SPECIAL COUNCIL MEETING to be held on Monday, July 10, 2017 at 7:00 p.m. in the Huntsville Civic Centre, Municipal Council Chambers A G E N D A

1. ADOPTION OF AGENDA

2. DISCLOSURE OF PECUNIARY INTEREST

3. INVITED AND CEREMONIAL PRESENTATIONS

3.1 Rob Alexander, Muskoka and Area Health System Transformation Re: MAHST Report – Charting the Course for Muskoka and Area Health Care Transformation 2-59

4. REPORTS FROM MUNICIPAL OFFICERS

4.1 Report prepared by Brandon Hall – Ref. No. OPS-2017-15 60-62 RE: Un-Assumed Road Allowance Improvement Agreement, Old School House Rd

5. BY-LAWS & AGREEMENTS FOR PASSAGE

5.1 1st, 2nd, 3rd and Final Readings

a) By-law 2017-74 - Regulation and Control of Parking Amendment 63

6. CONFIRMATION BY-LAW

7. ADJOURNMENT

Page 1 of 63 Charting the Course for Muskoka and Area Health Care Transformation A Community Plan for System Integration and Sustainability

June 2017

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Contents

Sections

A. Context for Change in Muskoka and Area Page 3

B. Charting the Course with Strategic Directions Page 11

C. Sustainability and Transformation Framework: Preliminary Recommendations and Implementation Plan Page 23

D. The Path Forward Page 31

Appendices

1. Detailed Preliminary Implementation Plan Page 34 2. Evidence Supporting the Preliminary Implementation Plan Page 38 3. Partner Endorsements Page 43 4. Stakeholder Engagement Schedule Page 44 5. MAHST Membership: Council, Work Streams, Project Team Page 47 6. Related Resources Page 57

Page 3 of 63 SECTION A: Context for Change in Muskoka and Area

MUSKOKA AND AREA DEFINED: Muskoka is the most northerly of five sub-regions of the North Simcoe Muskoka Local Health Integration Network (NSM LHIN). The District Municipality of Muskoka is comprised of six lower-tier municipalities including the Towns of Gravenhurst, Bracebridge and Huntsville, and the Townships of Georgian Bay, Muskoka Lakes, and Lake of Bays. There are two First Nation communities within the District – Moose Deer Point and Wahta Mohawk First Nations located on the western side of Muskoka.

While both The District Municipality of Muskoka and the NSM LHIN are defined by clear borders, health care services do not always align with these formal boundaries. People from surrounding municipalities (West and East Parry Sound, Haliburton County and Simcoe County) access health care services FOUNDATIONS OF SUCCESS: in Muskoka for reasons of convenience or due to Innovative Care Solutions in Muskoka

traditional service patterns. For example, over 20% of • North Muskoka’s Geriatric Care Huntsville Hospital Emergency Department visits come Team and South Muskoka’s Seniors from the District of Parry Sound. Likewise, many Muskoka Assessment and Support Outreach residents migrate out of boundaries to receive health Team - Two inter-professional teams care in adjacent jurisdictions for the same reasons. The keeping people in their homes Muskoka and Area Health System Transformation (MAHST) longer, providing better Council recognizes these cross-boundary referral and coordinated care – and reducing service patterns in health transformation planning. ED visit recidivism.

SNAPSHOT OF CURRENT SERVICES: A robust health system • Through the Health Link, the serves the residents of the area through primary and Muskoka Health Hub Demonstration specialized medical care, home and community Project with three rural Health Hubs services, and post-acute care services. Access to plus a mobile unit is extending regional programs and private care enhance local care. primary care and social services to The North Muskoka Nurse Practitioner-Led Health Clinic vulnerable populations in under- and two Family Health Teams offer residents a wide serviced remote communities - and range of primary health and allied health services in providing episodic care to seasonal Muskoka, while the Almaguin Highlands Health Centre residents and visitors to the region. and Family Health Team in Burk’s Falls provide care to those living north of Huntsville. • Over 150 coordinated care plans Mental health and addictions services are offered for people with complex needs through the Canadian Mental Health Association, have been facilitated through the Muskoka-Parry Sound Branch. In addition, mental health Muskoka Community Health Link therapies are offered by Family Health Teams, Muskoka program. That number is projected Community Services and other support agencies. to double over the next year.

The local hospital - Muskoka Algonquin Healthcare (MAHC) - currently operates two acute care sites offering emergency, surgical, medical and other services. The sites – one in Huntsville and in Bracebridge – both work closely with local health providers and the community to offer specialized services tailored to local needs.

Page 4 of 63 Longer-term care is available through four long-term care facilities that serve the Muskoka area, along with a variety of privately-operated retirement homes and other services.

Extensive home and community support services are available locally - delivered by a range of small MUSKOKA COMMUNITY community-based organizations some of which are HEALTH LINK: linked to provincial and national agencies. These Partners in Collaborative organizations are supported by a strong and active Health Planning volunteer base that provides important ties to the • The District Municipality of Muskoka community. • Algonquin and Cottage Country In 2013, a Health Link partnership was formed in Muskoka Family Health Teams aimed at improving care for patients with multiple, • North Muskoka Nurse Practitioner- complex conditions. This partnership has demonstrated Led Clinic the capacity of the local health community to come • North Simcoe Muskoka Community together to tackle difficult health and human service Care Access Centre issues. Muskoka is unique as the only municipally-led • Muskoka Algonquin Healthcare Health Link in Ontario. • Canadian Mental Health Association – Muskoka Parry Sound Emergency Medical Services, First Responders and Police Branch are important partners in the provision of urgent care. • Other community organizations Community Paramedicine is a new service to the area with potential to support home bound residents and more rural areas of Muskoka.

A full understanding of our health system would include a detailed review and analysis of the wide range of health care services currently being offered.

SYSTEMIC CHALLENGES TO HEALTH CARE IN MUSKOKA AND AREA: Despite the quality health services available to Muskoka and area, local conditions and systemic challenges are threatening population health and the long-term sustainability of the local system.

• Muskoka’s population is disbursed throughout a large and rugged geography – that poses challenges to travel and access to health care services, and leads to the isolation of more remote residents. Many of the most vulnerable residents within Muskoka and area are living in rural and remote areas. There are geographic variations in availability, access and equity of health care programs and services across Muskoka.

• There are dramatic seasonal fluctuations in population and demands upon the health system – with a permanent population of 60,5991 that swells to over 145,0002 with the influx of seasonal residents – many of whom remain for extended periods. The proportion of seasonal residents across Muskoka municipalities ranges from 26% to 87% of total populations. In

1 Statistics Canada Census Profile 2016 2 2013 Second Home Study, District of Muskoka. www.muskokacivicweb.net

Page 5 of 63 addition, approximately three million people3 vacation in Muskoka annually – all of whom rely on the Muskoka health system for episodic and emergency care.

• The local population includes a large and growing cohort of vulnerable populations - This cohort includes persons with disabilities; increasing levels of poverty and below average incomes. Also troubling are the unmitigated trends in youth outmigration. While this profile is similar to many rural communities, Muskoka exhibits one of the highest indices of vulnerability in the province.4 A situation that often is overshadowed by a wealthy seasonal population and affluent retirees to the area.

• The barriers to wellness are complex and closely tied to the social determinants of health - such as economic insecurity, inadequate housing, lack of transportation, and social isolation. The solutions are likewise complex and require a coordinated, and community-wide response. The linkages between health and social services are largely informal. More formal memorandum of agreement or other service arrangements are required to ensure a cross- sectoral response to these critical issues.

3 Stats Canada Travel Survey reported 2.7 million chose Muskoka as their travel destination in 2014. It should be noted international visitors are not captured in this survey. The Regional Tourism Organization (RTO12) which includes a broader catchment area of Muskoka, Parry Sound and Algonquin Park reports 4.3 million visitors to the area in 2014. 4 Our Health Our Future, Health Link Presentation, 2015. www.muskoka.civicweb.net

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• Limited access to specialized services is creating gaps in local care - and is directly related to challenges in retaining and attracting health professionals to a rural area.5 Lack of local psycho-geriatric, psychiatric and other mental health and addiction services for adults – as well as services for youth and adolescents are often cited examples. Funding for adult and youth services comes from different provincial ministries – adding to the ‘patchwork’ approach and lack of coordination. Residential mental health and addictions programs are located outside of the Muskoka area. This results in expensive travel costs and requires extended periods away from community and family.

• Health agencies frequently work in ‘silos’ with limited strategic alignment – resulting in fragmented, uncoordinated care and a congested health system.

• The hospital’s acute care sites are aging and unsustainable. There is lack of agreement regarding the long-term vision for acute care services, and the future of acute care in Muskoka remains a contentious community issue. While an important part of the health

5 North Simcoe Muskoka has 67 specialists per 100,000 population compared to the provincial ratio of 112 specialists per 100,000 population. Source: CIHI Health Indicators interactive web – 2011 standard population 2015 data.

Page 7 of 63 system, it is difficult to clearly define the future role and requirements for acute care services until the whole health system is re-designed.

Individual programs and services are working well, but Muskoka lacks an overall strategy to address challenges and threats to the health system. Currently, there is no mechanism or authority to undertake planning, coordination and decision-making at the local, sub-LHIN level. While the importance of offering services close to home and tailored to community is recognized, the opportunities for local design and control continue to erode.

THE CASE FOR HEALTH SYSTEM TRANSFORMATION FOR MUSKOKA AND AREA: Like many communities across Ontario, Muskoka and area’s health system struggles to meet local needs and faces long term sustainability issues. The permanent population of 60,599 is relatively small but represents a challenging demographic characterized by disbursed populations, high levels of disability and other vulnerabilities. Muskoka has additional challenges shared by other communities that attract large seasonal and transient populations.

Despite its many geographic, demographic and resource challenges, Muskoka offers an environment that is conducive to whole system transformation. The learnings from the Muskoka experience will have wide-spread application among small urban, rural and remote regions of the Province.

Fundamental to the transformation process is community engagement. The call for system change in Muskoka has been heard over the past 15 years with the strongest voice coming from two key sources:

• Those concerned with the protection of acute care services in Muskoka; and • The Muskoka Community Health Link committee’s strong plea for system coordination and integration to better serve those with complex conditions and care needs.

Based on broad consultation of over 600 stakeholders to date, it is evident that the community supports a system-wide restructuring that would enhance coordination, integration and streamlining of services in order to free up and re-direct the resources necessary to preserve and enhance local services. In the words of one community service volunteer, “It’s about time!”

There is a sense of urgency in Muskoka and area. Complacency is not an option. The pace of technology and innovation is growing while local infrastructure is aging and increasingly inefficient. Change is certain - and without intentional planning to ensure a ‘Muskoka-centric’ system, local residents will experience reduced service and accessibility. The effects will be far- reaching. Inadequate health care has negative economic impact - threatening growth, jobs, and property values in a community reliant upon tourism, seasonal residents and retirees moving to the area. Resulting outmigration will lead to a growing proportion of vulnerable people – the poor, disabled and elderly.

There is readiness for change. The degree of change proposed by MAHST is only possible if supported by strong inter-personal relationships and trust that characterize Muskoka and area’s health community. The MAHST planning process has leveraged these relationships and has led to community mobilization and shared leadership for a common vision.

Page 8 of 63 There is a unique opportunity associated with this proposal – not just for Muskoka and area - but for other small urban and rural regions who may adopt a similar change plan. Think of Muskoka as a new resource or ‘capacitor’ for the province. High functioning care systems like Muskoka’s could help other jurisdictions in which waitlists exceed accepted standards by matching their demand with capacity in our smaller more flexible systems. This could be a win-win by reducing provincial waitlists … and increasing revenues for Muskoka.

PLANNING FOR CHANGE – THE MUSKOKA AND AREA HEALTH SYSTEM TRANSFORMATION (MAHST)

Two significant health planning processes have acted as catalysts for system-wide sustainability and transformation planning in Muskoka. The Acute Care Capital Planning Process and Muskoka Community Health Link have aligned efforts through MAHST.

 Muskoka Algonquin Healthcare (MAHC) – Acute Care Capital Planning Process: Muskoka Algonquin Healthcare operates two hospital sites - Huntsville District Memorial Hospital and South Muskoka Memorial Hospital in Bracebridge. From 2012 – 2015, MAHC undertook extensive planning, community engagement, and outreach in conjunction with the development of a Master Program and Plan. The recommendation for future hospital services via a ‘one site model’ led to expressions of concern by municipalities and local communities. Emerging from this process was a strong movement to save valued acute care services.

 Muskoka Community Health Link: In 2013, a Health Link partnership was created to improve care for patients with multiple, complex conditions. Through the report Our Health, Our Future … Muskoka Community Health Link proposed Muskoka-wide planning for an integrated, sustainable health system that recognized the determinants of health and strengthened ties between health and social services.

Both groups endorsed a proposal for a single, comprehensive planning group to redesign Muskoka’s health system as a person-centred, integrated, efficient and equitable model of care. A proposal to go forward with community-based planning was approved by NSM LHIN and a small Working Group was formed to frame a structure and process for change planning.

Page 9 of 63 PLANNING TIMELINE

Spring, 2016 NSM LHIN appoints small Working Group of local leaders to draft proposal for health system transformation planning process

June, 2016 A comprehensive Terms of Reference for MAHST Council approved by NSM LHIN and Expression of Interest (EOI) process launched to recruit Council membership and 60+ volunteers to engage in the planning process.

Summer/Fall 2016 NSM LHIN appoints MAHST Chair, Co-chair, followed by 6 Executive members, and 11 General Council members and 1 NSM LHIN representative.

Fall 2016 – June Executive Committee met weekly* to frame the scope and design 2017 elements for MAHST and to oversee the planning process – informed by an extensive literature and best practice evidence review.

January – June MAHST General Council meet monthly to monitor planning process, 2017 validate recommendations and approve reports.

January, 2017 Work Streams launched – Weekly meeting schedule** established • Programs and Services • Governance and Sustainability • Information Management and Technology • Stakeholder Relations and Engagement

January, 2017 Community planning workshop*** – Current State and Value Mapping

February, 2017 Community planning workshop - Future State and Idealized Re-Design

March, 2017 Community planning workshop – Validation and Recommendations

March – June, 2017 Stakeholder and community engagement strategy implemented to refine model and validate recommendations. Policy-maker and provincial level engagement undertaken. Note: Approximately 600 people engaged to date

June, 2017 FINAL REPORT SUBMITTED TO NSM LHIN: • Sustainability & Transformation Framework for Muskoka including Preliminary Recommendations • Implementation Plan • New Governance Structure Plan • Progress Report on Tasks Remaining

* Executive Committee has met approximately 19 times over 52 hours of planning time ** Work Streams have met approximately 23 times over 63 hours of planning time *** Each community workshop attracted up to 60 participants

Page 10 of 63 STORYTELLING: Each MAHST meeting opens with a request to share a story related to health care – either a good news story or a bad news story. These stories have been a powerful tool to increase awareness and understanding of system issues and the impact on people. The result is a collective ‘agitation’ among MAHST members that has strengthened their resolve to make things better. Gary is a member of the MAHST Council and he shared his story. Who is Gary? Gary and his wife are long-time residents of Muskoka and are recognized as community leaders and innovators within the arts and culture sector. In 2013, Gary suffered the sudden onset of an unidentified virus that left him paralyzed. Gary with the help of his family and friends continually struggle to access the care he needs. Gary’s story will be re-visited as the plan for transformation unfolds.

