Board of Directors’ Meeting Tuesday June 21, 2016 2:00 to 5:00 pm The Plex – Rotary Hall A (2nd floor), 600 Tomlinson Drive, Port Elgin
AGENDA Item Agenda Item Lead Decision/ Time Information 1. Call to Order Chair 2:00-2:02 Health Service Provider Greetings- Health Links 2:05-2:20 Val Fleming, Health Link Project Lead, North Grey Bruce Health Link Sue McCutcheon, South West LHIN Health Link Lead Debbie Taylor, Health Link Project Lead, South Bruce Grey Health Centre
2. Declaration of Conflict of Interest Chair 2:20-2:22 3. Approval of Agenda Chair Decision 2:22-2:25 4. Consent Agenda Items 2:25-2:35 4.1 Approval of Minutes: Board of Directors – May 17, 2016 Chair Decision 4.2 Report on the Use of Consultants- April 1, M Barrett Decision 2015 to March 31, 2016 4.3 Audit Committee Minutes - February 16, 2016 Committee Chair Information 4.4 Back Office Collaboration and Integration M Brintnell Information Project 4.5 2016 Quality Symposium A Jackson Information 4.6 Health Links Update K Gillis Information 4.7 Senior Leadership Report Senior Leadership Information
5. Presentations 2:35-3:40 5.1 Medical Assistance in Dying (MAID) Donna Ladouceur/ Information Susan Nickle 5.2 LHIN Renewal M Barrett Information 6. Agenda Items for Decision 3:40-4:15 6.1 2016/17 Annual Business Plan (ABP) K Gillis Decision 6.2 Prostate Cancer Diagnostic Assessment K Gillis Decision Program 6.3 Grey Bruce Health Services, Markdale Hospital K Gillis Decision Redevelopment – Stage 2 Capital Submission 6.4 Specialized Unit Development K Gillis Decision 6.5 2016/17 H-SAA Extension and Schedules M Brintnell Decision
Board of Directors Agenda, June 21, 2016 Page 2
7. Agenda Items for Information 4:15-4:25 7.1 2014/15 Annual Stroke Report Card K Gillis Information 7.2 South West LHIN Report on Performance M Brintnell Information Scorecard & Ministry-LHIN Accountability Agreement Dashboard - 2015/16 Fourth Quarter
8. Governance 4:25-4:35 8.1 Patients First Governance Discussion Chair Discussion 8.2 Board Chair Report Chair Information 8.3 Board Director Reports Directors Information 8.4 Board Committee Reports Committee Chair Information
9 Closed Session Decision 4:35-5:00 10. Date and Location of Next Meeting Tuesday July 19, 2016, South West LHIN, 201 Queens Ave, Suite 700, London, Ontario, Main Boardroom
11. Adjournment Chair 5:00
North & South Grey Bruce Health Link
Health Links Approach to Care
SWLHIN Board Meeting June 21, 2016 What is the Health Link approach to Coordinated Care Planning?
2 Nancy Naylor, Associate Deputy Minister Health System Delivery and Implementation Nancy Naylor, Associate Deputy Minister Health System Delivery and Implementation Advancing the Health Link Approach
The Provincial model for Health Link geographies is evolving to achieve better results for patients and for the health care system.
Goal: Effective, coordinated care for ALL of Ontario’s patients with high care needs How: Enhanced Focus on vulnerable populations • 4+ Multiple chronic and/or high cost conditions • Frail seniors • Mental health and addictions • End-of-life • Low socio-economic status • Social determinants of health (housing, language, culture, etc.)
Why do we need Coordinated Care Planning?
• We want better care for people with many health care needs
• We want everyone involved in a patient’s care to know what is important to him/her
• We want everyone involved in a patient’s care to know what the plan is for him/her How will the Health Links Approach improve health?
7 The Health Links Approach to Coordinated Care Planning What is the Coordinated Care Planning Process across the South West LHIN?
