CENTRAL LHIN UPDATES/media/... · Central LHIN Updates ... 11.2 Shouldice Hospital Limited ......

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CENTRAL LHIN UPDATES

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4 Table of Contents 1.0 Strategic Priorities ........................................................................................................................................2 1.1 Quality (Appendix 1.1a/b) ............................................................................................................................2 1.2 Aging At Home Project Update ...................................................................................................................2 1.2.1 Detailed Aging At Home Timelines .................................................................................................................2 1.2.2 Aging At Home And Quality............................................................................................................................3 1.2.3 Citizen Expert Panel For Seniors....................................................................................................................3 1.2.4 Supportive Housing Work Group ....................................................................................................................3 2.0 Board Follow-Up – Board Of Directors Meetings......................................................................................3 2.1 2008/09 Nurse Led Long Term Care Outreach Team- Quality Indicators – February 24, 2009...........3 2.2 2009/11 Community Annual Planning Submissions – Opportunities For Integration – Canadian Mental Health Association/COTA Health – February 24, 2009................................................................3 2.3 2009/11 Community Annual Planning Submissions – CHC – Human Resources Recruitment Strategy – February 24, 2009.......................................................................................................................................3 2.4 Aging At Home Staff Capacity- Follow Up Letter To Deputy Minister (Appendix 2.4).........................3 2.5 Post Q3 Reallocations/Realignment of Funding – January 27, 2009 ........................................................4 2.6 Ophthalmology Update – January 27, 2009................................................................................................4 3.0 2008/09 Business Plan (Appendix 3.0) .........................................................................................................4 4.0 Compliance Declaration (Appendix 4.0) .....................................................................................................4 5.0 IHSP Action Plan (Appendix 5.0) ................................................................................................................4 6.0 Long-Term Care – Short Stay Beds (Appendix 6.0) ..................................................................................4 7.0 Cataract Transfer Price Principle ...............................................................................................................5 8.0 2009-11 Multi Sector Accountability Agreements......................................................................................5 9.0 Incremental Funding Summary For Central LHIN ..................................................................................5 10.0 Primary Care Ehealth Forum On April 30, 2009 (Appendix 10.0)...........................................................5 11.0 2008-10 Hospital Service Accountability Agreements ...............................................................................5 11.1 Stevenson Memorial Hospital –Budget Management Plan .......................................................................5 11.2 Shouldice Hospital Limited – Infection Prevention And Control Program Review................................5 11.3 2009-11 Community Annual Planning Submissions – Opportunities For Integration – CanadianMental Health Association And COTA Health..........................................................................6 11.4 2009-11 Community Annual Planning Submissions – Community Health Centre Human ...Resources Recruitment Strategy....................................................................................................................................6 12.0 Doorways To Care (Appendix 12.0) ............................................................................................................6 13.0 Chronic Disease Management And Prevention Network Terms Of Reference (Appendix 13.0)...........6 14.0 Seniors Advisory Network Terms Of Reference (Appendix 14.0) ............................................................6 15.0 Emergency Department Reporting System (For The Month Of November 2008) (Appendix 15.0).....7 16.0 Draft Integration Strategy Update ..............................................................................................................7 17.0 Draft Urgent Priority Fund Plan 2009/10 Update......................................................................................7 18.0 Integrated Health Service Plan- Work Plan Update..................................................................................8 19.0 2009/10 Annual Report (Appendix 19.0) .....................................................................................................8 20.0 Governance Toolkit – French Translation And Knowledge Transfer Slide Decks .................................8 21.0 Markham Stouffville Hospital Child And Adolescent Mental Health Day Program (Appendix 21.0).9 22.0 Expenditures Constraint (Appendix 22.0) ................................................................................................10 23.0 Additional CT/MRI Resources At Markham Stouffville Hospital (Appendix 23.0) .............................10 Appendices .................................................................................................................................................................11

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4 1.0 Strategic Priorities 1.1 Quality (Appendix 1.1a/b) The Central LHIN staff continues to work with health service providers and other stakeholders to define the quality agenda for the Central LHIN. A key focus of work this month is the measurement element of the strategy, as well as to identify specific projects on which to apply a quality lens. Criteria by which the projects will be selected include the following:

• Strategic Priority for Province and for the LHIN, e.g. Emergency Room/Alternate Level of Care • Evidence of gap between leading practice and current performance • Presence of local champions and local successes / Readiness of Partner Organizations • Probable impact on multiple quality/performance aims, including integration and patient-centred care • Will and ideas exist or are easily created • Applicability of Triple Aim Framework (Appendix 1.1a)

• Well defined target population • Experience of care • Per capita cost

• Measurement focus • Opportunity for Quality Improvement

During March, additional topics will be also identified for inclusion in a quality knowledge transfer series. The Quality Health Service Provider Reference Group continues to provide input into the development process. As well, a Webinar has been scheduled for interested providers, to provide them with an opportunity to learn more about the initiative and receive the results of a survey of HSP quality improvement practices. The quality initiative scope document, including a work plan (Appendix 1.1b) will be submitted for consideration at the April Board meeting. 1.2 Aging At Home Project Update 1.2.1 Detailed Aging at Home Timelines A number of key milestones are being developed over the next few months to prepare for funding approval and subsequent implementation of 2009/10 Aging at Home projects (both new and recurring). The following illustrates a schedule of the high level updates and approvals to be brought forward for Board approval between March and July 2009.

April 2009 2009/10 Funding flows for all Board approved Year 1 Aging at Home funded projects Aging at Home ( Year 1 and Year 2) project is identified for inclusion into Central LHIN Quality

Initiative Update to Central LHIN Board on Equity Focused Health Impact Assessment Tool Pilot

May 2009 Anticipated completed Ministry review of 2009/10 projects

June 2009 Pending receipt of Ministry review, estimated target to present final full slate of 2009/10 projects to flow

funds Planning process and timelines for Aging at Home Year 3, 2010/2011

July 2009 Estimated first payments to new Aging at Home 2009/10 projects to flow funds



4 1.2.2 Aging at Home and Quality Work is currently underway to identify an Aging at Home initiative slated for 2009/10 funding, which can be scoped to include a quality lens. This will be coming to the Central LHIN board within the Quality Initiative package in April 2009. 1.2.3 Citizen Expert Panel for Seniors Members of the Citizens Expert Panel for Seniors met in February 2009 to discuss seniors related initiatives currently offered in the Central LHIN. A successful outcome of this meeting included a brainstorming session which provided feedback on maximizing a community level marketing and awareness strategy Doorways to Care. A few members of this expert panel are members of the Doorways to Care marketing workgroup which is looking to expand consumer awareness of this service. 1.2.4 Supportive Housing Work Group The first meeting of the Supportive Housing Work Group took place at the end of February 2009. The members are health service providers with expertise among different population groups in supportive housing. The objective of the work group is to identify and prioritize issues related to supportive housing services and develop strategies to address these priorities. The initial discussion focused on the current needs and gaps in supportive housing, how supportive housing services can have an impact on the system level goals, and the priorities for the work group for 2009/10. Supportive housing has, and will continue to be, an important part of Aging at Home. 2.0 Board Follow-up – Board of Directors Meetings 2.1 2008/09 Nurse Led Long-Term Care Outreach Team- Quality Indicators – February 24, 2009 A request was made to identify the quality indicators for the Nurse Led Long-Term Care Outreach Team. There are two indicators in the Nurse-Led Outreach Team that align with two domains in the Ontario Health Quality Council framework as set out in the funding letter from the Ministry:

1. Patient Centred domain is aligned with the patient experience – the sponsors of the “Nurse-Led Outreach Team shall be a part of a resident/family and health care provider satisfaction survey which be conducted at year end”.

2. Efficiency domain is aligned with ‘visits to ER’ that can be seen elsewhere, in this case, it would be in the

patient’s (resident’s) Long-Term Care facility – sponsors of the Nurse-Led Outreach Team are to “reduce resident transfers from Long-Term Care facilities to ERs/hospitals for conditions which can be treated in the Long-Term Care facility/community”.

2.2 2009/11 Community Annual Planning Submissions – Opportunities for Integration – Canadian

Mental Health Association/COTA Health – February 24, 2009 An update on this item is provided under Item 11.3. 2.3 2009/11 Community Annual Planning Submissions – CHC – Human Resources Recruitment Strategy

– February 24, 2009 An update on this item is provided under Item 11.4. 2.4 Aging at Home Staff Capacity- Follow Up Letter to Deputy Minister (Appendix 2.4) On March 3, 2009, a letter was sent to Deputy Minister, Ron Sapsford, in reference to a request for additional operating funding of $300,000 on a one time recurring basis to support Aging at Home planning and portfolio management activities. A copy of the letter is included in the appendices.



4 2.5 Post Q3 Reallocations/Realignment of Funding – January 27, 2009 At the January 27, 2009 Board meeting, the Central LHIN Board of Directors approved the allocation of $1,193,893 in 2008/09 as one-time funding as part of the Post-Q3 Reallocation and realignment of funding, and directed staff to investigate and report on the feasibility to use the 2008/09 funds from the in-year long-term care homes surplus funds ($479,493) to assist the community sector agencies in meeting the Ministry mandated Management Information System compliance and to report back to the Board at its regular meeting in February 2009. It has been confirmed with the Ministry, that this allocation can and will be deployed as approved. Moreover, all 14 LHINs have approved their respective Long-Term Care surplus funds for Community Care Management Information System compliance. 2.6 Ophthalmology Update – January 27, 2009 In April 2007, Ophthalmologists and hospital leaders from across the Central LHIN began to meet to consider the future of ophthalmology services for the region. Their objective was to consider opportunities for consolidation of services within Centres of Excellence for Eye Care. A significant amount of good, collaborative, background work has been accomplished, laying the foundation for a successful model of large scale clinical integration in the Central LHIN. . The senior leaders from each organization constitute the Governance/Administrative team. This team provides strategic direction and oversees all aspects of planning and development of the venture. The work of the Governance/ Administrative Team also includes addressing issues such as the joint venture (JV) agreement, establishing operational teams at each of the two sites and drawing on the expertise of the CFO at each hospital, assisting in the cost analysis processes. This team will now evolve into an Implementation Task Force, a transitional body, until such time as the Central LHIN Eye Care Committee is appointed through the JV agreement. The Clinical Care Model Team was to develop the care model and scope of clinical services within the Central LHIN. In so doing, the team considered how best to provide timely access to an appropriate range of surgical ophthalmology services at the two sites while retaining an ophthalmology presence within each hospital community. This team will evolve into North/South Quality/Planning Committees. A project manager is being recruited to manage the work plan. A full report with final recommendations will be tabled with the Central LHIN Board in the summer 2009. 3.0 2008/09 Business Plan (Appendix 3.0) An updated Business Plan is included in the appendices. 4.0 Compliance Declaration (Appendix 4.0) The Compliance Declaration for March 2009 is included in the appendices. 5.0 IHSP Action Plan (Appendix 5.0) An updated IHSP Action plan is included in the appendices. 6.0 Long-Term Care – Short Stay Beds (Appendix 6.0) Under the Ministry-LHIN Accountability Agreement, LHINS are required to determine the operators of short-stay beds and the number of such beds. This information is captured by having individual providers submit applications directly to the LHIN. Central LHIN approved beds for those agencies achieving the minimum threshold as set out by the Ministry. On February 10, 2009, Central LHIN submitted to the Ministry the number of short-stay beds for 2009 by provider; this information is included in the appendices.