GARY’S STORY The sky was blue, the sun was shining and it was hot for the first time this year. The bugs weren’t too bad so why was I driving the road endlessly - as fast as my wheelchair could take me? I realized that the time I have been spending trying to understand "The System" has led to a state of frustration.

This chapter of the story begins with me trying to direct my own care. I called my CCAC Case Manager to set up a meeting to discuss a reassessment but couldn’t get an appointment for six weeks. At the meeting, I informed the worker that I felt I could cut out some services and would like to replace them with services I felt would be more helpful to me. Suddenly - ALL of my services were discontinued!

We needed help so my primary caregiver/wife called Health Link and I was assigned a navigator who came by to complete my intake. I now have two organizations in charge of my care.

In the midst of all of this - I am not feeling well.

• I called my Doctor - he is away for two weeks.

• I called my CCAC coordinator who told me my file is closed - and there was a wait list for an RN.

• I tried the Health Link navigator, but there was no answer.

• I was then off to the Port Carling Health Hub to find out the RPN is unable to see me for at a week.

It has been three days now and my health has deteriorated. I have no option but to call 911. Off to the South Muskoka Hospital I go where I am admitted 7 hours before I am told I shouldn’t have been admitted at all because there isn’t an Internist available at the hospital. I am then transferred to Huntsville Hospital where an Internist was available. Upon discharged from the Huntsville Hospital, a Discharge Planner informed me that she is now in charge of me.

I have been home for three weeks now and am TOTALLY CONFUSED.

It has been two months since I have had any physio and have not seen the Social Worker either. So, yesterday I called The CCAC and was told I have no support services other than a Respiratory Technologist. Since my re-assessment with CCAC and my assessment with Health Links and my communications with my new discharge planner, none of my issues have been resolved.

I FEEL STRANDED AND LOOKING FOR ‘MY HEALTH TEAM’!

Page 11 of 63 SECTION B: Charting the Course with Strategic Directions

Muskoka and Area Health System Transformation (MAHST) has been an ambitious project to help guide the redesign of the local health care system serving Muskoka and area. The locally- designed system is more responsive to local needs and places the responsibility and accountability for health system decisions in the hands of the community it serves. MAHST has engaged health, social services and community stakeholders to develop recommendations.

MAHST is aligned with broader Ministry of Health and Long-Term Care priorities (Patients First: Action Plan for Health Care, 2015; Patients First Act, 2016) and NSM LHIN priorities (NSM LHIN Integrated Health Services Plan 2016-19; Minister Hoskins Ministry – LHIN Mandate Letter, May 2017, and; Local Health System Integration Act, 2006). In addition, best practice based on Canadian and international experience, and health policy research informed the planning and design process.

WHAT IS THE GOAL OF MAHST? MAHST builds on the Institute for Healthcare Improvement’s triple aim for quality health care system in describing goals for Muskoka. An important addition is the goal to provide a better experience for providers. Retaining and attracting health care professionals is critical to a quality health system. These four interdependent elements form the foundation of the new health system and a lens through which strategic decisions are assessed6: • Better Care for the Person • Better Health for the Population • Better Experience for Providers • Better Value for the System

In addition, MAHST was commissioned with clear vision and mission statements from the small Working Group to guide its work.

6 http://www.annfammed.org/content/12/6/573.short?ssource=mfr&rss=1

Page 12 of 63 MAHST VISION STATEMENTS TO GUIDE PLANNING:

BY 2017 … We will have designed a model and implementation plan to transition to an improved health care system in Muskoka

BY 2018 … We will have an integrated governance structure in place

NO LATER THAN 2022 … The health care delivery system in Muskoka will be transformed to one that: • Will provide safe, accessible, high quality and sustainable care to individuals accessing care in Muskoka • Will be person-centred to ensure the right level of care is provided at the right time, in the right place and at the right cost to the system • Will have a program and service delivery system that avoids waste and duplication • Will achieve cost savings, retaining and redirecting these funds locally for the provision of front line health care services in Muskoka • Will have a new governance and administrative structure that is accountable for delivering quality health care and reducing administrative overhead and duplication • Will ensure the provision of the required level of care to be provided in the right place, at the right cost and at the right time to serve the demand of the population today and tomorrow • Will have an electronic portal for individuals to self-manage their care and will connect the information management systems of health care providers throughout Muskoka • Will recognize and respect the contribution it makes to the economic development, future sustainability and ultimate vitality of Muskoka

BOLD MISSION STATEMENTS TO IGNITE THE VISION:

• Design a health system that provides safe, accessible, high quality, and sustainable care to individuals. • Ensure all residents of Muskoka and area, who choose to, will have a primary health care provider. • Establish a governance structure that oversees the delivery of all health care services in Muskoka, significantly reducing and/or merging the current governance bodies. • Ensure that all transformational changes are made based on evidence, data, and best practices. • Establish a more efficient, system-wide governance and administrative structure that significantly reduces current cost, duplication, and waste, and improves quality. • Establish a better coordinated health and social service system that creates efficiencies and decreases redundancies, including unnecessary tests, medications, material procurement, collaborative procedures, integrated processes, referrals, and unnecessary wait times for service. • Retain the cost savings from the improved governance and administration structures of the health and social service system and redirect these funds back into local person-centred services and programs in Muskoka, including meeting the acute care needs of the community. • To be radically impactful and successful, free up and redeploy $10-15 million of savings through efficiencies achieved within the transformation planning process.

Page 13 of 63 ANALYSIS OF CURRENT STATE OF THE MUSKOKA AND AREA HEALTH SYSTEM: →There are many good programs and services, but they are not organized well. The current system is made up of discrete ‘silos’ of services and organizations operating largely in isolation from each other. Comprehensive mapping and analysis confirms the highly fragmented and complex nature of health care serving Muskoka - in contrast to a person-focused approach where individuals and caregivers are central and move seamlessly through the continuum of care.

Muskoka Health System – Current State

KEY PROGRAM AND SERVICES GAPS IN CURRENT STATE Same day/next day/evening service: Health Quality Ontario (HQO) reported that, based on 2014 data, only 29.4% of North Simcoe Muskoka patients reported being able to see their Primary Care Provider on the same day or next day when they were sick. This rate was the second lowest in Ontario. Emergency Department visits best managed elsewhere: Lack of access to primary care and influx of seasonal population over summer months can be linked to increased visits to the Emergency Department. Approximately 46% of Emergency Department visits are triage CTAS 4 & 5. These visits could be best managed elsewhere. Top users of the acute care system: For 2015/16, the top 1% users of the acute care system represented 32% of total costs; the top 5% of patients represented 60% of total costs. Sixty-four percent (64%) of the top 5% of users were over 65 years while 62% of the top 1% were over 65 years of age.

Lack of access to Mental Health and Addiction Services: North Simcoe Muskoka has 119 hospitalizations per 100,000 aged 15 and older for self-injury compared to 61 for Ontario. This is almost twice the rate. Data source: Muskoka District Market Share Analysis, (2017) & Sustainability (Funding) Update (Mar 23, 2017) prepared by Health System Management Services.

Page 14 of 63 →Complexity and lack of coordination in the system compromises quality of care by way of increased wait times and disruptive gaps in service. Access to Mental Health and Addiction Services is of particular concern in Muskoka and area. Delays in access to appropriate care in the right place can lead to wait times for individuals where inappropriate or an alternative level of care is provided in the wrong place. People with complex conditions who receive care from multiple care givers and access multiple programs and services are particularly challenged in navigating the system.

→Governance of Muskoka’s health system is as complex and fragmented as the model of care and delivery system. Among the 20 LHIN-funded programs alone, it is estimated that more than 120 governors (based on at least 6 governors per Board) are currently providing strategic direction and leadership to organizations under their responsibility. While local Board members provide critical links to the local community, small organizations in particular spend extensive amounts of time on administration, Board relations and fund development.

→The lack of coordinated and cross-sector response to population health indicators threatens sustainability. Data provided by the Simcoe Muskoka District Health Unit demonstrates strong links between three health indicators (tobacco use, healthy weights, and oral health, pain, and infection) and the cost to the health system. Better value for the system will mean addressing the high cost of lifestyle decisions and resulting health impacts.

Page 15 of 63 →The lack of coordinated financial and performance data available at the sub-LHIN level - and other decision support - has proven to be a significant barrier to planning. Although data is incomplete, local knowledge of the system and funding processes have been sufficient to enable current state estimates and projections. Total budget for Muskoka’s health care system is estimated at $225 million to $285 million supporting various organizations. Revenue sources include NSM LHIN, Ministry of Health and Long-Term Care, other Ministries, Municipalities, fundraising and private sources.

ESTIMATE OF ANNUAL HEALTH CARE SPENDING BREAKDOWN FOR MUSKOKA 29% Acute Care

23% LHIN and/or Ministry Funded (LTC, CCAC, Mental Health & Addictions, Community 2% 3% Support Services, FHTs, NPLC, other) 3% 2% Other Private LTC 4%

29% 14% Physicians and Nurse Practitioners 10%

10% Drugs and Labs

10% Dentistry 10%

4% Other District Funded

3% Vision 14% 23%

2% 2% Public Health

3% Other

Page 16 of 63 Population Health Cost to the Health System

Smoking – Simcoe Muskoka

• People aged 12 and older who reported smoking cigarettes daily or occasionally was 22.1% for Simcoe Muskoka compared to 17.2% for Ontario in 2014. • Estimated $7,275 per typical hospital admission in Ontario for potential smoking- attributable hospital stays (Congestive Obstructive Pulmonary Disease, Congestive Heart Failure, Respiratory System Malignancy) – 2014/15. More than 40% of these hospital stays were for patients aged 65+ with COPD.

Obesity

• Adult obesity rate in Simcoe Muskoka has increased significantly since 2001 and has been consistently above the Ontario average since 2003. Percentage of the population of North Simcoe aged 18 and older who were obese based on reported height and weight is 20.2% compared to 18.6% for Ontario. • Cost of obesity is high including direct costs to the health system (hospitalization, pharmaceuticals, physician care and institutions care) and indirect costs (economic output lost as a result of premature death and short and long term disability). • Between 2000-2008 annual economic burden of obesity in Canada - $4.6 billion.

Oral Pain and Infection

• Untreated dental problems leads pain, difficulty chewing, serious infection, and quality of life. • Estimated total cost of visits to Ontario hospital ER at least $31 million in 2015 • 499 oral health-related visits by Muskoka residents to MAHC - Bracebridge and Huntsville sites (2015/16) • Most often people were dealing with abscesses and dental pain – and sent home with prescription pain killers or antibiotics which are temporary measures.

Sources: http://simcoemuskokahealthstats.org/home.aspx Health Quality Ontario, Measuring Up 2016: a yearly report on how Ontario’s health system is performing. Toronto: Queen’s Printer for Ontario 2016 CIHI Patient Care Calculator (based on 2015 grouping methodology)

Page 17 of 63 WHAT WOULD AN IDEAL FUTURE HEALTH SYSTEM LOOK LIKE? MAHST built upon NSM LHIN’s Integrated Regional and Sub-LHIN Regional Models7 to conceptualize a sub-regional health system for Muskoka and area. An idealized and ‘Muskoka-centric’ health system would address the unique care needs of Muskoka’s permanent, seasonal and visiting populations … and address the socio- economic and geographic conditions that act as barriers MY HEALTH TEAM: to health and wellness. What would it look like? The new system will centre on MY HEALTH TEAM – primary While tailored to individual needs care-led multi-professional teams focusing on wellness care and fostering self-management. In this future state, … your Team might include: the silos are gone and there are clear pathways into and • Physician or Nurse Practitioner within the system. Service alignment and strong • Physician Assistant communications ensure seamless physical and mental • Care Coordinator health care that wraps around the patient, caregivers • Midwife and their families. Repetition in assessments will be • Registered Nurse avoided and navigation is easy. Primary care is • Social Worker coordinated with allied health services, urgent and acute • Community Home Care Worker care services – and has strong linkages with regional, • Mental Health Worker secondary and tertiary programs. Primary care and other • Dietician services will be co-located whenever possible. • Pharmacist In the future state, clinical services as well as • Physiotherapist administration and operations are supported by digital • Psychologist health and technology-based processes and tools that • Community Paramedics help streamline systems and bring services closer to home • Others as required…based on your for those in rural and remote communities. needs

The long-term vision is a care system that incorporates primary and specialized care with a full range of allied health, public health, community and social services, education services – public and private services working together to create an exceptional care community. In cases where full integration is not possible, formal partnership and/or service agreements will create the linkages necessary to address the social determinants of health.

7 Care Connections – Second Curve. www.nsmlhin.com

Page 18 of 63 SUSTAINABILITY AND TRANSFORMATION FRAMEWORK FOR HEALTH CARE IN MUSKOKA AND AREA

In the future state, a single governing authority will enable system-wide integration, planning, and performance management. The mandate of the new corporation will include service coordination (facilitate linkage between agencies) and service management (facilitate service to the public) roles –and extend to a service deliverer (provide service directly to the public) as full integration is realized and the corporation becomes the sole health service provider for Muskoka. Senior agency managers will join the staff of the new corporation.

Page 19 of 63 Potential financial impacts resulting from system transformation - have been charted for a number of key areas – by ‘level’ of impact and ‘time’ before impact realized. This analysis will inform MAHST as detailed sustainability plans are being developed. Note that each key area is described independently but could represent overlapping savings.