Implement the Engage with Interview Facilitate a Care Plan and Identify individual to individual to Care continually People who see if s/he understand Conference to Follow-up and would benefit would like to what is collaboratively Monitor the from CCP participate and important to develop a care individual's gain consent him/her plan progress
• Anyone, anywhere can identify someone
What is the implementation plan in our region? Grey Bruce Health Links Leads
• North : Grey Bruce Health Services
Owen Sound Family Health Team
• South: South Bruce Grey Health Centre
Brockton Area Family Health Team
GBHL - Partner Organizations
• Canadian Mental Health • South East Grey Community Association (CMHA) Grey Bruce Health Centre (CHC)
• Grey Bruce Health Unit • South West Community Care Access Centre (SW CCAC) • Home and Community Support Services of Grey Bruce • Southwest Ontario Aboriginal Health Access Centre (SOAHAC) • HopeGreyBruce (Hope GB) Mental Health and Addiction • Durham Family Health Network Services • Hanover and District Hospital • Peninsula Family Health Team • Hanover Family Health Team • Sauble Family Health Team • Grey & Bruce County (EMS, • Kincardine Family Health Team Housing)
Health Link Target Population 2013 MoHLTC (released spring 2016 )
SOUTH WEST LHIN
South Grey North Grey Huron-Perth London-Middlesex Complex Patients 2013/14 Elgin County Oxford County Bruce Bruce County County
Total patients (health care users) 75,222 92,547 44,110 72,102 109,169 379,098
Complex Patients (4+ conditions) # 4,265 5,005 2,590 4,830 5,905 21,200
% of patients that are complex 5.7% 5.4% 5.9% 6.7% 5.4% 5.6%
# of Complex patients NOT enrolled with a PEM 1,135 1,215 545 1,155 1,295 6,055
% of Complex patients NOT enrolled with a PEM 27% 24% 21% 24% 22% 29%
Complex patients, by age group
<18 yrs 80 115 45 85 150 515
18-44 340 420 220 415 455 2,225
45-64 1,130 1,185 635 1,175 1,385 5,735
65-79 1,650 1,845 935 1,835 2,050 6,965
80+ 1,070 1,435 755 1,315 1,870 5,760
Complex patients, by sex
Female 2,190 2,645 1,270 2,415 3,095 11,195
Male 2,075 2,360 1,320 2,415 2,815 10,005 Supporting the Health Link Approach in the South West
• Health Link Learning Collaborative
• eHealth Plan
• Specialist Directory • Electronic access to coordinated care plan by the patient/family (pilot – Owen Sound FHT participating)
• Measurement Plan and Dashboard in development Grey Bruce Coordinated Care Plan Update as of June 1, 2016
Process Stage Number of Patients
Identification Now focusing on current users with High Care Needs identified by various agencies across the region Interview (Coordinated Care Plans in 34 beginning stages)
Total Coordinated Care Plans Completed 77 (5 of which do not have Primary Care)
Total CCP’s in varying stages of completion 111
Fiscal Year 2016_2017 Completed CCP’s to 24 (9.6% of fiscal target) Date (Target total for GB counties is 250)
Declined a CCP or not appropriate to date 46
Early Outcome Data
Case ER Inpatient ALOS ER Inpatient ALOS Conference Visits Admits Visits Admits Date EM 18-Dec-15 129 7 10.7 1 0 n/a SC 5-Jan-16 5 4 3.5 5 2 6 PB 13-Jul-15 3 1 2 1 0 n/a SB 16-Oct-15 4 1 4 0 0 n/a BH 15-Nov-15 12 9 13.7 0 0 n/a JM 19-01-16 52 5 4 2 1 12
Black is pre- CCP Care Conference Red is post CCP Care Conference Patient Story – (Nursing Leadership, High Hospital Utilization List)
• 37 year old male who lives with his parents • Type 1 Diabetes, Cardiac – Myocardial Infarction (MI), Mental Health, Severe Abdominal Pain, Gastroenteritis, Cyclical Vomiting • Team – Patient, Mother, Family Physician, Cardiac Rehab (RN, Dietician), FHT (RN), CCAC (RN, Dietician) • ER visits (in 12 months prior) – 129; at time of Care Conference was coming in 2x/day • Hospital admissions (in 12 months prior) –7 (ALOS 10.7 days) • Prior Substance Use – Marijuana • Care Conference December 18, 2015
Our Approach
• Confirm team and identify one key primary contact • Helped patient identify his goals • I do not want to go to the hospital every day • I want to not be on so much pain medication cause it is bad for me. • I want to look at what jobs I might be able to do. • Engage client in journaling to better understand his experience • Met with physician to discuss impact of pain medication on current status
Our Approach
• Addiction to pain medications – Physician discussion with client re: addiction; Short inpatient admission to taper pain medications; engaged Mental Health & Addictions to assist us in managing withdrawal and counselling
• Oral Intake – Dietician focus on importance of solid foods and routine; provision of information on meal options
• Pro-active medical management - Regular follow up appointments with Family Physician and Care Team; treatment plan in ER for when an exacerbation happens
• Looking at social and employment options for the future – Meeting with YMCA Employment Services
Next Steps