4 7.0 Cataract Transfer Price Principle At the request of Hospital CEOs, the Central LHIN facilitated discussions among hospital CFOs which resulted in agreed upon principles to determine the transfer price when volumes of services are transferred between hospitals. Central LHIN has been asked to facilitate an agreement between North York General Hospital and Humber River Regional Hospital on the transfer of 1000 cataract cases. 8.0 2009-11 Multi Sector Accountability Agreements Draft M-SAAs for each of the 59 Community Health Service Providers were prepared and issued to the providers. Teleconferences and/or meetings were held in late February with each sector (Community Mental Health & Addictions, Community Support Services, Community Health Centres, and Community Care Access Centre) to clarify the agreement and supporting schedules. Providers have been asked to review their draft M-SAAs and if agreeable to sign no later than March 22, 2009. Once received the agreements will be signed and executed by the Central LHIN CEO and Board Chair. 9.0 Incremental Funding Summary for Central LHIN An updated summary of the Ministry of Health and Long-Term Care Incremental Funding for Central LHIN is included in the appendices. Also included as an appendix, is the Central LHIN 2008/09 Urgent Priorities Funding. 10.0 Primary Care eHealth Forum on April 30, 2009 (Appendix 10.0) On April 30th, 2009, the Central and Toronto Central LHINs will be hosting a Primary Care eHealth Forum. This forum is the first step in engaging family physicians and nurse practitioners in the Central and Toronto Central LHINs with respect to eHealth. Agenda topics will include: integrating health care information across the continuum of care; the use of registries in managing chronic diseases, such as diabetes; and privacy considerations when sharing personal health information electronically. These eHealth initiatives, in particular, will be of value to primary care practices and their patients. 11.0 2008-10 Hospital Service Accountability Agreements 11.1 Stevenson Memorial Hospital –Budget Management Plan Article 8 of Schedule B of the Hospital Accountability Agreement signed with Stevenson Memorial Hospital requires that the Hospital submit to the Central LHIN, no later than February 28, 2009, a Board approved deficit recovery plan identifying strategies to achieve a zero margin over the term of this agreement. Central LHIN received the recovery plan on February 25, 2009. The recovery plan reflects a balanced position for both years. The Hospital continues to aggressively pursue operating efficiencies, HAA performance indicators and best practice targets from the Health Care Management Group (HCM) efficiency performance benchmarking reporting. Central LHIN staff reviewed the recovery plan, and will monitor hospital performance on a quarterly basis to ensure compliance to balance budget requirement. 11.2 Shouldice Hospital Limited – Infection Prevention and Control Program Review As a requirement under Schedule B of their 2008-10 Private Hospital Accountability Agreement, Shouldice Hospital Limited submitted a review of its Infection, Prevention and Control Program. The audit, conducted by NOSO Health Care Inc. in December 2008, reviewed the infection prevention and control policies in place at the hospital. The audit took place during the months of November and December 2008. The



4 review was based on the Provincial Infectious Disease Advisory Committee (PIDAC) Best Practices: Infection Control Programs in Ontario and PICAC Best Practices Documents on Hand Hygiene and Cleaning, Sterilization and Disinfection. The current CSA Standards on Steam Sterilization and Decontamination were also used. The Shouldice Hospital Limited has most of the elements of an Infection Prevention and Control Program. As a result, the surgical site infection rate of the hospital is very low at 0.5% and a recurrence rate of less than 1%. The review recommended a number of improvements and Central LHIN has requested a progress report on how these are being addressed and incorporated into the current Infection Prevention and Control program at the hospital. 11.3 2009-11 Community Annual Planning Submissions – Opportunities for Integration – Canadian

Mental Health Association and COTA Health

At the February 24, 2009 Board meeting, a board member queried whether there are opportunities for integration between COTA Health and the Canadian Mental Health Association, Toronto Branch, which are located in the same building.

Opportunities for integration were not included in the Community Annual Planning Submissions of the two organizations. Staff held discussions with both agencies and were told that the Canadian Mental Health and Addictions Association, Toronto and COTA Health have some shared meeting rooms. There have also been some discussions around shared office space.

In terms of shared information technology services, COTA Health is involved in the Toronto Central LHIN SIMS (Shared Information Management Services). They are currently working with other mental health agencies to determine the feasibility of back office integration.

11.4 2009-11 Community Annual Planning Submissions – Community Health Centre Human Resources Recruitment Strategy

At the February 24, 2009 Board meeting, concerns were expressed regarding the recruitment challenges of the Black Creek Community Health Centre, and the impact this would have on health service delivery (e.g., Diabetes). The Physician-LHIN Tripartite Committee will review the alignment of the CHC physician compensation with CHC service profile and accountability within their LHIN. The review will be completed no later than October 1, 2009. At present, HealthForceOntario’s recruitment website (HFO Jobs) is available and accessible for all Community Health Centres at no cost for their recruitment initiatives. 12.0 Doorways to Care (Appendix 12.0) The Doorways to Care initiative responds to the need for a co-ordinated systems approach to helping seniors and their caregivers to access and navigate health-related community services through common and/or centralized mechanisms. It is designed to provide enhanced support to seniors, caregivers and providers seeking information and services in the community. The attached briefing note Appendix 12.0 is to report on the progress and deliverables for Doorways to Care for 2008/09 and to outline the plan, budget and deliverables for the Doorways to Care initiative for 2009/10. 13.0 Chronic Disease Management and Prevention Network Terms of Reference (Appendix 13.0) The Chronic Disease Management and Prevention (CDMP) Advisory Network was reconstituted in 2008. The Terms of Reference for the Advisory Network were revised to support the Central LHIN strategy Appendix 13.0. 14.0 Seniors Advisory Network Terms of Reference (Appendix 14.0)



4 The Terms of Reference for the Seniors Advisory Network (SAN) was revised June 2008 and are proposed to remain in effect unless revisions are required to support Central LHIN strategy Appendix 14.0. 15.0 Emergency Department Reporting System (for the month of November 2008) (Appendix 15.0) The Emergency Department Reporting System, a data dashboard maintained by the Ministry of Health, was implemented effective October 1st 2008. The data from November 2008 was made available on March 1st, the data from which is now available and included in the appendices. The funding for the initiatives under Pay for Results strategy Year 1 was disbursed to the three hospitals in October 2008. The performance targets are as follows:

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

2) Designated Hospitals to demonstrate a 5% absolute improvement in the proportion of CTAS I and II patients treated within Emergency Department with a Length of Stay of 8 hours or less, and within 6 hours or less for CTAS III patients, as measured against NACRS 2007/08 baseline data

3) Designated Hospitals to demonstrate improvement (LHIN recommended target of 5%) in the proportion of patients treated within Emergency Department with a Length of Stay of 4 hours for CTAS IV and V patients as measured against NACRS 2007/08 baseline data

Humber River Regional Hospital:

1) For the proportion of patients in the Emergency Department with a Length of Stay greater than 24 hours – both sites fall outside the performance target (4.45% and 7.12% of patients versus target of 2%).

2) For the high acuity patients (CTAS I, II and III), results from both sites falls outside the corridor (-4.70% and – 4.85% improvement versus target of 5% improvement)

3) For the lower acuity patients (CTAS IV and V), both sites show positive results (8.12% and 3.54% improvement versus target of 5% improvement)

North York General Hospital:

1) For the proportion of patients in the Emergency Department with a Length of Stay greater than 24 hours – the results are outside the performance target of 2% (6.32% versus 2%).

2) For the high acuity patients (CTAS I, II and III), North York General Hospital is showing improvement but has not yet met the target (6.39% versus target of 5%)

3) For the lower acuity patients (CTAS IV and V), the Hospital is showing an improvement (2.74% improvement versus target of 5% improvement).

York Central Hospital:

1) For the proportion of patients in the Emergency Department with a Length of Stay greater than 24 hours – the results fall outside the performance target of 2% (2.11% versus target of 2%).

2) For the high acuity patients (CTAS I, II and III), York Central Hospital has surpassed performance expectations (7.99%).

3) For the lower acuity patients (CTAS IV and V), York Central Hospital has surpassed performance expectations (3.76% improvement versus target of 5%)

16.0 Draft Integration Strategy Update The Central LHIN Board of Directors Education Session on Integration was held on March 9, 2009. Central LHIN draft principles for the Integration Strategy/criteria are currently under development and will be coming forward to the board in May 2009 as an update to the interim criteria approved in March 21, 2007. 17.0 Draft Urgent Priority Fund Plan 2009/10 Update Central LHIN staff are in the in the process of developing an Urgent Priority Fund Plan for the 2009/10 allocation. Currently the Central LHIN staff will be working with the criteria per Ministry 2008/09 administrative details,



4 summary of Central LHIN Use of Fund in 2008/2009 and committed funds for 2009/10 and preliminary milestones to guide work plan development. Below are draft deliverables and proposed milestones to bring forward the Urgent Priority Fund Plan for the Central LHIN Board of Directors.

Deliverable Proposed Milestone

Draft Context – Urgent Priorities Fund April 2009

Draft Context – All Funding Sources & Processes April 2009

Work plan & Proposal Review Criteria & RFP Package April 2009

Reallocation of Urgent Priority Fund – Alternate Level of Care (to reflect revised commitments)

April 2009

Proposal solicitation, review and confirmation May/June 2009

Slate of initiatives to Board May/June 2009

18.0 Integrated Health Service Plan- Work Plan Update A high level work plan has been developed for IHSP 2 (see below). The work plan is being directed by the IHSP 2 Steering Committee comprising a broad cross section of health service providers.

Phase 1Launch Project

Phase 2Assessment of Current State

Phase 3Develop / Test Priorities (CE)

Phase 4Draft IHSP & Validate

Phase 5Finalize IHSP & DevelopAnnual Service Plan

JAN FEB MAR APR MAY JUNE JUL AUG SEPT OCT NOV DEC

Project Plan, Commun. & CE Plans

Conceptual Framework and Priority Setting

Draft IHSP

Final IHSP Draft ASP

Development of Strategic Approach to Priorities

Board Workshop in March

19.0 2009/10 Annual Report (Appendix 19.0) The 2009/10 Annual Report is due to the Ministry of Health and Long-Term Care by June 30, 2009. The final draft Annual Report will be brought forward for Board approval on May 27, 2009. A work plan which sets out key milestones is being developed to meet the June 30th timeline. 20.0 Governance Toolkit – French Translation and Knowledge Transfer Slide Decks In September 2008, the Local Health Integration Network/Health Service Provider Governance Resource and Toolkit for Voluntary Integration Initiatives was distributed to Central LHIN Health Service Provider Board Chairs.



4 The purpose of the toolkit is to:

• Assist health service provider boards to understand evolving LHIN practices, processes and expectations arising from interpretations and applications of the act as illustrated by the experience of the participating LHINs;

• Support health service provider boards in understanding their respective roles and responsibilities in

providing appropriate leadership to their organizations and in developing strategies to work with one another and with the LHIN Boards on voluntary integration initiatives

A French translated version of the toolkit is now available on the Central LHIN website. Knowledge Transfer slide decks and a guide were developed to assist those making presentations to boards or other stakeholders regarding the Local Health Integration Network/ Health Service Provider Governance Resource and Toolkit for Voluntary Integration Initiatives. The guide accompanies a slide deck that introduces stakeholders to the document. For presenters and audiences wanting a more in-depth presentation, more extensive slide decks are available, comprising three modules: 1. Module One: The legislative requirements for voluntary integration initiatives (15 slides) 2. Module Two: LHIN expectations for board oversight, decision making processes and community engagement

(20 slides) 3. Module Three: Leadership supports for health service providers (25 slides). As requested by a number of health service providers, the following documents (Checklists/Tip Lists and Tools) are available in a downloadable format:

1) Sample Board Policy To Support Voluntary Integration (P.33) 2) Checklist For Board Accountability For Voluntary Integration (P. 34) 3) Checklist For Board Review Of Strategic Plan Alignment With LHIN IHSP And Potential Integration

Opportunities (P.35) 4) Factors That Could Influence Board-To-Board Involvement (P. 40) 5) Checklist For Board Review Of A Voluntary Integration Initiative (P. 43) 6) Sample Terms Of Reference For A Joint Board Task Force (P. 44) 7) Seven Challenges To Successful Integration (P. 45) 8) Nine Success Factors For Board Collaboration (P.49) 9) Tips For Facilitating Successful Meetings (P. 50) 10) Sample Guidelines For Working Together On A Joint Task Force (P. 51) 11) Sample Partnering Agreement (P. 57-62) 12) Questions To Ask When Developing A Voluntary Integration Initiative, To Ensure A Performance

Measurement Plan (P. 64) The Local Health Integration Network/ Health Service Provider Governance Resource and Toolkit for Voluntary Integration Initiatives and the above documents are available on the Central LHIN website at: http://www.centrallhin.on.ca/page.aspx?id=3860. 21.0 Markham Stouffville Hospital Child and Adolescent Mental Health Day Program (Appendix 21.0) Central LHIN management provided a letter of support to Markham Stouffville Hospital for the proposed Child and Adolescent Mental Health Day Program. The support letter was provided based on the following principles: • Appropriate/extensive community engagement and partnerships are sought with existing service providers; • Appropriate key funding sources are identified and sustainable; • Services provided


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4 A copy of the support letter is included in the appendices. 22.0 Expenditures Constraint (Appendix 22.0) In a memo dated March 10, 2009, Central LHIN Health Service Providers were advised of the Ministry’s expenditure restraint measures that were identified in the Fall Economic Statement and implemented across the Ontario Public Service. As part of this exercise, ministries were asked to consider how to reduce their expenditures and to track and report on measures taken to achieve this objective. Health service providers were asked to ensure that their organization has the appropriate controls in place to govern the expenditure of public funds in a manner that is consistent with the new fiscal environment. 23.0 Additional CT/MRI Resources at Markham Stouffville Hospital (Appendix 23.0) The Central LHIN management provided a letter of support for an additional CT and MRI scanner at Markham Stouffville Hospital. The additional CT and MRI will help to ensure continued access to key diagnostic resources and reduced wait times. A copy of the letter is included in the appendices.