Potential Financial Impact Estimates of Time Before Benefits System Transformation Source of Potential Savings/ Realized Annual Impact to System Net of Investment Costs: Increase in Revenues Short term = 1 – 3 years Medium term = 2 – 5 years High = $5-$20 million Long term = 5 – 15 years Medium = $1-$5 million Low = 0-$1 million

Better management of high end users Short / Medium Term (5% of high users account for 64% of health HIGH IMPACT expenditures in Muskoka) General improvement in population health Long Term through Public Health initiatives

Acute care re-development and capital planning Long Term

HIGH / MEDIUM IMPACT Increased revenues by attracting demand for Short Term local services, repatriation of care to Muskoka, and new revenue sources

MEDIUM IMPACT Lower administrative costs Short / Medium Term

Health care at the right place and right time by Medium Term relieving congestion at high cost level of care

General improvement in population health Short Term LOW IMPACT resulting from increased access to primary care Changes in work practice Medium / Long Term

Source of Annual Financial Impact Estimates

Better management of high end users: Low estimate = $2m (3% reduction in high-end user costs through better patient focus, Health Links) High estimate = $ 20m (25% reduction in high-end user costs through better patient focus, Health Links)

General Improvement in population health: Low estimate = $5m (2% improvement in determinants of health) High estimate = $12m (5% improvement in determinants of health)

Acute Care re-development and capital planning Low estimate = $1m (MAHC proposal with a cost of capital of 2.5%) High estimate = $7m (MAHC proposal with no cost of capital)

Increased Revenues Low estimate = $2m (Based on preliminary assessment of Medical Confidence surgery analysis extrapolated to other areas) High estimate = $12m (Find method to use up 50% of excess capacity throughout system, additional sources of funding (municipal, private, foundations)

Lower Administrative Costs Low estimate = $1.7m (Use estimated FHT consolidation savings as proxy for other organizations) High estimate = $5m (Estimate 30% reduction in non-front line health care personnel through consolidation)

Care at the Right Place, Right Time Low estimate = $1m (Based on low estimates of reduction of CTAS 4/5 extrapolated to other agencies) High estimate = $3m (Based on low estimates of reduction of CTAS 4/5 extrapolated to other agencies)

Changes in work practice Low estimate Low estimate = $.1m (Detailed case study of team-based practices within Primary Care High estimate = $1m (Higher utilization of physician and NP assistance)

Page 20 of 63 A COMMON QUESTION: DOES THIS MEAN ANOTHER LAYER OF ADMINISTRATION? While a new layer of administration will be shifted into place, roles will change. In the future state, the new corporation will assume some of the roles played by the NSM LHIN, such as sub-LHIN planning, integration, performance management and engagement – at the same time informing and contributing to broader NSM LHIN-wide goals, across remaining four sub-LHIN areas. The new authority will also assume planning, administration and service management roles of participating agencies and thus be reducing their administrative burden and realigning as appropriate.

There may be increased administrative costs in the short term as the new system is put into place but in the long term overall administration will be reduced allowing resources to shift from administration to frontline services.

As the new corporation takes on responsibility for health care in the sub-region of Muskoka and area, there is a requirement that the necessary operating funds and deliverables will also be shifted through a NSM LHIN service accountability agreement.

WHAT WOULD THE CHANGES MEAN FOR MUSKOKA AND AREA RESIDENTS?

• Primary care and health teams would replace a system in which individual providers work independently from each other – a system that has created barriers and boundaries to seamless care and ease of navigation.

• Health and wellness will be the focus rather than on sickness and illness care. The best way to keep the health system sustainable is to keep the population healthy. Health care providers will join public health and the broader community to continue to put policies and programs in place to make Muskoka a healthy community.

• Individuals will feel engaged in their care plans – setting personal health goals and working in partnership with their health team to meet those goals. As a result, local residents will take more responsibility for their own health and wellness.

• Confusion associated with health system navigation will be relieved. It will be clear who to contact if questions arise – and information will be readily available.

• Fragmentation in the system will be replaced by local accountability, planning and performance management. Plans will include collaborative, proactive strategies for better population health and community vitality.

Page 21 of 63 BUILDING BLOCKS TO SUPPORT A NEW HEALTH SYSTEM: ‘GOVERNANCE AND STRATEGY’ DESIGN ELEMENTS

 Integrated governance  Strong link between health and social services planning  Integrated administrative structure  Organizational design that retains and redirects funding within Muskoka  Quality and value measurement and management  Standards for safe, high quality and sustainable care  Strong community engagement in system planning and sustainability  Strong clinical governance and provider engagement in system management  Information Technology Integrated across System  Enhanced future vitality of Muskoka

‘DELIVERY OF CARE’ DESIGN ELEMENTS

 Care navigators (person-centred care) for those with complex needs  Way-finding and triage for patients and providers  Effective location of urgent and emergency care services with focus on quality  Quick and effective primary-care based management of care trajectory  Information Technology Portal to empower self-management and provider connectivity  Reduction of waste and duplication (at lower level on the care delivery side

Page 22 of 63

What our Stakeholders told us … “It’s about time we fixed the system!”

• “The barriers and challenges to care that you have identified are right on”.

• Problems with the system leading to frustration and anger escalate as patient needs increase and become more complex.

“Muskoka is a black hole in terms of mental health services. I can’t get what I need here. I have to leave to get the residential treatment I need in order to get my kids back. I can’t afford it - and who is going to look after them while I’m away?”

• Primary care providers and other health providers are equally frustrated with the inflexibility that hampers their ability to serve the people in their care.

“The ‘silos’ have largely developed over the past 15 years as the health system has become more centralized and decision making moved out of Muskoka. The more isolated members of the community in particular have become very disconnected as local services have been dismantled.

“The old system worked because it was relationship-based. Care providers knew each other and understood the system. We have lost the small town advantage and now refer people to services out of town.”

“I do 10 times the paper work that I used to do!”

“There is an issue around balancing autonomy. Muskoka and area gains increased control of health care for our community – but at the same time, agencies and providers are losing their autonomy through integration.”

“We need to stay involved in this process. There is so much new being proposed it is hard to digest through one session. We need more information to be able to provide concrete ideas and suggestions.”

“The changes are exciting!”

Page 23 of 63 SECTION C: Sustainability and Transformation Framework: Preliminary Recommendations and Implementation Plan

The proposed system transformation is based on a transitional implementation plan that will be phased in over a five-year period starting with areas of greatest potential impact on access and quality of care for individuals - and areas that are within the control of the NSM LHIN and MAHST.

There is recognition that system change can be disruptive. The phased implementation plan reflects a commitment to ensuring that the impact of change is minimized wherever possible – both for those using health care services and the providers working in the system. Care will be taken to preserve elements of the current system that work well and are valued by residents.

During the implementation process, the Council will continue to build clarity and support through stakeholder engagement and on-going refinement and planning.

The Muskoka and Area Health System Transformation plan is framed by four strategic elements: Leadership and System Architecture for Tomorrow; Person-Centred Care for Better Health; Information Management and Technology for a Better System; and, Communication and Engagement for Community Partnerships. While separated for planning purpose, the strategic elements are interdependent and will be coordinated through the implementation process.

MUSKOKA AND AREA FRAMEWORK FOR HEALTH SYSTEM TRANSFORMATION

Leadership and Person-Centred Care System Architecture for Better Health for Tomorrow

Information Management and

Technology for a Better System

Communication and Engagement for Community------Partnerships

Page 24 of 63 KEY ELEMENTS AND CHANGE AREAS

STRATEGIC ELEMENT 1: LEADERSHIP AND SYSTEM ARCHITECTURE FOR TOMORROW A re-designed system integrating the wide range of service agencies in Muskoka and area will be supported by a new sub-LHIN authority. The governing Board will include care providers – a condition considered essential to the success of the new model as an Accountable Care Organization8.

KEY CHANGE AREAS: LHIN-FUNDED PROVIDERS Alzheimer Society of Muskoka YEAR ONE (2017 – 2018) Gravenhurst Senior Citizens 1.1 Improve service management by establishing a new Huntsville Meals on Wheels corporation – Muskoka and Area Health (MAH)9 with a Moose Deer Point First Nations single integrated governance model Muskoka Seniors

Canadian Mental Health Establish MAH as a new corporation with service Association – Muskoka Parry management, service delivery and coordination Sound responsibilities. MAH will negotiate a Service Muskoka Algonquin Healthcare Accountability Agreement with the NSM LHIN to allow for District of Municipality of Muskoka future management and delegation of program funds. – The Pines LTCH Muskoka Landing LTCH The 20 LHIN funded agencies currently operating in Muskoka Shores LTCH Muskoka and area will be invited to join MAH on a Fairvern LTCH voluntary basis. In addition, other MOHLTC funded North Simcoe Muskoka Palliative agencies such as Primary Care agencies, Family Health Care Network (Hospice Muskoka Teams, Emergency Services already committed to MAH and Hospice Huntsville) will voluntarily join in the first phase. Existing governing Wahta First Nations Boards will transition to an advisory capacity to the new Muskoka Portion Only MAH Board. An arrangement with Simcoe Muskoka Public North Simcoe Muskoka CCAC Health will allow for their important and meaningful Brain Injury of Simcoe Muskoka involvement. Canadian Red Cross Society – Muskoka YEARS TWO-FIVE (2018 – 2021/22) Deaf Access Simcoe Muskoka 1.2 Through stakeholder relationship management, MAH CNIB Simcoe Muskoka improve population health and wellness of area residents VON Simcoe Muskoka especially the highest users of the health system The Friends (North East LHIN)

Muskoka and Area Health will enhance communications, information sharing, and linkages within the local health system and public health - and with secondary and tertiary health services contributing to better population health. Partnership agreements between health and social services will ensure social determinants of health are

8 “Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals”. Final report to the Ministry of Health and Long Term Care and the Canadian Foundation for Healthcare Improvement. 2014

9 MAH has not yet been confirmed as the name of the new corporation

Page 25 of 63 addressed. MAH will advocate at municipal, provincial and federal levels for policies to support health and wellness goals.

1.3 Establish a MAH System Performance Framework to be publically and transparently accountable for the change, transformation and evolution of Muskoka and Area Health

MAH will design and implement a Muskoka and area-wide Performance Framework based on the collection of quality clinical and financial data from all agencies joining MAH. Locally generated, relevant data will be critical to the assessment of transformation activities and inform quality management, decision making and other future service capacity planning.

1.4 Increase revenues to ensure sustainability of local programs and services

MAH will establish a Revenue Generation Plan to guide sustainability strategies and activities. Potential new funding sources and investors will be identified such as: i) surgical / operating room revenues for MAHC; ii) Home and Community Care revenue; and iii) additional funding sources to support both operating and longer-term capital needs (e.g. municipal, federal, provincial, private, philanthropy, research, etc.). Ongoing review and assessment process will enable continual refinement and plan improvements.

1.5 Achieve savings to retain and redeploy in the community and ensure funds follow the individual

MAH will obtain and confirm ability and mechanism to retain savings in local health system spending. MAH will establish process to manage and de-ploy retained savings to under- serviced programs and services where the need to build capacity is the greatest. Disincentives to efficiencies and quality improvement to the system will be identified and addressed.

1.6 Develop a Human Resource Plan to retain and attract health care providers making Muskoka and Area – a great place to work

MAH will strive to become a provincial model of excellence in person-centred care, and a leader among small urban health care systems. An innovative and effective system is attractive to health professionals. Reduction of administrative and other barriers is intended to improve quality of care and improve job satisfaction. Recruitment strategies will be linked to Muskoka’s leadership and assets - and reflect input through provider engagement.

MAH will also demonstrate exemplary solutions to managing fluctuating demands on the system due to seasonal residents and influx of transient visitors.

Page 26 of 63 STRATEGIC ELEMENT 2: PERSON-CENTRED CARE FOR BETTER HEALTH My Health Team provides Muskoka and area residents with a person-centred approach to care. Inter-professional teams contribute to ‘wrap around’ support and a continuum of care to meet individual needs. Strong linkages with secondary and tertiary system provide seamless care and ease transitions among providers and services.

Priorities of the new system include consistency of services across Muskoka and area, and access to services at preferred times. Urgent and episodic care for seasonal residents and visitors to the area will be integral to the new system.

KEY CHANGE AREAS

YEAR ONE (2017 – 2018) 2.1 Design and organize a system around Primary Care with expanded services to establish My Health Team

Central to system transformation is commitment to the My Health Team concept by all primary care providers in Muskoka and area. Clear description of My Health Team and associated operating principles will be established. The inclusion of Community and Home Care into My Health Team will be confirmed. Required resources to support the new system will be identified. A sequencing plan will be adopted and implemented across the new system (with Physicians and Nurse Practitioners) - on a voluntary basis. Primary care will work to enrol the entire permanent population of the area.

2.2 Improve access to care. Primary Care appointments will be scheduled for the individual on the day of choosing and access to Urgent Care will be available

A Task Group of Primary Care Providers will validate the operating principles for My Health Team including access, standardization, extended hours, equitable and consistent care standards, addressing seasonal population demands etc. Recommendations to include these principles in 2018/19 Service Agreements will be made to the NSM LHIN through MAHST.

2.3 Improved Efficiency, Reduce Waste. There will be standardized navigation forms and systems in place / there will be less duplication and improved access to programs and services

Patients receive equitable and consistent access to programs and services across Muskoka and area. Administrative requirements for providers will be reduced by identifying key areas of duplication in process or assessment, and through development of standardized forms, practices and operating systems.

Page 27 of 63 2.4 Supports and processes in place to enable improved system navigation for individuals needing care Tools to help connect A series of tools and processes will support an with the System: interface with the health system - Wayfinding tools will Wayfinding: To help people find support self-care; Care coordination will enhance their way in the system – to better seamless and informed movement through the manage their care and self-direct system, and; System Navigators will provide their care personalized assistance for more complex patients who currently struggle to find their way - and are high Care Coordination: To help users of the system. people and providers navigate through the system to triage, to 2.5 Ensure coordinated and better integrated Mental access and to referrals for the Health and Addiction Services in Muskoka for all ages, right care with the right provider populations and required level of care at the right time

Mental Health and Addiction agencies will come System Navigation: To match together to select a lead agency and develop a people living with chronic partnership agreement to coordinate and align conditions and complex needs to programs and services for Muskoka and area. The a Team Member that will coordinate goal-oriented care partnership will define tools and processes to enable plans successful collaboration.

2.6 Future Acute Care redevelopment. Work with MAHC to incorporate outcomes of new system design into future acute care re-development planning

The role of acute care services in the Muskoka area will change as the new health system progresses. A future state prototype for Acute Care services building on the new MAH model will be designed to inform acute care planning and future capital needs. MAHC and MAHST will continue to work with the NSM LHIN and the MOHLTC to demonstrate system transformation impacts and outcomes linked to future acute care needs of Muskoka and area.

Page 28 of 63 STRATEGIC ELEMENT 3: INFORMATION MANAGEMENT AND TECHNOLOGY FOR A BETTER SYSTEM Information management and technology play a critical role across all aspects of the health system – operations and administrative; governance and management systems, clinical and patient services. Technology is an indispensable partner in health care transformation and will increasingly drive and enable system change

Digital health improves quality and access to specialized care especially for those in more rural areas of Muskoka. Those who rely on home and community-based care will be able to monitor their health status through remote service. Digital health records allow greater engagement in health and care pathways. Online tools, applications, and education provide critical access to the health resources that support informed lifestyle decisions.