• Target – to support 250 people with Coordinated Care Planning
• Sustainability Planning
• Focus on Health Equity Impact Assessment Populations - Aboriginal, Poverty, & Mennonite
• Evaluation - Cross Health Link Evaluation Metrics; Grey Bruce ROI
• Expansion of OTN across Grey Bruce
• Action Teams for QI improvement Questions
Contact Information
North Grey Bruce Health Link: Val Fleming [email protected] 519-376-2121 x 2877
South Grey Bruce Health Link: Debbie Taylor [email protected] 416-370-2400 x 2215
South West LHIN Board of Directors’ Meeting Board of Directors’ Meeting Tuesday, May 17, 2016 2:00 to 5:00 pm The Bayfield Town Hall, 11 Clan Gregor Square (The Square) Minutes
Present: Jeff Low, Board Chair Lori Van Opstal, Vice Chair Ron Lipsett, Secretary Wilf Riecker, Board Director Leslie Showers, Board Director Aniko Varpalotai, Board Director Barbara West-Bartley, Board Director
Regrets: Andrew Chunilall, Board Director
Staff: Michael Barrett, Chief Executive Officer Mark Brintnell, Senior Director, Performance & Accountability Kelly Gillis, Senior Director, System Design and Integration Stacey Griffin, Executive Office Coordinator Ashley Jackson, Director, Communications & Community Engagement Lorri Lowe, Controller & Manager of Corporate Services
1. Call to Order – Welcome and Introductions The Chair called the meeting to order at 2:00 pm. There was quorum and three members of the public, which included health service providers, were in attendance for parts of the meeting.
Incoming Board Director Leslie Showers was welcomed to the LHIN Board.
Health Service Provider Greetings Pamela Somers, Board Treasurer, and Samantha Marsh, Chief Nursing Executive and Vice President of Clinical Services, Alexandra Marine and General Hospital presented to the Board on regional activities and clinical services planning work underway in Huron County
2. Declaration of Conflict of Interest No declarations were declared.
3. Approval of Agenda
MOVED BY: Lori Van Opstal SECONDED BY: Aniko Varpalotai THAT the Board of Directors’ meeting agenda for May 17, 2016 be approved as presented. CARRIED
4. Consent Agenda Items
MOVED BY: Ron Lipsett SECONDED BY: Leslie Showers
THAT the consent agenda items be received and approved as circulated in the agenda package. CARRIED
5.0 Agenda Items for Decision 5.1 Audited Financial Statements of the South West LHIN
MOVED BY: Wilf Riecker SECONDED BY: Lori Van Opstal
THAT the South West LHIN Board approves the Audited Financial Statements for the year ended March 31, 2016, as recommended by the Audit Committee. CARRIED
5.2 Health Links
MOVED BY: Ron Lipsett SECONDED BY: Wilf Riecker
THAT the South West LHIN Board of Directors approves the following allocation of $955,000 in one-time funding for fiscal year 2016/17 for the individual geographies implementing the Health Links approach and South West LHIN-wide initiatives supporting this approach:
Huron Perth: $50,000 for sustainability London Middlesex: $400,000 for implementation North Grey Bruce: $200,000 for implementation South Grey Bruce: $200,000 for implementation South West LHIN-wide: $105,000 for LHIN-wide Health Link initiatives (e.g. Health Links Learning Collaborative; South West Health Links Dashboard, Specialist Directory) CARRIED
5.3 Stage 1, Part A and Stage 2, Part A Capital Submissions-St. Joseph’s Health Care, London – Palliative Care Unit Expansion
MOVED BY: Barbara West-Bartley SECONDED BY: Aniko Varpalotai
THAT the South West Local Health Integration Network (LHIN) Board of Directors amend the April 19, 2016 endorsement of Part A of the St. Joseph’s Health Care, London (SJHC) Stage 1 (Master Program) and Stage 2 (Functional Program) Capital submissions to the Ministry of Health and 2
Long Term Care to include endorsement for the space to be renovated with the opportunity to expand to 21 beds. CARRIED
5.4 Board Knowledge & Skills Matrix
MOVED BY: Aniko Varpalotai SECONDED BY: Lori Van Opstal
THAT the South West LHIN Board of Directors adopt the attached Board Knowledge & Skills Matrix template to be completed and updated as needed by individual board members as recommended by the Governance and Nominations Committee. CARRIED
5.5 Governance Policy Amendments -A-5: Legislative Requirements
MOVED BY: Aniko Vapalotai SECONDED BY: Barbara West-Bartley
THAT the South West LHIN Board of Directors amend Governance Policy: A-5 Legislative Requirements as recommended by the Governance and Nominations Committee. CARRIED
6.0 Agenda items for Information 6.1 Value for Money Assessment - Access to Care Implementation in the South West LHIN The Board received its second Value for Money Assessment Report which was focused on Access to Care implementation across the LHIN. The report found that value for money was achieved in Access to Care, and represents good potential for long-term cost avoidance in the reduction in Alternate Level of Care (ALC) days.