4

APPENDICES

1Quality Initiative

Triple Aim - Overview

• Triple Aim: Simultaneous pursuit of population health management, enhanced individual care and controlled costs for a population

• Getting Started on the Triple Aim• Three dimensions of value• Potential Outcome Measures• System of Improvement, including

presence of a system integrator

Source: IHI February 2009 Training Session Presentations and Background Information

ConceptsDimension

Cost per capita of providing care for this population

Experience of care by the people in this population

Health of a defined population

Defined population for initial focus (e.g. 1% of population driving x% costs)

Population Segmentation

Per Capita Cost

Experience of Care

Population Health

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APPENDIX 1.1a

Central LHIN – DRAFT QUALITY WORKPLAN

Work plan

Description Output Timeline (& Key Meetings)

Project Organization / Information Gathering

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

• Inventory of Quality and System Frameworks

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

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

system and local frameworks

October-November

Preliminary Analysis / Information Gathering

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

• Stakeholder Focus Group Session

#1 • Inventory of HSP Quality

Initiatives • Performance Indicator Sets • Updated Inventory of Cross LHIN

initiatives

• Identification of Board Champion

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

• Preliminary Stakeholder Feedback • Updated Compilation Document to

include indicator Sets and survey results

Additional Analysis / Scenario Development

• Scenario Analysis / Options Framework Draft – Two-Three

• Draft Critical Path • Stakeholder Focus Group Session

#2

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

• Terms of Reference/Draft Scope Document

• Updated Stakeholder Feedback • Revise draft scope document/ project

charter

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

Monitoring Framework • Process Plan to Develop Framework

• Process Plan to Implement Framework

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

February-/March

Organizational and Stakeholder Impact

• Plan to address: Culture, Competency, Structure

• Quality Forum/Series Plan

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

February-March

Quality Initiative Finalized • Scope Document/Charter &

Presentation

• Board Information • Board Review

April Board Education Session #1 (April 2009) Public Board Meeting

Draft Quality Workplan – March 10, 2009 Page 1 of 2

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APPENDIX 1.1b

Central LHIN – DRAFT QUALITY WORKPLAN

Draft Quality Workplan – March 10, 2009 Page 2 of 2

Work plan

Description Output Timeline (& Key Meetings)

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

• Sessions: Education and Knowledge Transfer

May (Start date for series)

Key Stakeholders

1. Ontario Health Quality Council 2. Quality Healthcare Network 3. Centre for Healthcare Quality Improvement 4. University of Toronto 5. York University 6. Select Health Service Providers 7. Ministry of Health and Long-Term Care

Related Initiatives – to inform thinking

1. Balanced Scorecard 2. Outcome Map - Step One of Evaluation Framework 3. Integrated Health Service Plan – Redo 4. Service Needs Assessment and Gap Analysis 5. Emergency Room / Alternate Level of Care / Aging at Home

Resources

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

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

March 3, 2009 Mr. Ron Sapsford Deputy Minister Ministry of Health and Long-Term Care Hepburn Block, 10th Flr 80 Grosvenor Street Toronto ON M7A1R3 Deputy Minister Sapsford: Re: Staff Capacity Planning – Aging at Home In follow up to a resolution passed by the Central LHIN Board of Directors on February 24, 2009 (Appendix A), I am writing to request additional operating funding of $300,000 on a one-time recurring basis to support Aging at Home planning and portfolio management activities. Central LHIN has been allocated more than $106M for Aging at Home, or approximately 18% of total funding allocated to all LHINs, by far the largest allocation of all LHINs. While the Ministry of Health and Long-Term Care provided $263,000 in operating dollars to plan year one, planning dollars for subsequent years have not been allocated, and there have been no additional resources to manage, support implementation, monitoring and reporting for all Aging at Home projects. The staff is required to plan according to the Aging at Home strategy, and to ensure that materials are produced in appropriate time to support the Central LHIN Board in carry out its due diligence. Our previous requests for additional resources to the LHIN Liaison Branch have not produced any tangible results. Our Board and staff understand the challenges the government is facing in this time of global financial uncertainty. We have utilized existing resources to support the Aging at Home strategy, increasingly to the detriment of supporting other activities. We are seeking some interim ‘relief’ to support this critical program, as the demands continue to escalate. Thank you in advance for your consideration of this matter. I will contact you directly, as a follow-up to this letter. Sincerely,

Hy Eliasoph Chief Executive Officer /at (Attach.) c. Ken Morrison, Chair of the Board of Directors, Central LHIN

Nancy Buchanan, Controller, Central LHIN Carrie Hayward, Director, LHIN Liaison Branch

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APPENDIX 2.4


Pending approval of the Board Minutes of February 24, 2009

CENTRAL LHIN BOARD OF DIRECTORS FEBRUARY 24, 2009

RESOLUTION APPROVED BY THE BOARD OF DIRECTORS

AGING AT HOME 2009/10 STAFF CAPACITY PLANNING WHEREAS the Central LHIN has received a $106.5M allocation, as planned funding over a three-year period, for Aging at Home. WHEREAS although the Ministry provided $263K in operating dollars to plan year one for Aging at Home, planning dollars for subsequent years have not been allocated WHEREAS Central LHIN currently has approximately six Full Time Equivalent staff involved in various wide-ranging activities to support this $106.5M program; to plan, fund, manage, implement, monitor and report on Aging at Home. WHEREAS Central LHIN Staff project that an additional 3 Full Time Equivalents are required, given forecasted needs for years two and three, specifically

• Long-term care expertise to develop a Central LHIN plan and ongoing management of interim beds and innovative configurations for year three (and four)

• Program/Project management of year two projects • Year three allocation involving an incremental increase of an additional $26M. • The need for parallel planning processes to maximize allocations and meet targets • Resources needed to support greater cross LHIN collaboratives • Increasing Ministry accountabilities, including oversight and reporting

Full Time Equivalents Basis Projected additional requirements 4 New Ministry Full Time Equivalents (09/10 to be confirmed) (1) Projected Need 3

WHEREAS the re-direction of resources to Aging at Home has resulted in ongoing and continuous re-prioritization of activities to ensure that general planning obligations are maintained and fulfilled. “ON MOTION by Ms. Sandy Keshen and seconded by Mr. John Langs, IT WAS RESOLVED THAT,”

“Central LHIN staff request additional operating funds of $300K one-time recurring from the Ministry to support Aging at Home planning and portfolio management activities”.

CARRIED Feb-24-09-029

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APPENDIX A

2008/09 Business Plan Status Report – March 24, 2009 MINISTRY/LHIN ACCOUNTABILITY AGREEMENT

08/09 Business Plan Status Report- Updated March 9, 2009 1 Note: Changes highlighted BOLD.

Status Legend On-track slightly off-plan significantly off

Central LHIN 2008/09 Business Plan Status Report

March 24, 2009

PART A

MINISTRY/CLHIN ACCOUNTABILITY AGREEMENT

PART B

OTHER BUSINESS PLAN REQUIREMENTS

PART C

RISK MANAGEMENT REPORT

PART D

QUARTERLY MLAA PERFORMANCE REPORT

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APPENDIX 3.0




AA Schedule Pages Comments Status Schedule 1:General

3 Budget announcement and MLAA refresh underway.

Schedule 2: Community Engagement, Planning & Integration

4-5

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

Schedule 3: Local Health System Management 6-11

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

Schedule 4: Information Management Supports 11

Provincial Forum to be developed.

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

particular new capital requirements will be an issue.

Schedule 6: Financial Processing Protocols 15

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

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

Schedule 8: Integrated Reporting 16-18 CLHIN in compliance

Schedule 10: Local Health System Performance 18 CLHIN in compliance

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

20-22 Requirements being met.

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

Jun/Sept/Dec/Mar




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

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

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

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

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

Ongoing Ministry is revising the draft proposal. It will be provided to the Board for input when available. The Ministry has not committed to a date.

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

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

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

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

Completed The Effectiveness Report was publicly released on Nov 7/08. An Action Plan has been developed and is being implemented through a steering committee of Ministry and LHIN CEOs.




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

Part B. Community Engagement Performance Obligations 2.1

N/A

Regularly review community engagement strategy and plan.

February/09 A community engagement strategy is being developed for the Central LHIN. As part of Schedule B, a community engagement framework is being developed collaboratively with hospitals and other providers. That framework was brought to the board in February and the completed templates will be submitted to the LHIN by March 31/09.

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

Completed Submitted to Ministry on June 30th.

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

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

Completed-Further

Updates/changes, as required

The IHSP2 Roadmap has been released to all LHINs.

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

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

Oct/09 The IHSP2 Roadmap will be developed to support Central LHIN’S strategic plan.

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

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

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




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

Completed Aug. 31

IHSP priorities are articulated in the Annual Service Plan.

2.7 N/A

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

Completed 2006/07 Annual Report complete and submitted.

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

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

Ongoing To date, six voluntary and two facilitated integration decisions have been completed. A feasibility study for back-office integration in the community sector is underway.

Schedule 3: Local Health System Management

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status

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

provided including service volumes, performance requirements, and funding.

April/09 A Service Needs Assessment and Gap Analysis for Central LHIN was received by the Board at the November Meeting. Staff are developing an IHSP2 work plan building on the SNAGA report, and will be bringing it to the Board for approval in April.




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

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

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

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

Mar 31/09 A plan for negotiating new service accountability agreements with community health service providers was presented and approved at the November Board Meeting. Negotiations with agencies are ongoing with the intent that all will be signed by March 31/09.

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

Mar 31/08 One hospital agreement remains outstanding and is being brought forward to the Board for approval in March 2009. Progress on volume/budget achievements are reviewed as part of Quarterly reporting by hospitals on WERS. Significant variation to performance expectations are reported as part of risks. Specific reporting for Schedule 9 (Central LHIN specific performance obligations) under Schedule B of the H-SAA tracked quarterly and reported to the Board.




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

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

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

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

3.6 Determine the Dedicated Funding Envelope for Permanent Cardiac Pacemaker Services

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

Completed The Board has approved all known allocations. The allocations approved by the Board include initial cardiac volumes identified at the beginning of the year and in-year adjustments. Additional one time funding to reflect forecasted volumes will be provided by the Ministry as part of system-wide 2008-09 reconciliation and Board approval will be sought once information has been received from the Ministry to fund excess volumes performed.

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

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

In place Ministry is consulted on issues arising.




Emergency Room-Provincial Strategies 3.8 Determine the Dedicated Funding

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

Completed Board approved ER pay-for-performance initiated by the Ministry. Hospital performance will be monitored and reported monthly through the CEO Report.

Acute Care -Provincial Strategies 3.9 Determine strategic and operational

program policy (funding model and accountability framework).

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

In place

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

Underway A joint working group has been established.

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

Central LHIN Cancer Services Steering Committee continues to meet to discuss service delivery issues. Additional 2008/09 incremental oncology volumes reported in the IHSP Action Plan monthly. Cancer Care Ontario has funded forecast volumes. We will follow to determine unfunded volumes and the level of involvement by Cancer Care Ontario.

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

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

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

Completed Wait time targets have been established and communicated to hospitals. Volumes have been incorporated into schedules forming part of hospital accountability agreements. Variance from




targeted performance is reported in Part D.

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

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

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

3.14

Both parties will work together in the 2008-2009 fiscal year to move from funding specific wait time procedures to broader classes of related services. The Board approved additional wait time funding allocations for MRI and CT in January. 2009. Additional allocations are being brought forward for approval in March.

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

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

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

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

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

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

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

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

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

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

Completed

Central LHIN issued a RFP for additional interim/convalescent care beds from additional Interim/Convalescent Care beds as part of the AAH allocation for 2009/10 on January 23 2009. This item will go forward for approval to the Central LHIN board of directors on March 24, 2009




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

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

Fund per MOHLTC per Diem and require compliance with per Diem envelope spending. Board approved funding for convalescent care beds.

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

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

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

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

N/A Long-Term Care sector funding continues to be under the Ministry umbrella until 2010.

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

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

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

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




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

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

In Place

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

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

for occupancy for short stay beds.

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

Completed

Developing a monitoring process with the Community Care Access Centre. However, utilization is generally very high. A survey to LTC home operators was sent out and submissions received and sent to the Ministry on February 10, 2009.

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

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

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

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

Community Mental Health Vau 3.24 Determine and advise the LHIN of

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

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

In Place Dedicated funding is provided to agencies with specified expectations.

Addictions 3.25 Determine the Dedicated Funding

Envelope for Problem Gambling Treatment and for pregnant women with addictions funding

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

In Place

Dedicated funding is provided to agencies with specified expectations.




through the Early Childhood Development Initiative.

withdrawal management and counselling and support services.

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

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

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

Schedule 4: Information Management Supports


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

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

Completed The Board approved funding of $479,000 for CSS and MH&A, Community Care IM at the January 27, 2009 meeting. 12 of the 14 LHINs have committed their portion of the costs.