KEY CHANGE AREAS

YEAR ONE (2017 – 2018) 3.1 Establish an Information Management and Technology (IM&T) Strategy for MAH MAH will undertake a comprehensive scan of existing tools and assets available from the province and through other sources in order to identify those best suited for application in Muskoka and area. At the same time, a current state assessment includes a scan of local agencies to clarify local requirements, current systems in use, and any gaps. This research is a critical first step in designing a future state vision and development strategy. Leveraging existing local, regional and provincial systems is a priority. MAH will approve all IM&T investments to ensure congruency, compatibility and movement to a standardized system with economies of scale and scope. Privacy and security are over-riding principles of the new system.

Significant investment will be necessary to develop, automate and connect the required systems – getting to where we need to go.

YEARS TWO-FIVE (2018 – 2021/22) 3.2 Develop and implement Tools and Technology-Based Systems to support MAH IM&T Strategy • A secure and private electronic My Health Record (MHR) accessible to individuals and providers - a platform for information sharing • Electronic Wayfinding – patient and provider portals and tools for self-direction, education, health promotion and wellness Care Coordination – specialized tools to connect to services and follow the care trajectory System Navigation – specialized tools to support individuals with complex needs and multiple providers • System to support the integrated operations of MAH • Supply Management System for bed and service management • A Muskoka and Area Health Privacy and Security Framework – to ensure patient information remains private and secure and act as a custodian of health care information • Access to technology that supports remote and rural communities

Page 29 of 63 STRATEGIC ELEMENT 4: COMMUNICATION AND ENGAGEMENT FOR COMMUNITY PARTNERSHIP

The MAHST commitment to communication and engagement will remain an essential and permanent component of MAH. The stakeholder engagement schedule to date has been intensive and clearly is only the beginning of an important and ongoing conversation with the residents, providers and caregivers of Muskoka and area.

The requests for more in-depth involvement in the work underway is a clear indication of community interest. Plans are in place to extend information sharing and idea exchange sessions with a wide range of stakeholders beyond the planning phase. Community groups, primary care providers, other health care providers, municipal leaders, provincial associations and user groups have expressed strong interest in participation.

KEY CHANGE AREAS

YEAR ONE (2017 – 2018) + BEYOND 4.1 Establish and execute a Communication and Engagement Strategy to support transitional implementation of the transformation plan and on-going system design and refinement

On-going communication and engagement activities will support system planning, performance measurement, and inform program and service design throughout implementation of the transformation plan.

 Community and system user advisory panels established to inform implementation planning and program/service design – My Health Team  Regular engagement sessions scheduled with primary care providers  Regular presentations to Muskoka and Area Municipal Councils  Speaker’s Bureau available to update community organizations, system agencies, cross sectoral ministries and provincial associations  Online survey launched to continue feedback following consultations and forums  MAHST updates and project information consolidated in online, accessible website/portal/applications

See Appendix 1 Preliminary Implementation Plans for detailed, phased implementation plans

Page 30 of 63 MUSKOKA AND AREA FRAMEWORK FOR HEALTH SYSTEM TRANFORMATION Implementation Summary – Year One (2017-2018)

STRATEGIC ELEMENT 1: LEADERSHIP AND SYSTEM ARCHITECTURE FOR TOMORROW

1.1 Improve service management by establishing a new corporation – Muskoka and Area Health (MAH)10 with a single integrated governance model

STRATEGIC ELEMENT 2: PERSON-CENTRED CARE FOR BETTER HEALTH

2.1 Design and organize a system around Primary Care with expanded services to establish My Health Team

2.2 Improve access to care. Primary Care appointments will be scheduled for the individual on the day of choosing and access to Urgent Care will be available

2.3 Improved Efficiency, Reduce Waste. There will be standardized navigation forms and systems in place. There will be less duplication and improved access to programs and services

2.4 Supports and processes in place to enable improved system navigation for individuals needing care

2.5 Ensure coordinated and better integrated Mental Health and Addiction Services in Muskoka for all ages, populations and required level of care

2.6 Future Acute Care redevelopment - Work with MAHC to incorporate outcomes of new system design into future acute care re-development planning

STRATEGIC ELEMENT 3: INFORMATION MANAGEMENT AND TECHNOLOGY FOR A BETTER SYSTEM

3.1 Establish an Information Management and Technology (IM&T) Strategy for MAH

STRATEGIC ELEMENT 4: COMMUNICATION AND ENGAGEMENT FOR COMMUNITY PARTNERSHIP

4.1 Establish and execute a Communication and Engagement Strategy to support transitional implementation of transformation plan and ongoing system design and refinement

10 MAH has not yet been confirmed as the name of the new corporation

Page 31 of 63 SECTION D THE PATH FORWARD

While not formally guided by a Collective Impact process, the MAHST approach shares many of the same principles. The community has come together to develop a shared agenda for better health care in Muskoka and area. Multiple organizations – from multiple sectors – are aligning efforts and resources to accomplish goals that are much broader than that of any one organization. Clearly a new ‘backbone’ organization with the capacity to coordinate, COLLABORATIVE CHANGE IS manage and deliver services is essential to whole system ALREADY HAPPENING transformation. The process is already showing results as • relationships strengthen and the belief that real change is Muskoka Physicians and Nurse Practitioners are designing a plan possible takes hold. to ensure anyone interested will The momentum associated with the MAHST project will be attached to a primary care provider. continue to grow as community engagement has stimulated awareness, understanding, interest and involvement. • Opportunities for integration are being discussed by Family Health Executive Committee, Council and Work Stream members Teams. have pledged to continue to plan and explore opportunities to collaborate and align efforts in ways that improve health • Agencies are developing joint care in Muskoka and area – aligned with MAHST principles, Quality Improvement Plans. vision and recommendations. Many quick wins within control of the providers have been identified and will be • As relationships and acted on as this proposal is under review and consideration. collaborative planning develops – so does trust and the commitment to collective action.

TRANSITION PHASE - RECOMMENDATIONS:

The MAHST Council recommends a transition approach in order to maintain current momentum and support the many volunteers continuing to work toward health system transformation.

 It is proposed that the MAHST mandate is extended and that the structure and leadership remain in place during a transition period from July 1, 2017 to March 31, 2018. This period will be recognized as MAHST 1.5.

During this period, the Council will work with NSM LHIN to further refine the proposed plan, respond to any issues or concerns, explore legal implications of the new governance model, establish a new board, and continue to engage the local community to refine and develop the plan, and oversee the creation of MAH.

 A priority for Muskoka and area is addressing the social determinants of health. To this end, future planning must align health with public health and social services to improve services and remove policy barriers to health and wellness. The levels of poverty and

Page 32 of 63 other vulnerabilities distinguish this area. Planning to remove chronic obstacles to well- being will be an important next step for MAHST. The groundwork for a ‘social determinants strategy’ will commence during the transitional implementation phase.

 A final area of work to be undertaken during transitional implementation is building linkages with the education community. The growing concerns related to chronic disease and obesity are now focussing on the health status of children – our future generation. Working closely with the educators to shift the current health status trajectories of our youth will be key to a healthy population - leading to health system sustainability.

 During this important period of planning as future requirements for acute care are being clarified, the continued funding of MAHC’s current hospital sites is important and will provide the local community with a continued sense of security and confidence in the system. Through planned stakeholder engagement activities, the community will be kept informed of the progress being made in acute care planning and will have ample opportunity to participate.

The MAHST Council is recommending a bold step toward system transformation. It is proposed that 2017-18 unexpended funds held by agencies that are committed to the MAHST process be retained and consolidated to support transition activities undertaken between July 1, 2017 and March 31, 2018. This will model the new system – retaining savings in Muskoka and area - and re- deploying them to address local priorities.

By March 31, 2018, MAHST will have completed negotiation of the new system - as well as the preparatory legal work for incorporation. This will mark the final transition to whole system transformation as Muskoka and Area Health (MAH) gains legal incorporated status and forms a new board.

Page 33 of 63

THE LAST WORD GOES TO GARY …

I have been inspired by this group of dedicated professionals and by a community that has given so freely of their time in order to help create a fair, equitable and sustainable health care delivery model for Muskoka and area, and beyond.

I am confident that by building this sustainable structure that supports placing the Patient at the center of the ‘My Health Team’ model we are on the path to creating a Beta site for a Community of Care that is strong and responsive to the needs of all Ontarians.

To paraphrase Sir Winston Churchill … “This report is not the end - Nor is it the beginning of the end. I think we are indeed coming to the End of the Beginning”.

Page 34 of 63 APPENDIX ‘1’ Detailed Preliminary Implementation Plan

Ref # Start Completion STRATEGIC ELEMENT: Change Area, Actions Date Date 1 Leadership and System Architecture for Tomorrow 01-Jul-2017 31-Apr-22 1.1 Improve service management by establishing a new corporation - Muskoka and 01-Apr-2017 01-Apr-2020 Area Health (MAH) - with a single integrated governance model 1.1.1 Establish and incorporate Muskoka and Area Health (MAH) to provide a Service 01-Jul-2017 31-Mar-2018 Management, Service Delivery and Coordination role (e.g., conduct a legal review, articles of incorporation, etc.) 1.1.2 Transition Plans negotiated and approved through NSM LHIN and MOHLTC to 01-Jul-2017 31-Mar-2018 become a new Health Service Provider, as a new corporation 1.1.3 Current Health Service Provider corporations remain in place unless voluntary 01-Jul-2017 31-Mar-2018 realignment and/or integration occurs and aligned with MAHST (e.g., FHT, LTC,…) 1.1.4 Process established that all existing Boards transition to Advisory/Advocacy within the 01-Jul-2018 31-Mar-2019 Muskoka and Area Health infrastructure 1.1.5 Muskoka and Area Health becomes a new entity and ratified with a Board 01-Apr-2017 31-Mar-2018 1.1.6 Stakeholder groups continue and select representative(s) to Muskoka and Area 01-Apr-2018 31-Mar-2019 Health 1.1.7 May need some delegated function to Board Committee (MAH) for Collective 01-Apr-2018 01-Apr-2019 Agreements and other legal issues 1.1.8 Process continues until all health service providers have been fully integrated into the 01-Apr-2018 01-Apr-2019 new governance structure 1.1.9 May need arrangement for Public Health Unit, given funding and joint accountability 01-Apr-2018 01-Apr-2020 1.2 Through stakeholder relationship management, Muskoka and Area Health will 01-Apr-2018 31-Mar-2022 improve population health and wellness of area residents, especially for the highest users of the health system 1.2.1 Muskoka and Area Health will enhance and establish communications, information 01-Apr-2018 31-Mar-2022 sharing, and linkages within the local health system and public health and with secondary and tertiary health services will contribute to better population health 1.2.2 MAH to advocate at municipal, provincial and federal levels for policies to support 01-Apr-2018 31-Mar-2022 population health and wellness goals 1.3 Establish a Muskoka and Area Health System and Performance Framework to be 01-Apr-2018 31-Mar-2022 publicly and transparently accountable for the change, transformation and evolution of Muskoka and Area Health 1.3.1 A Muskoka and Area Health System-wide Performance Framework (V1.0) will be 01-Apr-2018 31-Mar-2019 DRAFTED 1.3.2 Building off of the Framework (1.0), ensure the quality of clinical and financial / 01-Apr-2018 31-Mar-2019 statistical data used by the various agencies / providers becoming part of Muskoka and Area Health 1.3.3 Have drafted an implementation plan to roll-out the new Performance Framework 01-Apr-2018 31-Mar-2022 by the transforming Muskoka and Area Health governance body (MAHST 2.0) 1.4 Increase revenues to ensure sustainability of local programs and services 01-Apr-2018 31-Mar-2022 1.4.1 Have established an overarching Revenue Generation Plan for Muskoka and Area 01-Apr-2018 27-Mar-2020 Health, including and not limited to these areas: i) surgical / operating room revenues for MAHC; ii) Home and Community Care revenue; and iii) additional funding sources to support both operating and longer-term capital needs (e.g. municipal, federal, provincial, private, philanthropy, research, etc.) 1.4.2 Launched the implementation of the new Revenue Generation Plan 01-Apr-2018 31-Mar-2019 1.4.3 Commence approaching new investors and funders with outlined proposals and 01-Apr-2018 31-Mar-2019 supported by evaluation outcomes from Year 2 1.4.4 Attain and acquire new funding sources and investors to move forward into Year 3 01-Apr-2019 31-Mar-2020 roll-out 1.4.5 Completed the implementation roll-out and evaluation of the new Revenue 01-Apr-2020 31-Mar-2022

Page 35 of 63 Generation Plan. Continuous improvement and evaluation will carry forward 1.5 Achieve savings to retain and re-deploy savings locally and ensure funds follow the 01-Apr-2018 31-Mar-2022 individual 1.5.1 Create a mechanism and/or funding model to retain and re-deploy savings locally 01-Apr-2018 31-Mar-2019 and ensure funds follow the patients (savings re-deployed to underserved programs and service areas, funding models improved) 1.5.2 Establish within the new Muskoka and Area Funding Model the key priority areas with 01-Apr-2018 31-Mar-2022 an associated impact timeframe for improvements and savings over short, medium, and longer term, including: better management of high user of the health system (top 1 to 5%), population health improvements with Public Health, acute care consolidation, increased revenues by attracting demand for local service, repatriation of care, and new revenue sources 1.5.3 Remove disincentives to improvements to ensure best value in the system is 01-Apr-2018 31-Mar-2019 achievable 1.6 Develop a Human Resource Plant to retain and attract health care providers making 01-Apr-2018 01-Apr-2022 Muskoka a Great Place to Work (i.e. family physicians, specialists, NPs, RNs, RPNs, PSWs, SW, OT, PT, volunteers etc.) 1.6.1 Create Human Resource Plan for Muskoka and Area Health to align with MAHST 01-Apr-2018 01-Apr-2022 recommendations while becoming a provincial model and leader for small rural and urban health care transformation meeting the needs of permanent population with flexible visitor and seasonal services that enable a mechanism to link to a robust provider recruitment and retention strategy 1.6.2 Improve and evaluate job satisfaction by reducing barriers to providing excellent 01-Apr-2018 31-Mar-2022 care (e.g., by leveraging IM/IT resources, creating a team approach - My Health Team, reducing administrative burden by standardizing systems and processes, etc.)

