & Development Council regarding the creation of AL/SH hubs and CSS Designated Geographic Services areas. This work is a key action within the IHSP and is intended to further strengthen services in the community. The planned approach is to leverage the Access to Care work in this sector by building from lessons learned through the interRAI CHA Collaborative Assessment & Referral project, the implementation of coordinated access to AL/SH/ADP services, the introduction of the eligibility criteria from the Provincial High Risk Seniors policy, as well as the adult day program redesign. The initial focus will be on implementation of AL/SH hubs across the LHIN. ‘Hubs’ are outlined in the Provincial High Risk Seniors Policy as geographic areas in in which assisted living services are provided and where clients may reside in the hub in a variety of settings, including their own home. The inclusion of community integration and service planning within the scope of Access to Care will ensure capacity to develop a framework for integration through the development of a strategy around community hubs which can then be leveraged for the development of designated geographic services areas. The Access to Care infrastructure will support LHIN staff to move this integration work forward, similar to the support being provided to the CCC/Rehab bed realignment work (change management, community and provider engagement, project management, legal and HR consultation, sector expertise). The implementation plan is expected to be ready for action in the 2014/15 fiscal year. Assisted Living and Adult Day Program Implementation Teams Implementation teams have now been launched in all geographic areas of the South West with London Middlesex launching in August 2013. • Implementation teams in Oxford, Grey Bruce and Elgin have all begun or completed assessing

seniors in the program for their eligibility based on the Provincial High Risk Seniors policy • By mid-summer, 184 of 236 clients had been assessed in these 3 geographies with 30 of these

being assessed as being more appropriate for a different level of care. Transition plans are in progress.

• Teams will begin to assess clients in Huron Perth and London Middlesex this fall. • Coordinated access has been implemented in Oxford and Grey Bruce using a manual process for

referrals and waitlist management, with all areas in the South West expected to implement coordinated access using the eReferral and waitlist management tool this fall

• Coordinated Access implementation timelines for the special populations (individuals with physical disabilities, acquired brain injury, HIV/AIDS/Hepatitis C or are considered to be medically fragile/technologically dependent) are currently being finalized with the expectation that it will be fully implemented by end of March 2014.

http://www.southwestlhin.on.ca/Page.aspx?id=6122#ADP

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Special Population Report Implementation Planning (highlights to date) • The preliminary work on documenting the activities associated with implementing coordinated

access has begun for each of the special populations and is expected to be completed by October 1, 2013.

• Draft eligibility criteria for adults with physical disabilities will be trialed with the Elgin and Huron Perth implementation teams. Clients with acquired brain injury will be considered next. Eligibility for clients with HIV/AIDS is already well outlined and able to be implemented.

• Full implementation of coordinated access is intended by March 31, 2013. • Priority populations have been identified as those who have acquired brain injury as well as those

persons who are medically fragile and technologically dependent. • Participation House (PH) is currently planning for the overnight respite and day program spaces

for medically fragile technologically dependent individuals. PH is meeting with families individually to understand the needs of each family.

• The majority of individuals they are meeting with for the day program are approximately 18 years of age, as they are coming out of the school system, where there is minimal or no structure to support the change.

• PH is planning to have the day program operational in October and is targeting December for the overnight respite program.

Access to Care infrastructure will also support the project group that is developing a collaborative model of care to support individuals with chronic ventilation needs to finalize an implementation plan with the South West LHIN. The implementation plan is expected to be ready for action in the 2014/15 fiscal year. Relationship between Access to Care Ongoing Work and Priorities for Investment Recommendations The following work of the Access to Care team is dependent on the Priorities for Investment Recommendations: • Complete planning and launching implementation of hub model for assisted living • Support planning for implementation of a collaborative model of care for individuals with chronic

ventilation needs • Complete implementation of coordinated access for special populations

A Healthier Tomorrow A Healthier Tomorrow A Healthier Tomorrow


Adult Day Program Redesign South West LHIN Board of Directors

September 25, 2013 Kelly Gillis


Objectives: • To update the South West

LHIN Board of Directors on the progress related to Adult Day Program (ADP) Redesign;

• Provide an understanding of the order of magnitude and impact of the changes proposed in ADP redesign

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Connie Emmerson and Helen Wright attend the Day Away Program in Wiarton


Previous Board Update The Board approved the following motion at the January 2013 meeting: THAT the South West LHIN Board of Directors approves the Access to Care recommendation to move to consistent ADP client fees and LHIN funding throughout the South West LHIN recognizing that the client and transit fees implemented will remain within 10% of the projected future state fees and the final allocation adjustments will be brought back to the LHIN Board of Directors for final approval.