4.2

N/A

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

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

Schedule 5: Financial Management




# MOHLTC Obligation CLHIN Requirement Deadline Activities Status Part B. Performance Obligations

Multi-Year Funding Targets 5.1 Provide multi-year funding targets Develop an Annual Service Plan within the multi-

year targets that outlines a three-year spending plan for each of its Operating and Transfer Payment Budgets.

Completed

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

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

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

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

Completed Hospital Service Accountability Agreements and Multi-Sector Service Accountability Agreements have been/will be signed based on the planned targets received by the Ministry.

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

balanced budget provisions. March/09

A joint LHIN/Ministry Working Group has developed and distributed draft Audit and Review Guidelines for the Hospitals. These guidelines were provided to the LHINs to enable discussions with hospitals to identify and resolve any issues. A LHIN-wide education video session ws held. The Guidelines have been shared with Central LHIN Hospitals and are available on the Central LHIN website. They have been shared with the OHA.




5.5

N/A

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

In place

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

In-Year and Year–End Reallocations 5.6

N/A

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

Last day of each

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

Q2 finalized and submitted on Sep 30/08. Q3 finalized and submitted on Dec 31/08 Hospitals reported their performance on financial and clinical targets before the quarter-end. This information was incorporated into the quarterly reporting to the Ministry.

5.7 N/A

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

Completed Submitted on June 30, 2008.

Risk Management Framework 5.8 Develop LHIN Risk Management

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

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

Jun 2008 Sept 2008 Dec 2008

The Q2 and ASP risk templates were submitted to the Ministry Sept. 29 and Sept. 30 respectively. Q3 risk template was submitted to the Ministry on Dec 31/08.




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

utilized effective April 1/2007. Capital-General Provisions

5.10

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

Capital Initiatives

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

In Place The MOHLTC/ LHIN Capital Working Group has developed a Provincial approach to aligning capital with operating. Central LHIN has proposed a coordinated approach to reviewing/planning capital projects among Central LHIN hospitals. The Minister has approved a capital planning grant to commence Master Programming for hospital services in Vaughan. The status is that we are in the early planning stages of getting the project off the ground. It has not been a priority, quite frankly, as there is no timeline, we have no dedicated resources and it can go into next fiscal year. It’s on my (long) list, and we do need to get it moving. Central LHIN has met with the Ministry, Humber River Regional Hospital, Markham Stouffville Hospital, York Central Hospital and Southlake Regional Health Centre separately to review




proposed capital plans, using the HBAM to assess inpatient bed projections. Meeting with the other hospitals is in relation to the recommendation in the Vaughan report to align our Vaughan planning efforts with what else is happening across CLHIN. As well, the Ministry has been running HBAM on several of the hospitals and has asked us to meet with them and the hospitals. In so doing HBAM was used using two scenarios: Vaughan and no Vaughan.




Schedule 6: Financial Processing Protocols # MOHLTC Obligation CLHIN Requirement Deadline Activities Status

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

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

6.2 Review and Approve potential

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

Reallocations to occur at every Q3. Board approved the

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

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

March/09 The MOHLTC/LHIN Capital Working Group has developed policy and guidelines on how Own Funds Capital will be managed by the LHINs and a process for LHIN engagement with Providers and provisions under the Public Hospitals Act. A draft policy was presented on Oct. 9/08 at the LHIN Senior Directors meeting. No policy proposals have yet been brought forward by the Working Group.

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

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

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

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

the eligibility, approval and funding of projects using the PCOP funding

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




potential reallocations and adjustments. allocation/reallocation plan tabled at the December Board meeting. Post Q3 reallocation plan was approved at the January Board meeting. Reallocation of remaining dollars is being presented in February for approval.

6.3 Collect and provide forecast information to LHINs.

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

Q2 submitted Sep 29/08. Q3 submitted Dec 31/08.

Schedule 7: Local Health System Compliance Protocols


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

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

March/09

The Ministry working group has finalized a draft for review. (as noted in Item 5.4).

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

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

In place

A process has been established with the Performance Improvement and Compliance branch to notify CLHIN of any Long-Term Care sector non-compliance.

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

See 7.1 above.

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

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

Schedule 8: Integrated Reporting





Part B. Performance Obligations Quarterly Regular and Consolidation Reports

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

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

Completed Submitted May 28, 2008

8.4 Collect and provide information for

Advertising Review Board annual fiscal report.

Provide expenditure details each year reporting Communications contracts Completed

Report sent May 28, 2008

8.5 Approved hospital allocations for the

current fiscal year and funding targets for the next three years by June 30

N/A Completed

8.6 Provide data on performance

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

N/A N/A

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

8.7 Provide report containing year-to-date

expenditures by June 8 First Quarter Report Completed

8.8 Provide report containing year-to-date

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

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

Submitted to Ministry on Dec 31/08.

8.10 Provide a form for the Reallocation

Report by February 15.

Fourth Quarter Report (optional – if required) March 31/09 Work on Q4 report has commenced.




Year End Reports 8.11 Provide for each fiscal year the form

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

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

8.12 Provide Annual Report requirements

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

Submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements, which includes: i) The effectiveness of the LHIN’S community engagement strategy using the common assessment tool. ii) Engagement with planning entities prescribed under the Act. iii) A report on the LHIN’s integration activities. iv) A report on the performance of the local health system on all performance indicators.

Complete

8.13 Provide by April 30 of each year,

information for the preceding fiscal year on transfer payments to support the preparation of Year-end Reports.

N/A Completed

Annual Service

8.14 Provide the forms and information requirements for Multi-year Consolidation Report component of the Annual Service Plan by August 31 of each fiscal year.

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

Completed

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

Schedule 10: Local Health System Performance


Part B. Performance Obligations General Obligations




10.1

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

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

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

Refer to Part D: Quarterly MLAA Performance Report.

10.2 Report on the performance of the local health

system on all performance indicators in the LHIN Annual Report.

Complete Submitted June 30, 2008.

Schedule 11: e-Health

# MOHLTC Obligation CLHIN Requirement Deadline Activities Status Part B. Performance Obligations

11.1

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

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

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

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

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

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

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

Completed Board approval secured for continued operation of and support for the joint LHIN E-Health Council. A refreshed e-Health strategy, aligned with the new Provincial strategy and a deployment plan with a proposed budget allocation.




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

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

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

PART B – OTHER BUSINESS PLAN

Operations

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

Completed

A recommendation was brought before and approved by the Central LHIN Board in January 2009 to retain Deloitte as the external auditor for the 2008/09 fiscal year.

1.2

Recruit LHIN staff.

As Required

Currently Recruiting: - (2 positions) Senior

Integration & Planning Consultant

- (2 positions) Project Coordinator

- Senior Community Engagement Consultant

- Decision Support Lead

1.3

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

Completed. Board Approved and communicated to Ministry in April

Accountability Requirements




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

Understanding directives. N/A

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

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

On Request

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

per Freedom of Information and Protection of Privacy Act.

Completed

Board/Governance Requirements

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

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

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

Completed 2007/08 Annual Assessments were completed. Results were reviewed by the Board on August 6, 2008. Individual Board Member assessments were discussed at the Board Development Day on August 6, 2008. A common tool for individual assessments has not been provided.




PART C – RISK MANAGEMENT REPORT

Risk Potential Impacts Mitigation Strategy Of the 10 hospitals, 1 remains outstanding. 1 unsigned agreement has been extended. Hospital is in the process of submitting a

balanced HAPS to the Board in March 2009.

PART D – QUARTERLY MLAA PERFORMANCE REPORT

The Ministry has developed a LHIN dashboard to assist with quarterly performance reporting as per the MLAA. The scorecard has gone through various iterations and continues to evolve. Generally, the Ministry releases the dashboard to each LHIN a few weeks in advance of the quarterly report due date. The dashboard below was released in preparation for the Q3 report (due December 31, 2008). As seen below, all indicators are within acceptable limits and thus, no variance report was required for the Q3 report as it relates to performance.

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


08/09 Business Plan Status Report- Updated February 10, 2009 25 Note: Changes highlighted BOLD.

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

Performance Indicator Indicator

TypeProvincial

Target

LHIN Starting

Point

LHIN Performance

Target - 2008/09

Projected Performance

Target

Performance Corridor -

Higher Value

Performance Corridor - Lower

ValueActual

Performance

90th Percentile Wait Times for Cancer Surgery1 Access 84 Days 55.00 51.00 53.00 58.30 47.70 49.00

90th Percentile Wait Times for Cardiac By-Pass Procedures1 Access 182 Days 68.00 60.00 64.00 70.40 57.60 62.70

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

90th Percentile Wait Times for Hip Replacement1 Access 182 Days 183.00 182.00 182.50 200.75 164.25 146.00

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

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

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

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

100,000 210.00 210.00 210.00 231.00 189.00 -

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

Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 2

e2

Integration 9.46% 9.80 9.60 9.70 10.67 8.73 -

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

1,000 9.47 9.40 9.44 10.38 8.49 -

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

)2

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

23

= No data to facilitate analysis & reporting for this Quarter (Q2 2008/009) = Actual Performance Value is from Q1 2008/09 (Apr, May, & Jun 2008)

Central LHIN MLAA Performance IndicatorsBased on Q2 2008/09 Data

Column


Pa

CENTRAL LHIN COMPLIANCE DECLARATION

MARCH 24, 2009

We, Hy Eliasoph, CEO, and Shaukat Moloo, Senior Director, Performance, Contracts & Allocations, declare that, to the best of our knowledge, as of March 19, 2009:

1. Central LHIN has complied with all laws, rules and regulations pertaining to the payment of salaries, vacation pay, pension contributions, Employment Insurance, Canada Pension Plan, income tax and other deductions (including withholding tax of all kind) and Ontario Retail Sales Tax and GST.

2. Central LHIN has complied with all the financial covenants, and has adhered to relevant

Management Board policies and directives, and has followed all regulations governing the privacy and confidentiality of information.

Signed:

____________________________________ Hy Eliasoph, CEO

Signed: ____________________________________ Shaukat Moloo, Senior Director Performance, Contracts & Allocations

ge 1 of 2

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SCHEDULE A TO COMPLIANCE DECLARATION OF MARCH 24, 2009

List of any exceptions to declaration: As part of a recent review of the payroll reporting practices for all LHINs it was determined that deductions for remuneration paid to Directors should have been withheld at source in respect of such remuneration. The LHINs auditors Deloitte and Touche are currently reviewing source deductions for 2005, 2006 and 2007 on behalf of the LHIN with the Canada Revenue Agency.

2008/09 IHSP Action Plan - Updated March 10, 2009

2008/09 Planning, Integration &

Community Engagement IHSP and Emerging Priority

Action Plan March 24, 2009

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APPENDIX 5.0

2008/09 IHSP Action Plan – Updated March 11, 2009

Table Page

1 IHSP Priority - Seniors 1

2 IHSP Priority - Mental Health and Addictions 2

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

3

4 IHSP Priority - Wait Times 3

5 IHSP Priority- Cancer 4

6 IHSP Priority-Emergency Services 5

7 Community Engagement 6

8 Emerging Priority- Hospice Palliative Care 7

9 Emerging Priority- Alternative Levels of Care 8

10 Integration Activities In Progress 8

11 Integration Activities Complete ( 2007/2008) 9

2008/09 IHSP Action Plan - Updated March 10, 2009

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

# Workgroup Description of Deliverable To Board Activities Status 1.1

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

Update to

Board in April 2009

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

1.2 Aging at Home Final allocation for Aging at Home 2009/10 Incremental amount of $2.5M

Update to Board

April 2009

Central LHIN will be preparing a recommendation to allocate the remaining 2009/10 Incremental Aging at Home funding of $2.5M. This funding is to be spent on an initiative(s) which has a direct impact on Emergency Room Wait Times and Alternate Levels of Care rates.

1.3 Aging at Home Equity Focused Health Impact Assessment Tool Update to Board April

2009

Central LHIN staff has met with the Ministry to gain better understanding of the draft Equity Focused Health Impact Assessment Tool. It is the intention to pilot this draft tool on a macro level to the Aging at Home Strategy with the assistance of the Diversity and Inclusion Advisory Group.

1.4 Long Term Care Long Term Care Assessment for Central LHIN Update to Board April

2009

Central LHIN is in the process of retaining a dedicated resource for long term care bed planning.

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

# Workgroup Description of Deliverable To Board Activities Status

2.1

Consumer/Survivor Leadership Team

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


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

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


2.2

Centralized access

Centralized access-Phase 1, Phase 2 plan Ministry responses pending regarding alternate sources of funds

To Board for

Approval- March 2009

. Request for Phase 2 funding was presented to the Board in October 2008. Request for Phase 3 funding coming forward for board approval in March 2009.