2 Person-Centred Care for Better Health 01-Jul-2017 31-Mar-2022 2.1 Design and organize a system around Primary Care with expanded services to 01-Jul-2017 02-Apr-2019 establish My Health Team 2.1.1 All primary care providers committed to a plan to establish My Health Team with 01-Jul-2017 31-Mar-2018 common operating principles, along with the core and supportive programs and services 2.1.2 Seek commitment around My Health Team model to ensure all patients seeking 01-Jul-2017 31-Mar-2018 primary care in Muskoka and area have access to primary care provider 2.1.3 Integrate the home and community care services of CCAC into the My Health Team 01-Jul-2017 31-Mar-2018 model in partnership with NSM LHIN 2.1.4 Adopt, establish and implement the spread and sequencing of the quick wins and 01-Jul-2017 29-Dec-2017 the plan across Muskoka (with voluntary MDs and NPs) 2.1.5 Identify required resource plan to support implementation and seek additional 01-Jul-2017 29-Dec-2017 resources and support through various channels 2.1.6 Establish and formalize cross-agency agreements to operationalize My Health Team 01-Jul-2017 29-Dec-2017 2.1.7 Evaluate the process to measure success, as well as impacts and outcomes to 01-Jul-2017 29-Dec-2017 person-centred care 2.1.8 Complete a full implementation of My Health Team(s) across Muskoka will all 01-Apr-2018 31-Mar-2019 identified stakeholders 2.1.9 Create new accountability agreements with the LHIN and aligned with Muskoka & 01-Apr-2018 02-Apr-2019 Area Health Vision and Goals 2.1.10 Continue with monitoring performance results and evaluation of impacts, benefits 01-Apr-2018 02-Apr-2019 and targets (e.g., all individuals who so chose to have a Primary Care Provider, will be attached) 2.2 Improve Access to Care. Primary Care appointments will be scheduled for the 01-Jul-2017 31-Mar-2018 individual on the day of choosing and access to urgent care will be available 2.2.1 Establish a Task Group of Primary Care Providers to establish and validate the 01-Jul-2017 31-Mar-2018 operating principles for "My Health Team" (e.g. access, standardization, extended hours - weekends/evenings, equitable and consistent care, seasonal population demands, ensure all who chose to have a primary care provider will have, etc.)

Page 36 of 63 2.2.2 Clearly define: i) what is to be provided in/thru primary care vs. in acute care; ii) 01-Jul-2017 31-Mar-2018 what is meant by urgent care and determine community need for this level of care; and iii) the system required to meet needs of permanent, seasonal and tourist population (building from My Health Team implementation) 2.2.3 Provide recommendations to the LHIN via MAHST 2.0 as an input to the 2018-19 01-Jul-2017 31-Mar-2018 Funding and Service Accountability Agreements with providers 2.3 Improve Efficiency, Reduce Waste. There will be standardized navigation forms and 01-Jul-2017 31-Mar-2018 systems in place/there will be less duplication and improved access to programs and services 2.3.1 Identification of key areas for standardization of forms, practices and operating 01-Jul-2017 31-Mar-2018 systems to support the establishment of My Health Team(s) 2.3.2 Monitor and evaluate that individuals receive equitable and consistent access to 01-Jul-2017 31-Mar-2018 programs and services across Muskoka and area 2.4 Supports and processes in place to enable improved system navigation for 01-Jul-2017 31-Mar-2019 individuals needing care 2.4.1 Supports, processes and tools created and being tested to enable Wayfinding, Care 01-Jul-2017 31-Mar-2018 Coordination and System Navigation 2.4.2 Based on evaluation of roll-out in Year 1, refinements and improvements will be 01-Apr-2018 31-Mar-2019 required and further spread and/or tool development will be needed 2.5 Ensure coordinated and better integrated Mental Health & Addictions Services in 01-Jul-2017 31-Mar-2019 Muskoka for all ages, populations and required level of care 2.5.1 Engage all Mental Health and Addiction agencies to agree (consensus) on process 01-Jul-2017 31-Mar-2018 to identify and recruit lead agency that will be responsible for coordinating and better integrating Mental Health and Addiction programs and services across the age and care continuum within Muskoka (e.g. children, youth, adult and seniors living with mild to moderate to severe mental illness) 2.5.2 Conduct process to recruit and select a lead agency, responsible for coordinating 01-Jul-2017 31-Mar-2018 and better integrating Mental Health and Addiction programs and services 2.5.3 Created a Lead Agency Partnership Agreement 01-Jul-2017 31-Mar-2018 2.5.4 Based on evaluation of roll-out in Year 1, refinements and improvements will be 01-Apr-2018 31-Mar-2019 required and further spread and/or tool development will be needed 2.6 Future acute care redevelopment – work with MAHC to incorporate outcomes of new 01-Jul-2017 31-Mar-2022 system design into future acute care redevelopment plans 2.6.1 MAHST will work with MAHC to help apply the learnings, planning and projected 01-Jul-2017 31-Mar-2018 impacts of the MAHST model to help inform future Acute Care planning options. 2.6.2 A refresh of the MAHC Acute Care Programs and Services will be conducted with 01-Jul-2017 31-Mar-2018 exploration of the infrastructure requirements to support 2.6.3 MAHC and MAHST will continue to work with the NSM LHIN and the Ministry to 01-Jul-2017 31-Mar-2022 demonstrate the system transformation impacts and outcomes associated with future acute care needs of Muskoka and area, including advocating for required operational base funding stabilization 2.6.4 Redevelopment plans will continue to be refined and updated throughout the 01-Jul-2017 31-Mar-2022 planning stages with all parties working together to ensure planning is based on the best information and projections available at the time 3 Information Management and Technology for a Better System 01-Jul-2017 31-Mar-2021 3.1 Develop an overarching Information Management and Technology Strategy aligned 01-Jul-2017 31-Mar-2018 with the implementation of the recommendations for Muskoka and Area Health, including governance, sustainability, and the person-centred care model transformation 3.1.1 Current State Assessment & Gap Analysis 01-Jul-2017 31-Mar-2018 3.1.2 Develop detailed Future State Vision/Plan 01-Jul-2017 31-Mar-2018 3.2 Individuals and providers will have access to a complete electronic 01-Apr-2018 31-Mar-2021 "MyHealthRecord" (MHR) 3.2.1 Consolidate Primary Care, Specialty Care Systems 01-Apr-2018 31-Mar-2019 3.2.2 Integration with Connecting Ontario for MAHC 01-Apr-2018 31-Mar-2019 3.2.3 Develop ePrescribeIT plan 01-Apr-2018 31-Mar-2019 3.2.4 Integrate Connecting-Ontario into MHR 01-Apr-2019 31-Mar-2020

Page 37 of 63 3.2.5 Integrate OTN into MHR 01-Apr-2019 31-Mar-2020 3.2.6 Develop e-referral and e-consult strategy for MHR and MAHST providers 01-Apr-2019 31-Mar-2020 3.2.7 Implement ePrescribeIT with early adoption 01-Apr-2019 31-Mar-2020 3.2.8 Provide MHR access to common assessment tools 01-Apr-2019 31-Mar-2020 3.2.9 Provide ConnectingOntario access to Community providers 01-Apr-2019 31-Mar-2020 3.2.10 Integrate eReferral, eConsult tools into Community providers 01-Apr-2019 31-Mar-2020 3.2.11 MHR becomes a contributor to Ontario repository 01-Apr-2018 31-Mar-2020 3.2.12 Align with eHealth Ontario drug Repository Solution 01-Apr-2020 31-Mar-2021 3.2.13 Community Health/Mental Health contributing to clinical Ontario repository 01-Apr-2020 31-Mar-2021 3.3 Electronic Wayfinding tools developed for wayfinding, care coordination, system 01-Apr-2018 31-Mar-2020 navigation 3.3.1 Develop a plan for the creation of a wayfinding system/suite of tools 01-Apr-2018 31-Mar-2019 3.3.2 Develop plan for client navigation, tracking and scheduling 01-Apr-2018 31-Mar-2019 3.3.3 Build MyHealthTeam Website and patient centred application 01-Apr-2018 31-Mar-2019 3.3.4 Adopt patient tracking and navigation system best suited for MAHST 01-Apr-2019 31-Mar-2020 3.3.5 Add education and self-help content to MHT Wayfinding application/web 01-Apr-2019 31-Mar-2020 3.3.6 Launch MyHealthTeam Web and patient education web and application 01-Apr-2019 31-Mar-2020 3.4 Develop back office system to support Muskoka and Area Health (MAH) 01-Apr-2018 31-Mar-2021 3.4.1 Identify needs & priorities of support system requirements for Muskoka Health 01-Apr-2018 31-Mar-2019 3.4.2 Identify priorities and optimal return for system integration 01-Apr-2018 31-Mar-2019 3.4.3 Develop Materials Management system plan 01-Apr-2018 31-Mar-2019 3.4.4 Develop financial system requirements (A/R, A/P, Payroll etc.) 01-Apr-2018 31-Mar-2019 3.4.5 Consolidate Clinical Systems into IT infrastructure at Muskoka and Area Health 01-Apr-2020 31-Mar-2021 3.5 Develop a Supply Management System for beds and service management 01-Apr-2018 31-Mar-2020 3.5.1 Evaluate existing Bed / Service Management Solutions in MAHST 01-Apr-2018 31-Mar-2019 3.5.2 Evaluate other tools and integration capabilities 01-Apr-2018 31-Mar-2019 3.5.3 Develop/Adopt a central and complete Bed / Service Management solution for 01-Apr-2019 31-Mar-2020 MAHST 3.5.4 Visibility to manage capacity of MAHST and understand Regional availability for: 01-Apr-2019 31-Mar-2020 Acute, ALC, LTC, Mental Health, Hospice, etc. 3.6 Develop and establish a Muskoka and Area Health Privacy and Security Framework 01-Jul-2017 31-Mar-2019 3.6.1 With Governance build the framework to support the newly proposed 01-Jul-2017 31-Mar-2018 organization/Health Information Custodian 3.6.2 Evaluate framework and identify gaps in IT infrastructure to support required privacy 01-Apr-2018 31-Mar-2019 and security 3.6.3 Build requirements into IT plans and development 01-Apr-2018 31-Mar-2019 3.7 Access to technology to support remote and rural communities 01-Apr-2018 31-Mar-2019 3.7.1 Develop a plan for providing required clinical technology to remote and rural 01-Apr-2018 31-Mar-2019 communities 4 Communication and Engagement for Community Partnerships 01-Jul-2017 31-Mar-2018 4.1 Establish and execute a Communication and Engagement Strategy to support 01-Jul-2017 31-Mar-2018 transitional implementation of transformation plan and ongoing system designing and refinement

Page 38 of 63 APPENDIX ‘2’ Evidence Supporting the Preliminary Implementation Plan

KEY CHANGE AREA DATA/METRIC DATA SOURCE

1 Leadership and System Architecture for Tomorrow

Through stakeholder relationship management, Muskoka and Area Health will improve population health and 1.2 wellness of area residents, especially for the highest users of the health system.

• Health Quality Ontario, 1.2.1 Muskoka and Area According to Public Health, there are 3 key areas Measuring Up 2016: a yearly Health will enhance of improvement for Simcoe Muskoka residents: report on how Ontario’s and establish • Tobacco use health system is performing. communications, Toronto: Queen’s Printer for o 2014 stats for NSM LHIN for % of population information sharing, and who reported smoking cigarettes daily or Ontario 2016. linkages within the local occasionally was 22.1% compared to health system and 17.2% for Ontario.

public health and with • Health weights secondary and tertiary o Percentage of the population aged 18 and older who were obese based on health services will reported height and weight, 2014 – 20.2% contribute to better NSM LHIN compared to 18.6% for Ontario. population health. • Oral Health pain and infection

o Untreated dental problems can lead to pain, difficulty chewing and serious infection. o Untreated dental problems can sometimes lead to poor self-esteem, social isolation or stigma, difficulty sleeping, changes to diet and the avoidance of some activities. o People continue to go to ER and their doctors’ offices for dental issues. o ED visit on average was $1865 based on 2015 CACS weight and MAHC HBAM Unit Cost for ED ($6903) 1.5 Achieve savings to retain and re-deploy savings locally and ensure funds follow the individual.

1.5.2 Establish within the new • Estimated high users (using criteria of 4+ • Assessing Value in Ontario Muskoka and Area chronic conditions) is 2724 for 2014 population Health Links. Part 5: Health Funding Model the key – identified as being Muskoka Health Links System Performance Trends in geography. Health Links Population: 2012- priority areas with an 2014 by Luke Mondor, Kayla associated impact • Review cases where Muskoka patients are Song and Dr. Walter P. timeframe for going elsewhere for treatment for activity that Wodchis improvements and is performed at MAHC. From marketshare savings over short, report, this would include general surgery and • HIMS Marketshare medium, and longer cataracts. term, including: better • Is Rehab a possible service considering the management of high volumes of patients with hip/knee

Page 39 of 63 KEY CHANGE AREA DATA/METRIC DATA SOURCE

user of the health replacements? According to marketshare system (top 1 to 5%), analysis, most are receiving Rehab outside population health LHIN (14/81 = 17.3% treated at NSM hospitals in 2015). Number of rehab cases may improvements with increase due to best practice guidelines for Public Health, acute joint replacement and stroke. care consolidation, increased revenues by attracting demand for local service, repatriation of care, and new revenue sources.

1.5.3 Remove disincentives to Examples of disincentives in the health care improvements to ensure system: best value in the system • Patients who cannot see their family doctor is achievable. on same day/next day run the risk of being de-rostered because of “claw back” to their FP if they go to walk in clinic. • Some of the “ED visits best managed elsewhere” conditions are also quality based procedures. 2 Person-Centred Care for Better Health

2.1 Design and organize a system around Primary Care with expanded services to establish My Health Team

2.1.2 Seek commitment • As of 2015/16, 10% of Muskoka are • Health Quality Ontario, around My Health Team unattached from a primary care provider = Measuring Up 2016: a yearly model to ensure all 6376 patients report on how Ontario’s • The percentage of patients who saw a family health system is performing. patients seeking primary doctor or specialist within 7 days of discharge Toronto: Queen’s Printer for care in Muskoka and for COPD or CHF 2014/15: NSM – CHF = 51.2% Ontario 2016. area have access to and COPD = 36.0%; Ontario 45.8 for CHF and primary care provider 35.8% for COPD. • Number of family doctors per 100,000 people 2014: NSM = 96 which matches Ontario. Toronto Central is the highest at 138. • Percentage of adults aged 16 or older who have a primary care provider in 2015: NSM LHIN 95.6 compared to 93.8% Ontario. • Percentage of adults aged 16 and older who report that their provider always or often involves them in their care in Ontario 2015: 87.5% NSM LHIN compared to 85.9% Ontario. • General/Family Physician per 100,000 population (2011 population/2015 data): 109.3 for Ontario and 102.9 for Muskoka. 2.1.3 Integrate the home and • Percentage of home care patients aged 19 • Health Quality Ontario, community care or older who received their first nursing visit Measuring Up 2016: a yearly services of CCAC into within 5 days of authorization – 91.5% in NSM report on how Ontario’s LHIN compared to 93.7% Ontario. North West health system is performing. the My Health Team LHIN worst @ 89.3%. 2014/15 Toronto: Queen’s Printer for model in partnership Ontario 2016.