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Background • In May, 2012 an Access to Care report was

completed for the South West LHIN that summarized Adult Day Program (ADP) client characteristics, demographics, service variability and recommendations to improve access to these services across the LHIN.

• These recommendations called for the development of consistent eligibility and prioritization criteria, referral processes, waitlist management, service definitions, client fees and LHIN funding.

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ADP Redesign Overall Objectives Client Perspective

• Consistent ADP Fees, ADP Transit Fees

• Equitable Access (based on supply/demand ratio)

• Consistent quality

System Perspective

• Consistent Revenue Structures – LHIN Direct ADP Funding, LHIN ADP Admin Funding, LHIN ADP Transit Revenue

• Equitable Access (based on changes in behaviour/ culture)

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Planning & Implementation Timeline

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Communication

Impact & Readiness Assessment: Sept 2012 – Aug 2013

Collection and analysis of information to assess impact on client, program, organization and system related to consistent client fees, LHIN funding for each program and financial shifts between programs

Planning for Transitions: Feb 2013 – Oct 2013

Determine phased-in approach to which ADPs and LHIN can implement recommended changes

Phased Implementation: Sept 2013 – Mar 2015 Implement and monitor the progress, impact and deliverables Evaluate and report on deliverables


Current State • 12 providers operate 31 Adult Day Programs (ADP) throughout

the South West LHIN

• Currently there are 109,500 ADP spaces available per year LHIN-wide

• What we learned:

• Significant differences in service offerings

• No common way of determining budget allocation for providers

• Significant difference in client fees

• Limited empirical knowledge of client outcomes

• Not enough program spaces based on current and future demographics

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What has been agreed to? ADPs have been fully engaged to verify data, articulate impacts to clients, programs and organizations and have agreed to the implementation of the following:

• Standard ADP Service Delivery Model

• Minimum levels of efficiency

• Standard cost model

• Standard client fee

• Standard LHIN funding

• Geography specific capacity changes

• Optional services

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Standard ADP Service Delivery Model These components are included in the Standard ADP Service Delivery Model to be funded by the LHIN:

• ADP Client Characteristics

• Goals of the Program

• Core services

• Additional Key Service Delivery Requirements

• Operational Standards

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ADP Client Characteristics (Benchmark) Frail and elderly and those with Alzheimer/Dementia related disease or physically impaired individuals who are relatively independent and can manage certain personal activities but who require close monitoring and assistance with personal activities (e.g. hygiene, dressing):

• 61% were at risk for falls

• 34% were at risk of depression

• 45% has issues related to incontinence

• 47% showed potential of improving function in their activities of daily living

• 62% showed some level of confusion/dementia

• 56% need help with their shopping, banking, etc.

• 65% score as high or very high risk in the standard assessment tools

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Goals and Core Services of ADP Goals of Programs: These services assist the participants to: • Achieve and maintain their

maximum level of functioning/independence

• Prevent early or inappropriate institutionalization

• Provide respite and access to information for their significant others

Core Services: • Planned social and recreational

activities including regular exercise programs

• Supervised programming • Meals • Assistance with activities of

daily living • Assistance with minor health

care assistance (for example: monitoring essential medications)

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Key Service Delivery Requirements: ADPs will be able to accommodate clients who:

• Have mobility needs that may create a barrier to participation i.e. 2 person transfer, non-weight bearing, use of mechanical lift;

• Have incontinence of bladder/bowel on a daily basis;

• Pose a wandering risk;

• Have behaviours which may present risk or harm to staff or others present;

• Need assistance with medication.

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Financial Operating Standards • Consistent practice for fees related to client absence

• Two week discharge notice to be provided

• Vacation – 30 consecutive days/year pro-rated based on number of days attended

• Move to standard subsidy eligibility tool across ADPs

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Human Resources Operating Standards • Staff model is informed by client population, care needs and program

goals.