2.3

Diversity

Mental Health and Addictions Cultural Competency Project

Diversity Lens has been applied with all Central LHIN Health Service Providers delivering mental health and addiction services; developing an environmental scan; education and mentoring is underway. Professional Development Day successfully occurred in January 2009- to share leading practices and to provide mentorship regarding cultural competency. Final report in process-will be complete by March 31, 2009

2.4

Education

Education Strategy Phase II

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

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


3.1 CDMP Advisory Network

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

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



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


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

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

CDMP Advisory Network will identify and delegate approach to the work group, who will use the continuum of care and the coordination of services.

3.3 CDMP Self Management

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

Six 4-hour workshops and six 1-hour rounds being offered. On-line registration available; website active; literature review available online. The current project is being enhanced by developing a plan that considers how the training received by practitioners can be supported across the continuum of service.

TABLE 4: IHSP Priority-Wait Times ( Board Observer: Arthur Walker and John Langs) (Staff Lead: Ashif Damji)


4.1 Wait Times Strategic Planning Group

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

On-Going

Completed:

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

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

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

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

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




reallocation process underway; awaiting final MOHLTC confirmations.

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

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

On-Going

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

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

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

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


5.1

Cancer Care Services Steering Committee

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

Work

underway not anticipated to require board

approval

Dr. Balogh was happy to report that Southlake has a new Director of the Regional Cancer Program. Her name is Sarah Etheridge, she comes from Credit Valley and she will be starting February 23, 2009.



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

# Description of Deliverable To Board Activities Status 6.1

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

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

Access to support services

Nurse-led Outreach Team proposal submitted to the Ministry of Health and Long-Term Care on August 22nd – Ministry review pending. Approval received from Ministry on December 18,2009 The recommendations from these workgroups are being finalized and will be complete over the next two months.

6.2

The Emergency Department Pay for Performance Year 2 Action Plans are being requested from health service providers. The following performance targets will need to be achieved:

10% absolute improvement in the number of admitted patients with a Length of Stay within 8 hours

10% absolute improvement in the proportion of high acuity patients treated within the benchmark (8 hours for CTAS I and II; 6 hours for CTAS III)

10% absolute improvement in the proportion of low acuity patients treated within 4 hours

The Central LHIN Action Plan is due to the Ministry on March 16, 2009.

To Board for

approval – March 2009

The Emergency Services Advisory Network will be reviewing the action plans on March 5, 2009 and will provide recommendations for improvement. The Network has also recommended an additional performance indicator for the hospitals to achieve as part of the Pay for Performance:

Patients Leave without Being Seen/Patients Leave Against Medical Advice (proportion of patients should not exceed 4%)

The Network has completed the review of these proposals and are currently being revised by the hospitals based on the recommendations of the review panel.



Table 7: Community Engagement

Description of Deliverable/Activities Outcome

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

Draft Stakeholder Engagement Strategy and plan

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

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

Task Force of hospital and community providers established

Survey is complete and results analyzed Task Force kick off-November 2008 The Group has completed work with the consultant to develop a template to be populated by each hospital that will outline community engagement plans/activities for the next year as they relate to the HAPS process, integration opportunities and strategic planning. The completed template is due on March 31, 2009. Hospitals will provide quarterly updates to the LHIN on their progress, results and lessons learned.

Aboriginal Greater Toronto Area LHINs urban Aboriginal engagement session has been scheduled for

March 3, 2009

Meeting with band leadership on Georgina Island has resulted in the identification of an issue that a health plan will be developed Aboriginal report to be completed by March 31, 2009

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

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

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

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

A French Language Services Survey was distributed to health service providers who have identified having French-speaking staff or serving French-speaking clients

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

the Ministry to develop indicators for successful engagement

Development of indicators for engagement from the public perspective that will feed into the common assessment tool for community engagement – report will be complete by end of March



Description of Deliverable/Activities Outcome

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

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

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

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

• Provincial Community Engagement training is being conducted by the International Association of Public Participation (October 2008 and January 2009)

Development of a web-based community engagement toolkit for LHINs and health service providers Methods in place to ensure that communications and community engagement are working closely together across LHINs Common assessment tool is being developed for all LHINs to use in evaluating their community engagement efforts (as per MLAA requirements) Development of indicators for engagement from the public perspective that will feed into the common assessment tool for community engagement Session on public engagement targeted to LHIN Boards, CEOs and health service providers

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

# Workgroup Description of Deliverable To Board Activities Status 8.1

Palliative/End-of-Life Care Steering Committee

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

Work underway

not anticipated to require board

approval

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



Table 9: Alternate Levels of Care (Board Observers: Colin Benjamin, Raksha Bhayana) ( Staff Lead: Mary Byrnes)

# Description of Deliverable To Board Activities Status

9.1

Alternate Levels of Care Framework & Emergency Room/ Alternate Level of Care Overarching Plan

Board Approved in Principle-December

2008

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

.

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

Board Approved November 2008.

Central Community Care Access Centre took the lead in developing a proposal for interim long-term care home beds, building on information from the Ministry, Central LHIN Joint Hospital/Community Care Access Centre Collaborative and Transitional Bed Survey. Submitted on September 29, 2008 for review by Ministry. Ministry approval in November. Subsequent Board approval in November. Unmet Ministry inspection expectations are extending start dates for interim beds in retirement home sites co-located with long-term care homes.

9.3

Emergency Department Pay for Performance: Year 2- 2009/2010

To Board in March

2009

Refer to Emergency Services (Table 6)

Table 10: Integration Activities In Progress ( Board Observer: John Langs)

Project Name Decision Date Description/Partners Outcome

Central LHIN Wide Ophthalmology Services Integration Plan Integration Plan Development – LHIN funding approved in February 2009

Plan by August 2009

Human Resource Information System (HRIS) – LHIN wide/cross sector feasibility study

Feasibility study - LHIN funding approved in February 2009.

Report by July 2009

PalCare Network of York Region/Southlake Regional Health Centre Voluntary integration request to transfer Palliative Pain & Symptom Management Services

HSIP Received

Homeward / COTA Health Proposed integration of services HSIP Pending Bethany Lodge/Markhaven

Financial Collaborative

HSIP pending



Table 11: Integration Activities Complete ( 2007 & 2008)

Project Name Decision Date Description/Partners Outcome

Deaf Access Simcoe/Canadian Hearing Society

June 2007 Voluntary

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

1-year update provided Sept08

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

November 2007

Voluntary

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

Update provided Dec08

Central Ontario Hospital Procurement Alliance

February 2008

Voluntary

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

1-year update provided in February09

Council of Academic Hospitals of Ontario Capital Equipment Group Purchasing Initiative

March 2008 Voluntary

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

1-year update due March09

Matthews House Hospice Divestment from Hospice Simcoe to Hospice Alliance

April 2008 Facilitated

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

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

Back-Office Integration Study: Phase I

Feasibility study for group purchasing and financial integration in the community sector.

MOHLTC approval October08. Project nearing completion.

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

November 2008

Facilitated

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

6-month update due June 2009.



North York Central Meals on Wheels

January 2009

Voluntary

Voluntary Integration Don Mills Foundation for Seniors

Report back in April 2009

York Central Hospital/Southlake Regional Health Centre Cataract Surgery Collaboration

January 2009

Voluntary

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

Funding transfer amount to be confirmed by March 31, 2009. Report back in April 2009.

Draft Integration Strategy developed for board education session

Strategic goals guiding integration activities for Central LHIN

Board session, March 2009

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

Central LHIN 2009 Short Stay Bed Approvals

# of beds Provider4 City of Toronto, Long-Term Care Homes and Services (Cummer Lodge)2 Corporation of the County of Simcoe - Simcoe Manor3 Regional Municipality of York (York Region Maple Health Centre)3 Regional Municipality of York (York Region Newmarket Health Centre)4 Casa Verde Health Centre2 Chartwell Master Care LP (Aurora Resthaven)1 Extendicare Southwestern Ontario Inc. (Extendicare/Bayview)2 Friuli Long Term Care (Villa Leonardo Gambin)1 2063414 Investment LP o/a Leisureworld Caregiving Centre - Cheltenham1 Revera Long-Term Care Centre Inc. (Elginwood Long-Term Care Centre)5 Villa Colombo Seniors Centre (Vaughan) Inc.1 Yee Hong Centre for Geriatric Care3 Yorkview Lifecare Centre1 1367178 Ontario Inc. (The Woodhaven)1 Mon Sheong Foundation1 Specialty Care Bloomington Cove Inc. 1 ATK Care Inc. o/a River Glen Haven Nursing Home1 Bethany Lodge*2 Chartwell Master Care LP (The Gibson Long Term Care Centre)39

Updated: February 10, 2009

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APPENDIX 6.0

MEMORADUM

Date: March 11, 2009

To: Executive Directors/Administrators of the Central and Toronto Central LHINs Family Health Teams

and Community Health Centres

From: Miriam Wiebe, Physician Sponsor, Central and Toronto Central LHINs Physician eHealth Initiative

Diane Salois-Swallow, eHealth Lead, Central LHIN

Lydia Lee, eHealth Lead, Toronto Central LHIN

Re: “SAVE THE DATE” - Primary Care eHealth Forum on April 30, 2009

The Province of Ontario is making significant investments in eHealth, viewing eHealth as an enabler for

achieving clinical priorities: Diabetes Management, Medication Management; Wait Time Reduction.

With the recent formation of the new eHealth Ontario Agency and the publication of the draft Provincial

eHealth Strategy, the province is well positioned to make advancements in the above noted priority areas.

Aligned with the Provincial eHealth Strategy, the Central and Toronto Central LHINs have developed a

joint, local eHealth Strategy, the success of which is largely dependent on local adoption and

participation.

On April 30th, 2009, the Central and Toronto Central LHINs will be hosting a Primary Care eHealth

Forum. This forum is the first step in engaging family physicians and nurse practitioners in the Central

and Toronto Central LHINs with respect to eHealth. Agenda topics will include: integrating health care

information across the continuum of care; the use of registries in managing chronic diseases, such as

Diabetes; and privacy considerations when sharing personal health information electronically. These

eHealth initiatives, in particular, will be of value to primary care practices and their patients. There will

be ample opportunity to learn ad ask questions.

We are requesting your assistance in identifying the family physicians and nurse practitioners in your

practice that will benefit from attending the eHealth Forum. Please fill in the contact information for

these individuals in the attached form and kindly return it to [email protected] by Monday,

March 16, 2009. Please note that this is not an RSVP list; an invitation will be sent to yourself and to

these individuals shortly thereafter, providing each individual the opportunity to accept the invitation

directly. As space is limited, attendance will be determined by RSVP on a first come-first serve basis.

RSVPs should be directed to [email protected].

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APPENDIX 10.0

In the interim, please feel free to circulate this notice within your practice, as we are cognizant of the need

to block off time in your respective schedules. Specific details of this event will be forthcoming; please

reserve April 30th from 7:30am – 1:00pm.

Thank you in advance for your assistance in making this a successful event! We look forward to hearing

back from you soon.

Sincerely,

Miriam Wiebe, MD, CCFP Diane Salois-Swallow Lydia Lee

Physician Sponsor, eHealth Lead, eHealth Lead,

Physician eHealth Initiative Central LHIN Toronto Central LHIN

CC:

Hy Eliasoph, CEO, Central LHIN

Matthew Anderson, CEO, Toronto Central LHIN

Mario Longo, Communications Manager, Central LHIN

Janine Hopkins, Director, Community Engagement and Corporate Affairs, Toronto Central LHIN

Anne Lawrence, Implementation & Adoption Team, MOHLTC

Wayne Mills, Implementation & Adoption Team, MOHLTC

Susan Wattam, Physician eHealth Strategy, MOHLTC

Fraser Ratchford, Physician eHealth Strategy, MOHLTC

Frank Vassallo, eHealth Program, MOHLTC

1

1


Briefing Note Updated: March 3, 2009 Template Updated January 2009

CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE

DOORWAYS TO CARE MARCH 24, 2009

ISSUE For 2008/09, Doorways to Care was funded for $435,000 on a one-time basis, from the 2008/09 Central Community Care Access Centre base budget. PURPOSE: The purpose of this note is to report on the progress and deliverables for Doorways to Care for 2008/09 and to outline the plan, budget and deliverables for the Doorways to Care initiative for 2009/10. BACKGROUND: The Doorways to Care initiative responds to the need for a co-ordinated systems approach to helping seniors and their caregivers to access and navigate health-related community services through common and/or centralized mechanisms. It is designed to provide enhanced support to seniors, caregivers and providers seeking information and services in the community. Doorways to Care is a shared referral model which includes a toll-free line and client “warm transfer” process to provide an enhanced level of support to seniors and caregivers seeking help and services. The goals of the Doorways to Care model are to:

- Support and assist seniors and/or their caregivers in accessing the appropriate community services - Optimize a shared and standardized intake screening and (initial) assessment process among agencies - Facilitate information and referral exchange among providers to more effectively support seniors and

caregivers - Improve the knowledge levels of staff in agencies, the Central Community Access Centre, and

hospitals about the various services offered by community providers to then enable informed referrals, and

- Strengthen the linkages among providers. In September 2007, the Board of Directors reviewed the Doorways to Care model description and proposed implementation parameters. Funding of $260,000 was provided for fiscal 2007/2008 to initiate implementation, with the key goals to: create agency partnerships, initiate a project management process and develop key infrastructure support and resources by March 31, 2008. Upon completion of this work in 2007/2008 the Central LHIN Board approved an additional $435,000 for

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APPENDIX 12.0

2

2



2008/2009 to enable the full launch of the model. ANALYSIS:

2008/09 ACHIEVEMENTS: Doorways to Care has achieved and exceeded deliverables set for 2008/09.