Page 40 of 63 KEY CHANGE AREA DATA/METRIC DATA SOURCE

with NSM LHIN

2.2 Improve Access to Care. Primary Care appointments will be scheduled for the individual on the day of choosing and access to urgent care will be available

2.2.1 Establish a Task Group • (2015) Percentage of adults (age 16 and • Health Quality Ontario, of Primary Care older) who report that getting access to care Measuring Up 2016: a yearly Providers to establish on evening or weekend, without going to ED report on how Ontario’s was very difficult or somewhat difficult, health system is performing. and validate the Ontario, by Region – 2015. NSM LHIN level - Toronto: Queen’s Printer for operating principles for 60.9 compared to 52.0 for Ontario. Ontario 2016. "My Health Team" (e.g. • (2015) Percentage of adults aged 16 and access, standardization, older who were able to see their PCP or • HQO, Quality Matters: extended hours, another PCP in their office on the same day Realizing Excellent Care for All equitable and or next day when sick – 36.1% compared to consistent care, 43.6% for Ontario • More than 90% of Ontarians have primary seasonal population care provider they can see regularly but more demands, etc.) than half report they cannot see their provider the same day or next day. • Ontarians and Canadians reported the worst access to same and next day appointments among the 11 countries in a 2013 Commonwealth Study. • More than half of patients who were treated in a hospital for conditions requiring follow-up do not see a doctor within 7 days of leaving hospital (2014/15). 2.2.2 Clearly define: i) what is • Hospitalization rate for conditions that can be • Health Quality Ontario, to be provided in/thru managed outside hospital – 2014/15 (per Measuring Up 2016: a yearly primary care vs. in 100,000 population) at LHIN level – 324 NSM report on how Ontario’s compared to 292 for Ontario health system is performing. acute care; ii) what is Toronto: Queen’s Printer for meant by urgent care Ontario 2016. and determine community need for this level of care; and iii) the system required to meet needs of permanent, seasonal and tourist population (building from My Health Team implementation).

2.3 Improved Efficiency, Reduce Waste. There will be standardized navigation forms and systems in place/there will be less duplication and improved access to programs and services.

2.3.2 Monitor and evaluate • Ambulatory care sensitive conditions • CIHI Health Indicators, website that individuals receive (specifically inpatient visits for conditions like equitable and COPD, CHF, diabetes, angina, etc.) per • HIMS marketshare – 2015/16 100,000 population (2011 population/2015 16 data consistent access to data): 363 for NSM LHIN compared to 310

Page 41 of 63 KEY CHANGE AREA DATA/METRIC DATA SOURCE

programs and services Ontario. across Muskoka and • Marketshare data shows Muskoka patients area. leaving the area for: orthopaedics, cardiology, obstetrics, neonatology and general surgery based on 2015/16 data 2.4 Supports and processes in place to enable improved system navigation for individuals needing care.

2.4.1 Supports, processes and • Home care patients as percentage of people • Health Quality Ontario, tools created and being who entered LTC with low to moderate care Measuring Up 2016: a yearly tested to enable needs who entered a long term care home report on how Ontario’s 2014/15 – 19.8% NSM compared to 17.8% for health system is performing. Wayfinding, Care Ontario. Toronto: Queen’s Printer for Coordination and • Median number of days to move into a long Ontario 2016. System Navigation term care home from either home or hospital, in Ontario 2014/15: NSM LHIN from hospital 107/from home 124; compared to 68 and 94 for Ontario. • Percentage of palliative care patients who received home care (any or palliative specific) in their last 90 days of life – 2014/15: NSM – 56.1% pall specific; 79.3% overall. Ontario – 43.3 pall specific and 76.7 overall. NSM LHIN best performing of all LHINs. • Percentage of palliative care patients who had at least one unplanned ED visit in their last 30 days of life 2014/15: 62.0% in NSM LHIN, 62.7% for Ontario. • Percentage of palliative patients who died in hospital 2014/15 – 50.4% NSM compared to 64.9% Ontario. • Readmissions within 30 days of leaving hospital for medical surgical 2014/15 per 100 patient discharges: NSM LHIN 6.8% for surgical and 13.6% for medical. Ontario is 7.0 for surgical and 13.7 for medical. • Percentage of inpatient days that were beds occupied by patients who could have been receiving care elsewhere. 2014/15: 15.0% for NSM LHIN compared to 13.7% for Ontario. Central West is best at 6.3%. 2.5 Coordinated and better integrated Mental Health & Addictions Services in Muskoka for all ages, populations and required level of care.

2.5.1 Engage all Mental • Percentage of patients who saw a family • Health Quality Ontario, Health and Addiction doctor or psychiatrist within 7 days of Measuring Up 2016: a yearly agencies to agree discharge after hospitalization for mental report on how Ontario’s illness – 2014/15: LHIN level – 25.3 compared health system is performing. (consensus) on process to 30.2 for Ontario. Toronto: Queen’s Printer for to identify and recruit • Percentage of patients readmitted to hospital Ontario 2016. lead agency that will within 30 days of discharge after be responsible for hospitalization for mental illness or addiction – • CIHI Health Indicators, website coordinating and better 2014/15: 13.7% compared to 13.1% for integrating Mental Ontario. Health and Addiction o Interesting note is that more than 60% of patients hospitalized for a mental

Page 42 of 63 KEY CHANGE AREA DATA/METRIC DATA SOURCE

programs and services illness or addiction who are across the age and readmitted to hospital within 30 days care continuum within go to a different hospital than the one from which they were most Muskoka (e.g. children, recently discharged. youth, adult and seniors • Rate of follow up seems to be impacted by living with mild to income level – Ontario stats show 27.8% follow moderate to severe up for poorest compared to 33.3% for the mental illness) richest. • Percentage of long term care home residents who suffered increased symptoms of depression, 2015/16 – NSM LHIN 23.9 compared to 24.2 for Ontario. 30.2% SE LHIN is highest and 16.5% - Toronto Central is lowest. • Self-injury hospitalization per 100,000 population using 2011 population and 2015/16 stats: 64 for Ontario compared to 127 for NSM LHIN.

Other Metrics (from CIHI Health Indicators interactive web) (2011 standard population and 2015 data):

Metric Ontario NSM LHIN Hospitalization entirely caused by alcohol – per 100,000 population 195 223 Hospitalized acute myocardial event per 100,000 population 226 286 Hospitalized stroke event per 100,000 population 145 152 Rate of acute care hospitalization due to injury per 100,000 population 490 583 Hospitalized hip fracture event per 100,000 population 476 590 30 day myocardial infarction readmission 10.9% 10.5% Wait time for hip fracture surgery (proportion within 48 hours) 89.7% 83.3% Hip replacements per 100,000 population for patients aged 18 and older 179 213 Knee replacements per 100,000 population for patients aged 18 and older 230 224 Specialist physicians per 100,000 population 111.8 66.5

Page 43 of 63 APPENDIX ‘3’ Partner Endorsements - TBC

Page 44 of 63 APPENDIX ‘4’ Stakeholder Engagement Schedule

Approximately 600 people engaged to date

Provincial

Type of Engagement Date Number of Attendees Ministry of Health & Long- Term Meeting March 29, 2017 3 Care – Dr. Bob Bell, Deputy Minister; Nancy Naylor, ADM, Delivery and Implementation; Sharon Lee Smith, ADM, Policy and Transformation Ministry of Health & Long- Term Meeting April 7, 2017 1 Care – Geoff Bannon, Director of Health Data Branch, Health Information Management Division Ontario Hospital Association Presentation/Meeting June 12, 2017 3 Association of Family Health Presentation/Meeting July 20, 2017 Teams of Ontario Ontario College of Family Presentation/Meeting Date to be confirmed Physicians Nurse Practitioners’ Association of Presentation/Meeting Date to be confirmed Ontario MPP Muskoka-Parry Sound – Norm Presentation/Meeting Date to be confirmed Miller Ministry of Health & Long- Term Presentation/Meeting Date to be confirmed Care – Dr. Bob Bell, Deputy Minister; Nancy Naylor, ADM, Delivery and Implementation

Municipal

Organization Type of Engagement Date Number of Attendees Town of Bracebridge Presentation February 1, 2017 19 Town of Huntsville Presentation February 27, 2017 17 Township of Georgian Bay Presentation March 13, 2017 14 Township of Lake of Bays Presentation March 21, 2017 14 Town of Gravenhurst Presentation April 11, 2017 9 Township of Muskoka Lakes Presentation April 12, 2017 17 Muskoka District Council Presentation June 19, 2017 30

Page 45 of 63 Governance

Organization Type of Engagement Date Number of Attendees NSM LHIN Board of Directors Presentation January 23, 2017 15 Trillium Lakelands District School Meeting March 9, 2017 1 Board – Dave Lyons, Healthy Active Living Consultant Hospice Muskoka Board Presentation March 21, 2017 8 MAHC Governance Education Presentation April 21, 2017 35 Day NSM LHIN Board of Directors Presentation April 24, 2017 15 Trillium Lakelands District School Meeting May 9, 2017 1 Board - Larry Hope, Director of Education Wahta Mohawks – Chief Philip Meeting May 9, 2017 2 Franks & Hereditary Chief Terry Sination Simcoe Muskoka District Board of Presentation May 17, 2017 19 Health Muskoka-wide Board Governors & Forum May 26, 2017 33 Administrators/Executive Directors Breakfast Huntsville Hospital Foundation Presentation June 9, 2017 19 Board Rama First Nation Presentation/Meeting July 14, 2017 Wahta Mohawks Presentation/Meeting Date to be confirmed Moose Deer Point Presentation/Meeting Date to be confirmed

Community Organizations

Organization Type of Engagement Date Number of Attendees Seniors Services Planning Table Presentation March 27, 2017 29 Lions Club of Bracebridge Presentation May 11, 2017 19 Rotary Club of Bracebridge Presentation May 19, 2017 30 Dorset Community Health Hub Presentation June 6, 2017 9 Advisory Committee Rotary Club of Huntsville Presentation June 7, 2017 21 Huntsville Hospital Auxiliary Presentation June 14, 2017 41 Rotary Club of Gravenhurst Presentation June 19, 2017 47 Huntsville Lakes Probus Club Presentation Aug. 24, 2017

Page 46 of 63 Health Care Providers

Organization Type of Engagement Date Number of Attendees South Muskoka Hospital Rounds Presentation April 27, 2017 20 Muskoka Community Health Link - Focus Group May 16, 2017 3 Care Navigator Muskoka-wide Physician & Nurse Forum May 29, 2017 51 Practitioner Dinner Muskoka-wide Patient Experience Workshop June 2, 2017 35 Design (Frontline Providers) MAHC Leadership Team Presentation June 27, 2017 24 Muskoka Midwives & Focus Group Date to be confirmed Obstetricians

System Users

Organization Type of Engagement Date Number of Attendees MAHC Patient & Family Advisory Presentation April 4, 2017 10 Committee Muskoka Community Services – Focus Group May 24, 2017 5 Clients Cottage Country Family Health Focus Group June 6, 2017 2 Team – Patients Mental Health – Patients Focus Group Date to be confirmed

Page 47 of 63 APPENDIX ‘5’ MAHST Membership: Council, Work Streams, Project Team

MAHST COUNCIL CHAIRS

Don Mitchell, MAHST COUNCIL CHAIR A resident of Huntsville, Don is a member of the Institute of Corporate Directors and is currently a Director on the Boards of Muskoka Futures and Muskoka Condominium Corporation #22. Don served as a member of the NSM LHIN Board from 2010-2015 during which time he completed a term as Vice Chair and served as Chair of the Audit committee and a member of the Governance Committee.

As a member of the Muskoka Futures Board Don is the Treasurer and is the past Chair. Recently Don completed a term on the Board of the Institute of Certified Management Consultants of Ontario (ICMCO) where he was responsible for the membership portfolio.

A graduate of the Ivey School of Business Don has an MBA and is certified by ICMCO as a Management Consultant (CMC) and the Project Management Institute (PMI) as a Project Management Professional (PMP).

Dr. Adalsteinn Brown, MAHST COUNCIL CO-CHAIR Adalsteinn Brown is Interim Dean of the Dalla Lana School of Public Health, University of Toronto and currently serves as Director of the Institute of Health Policy, Management and Evaluation (IHPME) at the School, where he has sustained and grown its reputation as an interdisciplinary Institute known for excellent scholarship and collaborative partnerships. Professor Brown holds a number of other titles, including the Dalla Lana Chair in Public Health Policy and Scientist at Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

Professor Brown has extensive leadership experience in various health-related sectors, from policy leadership with the Ontario Ministry of Health and other agencies provincially and nationally, to spearheading complex training challenges such as the IDEAS Program involving partnerships among multiple universities.

Page 48 of 63 EXECUTIVE COMMITTEE

Charlane Cluett Charlane has worked for Canadian Mental Health Association, Muskoka –Parry Sound (formerly known as Muskoka Parry-Sound Community Mental Health Services) for over 27 years where she started as a frontline counsellor, advancing to the role of Manager of Operations (Muskoka) which she has held for the last 12 years. In her tenure, Charlane established the Assertive Community Treatment team for Muskoka and Parry Sound and served as interim Executive Director for 4 months. She has participated in the integration of mental health and addiction services, and served as Co-chair of the inaugural Muskoka Health Link Steering Committee. Charlane is currently Vice Chair of the Muskoka Victim Services Board of Directors and Co-Chair of the Ontario Provincial Police Mental Health Advisory Committee. She has a strong belief in community development and continuity of care, advocating that every door is the right door for service accessibility. She passionately believes that everyone belongs, is important and valuable, needs hope, can recover and needs a good cheerleader. Charlane graduated from Wilfred Laurier University with a Masters in Social Work. She was born and raised in Virginia where she experienced poverty first hand. She has survived an abusive and alcoholic family life growing up and an abusive marriage, but has been rewarded now with a marriage of over 30 years and 2 children. She lives in Bracebridge where she enjoys flying, motorcycle riding, gardening, reading, cooking, and quilting.