• Staffing model is flexible and should include roles such as:

Manager/Coordinator/Supervisor (decision making),

Registered staff (clinical issues/care needs),

Recreationist (design therapeutic programming),

PSWs or other non-registered professionals (implement programs, assist with personal care and other needs),

Volunteers

Other program supports: nutrition and janitorial

• Goal: minimum staff to client ratio, 1:5

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Accountability Each ADP site will:

• Operate a minimum number of spaces per day: 15

• Operate a minimum number of days per week: 3

• Maintain a threshold for minimum occupancy: 90%

• Share accountability indicators (CSS & CCAC)

• Use an ethical decision-making framework

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Proposed Cost Structure Orgs operating 3 sites or less

Orgs operating greater than 3 sites

Specialized Programs Adjustment Factors*

Direct Cost $57.10 /space $57.10 /space $12.00 /space

Admin Cost $10.10 /space $15.30 /space n/a

Total Cost $67.20 /space

$72.40 /space

As above

% of Admin Cost over Total Cost

15% 21% n/a

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* Specialized program adjustment factors will be applied to programs that operate days that are 100% dementia/Alzheimer clients or 100% Stroke Clients


Cost Containment Moving to the standard cost model for ADP:

• 5/12 (42%) of organizations are already aligned with the proposed cost structure and will not have to do any cost containment

These orgs will be working to implement the identified best standards within ADP sites (e.g. medication administration is the best practice whereas medication management is a minimum standard)

• 7/12 (58%) of organizations will have to implement cost containment strategies

4/12 (33%) must cost contain more than 10% which will require plans to pace the impact

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Standard Client Fee • Current client fees range between $16 and $27/day

• Some client fees currently include bathing, foot care and/or transportation to and from the ADP

• Explored multiple client revenue structures to support proposed standard cost model

• Proposed standard client fee is $10 / day for ADP services

• Goal is to minimize the financial impact to the client when considering the combined ADP and transportation fee

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ADP Funding How are ADPs funded now? Approximately • 73% LHIN funding • 25% client fee revenues • 2% from donations and

foundation grants

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How will ADPs be funded? Approximately • 88% LHIN funding • 12% client fee revenues • Charitable dollars as

required to support subsidy

Any changes to LHIN funding allocations will be well planned and carefully implemented to ensure that changes do not negatively impact clients or the operations of the programs. Funding mitigation strategies, similar to those utilized through the implementation of Health System Funding Reform, will be incorporated to identify change thresholds per program per year


Capacity • Identified minimum level of efficiency (all sites operate 15

spaces/day, 3 days/week) ensuring effective use of LHIN funding and value for money

• 5/12 (42%) providers require additional capacity to meet identified minimum

• Proposed shifts in capacity have been identified to ensure sites operate at minimum standard within overlapping catchment areas

• Proposed increase of 4,750 (4%) ADP spaces LHIN-wide (represents an increase in capacity from current 109,500 to 114,250 spaces)

• Includes addition of 2 more days operating the 2nd shift at McCormick to reduce the significant waitlist (3 days were approved last year through community investments)

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Optional Services • Optional services such as bathing and foot care are important

community services, however, they are separate and distinct from the standard ADP service delivery model

• They are not services that the LHIN would have a reasonable expectation to fund as part of an ADP

• The total cost of optional services offered through ADP is approx. $987,887 annually

• Proposing that LHIN dollars currently funded through the ADP functional centre be used for the delivery of services included in the ADP service delivery model

• Recommendation to explore full cost recovery model for these optional services

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Impact to “Optional” Services Bathing

• Approx. 285 unique individuals receive bathing services through an ADP location each year (approx. 37/day)

• ~40% receive these services at no additional cost

• ~25% receive these services at some additional cost (ranges from $2 – 6$/bath)

• ~35% pay a cost recovery fee (ranges from $17-$25/bath)

• Providers will continue to use bathing to support client participation in ADP (incontinence)

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Impact to “Optional” Service cont. Foot care

• There is minimal impact as only 2 sites currently provide as part of the ADP client fee

• Clients are already familiar with full cost recovery model for foot care

• Average foot care fee is $21 (range is $12 – $27)

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Next Steps • September: Recommendation as part of Priorities for

Investment for additional investment in ADP services ensuring:

• Quality • Access • Value for Money

• October: Board will receive detailed organizational level information that will inform the funding changes to be reflected in new M-SAA process

• September to November: Action plans will be developed with each ADP org to stage and pace programming and financial changes

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Next Steps continued • September to November: Engagement of providers

related to ADP transportation as a key enabler to access

• November to March: Planning and implementation of cost recovery models related to optional services

• December to April 2014: Capacity changes implemented paced as appropriate

• April 1, 2014: Implementation of the $10 client fee

• April 1, 2014: Implementation of principles related to transportation client fees

• Fiscal 2014/15: Funding shifts staged and paced as dictated by action plans

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Thank you

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Connie says her favourite thing about going to the Day Away program is getting ready in the morning.

Isabelle Lankin attends the Day Away Program in Wiarton

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