Implementation elements for 2008/2009

Actual Deliverables Achieved

Operational Testing Phase (from April to June 2008):

Launch of Shared Referral Model, Process and Tools (June 25, 2009 onwards)

Initial Staff Training Curriculum Developed and Implemented (reaching over 285 staff)

Public Launch of the Doorways to Care Initiative (June 2008, Seniors Month)

Doorways to Care Public Launch June 25, 2008

Operations (e.g. installation of phone line and website)

Development of the Doorways to Care Website

Phone line installation in all 22 agencies

Expanding the partnership beyond the test phase to include all partners

Creation of a Network of Doorways to Care partnerships made up of 22 agencies (via a Memorandum of Understanding Agreement)

Monitoring and Evaluation

Performance Data Collection Systems Established (manual process)

Ongoing Project Management and Post-Launch Improvements to Tools and Processes (including common consumer friendly service descriptions/categories)

External evaluation by Cadence Human Systems

eHealth Enablers (e.g. e-referral - Dependant upon other sources being available)

Participation in the Central LHIN Resource Matching and Referral Third Party Review (scheduled for completion March 2009)

3

3



Sustainability Assessment and Recommendations for 09/10 Plan

Governance and Sustainability Model Developed (e.g. Steering Committee and Work Groups)

Development of Sustainability Plan Recommendations

NEW: Engagement with community stakeholders to form marketing strategy to seniors

Marketing/Public Education efforts initiated and consultations with seniors held, including with the Central LHIN’s Citizen Expert Panel for Seniors

NEW: Collaboration with similar project in development stages at Toronto Central LHIN

Collaboration with the Toronto Community Access and Navigation Project (CNAP) to ensure model coherence

KEY FINDINGS FROM DATA COLLECTED AND EXTERNAL EVALUATION (June 2008-January 2009): 1. Collaborative Cross-Agency Design and Implementation New relationships have been formed among the staff, which enables stronger linkages and collaboration across agencies within Central LHIN. Doorways to Care is playing an important role in supporting the Central LHIN system goals to improve access to and coordination of healthcare services in our communities. 2. Marketing to Seniors and Caregivers A marketing effort was put in place following the June 25, 2008 launch and involved leveraging the newsletters, mailings, events and mechanisms already in place at the participating Doorways agencies. This strategy was effective at reaching the seniors already connected with the existing agencies and needs to be built upon in order to reach seniors and caregivers not yet connected to a formal agency. Additional strategies have recently been initiated to seek partnerships with cultural groups and new settlement agencies. Based on consultations with the Central LHIN Citizens Expert Panel for Seniors and other seniors via community agencies, the next phase of the outreach strategy will build on “grass roots” efforts to reach seniors and caregivers. This strategy is designed to achieve a higher volume of referrals to community agencies. 3. Optimizing the Doorways to Care Website for Informed Self-Referrals The traffic on the Doorways to Care Website has been much higher than anticipated reaching 19,151 - February 2009. The Doorways to Care website can be an important tool for reaching younger seniors and younger caregivers, and its functionality will be enhanced to offer on-line supported access to community services.

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4. Clarifying Fees, Catchment Areas and Service Boundaries The project’s external evaluation revealed that one challenge for some Doorways to Care users and staff is the need for additional clarification around catchment areas, fee schedules and detailed knowledge on types of community services. In some cases, the fee has been a barrier to successful completion of a referral. Current data shows that 12% of clients decline the service due to fees. 5. Staff Training and Mentoring to Improve Staff Compliance to Common Referral Process The Doorways to Care project team carried out initial training with agency intake staff and supported them via weekly teleconferences, as the new phone technology was introduced and the new referral tools and processes were implemented. This support has helped to sustain the new referral practices and to facilitate the continued communication across agency intake staff. Continued support is required to ensure these practices are fully implemented within all of the Doorways to Care organizations. SYNTHESIS/CURRENT STATUS: 2008/2009 STATUS UPDATE Delay of E-Referral Solution – Challenge for Sustainability The Doorways to Care initiative encountered an unexpected barrier when the Ministry of Health and Long-term Care discontinued the e-referral solution that was being piloted in three Doorways to Care agencies. This has had the following impacts:

• Inter-agency Referrals are sent manually and lack a robust on-line search tool for matching clients to service.

• Agency Overflow Call Handling: Until an e-solution is implemented, only Community Care Centre

staff have phone lines linked in to the Doorways line to handle these extra calls.

• Evaluation Data Collection: The lack of an e-referral system has had an impact on the ability to collect complete and reliable data to fully measure the impact of the Doorways to Care initiative..

Current Status: E-referral Strategy As part of the Joint Toronto Central and Central LHIN e-health council, Doorways to Care is involved in the Central LHIN Resource Matching and Referral Third Party Review which is scheduled for completion by March 2009. Being involved in ongoing e-referral planning will enable Doorways to Care to update its e-strategies concurrently and in alignment with those of the Central LHIN. Sustainability Plan Sustainability of this coordinated model can be defined using two different methods; one electronic, the other manual (current).

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1) Future of Doorways to Care Using E-Referral E-referral is the preferred future for Doorways to Care. By adopting an e-referral system, a common data platform can be shared among all health service providers. This will enable an efficient and effective process to complete referrals and exchange information thereby reducing the burden on the Community Care Access Centre staff. In addition, it will eliminate manual data collection and collation and the resources associated with this work. 2) Sustaining Manual Process (current) for Doorways to Care The vision for Doorways to Care is hindered by maintaining a manual process. This process is labour intensive and does not optimize the coordinated nature of the service model. To maintain a manually driven service, Doorways to Care would require a minimum of 1 full-time equivalent at the Community Care Access Centre to answer calls, 0.5 full-time equivalent to collect and compile data and 1 full-time equivalent for outreach and access coordination among seniors, providers and community services. Information gathered through the Doorways to Care data collection is not sufficiently conclusive yet to project the impact on human resource requirements if referrals increase significantly (data only available for the past 6 months), however this may be a staffing line where future additional funding may be required. Other considerations for sustainability Coordination among LHINs Another element which is being considered under the vision for future sustainability of Doorways to Care is the importance of design coordination with other similar types of projects that are in progress in other LHINs. Examples of these projects include Toronto Central LHIN’s Community Access and Navigation Project and Mississauga Halton LHIN’s “ASSIST” seamless services for seniors. Link to Aging at Home initiatives The last element for sustainability is the connection with Aging at Home initiatives such as Community Alternatives to Long-term Care Placement, Home at Last and Specialized Geriatric Outreach Teams. To achieve the goals for Doorways to Care for 2009/10, some of the resources originally assigned to the contact centre (phone line) will be shifted into a new role, Doorways Outreach and Access Coordinator. 2009/10 Proposed Project Funding Allocation The following budget is proposed one-time funding from the 2009/10 Central Community Care Access Centre base funding.

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Budget Item Description Total Staffing

Staffing Requirements $128,000 Infrastructure

Website Phase II $15,000 Phone system maintenance $22,000

Marketing Pamphlets and Cards Revisions, translation and printing $25,000

Total Funding Request $251,000 Note on potential e-referral solution: If an e-referral solution becomes available during 2009-10, the associated implementation and training costs would require separate and additional funding. A full migration to an electronic referral system (e-referral) involves a full integration of the Doorways to Care intake processes, practices and tools into the business processes of all participating agencies. This will include standardized staff training methods embedded into each agency’s intake and referral processes. DELIVERABLES/IMPACT OF CARE: (How will it be measured?) The key deliverables for Doorways to Care for 2009/10 address the challenges experienced to date, lessons learned as well as the long-term vision for Doorways to Care sustainability.

1. Service: a. Maintain supported referrals for clients and caregivers to community services by Community

Care Access Centre Contact Centre and member agency staff b. Establish planning target volumes of 1,500 calls and 750 referrals

2. Staff Training and Mentoring:

a. Continue coaching, support and training on the implementation of the new tools and processes on a manual basis to enable staff to be fully ready for the implementation of the selected e-referral solution.

b. Increase the availability of detailed information on community service options (e.g. services, maps and fees).

3. Marketing and Knowledge Transfer:

a. Continue outreach work of member agencies b. Enhance reach to seniors and caregivers through increased grass-roots efforts and strengthen

partnerships with cultural organizations, seniors groups, church groups and others c. Update Promotional material materials (translate and print) d. Enhance Doorways to Care website including a link to a customized, advanced search tool

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and links to other organizations including the LHIN e. Link Doorways to Care work with other Aging at Home projects

4. Partnerships

a. Improve the integration of access mechanisms for existing Doorways agencies b. Investigate partnership strategies among sectors (e.g Mental Health, Primary Care and

Palliative Care Sectors) c. Pursue opportunities to increase consistency between Doorways to Care-like models

including the Toronto Central LHIN’s Community Access and Navigation Project and the Mississauga Halton LHIN’s initiative called “ASSIST” seamless services for seniors

5. Sustainability

a. Implement Sustainability Plan for Doorways to Care e.g. lead agencies responsible for different aspects of the model such as technology, tools, training, and public education.

6. Evaluation:

a. Continued evaluation and manual performance data collection Doorways to Care has the following evaluation and indictor measurement plans:

Deliverable 2009/10 Evaluation Plan (sample indicators) Service

Number of calls 1,500 Number of referrals 750 Number of website hits 25,000

Marketing and Partnerships Circulation of revised marketing materials (100,000 rack cards & flyers in 21 languages)

Grass roots and agency events - 100 Number of linkages/partnerships with related

initiatives in Central LHIN - 10 Number of agency link to the Doorways to Care

website - 15

Deliverable 2009/10 Evaluation Plan (sample indicators) Service

Number of calls 1,500 Number of referrals 750 Number of website hits 25,000

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Marketing and Partnerships Circulation of revised marketing materials (100,000 rack cards & flyers in 21 languages)

Grass roots and agency events - 100 Number of linkages/partnerships with related

initiatives in Central LHIN - 10 Number of agency link to the Doorways to Care

website - 15

COMMUNITY/STAKEHOLDER CONSULTATION/RESULTS:

The Communications and Public Education Work Group of Doorways has reviewed the existing print materials and public outreach efforts. The Central LHIN’s Citizen Expert Panel for Seniors provided feedback on the existing approaches and materials. Key findings on Communicating with Seniors: Information from trusted sources is the most effective way to gain the trust of seniors and encourage them to call the line. This includes direct contact with seniors (one on one at events) and senior to senior and/or to trusted providers. Also, seniors find information via local community or culturally based papers and yellow pages (seniors are the largest demographic readership for community papers). These findings will be incorporated into Doorways to Care marketing plans, materials and out-reach efforts. ALIGNMENT WITH IHSP:

This plan advances Central LHIN’s Integrated Health Service Plan and is aligned with the Seniors priority. Support of Central LHIN’s System Level Goals is achieved as many of the initiatives demonstrate:

The potential cost-effectiveness and efficiency of the community sector; Increased co-ordination among the community sector agencies; Coordinated access to services; Addressing improvements in quality and standards of service delivery; New degrees of integration, collaboration and coordination.

DIVERSITY/EQUITY:

Throughout 2008/09, Doorways to Care incorporated cultural competency into its operations and will build on these strategies into 2009/10. Strategies addressing diversity include:

A translation line is available within the 1-800 access point. Certain Doorways to Care partners bring ethno-cultural perspectives to call and referral management. Existing staff within Doorways to Care agencies offer assistance in other languages including:

English, French, Mandarin, Cantonese, Italian, Hebrew, Portuguese, Spanish, Hindi, Russian, Urdu, Punjabi, Farsi, Tagalog, and Polish.

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Print materials (posters and rack cards) were translated into the following languages: Arabic, Farsi, French, Greek, Hebrew, Hindi, Italian, Latvian, Polish, Portuguese, Punjabi, Russian, Somali, Spanish, Tagalog, Tamil, Telugu and Urdu.

RECOMMENDATIONS: SOURCES OF FUNDING: Central Community Care Access Centre base budget.