Gary Froude Gary moved to Muskoka 20 years ago where he met Gayle Dempsey, the love of his life who shares his passions and life’s work. Gary became Managing Director of the Muskoka Lakes Music Festival which evolved into an international Chautauqua and chaired the national Arts Network for Children and Youth for several years. Gary was one of the first presidents of a newly formed Rotary Club in Muskoka Lakes and was Secretary of a leading edge, affordable home ownership project. He has served as Chair of the Board for both Muskoka Tourism and the Regional Tourism Organization (RTO 12) Explorers’ Edge. In 2012 Gary was honoured to receive the Muskoka Citizen of the Year award. Gary and his wife are very active members of their community, striving for positive change and valuing quality of life. They believe that arts and culture are what gives a community the glue to work together and gives tourists the depth of experience they are looking for. In 2013, Gary was paralyzed by an unknown virus and was introduced to the field of health care as he gained insight into the challenges of complex continuing care in the province and in Muskoka.

David Mathies, MD Dr. David Mathies has lived in Huntsville for the past 35 years, arriving out of a residency in Family Medicine from the University of Western Ontario. His goal in coming to a rural setting was to practice comprehensively, and his scope of practice has included Obstetrics, Emergency Room, Hospital, Nursing Home, as well as a large office practice. He is also part owner of a multi-specialty building in Huntsville, and Lead of the Huntsville Family Health Organization. Early on, Dr. Mathies became involved in system management, accepting positions on the Medical Staff executive, and then expanding to become involved in provincial medical affairs. This culminated in a term as President of the Ontario College of Family Physicians. He continues to serve on the Finance Committee of the College of Family Physicians of Canada. He participated in OMA negotiations as a member of the Ministry of Health negotiating team that saw the initiation of Family Practice group funding through rostering and Family Health Teams. He was an instigator of the Family Health Team in Huntsville as part of the first provincial rollout of these teams. Overlapping these roles, Dr. Mathies served for seventeen years as the Chief of Staff of Algonquin Health Services and then after hospital amalgamation, of Muskoka Algonquin Healthcare. He has an abiding interest in the integration of health services as the preferred model of health service organization. He promoted the investigation for Huntsville of Comprehensive Health Organizations in the 1980s, the amalgamation of South Muskoka and Huntsville Hospital in the 1990s and early 2000s, and now actively champions comprehensive integration of health services for all of Muskoka.

Page 49 of 63

Philip Matthews Philip Matthews is a Chartered Accountant with an M.A. Economics (Hons.) from Edinburgh University. Mr. Matthews was a Partner with Clarkson Gordon/Ernst & Young from 1980 until he retired in 2004. Mr. Matthews is currently serving as Director with a number of organizations. He is Chair of the Audit Committee and member of the Governance Committee with Exco Technologies Limited. As well, he is Chair of the Board, Lakeland Holding Ltd., Bracebridge Generation Ltd., Lakeland Power Distribution Ltd., and Lakeland Energy/Networks. Since his election to the Muskoka Algonquin Healthcare Board of Directors in 2011, Mr. Matthews has served as Chair of the Resources, Audit and Strategic Planning Committees as well as Co- Chair of the Master Program/Master Plan Ad Hoc Steering Committee. Currently, Mr. Matthews holds the position of Vice-Chair of the Board and Chair of the Quality & Patient Safety Committee.

Sven Miglin Sven has been an independent business operator since 1976. Sven has an engineering degree from the University of Toronto and an MBA from the York University School of Business. Sven and his wife Donna, along with his brother Eric Miglin created Alquon Ventures. Together they have operated the Portage Store in Algonquin Park for more than 40 years under contract from the Ontario government. During that time, Alquon Ventures has also operated other concessions and campgrounds in Algonquin Park, as well as retail stores in Huntsville, including Flotron’s on Main Street. Today, Sven’s daughter Liana and her spouse Vince have joined Alquon Ventures as the business transitions to the next generation. A resident of Huntsville since 1985, Sven has been actively involved in his community. He served as a Town and District Councillor for two terms, President of the Huntsville Chamber of Commerce, and more recently as Chair of the Board of Muskoka Algonquin Healthcare. Sven enjoys an active lifestyle, skiing, golfing and canoeing in Algonquin Park and was previously a member of the Huntsville Goodtymers Hockey team. He and Donna have two children and four grandchildren.

Larry Saunders A career banker by background, Larry was employed by the Bank of Montreal and Chase Manhattan Bank of Canada, working in branch, area, regional, and head office roles. These positions provided extensive experience in human resources, personal and commercial account management, marketing, credit, training, national mortgage operations and Ontario operations backroom processing centre. Operations positions provided exposure to end to end processing analysis resulting in efficiency improvements and change management implementation. Previous volunteer leadership positions were held with the Richmond Hill Hockey Association, Appeals Committee of Ontario Hockey Federation, York Central Hospital Foundation, Beta Theta Pi Foundation of Canada, Muskoka Algonquin Healthcare Chair and most recently North Simcoe Muskoka LHIN Board Member. Larry graduated from the University of Western Ontario with a degree in Social Sciences – Economics.

John Sisson John has been the Chief Administrative Officer for the Town of Bracebridge since June 2007, responsible for leadership and general management of the Corporation. Prior to starting with the Town, John had over 19 years of progressively responsible senior municipal experience with the City of Barrie. John graduated from Queen’s University with a Masters Degree in Public Administration. He received an Honours Bachelor of Arts Degree from Wilfrid Laurier University with a major in Political Science and courses in Urban Studies. John holds the Certified Human Resource Leader (CHRL) designation from the Human Resources Professionals Association and the Certified Municipal Officer (CMO) designation from the Association of Municipal Managers, Clerks and Treasurers of Ontario. John is an active member of the Ontario Municipal Administrator’s Association. In addition to his busy role with the Town, John serves as a member of the Board of Directors of Hospice Muskoka.

Page 50 of 63 GENERAL COUNCIL MEMBERS

MEMBER SECTOR REPRESENTED

Rob Alexander: Business leader Municipal - North Area

Natalie Bubela: CEO, Muskoka Algonquin Healthcare Acute Care

Dr. Keith Cross: Family Physician Physician

Valerie Johnston: Private consultant Mental Health and Addiction

Sue Kelly: Registered Nurse, Community Health Nurse Community and Home Care

John Klinck: Chair, District Municipality of Muskoka District Municipality of Muskoka

Christine Fitchett: NP, Cottage Country Health Team Nurse Practitioner

Colleen Nisbet: Director Clinical Services, Simcoe Muskoka District Public Health Health Unit

Lynn Sharer/Shelly van den Heuvel: Algonquin Family Health Team – Family Health Teams former Executive Director, Cottage Country Family Health Team – Executive Director (shared appointment)

Graydon Smith: Mayor, Town of Bracebridge Municipal, South Area

Rick Williams: Commission, Community Services, District Municipality Long-Term Care and Social Services of Muskoka

Neil Walker: Chief Operating Officer, NSM LHIN North Simcoe Muskoka Local Integrated Health Network

Page 51 of 63 WORK STREAM MEMBERS

1. Governance and Sustainability Work Stream

CHAIR Governance: Rick Williams Muskoka’s Commissioner of Community Services Rick Williams is a change agent and educator, with leadership experience in human, health and social services at both regional and provincial levels. Rick’s greatest strengths are as an innovator and relationship builder. His thoughtful manner help him in bringing groups together to tackle complex issues and achieve positive and successful outcomes.

Rick earned his B.A. in Psychology/Economics at Queens and his M.A. in Clinical Psychology from the University of Toronto. He began his career as a professor in Early Children Education at Loyalist College, before starting his work with the Provincial Government where he served as Director, Social Planning Supports and as Administrator, Prince Edward Heights. Rick left his work at the provincial level to follow his passion to work directly with communities through Municipal social and human services leadership roles in Eastern Ontario as well as Muskoka.

Rick has previously served as Board member and President, Ontario Municipal Social Services Association (OMSSA) and a board member with the Ontario Non Profit LTC Association. His history of community leadership also includes time as Chair of the Belleville Transit Commission, Chair of the Arts Council, Trustee with the Hastings County Board of Education, and President, Belleville District YMCA.

Rick was born and grew up in Montreal. He has played and coached a lot of basketball.

CHAIR Sustainability: Rob Alexander Rob Alexander is President of R. Alexander & Co., a management and technical consultancy focused on leading turnarounds, and growth strategies and advising for mergers and acquisitions primarily for small to medium sized businesses in the US, Canada and Europe.

Currently he is COO of MBRP, Inc., a fast growing developer and manufacturer of branded performance products for the automotive and power sports markets in Muskoka. Prior to that, he led the turnaround and subsequent sale of Farmer Automatic, an agricultural automation company in Germany.

Rob is also a shareholder of Sheer Technology Inc., a private research and development company focused on Clean Tech innovations and commercialization of an underwater drone called Starfish.

Prior to starting R. Alexander & Co., Rob was the majority owner and CEO of Algonquin Automotive, an award-winning exterior automotive accessory supplier to Toyota, GM, and Chrysler. He led a leveraged buyout of the company in 1998, and sold Hidden Hitch in 2001. Rob led the growth of Algonquin Group from $18 million in sales to over $100 million. Algonquin Automotive had operations in Ontario, Canada, Detroit and LA, and Suzhou in China. Rob chaired Toyota’s Supplier Alliance for 8 years. Rob sold Algonquin in 2009.

Prior to Algonquin, Rob advised large businesses on strategy and operations for the global consulting firm McKinsey & Co. He also spent two years working in New York in corporate finance for Kidder Peabody and a year traveling and doing volunteer work in Asia and Europe.

Rob has a Bachelor of Science in Electrical Engineering and Computer Science from Princeton University, and two Masters of Science degrees in Management (Sloan School) and Mechanical Engineering from the Massachusetts Institute of Technology. Rob is a fellow of the Leaders for Global Operations program.

Rob is very active in the Christian community. He is a leader and speaker for the Leader Impact, a division of Power to Change and an Elder and Worship Team member for the 3 Crosses Café. He is involved in

Page 52 of 63 numerous charitable activities including house builds, mission trips, Christian radio, mentoring programs, outreach activities and education (Montessori, Georgian College).

He lives in Huntsville, Ontario, Canada with his wife Roberta, and three children, Chelsea, Luke and Noah.

MEMBERS: • Dr. David Mathies, Medical Doctor • Dr. Keith Cross, Medical Doctor • Valerie Johnston, Mental Health and Addictions • Dr. Caroline Correia, Medical Doctor • Dr. Jennifer MacMillan, Surgeon • Philip Matthews, Board of Directors, Muskoka Algonquin Healthcare • John Sisson, Chief Administrative Officer, Town of Bracebridge • Tim Smith, Chief Financial Officer, Muskoka Algonquin Healthcare • Shelly Van den Heuvel, Executive Director, Cottage Country FHT • Larry Saunders, Board Member, North Simcoe Muskoka LHIN

Page 53 of 63 2. Programs and Services Work Stream

CHAIR: Harold Featherston Harold Featherston is the Chief Executive Diagnostics, Ambulatory and Planning for Muskoka Algonquin Healthcare in Muskoka, Ontario. He received his Respiratory Therapy Diploma from Algonquin College, and is a graduate of the Advanced Health Leadership Program from the Rotman School of Business at the University of Toronto. With over 30 years of experience, he is a seasoned healthcare professional whose career has taken him through several phases. From front line Respiratory Therapist, to diagnostics, clinical instructor, management, and for the past 10 years, in Senior Leadership positions. In his planning role Harold has led the capital redevelopment planning for MAHC. Regionally, Harold has participated on the NSM LHIN Leadership Council, and played an active role in the development of the local Health Links. Harold has held positions with the College of Respiratory Therapists sitting on the Discipline Committee, and chaired the Quality Assurance Committee for 3 years. Provincially, he is currently the Vice Chair of the GTA-w DIR (Diagnostic Imaging Repository) Executive Council.

In his spare time, when not spending time with his family, Harold is the Medical Coordinator for a Muskoka based half-ironman triathlon, and enjoys writing about himself in the 3rd person.

CO-CHAIR: Charlane Cluett Charlane has worked for Canadian Mental Health Association, Muskoka –Parry Sound (formerly known as Muskoka Parry-Sound Community Mental Health Services) for over 27 years where she started as a frontline counsellor, advancing to the role of Manager of Operations (Muskoka) which she has held for the last 12 years. In her tenure, Charlane established the Assertive Community Treatment team for Muskoka and Parry Sound and served as interim Executive Director for 4 months. She has participated in the integration of mental health and addiction services, and served as Co-chair of the inaugural Muskoka Health Link Steering Committee. Charlane is currently Vice Chair of the Muskoka Victim Services Board of Directors and Co-Chair of the Ontario Provincial Police Mental Health Advisory Committee. She has a strong belief in community development and continuity of care, advocating that every door is the right door for service accessibility. She passionately believes that everyone belongs, is important and valuable, needs hope, can recover and needs a good cheerleader. Charlane graduated from Wilfred Laurier University with a Masters in Social Work. She was born and raised in Virginia where she experienced poverty first hand. She has survived an abusive and alcoholic family life growing up and an abusive marriage, but has been rewarded with a marriage of over 30 years and 2 children. She lives in Bracebridge where she enjoys flying, motorcycle riding, gardening, reading, cooking, and quilting.

MEMBERS: • Dr. Jessica Reid, Medical Doctor • Natalie Bubela, CEO, Muskoka Algonquin Healthcare • Beth Ward, North Simcoe Muskoka LHIN • Dr. Greg Stewart, Medical Doctor • Leanna Lefebvre, Nurse Practitioner • Dr. Kirsten Jewell, Medical Doctor • Dr. Sheena Branigan, Medical Doctor • Dianne Smith, Midwife, Midwives of Muskoka • Sue Kelly, Community and Home Care • Sven Miglin, Alquon Ventures • Jeff McWilliam, Chief, Paramedic Services & Emergency Planning • Colleen Nisbet, Director, Clinical Services, Simcoe Muskoka District Health Unit • Neil Walker, Vice President, System Transformation, North Simcoe Muskoka LHIN • Marliese Gause, CEO, The Friends • Shelly Van den Heuvel, Executive Director, Cottage Country FHT

Page 54 of 63 3. Information Management and Technology Work Stream

CHAIR: Beth Goodhew Beth Goodhew graduated from the University of Waterloo in 1985 with a Bachelor of Math, Computer Science Degree. Following graduation she worked with General Electric Canada for 17 years holding positions in Information Technology (IT) Management, Customer Service Management, Services Marketing and finally Manager for GE Healthcare Canada IT Professional Services.

Ms. Goodhew has worked in the health care IT industry for over 20 years. She has worked with regional health care boards and LHINs across Canada, partnering with Canada Health Infoway and Provincial eHealth organizations to define governance, privacy and security for the delivery of aspects of the electronic medical record to Canadians.

Ms. Goodhew has owned and managed a health care IT consulting company since April 2003 that delivers consulting services including strategic planning and implementation of IT systems that enable the sharing of data across the health care system. Her projects include the Ontario Perinatal Registry, Ontario Osteoporosis Data Management and Research Solution, and the Ontario Regional Diagnostic Imaging Networks.

Ms. Goodhew and her family have cottaged in Muskoka for the last 25 years and in 2015 she retired and moved to Huntsville with her husband making it their permanent home. Beth loves to golf, hike, snowshoe, cross-country ski and curl. She has two grown children living in British Columbia.

Ms. Goodhew was elected to the Board of Directors in June 2016 and serves on the Quality and Patient Safety Committee.

MEMBERS: • Robert de Korte, General Manager, The Garage, MBRP Performance Exhaust

Page 55 of 63 4. Stakeholder Relations and Engagement Work Stream

CHAIR: Gary Froude Gary moved to Muskoka 20 years ago where he met Gayle Dempsey, the love of his life who shares his passions and life’s work. Gary became Managing Director of the Muskoka Lakes Music Festival which evolved into an international Chautauqua and chaired the national Arts Network for Children and Youth for several years. Gary was one of the first presidents of a newly formed Rotary Club in Muskoka Lakes and was Secretary of a leading edge, affordable home ownership project. He has served as Chair of the Board for both Muskoka Tourism and the Regional Tourism Organization (RTO 12) Explorers’ Edge. In 2012 Gary was honoured to receive the Muskoka Citizen of the Year award. Gary and his wife are very active members of their community, striving for positive change and valuing quality of life. They believe that arts and culture are what gives a community the glue to work together and gives tourists the depth of experience they are looking for. In 2013, Gary was paralyzed by an unknown virus and was introduced to the field of health care as he gained insight into the challenges of complex continuing care in the province and in Muskoka.

MEMBERS: • Lynn Sharer, Executive Director, Algonquin FHT • John Sisson, Chief Administrative Officer, Town of Bracebridge • Sven Miglin, Alquon Ventures • Charlane Cluett, Manager of Operations, Canadian Mental Health Association - Muskoka-Parry Sound • Philip Matthews, Board of Directors, Muskoka Algonquin Healthcare • Elaine Harkiss-Laird, Dragonfly HR Solutions Inc. • Rick Williams, Commissioner, Community Services, The District Municipality of Muskoka • Dr. David Mathies, Medical Doctor • Neil Walker, Vice President, System Transformation, North Simcoe Muskoka LHIN • Graydon Smith, Mayor, Town of Bracebridge • Larry Saunders, Board Member, North Simcoe Muskoka LHIN • John Klinck, District Chair, The District Municipality of Muskoka

Page 56 of 63 MAHST PROJECT TEAM MEMBERS

Project Director: Cheryl Faber Cheryl’s motto in life is to find balance in everything that she does. She values commitment, determination, honesty, purposefulness and authentic leadership.

She enjoys living and being active outdoors in Muskoka by keeping herself busy with swimming, biking and running. She prefers to think that variety is the spice of life; and that “life is not measured by the number of breaths we take, but by the number of moments that take our breath away” (Tahitian Choreographies by Vicki Corona).

She works as Director with the District Municipality of Muskoka’s Community Services Department, leading out on the innovative and exciting Muskoka and Area Health System Transformation (MAHST) project. She thrives on building collaborative, trusting and open relationships with stakeholders in order to work together for a shared vision and collective impact…of which MAHST is a true example of ‘grass roots’ community empowerment and ownership for a sustainable local health system. Having steered the collaborative implementation of both the Muskoka Health Link and Muskoka Community Health Hubs initiatives, along with ten years of strategic planning, engagement and integration experience at the North Simcoe Muskoka Local Health Integration Network made her well qualified for this leading edge transformation undertaking. A strategic planner and systems thinker that brings with her master’s education preparation, teaching faculty and various professional leadership experiences from many sectors across community including health, social services, health promotion and prevention, children & youth services, education, municipal and provincial government.

Communications and Engagement Lead: Molly Ross Molly is a relationship management professional with more than 15 years of leadership experience as a strategist and facilitator. Molly excels in working with groups to forge a clear path forward, by engaging and drawing out perspectives from all stakeholders. Her diverse roles in consulting, corporate, not-for-profit, and municipal settings give her a great appreciation for the complexity and realities of communicating and building relationships within and across these dynamic environments. She specializes in synthesizing complex ideas into consumable models and bringing clarity to ambiguous topics and issues. Molly personifies the learning organization by continually testing new ideas and approaches to address the unique needs of the organizations and projects she is engaged with.

Molly is the Communications Officer for the District Municipality of Muskoka and has served as Communication and Engagement Lead for the MASHT project since its inception in 2016. Molly was previously Principal Consultant with Bloom Strategic Solutions and Consulting Inc., a boutique consulting firm specializing in community engagement and strategic planning. Clients included the District Municipality of Muskoka; North Simcoe Muskoka Specialized Geriatric Services Program, Muskoka Health Link; Township of Muskoka Lakes; Township of Lake of Bays; Town of Gravenhurst; Muskoka Futures CFDC; Huntsville Lake of Bays Chamber of Commerce; Volunteer Muskoka; Muskoka Women’s Advisory Group; Ontario Association of Certified Engineering Technicians and Technologists.

Molly has extensive professional and volunteer networks throughout Muskoka and at a provincial level, with links across multiple sectors: community economic development; health and human services; arts, culture and heritage; and education. She currently serves on the Board of the Rural Ontario Institute (Treasurer) and volunteers locally in her home community.

Project Coordinator: Jennifer Duncan

Project Coordinator: Leigh Diggles

Shelley Perritt: Data Analysis Specialist - Health Information Management Services

Dr. Mary Robertson Lacroix: Documentation Specialist - ME Robertson & Associates

Page 57 of 63 APPENDIX ‘6’ Best Practice and Framing Resources

REFERENCES

Bodenheimer, T., Sinsky, C. (2014). “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider”, Annuals of Family Medicine. Retrieved from: http://www.annfammed.org/content/12/6/ 573.short?ssource=mfr&rss=1

Canadian Foundation for Healthcare Improvement (2014). Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals. Retrieved from: http://www.cfhi- fcass.ca/sf-docs/default-source/reports/exploring-accountable-care-brown-en.pdf?sfvrsn=2

Department of Family and Community Medicine Quality Improvement Program, University of Toronto (2016). The Teaming Project: Learning from high functioning interprofessional primary care teams. Retrieved from: http://www.dfcm.utoronto.ca/sites/default/files/The%20Teaming%20Project%20Repor %202016-10-17.pdf

Laycock, E., Fischer, E., Haldenby, E. (2017). Saving STPs: Achieving meaningful health and social care reform. Retrieved from: http://www.reform.uk/publication/saving-stps-achieving-meaningful-health-and- social-care-reform/

Ministry of Health and Long-Term Care (2015). Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. Retrieved from: http://www.health.gov.on.ca

North Simcoe Muskoka LHIN (2016). NSM LHIN Integrated Health Services Plan 2016-19: Healthy People. Excellent Care. One System. Retrieved from: http://www.nsmlhin.on.ca

Patients First Act, Bill 41 (2016). Province of Ontario. Retrieved from: http://www.ontla.on.ca/web/bills/ bills_detail.do?locale=en&BillID=4215

Price, D., Baker, E., Golden, B., Hannam, R. (2015). Patient Care Groups: A new model of population based primary health care for Ontario. Retrieved from: http://www.health.gov. on.ca/en/common/ ministry/ publications/reports/primary_care/primary_care_price_report.pdf 74

Ontario College of Family Physicians (2011). The Patient’s Medical Home. Retrieved from: http://www.ocfp.on.ca/policy/patients-medical-home

Ontario Hospital Association (2015). The Case for Implementing Fully Integrated Rural Health Hubs on a Pilot Project Basis. Retrieved from: https://www.arnpriorregionalhealth.ca/images/content/arh/integration/ Final%20Hub%20Paper%20.pdf

Ontario Hospital Association and Ontario Medical Association (2015). Rural Health Hubs Framework for Ontario. Retrieved from: https://www.oha.com/Documents/Rural%20Health%20Hub%20Framework%20 Ontario.pdf

HEALTH CARE TRANSFORMATION – MODEL REVIEW

Northern Ireland Department of Health (2016). Health and Wellbeing 2016: Delivering Together. Retrieved from: https://www.health-ni.gov.uk/sites/default/files/publications/health/health%20and%20wellbeing%202026- %20delivering%20together-october%202016%20.pdf

Page 58 of 63 Nova Scotia Ross, J. (2010). The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine. Retrieved from: https://novascotia.ca/dhw/publications/Dr-Ross-The-Patient-Journey-Through- Emergency-Care-in-Nova-Scotia.pdf

Care Right Now: Evaluating the Collaborative Emergency Centre Experience in Nova Scotia (2014). Retrieved from: https://novascotia.ca/dhw/publications/Care-Right-Now-Evaluating-the-CEC-Experience- in-Nova-Scotia-Full-Report.pdf

Oregon - Deschutes County Central Oregon Health Council. Central Oregon Regional Health Improvement Plan 2016-2019. Retrieved from: http://cohealthcouncil.org/apps/uploads/2016/03/2016-2019-Central-Oregon-RHIP_compressed.pdf

Sweden Institute for Healthcare Improvement. Improving Patient Flow: The Esther Project in Sweden. Retrieved from: http://www.ihi.org/resources/Pages/ImprovementStories/ImprovingPatientFlowTheEstherProjectin Sweden.aspx

United Kingdom - Torbay Thistlethwaite, P., (2011). Integrating Health and Social Care in Torbay. Retrieved from: https://www.kingsfund.org.uk/sites/files/kf/integrating-health-social-care-torbay-case-study-kings-fund- march-2011.pdf

Page 59 of 63 Town of Huntsville Staff Report

Meeting Date: Friday, July 07, 2017 To: Council

Report Number: OPS-2017-15 Confidential: No

Author(s): Brandon Hall, Engineering Technician

Subject: Un-Assumed Road Allowance Improvement Agreement, Old School House Rd

Report Highlights

David Wright would like to enter into an Un-Assumed Road Allowance Improvement Agreement to extend Old School House Road approximately 170ft and have the Town of Huntsville assume the road upon its completion so that he may build a year round residence.

Recommendation: Requires Action

That: Committee approve the Un-assumed Road Allowance Improvement Agreement to David Wright, to extend Old School House Road approximately 170ft to municipal standard in order to obtain a building permit for a year round residence and the Town of Huntsville Public Works assume the additional 170ft extension of Old School House Rd.

Background:

Staff brought a report (TI-2015-07) to Committee July 29th, 2015 to request to execute an “Un- Assumed Road Allowance Improvement Agreement” to William Hutcheson, owner of 303 Old School House Road. This was approved under Resolution GC138-15 and later ratified by council under Resolution 238-15.

A minor Variance was also approved to William Hutcheson to recognize 30m (100ft) of year round road frontage as sufficient frontage for a building lot, dated October 14th, 2015.

Page 60 of 63 Since then property 303 Old School House Road has be sold to David Wright and the Agreements approved under William Hutcheson’s were never fulfilled.

David Wright would like to extend Old School House Road approximately 170ft to municipal standard to allow for year round access so that a home can be built.

Discussion:

Dave Wright would like to extend Old School House Road approximately 170ft to municipal standard to allow for year round access so that a home can be built.

Applicant must adhere to all requirements within the Un-Assumed Road Allowance Improvement Agreement “Schedule A”.

The applicant would then like the Town of Huntsville Public Works to assume the additional 170ft extension of Old School House Rd.

Options

Financial Implications

Capital: N/A

Operational

 Implications: The Licences covenant and agree to provide the Town of Huntsville evidence

of Commercial General Liability Insurance in the amount of $5,000,000.00 naming the

“Corporation of the Town of Huntsville” as an additional insured.

The distance is minimal and therefore maintenance costs would also be minimal. There do

not appear to be other properties in this area that would require further road extension as they

all currently have access of other surrounding roads.

 Funding Source: Public works Operating Budget

Council Strategic Direction: N/A

Relevant Policies/ Legislation / Resolutions:

Page 61 of 63 Un-Assumed Road Allowance Improvement Agreement

Attachments

N/A

Consultations

David Wright, Owner of 303 Old School House Road

Karen Schamehorn, Risk Management & Purchasing Coordinator

SIGNED Respectfully Submitted: .

Brandon Hall, Engineering Technician SIGNED Director Approval: .

Steve Hernen, Executive Director of Operations and Protective Services

CAO Approval: .

Denise Corry

Page 62 of 63 CORPORATION OF THE TOWN OF HUNTSVILLE

BY-LAW NUMBER 2017-74

Being a By-law to amend By-law 2017-66 a By-law to Regulate and Control Parking in the Town of Huntsville

WHEREAS sections 8 and 11 of the Municipal Act, 2001, S.O. 2001, c. 25 as amended confer upon Councils the power to pass by-laws including broad authority to enable the municipality to govern its affairs as it considers appropriate and to enhance the municipality’s ability to respond to municipal issues;

AND WHEREAS the Council of the Corporation of the Town of Huntsville enacted By-law 2017-66 being a By-law to Regulate and Control Parking in the Town of Huntsville;

AND WHEREAS the Council of the Corporation of the Town of Huntsville deems it expedient to amend By-law 2017-66 to ensure continuity in the regulation and control of parking in the Town of Huntsville pending final approval by the Province of Ontario of Schedule “A” to By-law 2017-66 as required;

NOW THEREFORE THE COUNCIL OF THE CORPORATION OF THE TOWN OF HUNTSVILLE ENACTS AS FOLLOWS:

1. That the heading for Section 9.0 of By-law 2017-66 shall be amended to read: “Repeal and Transition”.

2. That Section 9.0 of By-law 2017-66 shall be amended by adding:

9.3 That notwithstanding the repeal of By-laws 89-94, 2013-46 and 2014-54, the set fines approved by the Province of Ontario contained within those By-laws shall be adopted and continue in force as the set fines to be applied pursuant to this By-law from the time of its enactment until such time as the Province of Ontario has given approval to the set fines contained in Schedule “A” to this by-law.

9.4 That this amending By-law shall be deemed to have retroactive effect and apply to all tickets issued for parking infractions issued since the date of enactment of By-law 2017- 66 until such time and Schedule “A” to By-law 2017-66 has received provincial approval.

READ a first time this 10th day of July, 2017.

______Mayor (Scott Aitchison) Clerk (Tanya Calleja)

READ a second and third time and finally passed this 10th day of July, 2017.

______Mayor (Scott Aitchison) Clerk (Tanya Calleja)

Page 63 of 63