CHRONIC DISEASE MANAGEMENT AND PREVENTION ADVISORY NETWORK

TERMS OF REFERENCE FEBURARY 12, 2009

1. Mandate The Purpose of the CDMP Advisory Network is to establish strategic directions and support the implementation of the Central LHIN Integrated Health Service Plan for CDMP. The Advisory Network will be the first point of contact for the CDMP Coalition and other stakeholders. The Advisory Network will, with the assistance of the Central LHIN staff:

• Identify needs and develop a strategy for CDMP for Central LHIN • Encourage stakeholders to become involved with the Coalition and the CDMP strategy

and to support the implementation of the strategy • Support knowledge building and information exchange

The Mandate of the Chronic Disease Management and Prevention Advisory Network is to determine the strategic goals and direction for chronic disease management and prevention in Central LHIN with input from the Coalition. The work of this Advisory Network will be responsive to the needs of consumers with various chronic diseases within the Central LHIN. In order to do this, the Committee will:

• Through the Central LHIN Senior Director, Planning, Integration and Community Engagement, provide advice, decision support and communication for the Central LHIN Board of Directors on CDMP activities

• Refresh the Central LHIN CDMP plan based on evidence and identified needs (e.g. demographic, epidemiological etc.)

• Develop a strategic plan, with input from the Coalition, for three years with action plans identified for years one, two and three

• Monitor the implementation of the action plans related to chronic disease management and prevention and their associated outcomes as identified in the Central LHIN IHSP. Identify challenges to timely implementation and develop appropriate mitigating strategies

• Monitor the deliverables from the projects undertaken by the work groups. • Identify new issues that arise related to implementation that need to be addressed by

future planning including system changes. • Identify key success factors, risks and appropriate mitigation strategies for chronic

disease management and prevention. • Act as a resource to and/or work in collaboration with other Central LHIN

advisory/working groups. Share knowledge with other Central LHIN planning groups and sub-committees

• Communicate and collaborate with other LHINs as appropriate • Participate at Central LHIN system planning and integration tables

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140 Allstate Parkway, Suite 210 Markham, ON L3R 5Y8

05 948-8011 Tel: 905 948-1872 • Fax: 946 Toll Free: 1 866 392-54

www.centrallhin.on.ca


As per the Central LHIN Board approved Successor Group Principles, the CDMP Advisory Network will make recommendations to the Central LHIN about funding however neither the Chair nor any member of the CDMP Advisory Network will commit any funds on behalf of the Central LHIN. Neither the Chair nor any member of the CDMP Advisory Network will speak on behalf of the Central LHIN.

2. Timelines The Advisory Network will meet monthly and a minimum of 9 times per year, with additional ad hoc meetings, as required, at the call of the Chair. Central LHIN staff will act as recorder for these meetings and maintain a file of meeting minutes and agendas.

3. Membership

Responsibility of the members is to the Central LHIN and to provide strategic recommendations to advance CDMP within the LHIN. To support continuity and consistency for decision-making, a designated delegate is not permitted to attend an Advisory Network meeting without prior approval by the Chair. To support full participation, a member who misses three consecutive meetings without prior approval of the Chair will be removed from membership. Term of membership is two years with opportunity to reappoint. A maximum of half the Advisory Network will turnover each time.

Membership shall not exceed 20 people members and shall include the following: • Central LHIN Board Member (1) • Up to 5 Senior Management/Administrators from Health Service Providers including:

o Hospital o Community Health Centre o CCAC

• Up to 5 Content experts in CDMP including: o Hospital-based chronic disease management program (2) o Community-based chronic disease management program (1) o Community-based chronic disease prevention program (2)

• Up to 4 Representatives from relevant Central LHIN Networks including: o Family Physicians Advisory Network o Health Professionals Advisory Committee o Cancer Care Network o Mental Health and Addictions

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• Up to 2 Non-LHIN Funded Health Providers engaged in CDMP

o Public Health o Family Health Team

• Administrator/Specialist in Information Technology / Information Management (1) • One Co-Chair from each active Work Group in CDMP 4. Reporting Relationships

The Advisory Network will report through the Senior Director of Planning, Integration and Community Engagement, to the Central LHIN CEO and the Central LHIN Board of Directors. The Advisory Network will establish Work Groups as required to implement the IHSP action plans. All Work Groups developed by the Advisory Network are accountable to the Advisory Network. Either the Chair or Co-chair from each of the three Working Groups will be members of the Advisory Network.

Members of the Committee will not speak on behalf of the Central LHIN. 5. Methodology

The Chronic Disease Management and Prevention Advisory Network will advance the implementation of the Central LHIN IHSP strategies related to chronic diseases by:

a. Supporting new processes, protocols, structures and supports as needed according to action plans

b. Collaborating with providers c. Leveraging local resources d. Facilitating Ministry of Health and Long Term Care support

Chair of Advisory Network

The Chair for the Advisory Network will selected by majority vote by the members of the Advisory Network, based on his or her willingness and knowledge of the chronic disease management and prevention services continuum.

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Role of Chair

The Chair for the Advisory Network includes the following roles and responsibilities:

• Chair will be the conduit of information between the Central LHIN and the Advisory Network

• Work with LHIN staff to set the meeting agendas for the Advisory Network and the Coalition

• Chair the meetings

The term of the Chair will be two years.

Decision Making • The Chronic Disease Management and Prevention Advisory Network shall operate in a non-

judgmental manner, respecting individual rights and confidentiality, employing no fault discussion and reaching consensus. The Chronic Disease Management and Prevention Advisory Network will strive for consensus with consensus being defined as being able to live with and support a decision, which does not necessarily require total agreement.

• A meeting quorum will be defined as 50% of membership plus one member. If insufficient members are present and a meeting quorum is not available, the meeting will proceed and decisions will be voted upon using electronic voting mechanisms after the meeting.

er. If insufficient members are present and a meeting quorum is not available, the meeting will proceed and decisions will be voted upon using electronic voting mechanisms after the meeting.

• The Chair shall allow for and control participation in discussion by all members in attendance. • The Chair shall allow for and control participation in discussion by all members in attendance. • When the Chair decides that a matter should be resolved by vote rather than consensus, all voting

members of the Chronic Disease Management and Prevention Advisory Network may vote. A decision can only be passed if the 50% of voting members plus one member vote in favor. Non-voting members of the Advisory Network consist of the Central LHIN Board representative and Central LHIN staff.

• When the Chair decides that a matter should be resolved by vote rather than consensus, all voting members of the Chronic Disease Management and Prevention Advisory Network may vote. A decision can only be passed if the 50% of voting members plus one member vote in favor. Non-voting members of the Advisory Network consist of the Central LHIN Board representative and Central LHIN staff.

Terms of Reference Terms of Reference The Terms of Reference will be reviewed bi-annually The Terms of Reference will be reviewed bi-annually


Appendix A

DRAFT IHSP SUCCESSOR GROUP PRINCIPLES

Approved November 25, 2008

Principles are statements or descriptions of what should or should not be done. They provide parameters or guidelines for performing the work of the Successor Groups. Principles will inform or shape all subsequent decision-making. 1. Successor Groups will provide advice and make recommendations to the Central LHIN based on best

practice and evidence based need. 2. Activities of the Successor Groups will be guided by the Central LHINs core values of collaboration and

partnership, system responsiveness and quality, people/community focused, and openness and transparency. 3. Activities of the Successor Groups will be in keeping with the strategic directions of the Central LHIN. 4. In all deliberations, the primary focus is the benefit to the community and the health care system 5. Successor Groups will be linked and coordinated to build on opportunities and successes and to minimize

duplication of effort. 6. Successor Groups will identify evaluation indicators and process for all recommendations to the Central

LHIN. 7. Successor Groups will have a transparent process for bringing advice and recommendations to the Central

LHIN, and will indicate the level of stakeholder support for such recommendations. 8. Participants are expected to bring their perspectives and experience to bear within the context of an

integrated health system. 9. It is expected that participants will inform and, where appropriate, engage, the leadership of their respective

organizations/constituency, particularly as it relates to recommendations being formulated by the group. 10. The Chairperson of the Successor Group will be the spokesperson of the Group; however, neither the Chair

nor the members of Successor Groups will speak on behalf of the Central LHIN. 11. All information and material of any kind whatsoever acquired or prepared by or for the Successor Groups

shall, both during and after the term of membership, be the sole property of the Central LHIN. 12. The Successor Groups may make recommendations to the CLHIN about funding however neither the Chair

nor any member of the Successor Group will commit any funds on behalf of Central LHIN.

Approved by Board of Directors: January 23, 2007 Revised/Re-approved: April 24, 2007 Revised/Re-approved: December 16, 2008

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DRAFT SENIORS ADVISORY NETWORK TERMS OF REFERENCE

Revised June 2008

The Terms of Reference for the Seniors Advisory Network (SAN) was revised June 2008 and are proposed to remain in effect unless revisions are required to support Central LHIN strategy

1. Mandate The mandate of the Seniors Advisory Network is to advise, support , and monitor the strategies related to seniors and specialized geriatric services contained in the Integrated Health Service Plan (IHSP) and Aging at Home.. In order to do this, the Seniors Advisory Network will: • Provide input & feedback into the development of action plans for the strategies related to

seniors, caregivers and specialized geriatric services identified in the Central LHIN IHSP and Aging at Home Strategy.

• Monitor the implementation of the action plans related to seniors, caregivers and specialized geriatric services identified in the Central LHIN IHSP and Aging at Home Strategy.

• Provide input and feedback to the Central LHIN on the processes and implementation of the action plans related to seniors, caregivers and specialized geriatric services identified in the Central LHIN IHSP and Aging at Home Strategy

• Act as a resource to and/or work in collaboration with other Central LHIN advisory/working groups

The Network will seek approval from the Board prior to implementing any actions that have a financial impact on a transfer payment agency of the Central LHIN. In fulfilling their mandate, the Network will follow successor group principles identified in Appendix A 2. Time Lines The Seniors Advisory Network will develop and monitor the work plan outlined in the Central LHIN Integrated Health Service Plan and Aging at Home Strategy for the relevant fiscal year. 3. Membership Representation – The membership of the Seniors Advisory Network will not exceed twelve (12) members and will form a comprehensive representation of individuals from across relevant sectors along the health care continuum. This will include, but is not limited to;

• Community support services, • Long term care homes, • Mental health, • Supportive housing, • Regional Geriatric Program,

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APPENDIX 13.0

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• Hospitals, • Public health, and • E-health

The constitution of membership will consist of representation necessary to fulfill the mandate of the group and/or the representational needs acquired through the strategies related to seniors and specialized geriatric services contained in the IHSP and Aging at Home. Term of Office – The term of office for each member will be two years, with opportunities for renewal at the discretion of Central LHIN Attendance – Attendance is a mandatory condition of membership to SAN, with a maximum allowance of two (2) absences per fiscal year. Exceptions can be made under extenuating circumstances. Membership is representative of the individual on the Network, not the organization. As such, delegates are not to be sent if a member is unable to attend a meeting or if a member terminates their participation prior to membership expiration date. Meetings – Regularly scheduled meetings will be held on a monthly basis. Nomination Process

• A nominating committee will be created for choosing representation on SAN. Membership will be reviewed according to candidate qualifications, expertise and ability to fully participate

• An individual will be considered to participate on SAN based on their expertise and knowledge of seniors and geriatric care as well as their ability to fill any identified gaps in representation (multi-service, multi-level, and specialty service area agencies) as identified by the SAN.

• Existing members will be given an opportunity to extend their participation on SAN for another year as long as they have fulfilled their commitment to the group (including attendance) and Central LHIN determines a continuing need for the representation

4. Reporting Relationships The Terms of Reference for the Seniors Advisory Network will be approved by the Central LHIN Board of Directors. Following Board approval, the Seniors Advisory Network will report through the Senior Director of Planning, Integration and Community Engagement, to the CEO. The Seniors Advisory Network will report directly to the Board on an annual basis about the activities of the Network and its Work Groups. Members of the Advisory Network will not speak on behalf of the Central LHIN. 5. Methodology The Seniors Advisory Network will advance the implementation of the Central LHIN IHSP strategies related to seniors and their caregivers.

The Seniors Advisory Network will also:

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• Identify challenges to timely implementation where these arise and mitigating strategies • Identify new issues that arise related to implementation that need to be addressed by future

planning • Participate at Central LHIN system planning and integration table • Share knowledge with other LHINs’ planning groups concerned with seniors and their

caregivers. The following Work Groups will be formed to develop action plans for each strategy: • Specialized Geriatric Services Work Group • Transportation Work Group • Identified Aging at Home Work Group as defined

Work Groups will be populated with members of the Seniors Advisory Network as well as other stakeholders with expertise and interest in these areas. Efforts will be made to draw on appropriate individuals who have expressed an interest in participating during the Central LHIN consultation processes.

The Network will be Co-Chaired by two members of the Network who are appointed by the Central LHIN, based on their willingness and knowledge of the seniors and specialized geriatric services sector. Term of office for each Co- Chair of the Seniors Advisory Network is one year, with opportunity for renewal at the discretion of the Central LHIN.

Role of Chairs:

• Contact with Central LHIN on behalf of the Network • The Chairperson of the Successor Group will be the spokesperson of the Group; however,

neither the Chair nor the members of Successor Groups will speak on behalf of the Central LHIN.

• Work with the meeting facilitator • Set agenda • Dispute resolution

It is intended that a consensus model of decision making will be used whenever possible.

The consensus model will encompass the following parameters:

1. Have members had the opportunity to discuss the issue? 2. Do members understand the decision to be made? 3. Can members live with the decision? 4. Can members defend the decision? 5. Are members committed to moving the decision into action


Appendix A

DRAFT IHSP SUCCESSOR GROUP PRINCIPLES

Approved November 25, 2008

Principles are statements or descriptions of what should or should not be done. They provide parameters or guidelines for performing the work of the Successor Groups. Principles will inform or shape all subsequent decision-making. 1. Successor Groups will provide advice and make recommendations to the Central LHIN based on best

practice and evidence based need. 2. Activities of the Successor Groups will be guided by the Central LHINs core values of collaboration and

partnership, system responsiveness and quality, people/community focused, and openness and transparency. 3. Activities of the Successor Groups will be in keeping with the strategic directions of the Central LHIN. 4. In all deliberations, the primary focus is the benefit to the community and the health care system 5. Successor Groups will be linked and coordinated to build on opportunities and successes and to minimize

duplication of effort. 6. Successor Groups will identify evaluation indicators and process for all recommendations to the Central

LHIN. 7. Successor Groups will have a transparent process for bringing advice and recommendations to the Central

LHIN, and will indicate the level of stakeholder support for such recommendations. 8. Participants are expected to bring their perspectives and experience to bear within the context of an

integrated health system. 9. It is expected that participants will inform and, where appropriate, engage, the leadership of their respective

organizations/constituency, particularly as it relates to recommendations being formulated by the group. 10. The Chairperson of the Successor Group will be the spokesperson of the Group; however, neither the Chair

nor the members of Successor Groups will speak on behalf of the Central LHIN. 11. All information and material of any kind whatsoever acquired or prepared by or for the Successor Groups

shall, both during and after the term of membership, be the sole property of the Central LHIN. 12. The Successor Groups may make recommendations to the CLHIN about funding however neither the Chair

nor any member of the Successor Group will commit any funds on behalf of Central LHIN.

Approved by Board of Directors: January 23, 2007 Revised/Re-approved: April 24, 2007 Revised/Re-approved: December 16, 2008

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Emergency Department Reporting System: The Emergency Department Reporting System, a data dashboard maintained by the Ministry of Health, was implemented effective October 1st 2008. The funding for the Emergency Department Pay for Results initiatives was disbursed to the 3 hospitals in October 2008. The data from November 2008 is now available and shown below:

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

2) Designated Hospitals to demonstrate a 5% absolute improvement in the proportion of CTAS I and II patients treated within ED-LOS of 8 hours or

less, and within 6 hours or less for CTAS III patients, as measured against NACRS 2007/08 baseline data:

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APPENDIX 15.0

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3) Designated Hospitals to demonstrate improvement in the proportion of patients treated within ED- LOS of 4 hours for CTAS IV and V patients, as

measured against NACRS 2007/08 baseline data:

The Ministry has confirmed that a hospital’s Q3 + Q4 2008/2009 performance will be evaluated in comparison to the baseline period (Q3 + Q4 2007/2008 National Ambulatory Care Reporting System). Although a month to month analysis is useful to view performance trends, quarterly analysis (specifically Q3 and Q4) will be more meaningful in identifying if a hospital has achieved its results. The Ministry has identified that a recovery analysis will take place in the Summer of 2009.

Final Annual Report submission due to the Ministry of Health and Long-Term Care: June 30, 2009

2008-2009 Annual Report Work Plan Theme: Caring Communities – Healthier People: Making a Difference Key messages: Advancing IHSP, promoting collaborations, adding/enhancing and sustaining our health system MOHLTC requirements:

• The Annual Report is primarily a report to meet legislative requirements • One English and one French report with original signatures of the Board Chair and one other

Board member. • Send 285 reports - 146 English and 139 French • Electronic copy to the Ministry in both English and French • Report must meet LHIN visual identity standard • Two column inside layout / Inside photos optional • Printed (double-sided) on higher quality photocopier (no designer required) • Stapled (no professional binding required)

Work Plan: High-level milestones required for delivery of the Annual Report to MOHLTC by June 30:

DATE MILESTONE March – June 2 • Content development

March – Mar 31 • Develop potential themes/key messages/narrative direction

• Work with other LHINs /CIB re approach to design and layout

March 6 • Share proposed themes and work plan with CEO

March – April 30 • Content development

April 1 • Updated work plan to board via info session

April 15 • Chair/CEO msg draft to Chair/CEO for review

April 30 • Draft content** available for review by Chair/CEO/board

May 6 • Feedback on content from Chair/CEO/Board/Snr Mngmt

May 6 – 26 • Further refinement of content

May 27 • Final approval on content by CLHIN Board

• Delivery for translation

June 16 • Final layout proof arrives/ approval by CLHIN staff

June 22 • Final printed product delivery

June 23 • Printed product provided at Board meeting for information only

June 30 (Tuesday) • Delivery to Ministry N.B. **Audited Financial Statements and performance indicators to be available late May

As at: March 15, 2009

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APPENDIX 18.0

Final Annual Report submission due to the Ministry of Health and Long-Term Care: June 30, 2009

As at: March 15, 2009

Proposed Table of Contents

I. Message from the Chair and CEO

II. Welcome to our LHIN a) Introduction b) Map c) Population profile – including numbers on aboriginal and francophone

communities d) Health profile – including aboriginal health risk facts

III. Ministry/LHIN Accountability Agreement

a) What is it?(This should be a standard, no more than two paragraphs, for all LHINs)

b) IHSP (brief description) c) Implementation of the IHSP d) Progress Report with specific examples e) Community Engagement Activities f) Evaluating CE that’s been done with the common assessment tool (tbd) g) Community Engagement Activities for 08-09 h) Aboriginal Initiatives (including community engagement activities that have taken

place in 08/09 i) Francophone Initiatives j) Integration Activities k) Report on MLAA performance indicators (chart provided by ministry + narrative

explanation of results whether positive or negative)

IV. LHIN Initiatives in support of government priorities a) ER Wait Times initiatives b) Improving ALC Situation (include examples and results to date if available)

V. Other initiatives to improve health care system in Central LHIN

VI. Analysis of LHIN Operational Performance (This refers to things like staffing,

operational infrastructure, how the LHINs are working. Should be brief and high level – Examples can be found on page 13 of Champlain’s AR from last year, or page 25 of Central’s, or page 4 from the NE LHIN)

VII. Board of Directors

a) Members – appointment date/term (photos/bios not essential) VIII. Financial Statements – this section will include the total board compensation, so there is

no need to include elsewhere.


March 2, 2009

Sent via e-mail: [email protected]

Ms. Janet Beed President and CEO Markham Stouffville Hospital 381 Church Street Markham, ON L3P 7P3

Dear Ms. Beed: RE: Markham Stouffville Hospital Child and Adolescent Mental Health Day Program per the Markham Stouffville Hospital Redevelopment Project Functional Program dated for 2013/2014 Further to our previous discussions, the Central LHIN management is pleased to provide a letter of support for the proposed Child and Adolescent Mental Health Day Program. The Central LHIN provides support based on the following principles: • Appropriate/extensive community engagement and partnerships are sought with existing service providers; • Appropriate key funding sources are identified and sustainable; • Services provided will compliment or address significant gaps in the services for children with mental health issues in the

Central LHIN. A meeting was held with key project contacts at Markham Stouffville Hospital regarding this innovative venture. We are confident that the project team at Markham Stouffville Hospital will consider the above principles in their continued planning. We believe this project will enhance the provision of mental health services for children and adolescents in the Central LHIN. As well, this program demonstrates a clear alignment with the Central LHIN Integrated Health Service Plan by increasing access to quality, mental health services. Sincerely,

Hy Eliasoph CEO Central LHIN /cs c: Kim Baker, Senior Director, Planning, Integration and Community Engagement, Central LHIN Shaukat Moloo, Senior Director, Performance, Contracts and Allocations Neil Walker, Chief Operation Officer, Markham Stouffville Hospital Irv Mapa, Senior Program Consultant, LHIN Liaison Branch

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APPENDIX 21.0

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

March 10, 2009 TO: Central LHIN Health Service Provider Executive Directors FROM: Hy Eliasoph, CEO, Central LHIN RE: Expenditures Restraint On December 2, 2008, the Ontario government announced measures to constrain spending on public salaries and to freeze the current size of the Ontario Public Service (OPS). The announcement was built upon expenditure restraint measures that were identified in the Fall Economic Statement and implemented across the OPS. As part of this exercise, ministries were asked to consider how to reduce their expenditures and to track and report on the measures taken to achieve this objective. Ministries have been asked to manage their costs, and the cost to the taxpayers of Ontario, in the following ways:

• Using non-print forms of advertising, including job advertising; • Delaying the implementation of any office relocations/expansions where possible; • Freezing the purchase/lease of new vehicles; • Postponing or cancelling IT projects or limit the scope and number of IT projects, depending on contractual obligations; • Reducing the use of print, photocopying and fax services; and • Containing travel costs by using another form of communication such as teleconferencing or video conferencing, or

combining/scheduling face-to-face meetings to maximize efficiency. In addition to these actions, the government is encouraging its partners in the Broader Public Service (BPS) to limit pay increases of employees earning more than $150,000 to 1.5 per cent. As a recipient of public funds, your organization has an obligation to ensure that these funds provide value for money and are spent prudently, in a manner that is consistent with the program mandate and funding agreement with the province. Given this obligation, and mindful of the legislative and contractual framework within which your organization operates, we would ask that you please ensure that your organization has the appropriate controls in place to govern the expenditure of public funds in a manner that is consistent with the new fiscal environment in which we find ourselves. The government, Local Health Integration Networks, and all health care providers must be mindful of the current fiscal environment as we carefully monitor the expenditure of public funds and assess our needs on an ongoing basis. Your leadership is essential to assist us in demonstrating a prudent and balanced approach in the management of public funds. Best regards,

Hy Eliasoph CEO Central LHIN /at

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APPENDIX 22.0


March 5, 2009 Sent via e-mail:

[email protected] Ms. Leela Prasaud Manager, GTA Operations LHIN Liaison Office 80 Grosvenor St., 5th Floor Hepburn Block Toronto, ON M7A 1R3 Dear Ms. Prasaud:

Re: Letter of Support – Additional CT and MRI Resources at Markham Stouffville Hospital

The Central LHIN management is please to provide this letter of support for an additional CT and MRI scanner at Markham Stouffville Hospital. The additional CT and MRI resources will help to ensure continued excellence in the delivery of progressive healthcare services at Markham Stouffville Hospital.

Enclosed are the business cases for your reference. As outlined in the business cases, Markham Stouffville Hospital has reviewed their plans to deliver increased services for inpatient, emergency room and ambulatory patients within their redeveloped campus. A core component of providing these services is rapid assessment using diagnostic technologies. Accordingly, they have added a CT scanner and an MRI in the Diagnostic Imaging Department. The design of the new space has been carefully considered with respect to the current Master Plan with input from planners, medical and allied health professionals and architects (letter attached). The hospital has confirmed that the additional CT and MRI, along with any required construction, will be fully funded by the Hospital and has been accounted for in their Local Share Plan. Capital costs will be funded by gifts from the MSH Foundation as submitted in accordance with their Local Share Plan to the Ministry of Health & Long Term Care. After reviewing the proposals submitted by Markham Stouffville Hospital, Central LHIN’s management is satisfied that this proposal is in keeping with the Central LHIN service provision goals outlined in the Central LHIN Integrated Health Services Plan (IHSP).

If you have any questions regarding the attached, please contact Kim Baker, Senior Director, Planning, Integration and Community Engagement.

Best regards,

Hy Eliasoph, Chief Executive Officer /at (Attach.) c. Irv Mapa, Senior Program Consultant, LHIN Liaison Janet Beed, President & Chief Executive Officer, MSH Kim Baker, Senior Director, Planning, Integration & Community Engagement Shaukat Moloo, Senior Director, Performance, Contracts & Allocations

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APPENDIX 23.0

CENTRAL LHIN UPDATES/media/... · Central LHIN Updates ... 11.2 Shouldice Hospital Limited ......

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