7.0 Governance 7.1 Patients First Governance Discussion The Board received an update on the work associated with the Patients First discussion paper. The update addressed the implementation work underway, an overview of the proposed transition structures in the South West LHIN, and a review of next steps.
7.2 Board Chair Report The Chair proposed holding a Board of Directors meeting in the August. A note will be sent to all board directors on a proposed date. The Chair reported attendance at the following events/meetings: On April 28, 2016 the Chair attended the South Huron Hospital Association Board Meeting with Michael Barrett, CEO. On May 11th and May 13th, 2016 webcast updates were held on the Integrated Health Service Plan 2016-19. The video and presentation can be found on the South West LHIN website. On May 27, 2016, the Chair will be attending the OHA Health System Reconfiguration Regional Sessions - London Event
3
On May 31, 2016, the Chair will be at a meeting with Michael Barrett, CEO with Board Executive representatives and the President & CEO of Strathroy Middlesex General Hospital. On June 2, 2016, The Chair will be attending LHIN Leadership Council Meeting and LHIN Board Chairs meeting in Toronto and therefore will not be attending the South West LHIN Quality Symposium and encouraged Board Directors to attend. On June 6th and 7th, 2016, The Chair will be attending the Ontario Association of Community Care Access Centres (OACCAC) Achieving Excellence Together 2016 conference.
7.3 Board Director Reports Board Directors provided brief verbal reports on their individual activities and observations since the last meeting of the board.
Barbara West Bartley attended the Rural & Northern Health Care Conference – May 4-6, 2016. Board Directors participated in the OHA - Governance Implications of Health System Reconfiguration Webcast on May 9, 2016 Barbara West Bartley attended the London & District Distress Centre and CMHA Middlesex meeting on May 11, 2016 Board Directors were invited to attend the June 27, 2016 OHA Webcast: View from the Top – System Reconfiguration
7.3 Board Committee Updates No update were reported.
8. New Business No new business was tabled.
9. Closed Session
MOVED BY: Lori Van Opstal SECONDED BY: Barbara West Bartley
THAT the Board of Directors move into a closed session at 3:28 pm pursuant to s. 9(5)(a) of the Local Health System Integration Act, 2006 CARRIED Michael Barrett, CEO was permitted to attend for part of the meeting.
MOVED BY: Ron Lipsett SECONDED BY: Leslie Showers
THAT the South West LHIN Board of Directors rise from closed session at 4:10
The Chair reported that the Board Discussed discussed personnel matters in the closed session.
10. Date and Location of Next Meeting Tuesday, June 21, 2016, The Plex – Rotary Hall A (2nd floor), 600 Tomlinson Drive, Port Elgin
11. Adjournment 4 The meeting was adjourned by the Chair at 4:10 p.m.
APPROVED: ______Jeff Low, Board Chair
Date: ______
______Ron Lipsett, Board Secretary
Date: ______
5
Agenda Item 4.2
Report to the Board of Directors Report on the Use of Consultants April 1, 2015 to March 31, 2016
Meeting Date: June 21, 2016
Submitted By: Michael Barrett, CEO Lorri Lowe, Controller and Manager of Corporate Services
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Suggested Motion: THAT the South West LHIN Board of Directors approve the Report on the Use of Consultants for submission to the Ministry of Health and Long-Term Care on/before June 30, 2016.
Background: As outlined in the Ministry of Health and Long Term Care (MOHLTC) communication dated July 15, 2011, LHINs are required to provide a fiscal year report on consultant use.
The South West LHIN is providing a review of all consultant contracts which the LHIN has entered into over the last year. This reporting will ensure compliance with the recommendations contained in the Ontario Auditor General’s Special Report, Consultant Use in Selected Health Organizations.
The LHIN works to ensure our procurement process is in compliance with the Procurement Directive and the Auditor General Report recommendations when engaging in consultant contracts. Tools include the LHIN-developed checklist, business case, preparation of Request for Services (RFS) / Request for Proposals (RFPs), vendor selection using a ranking system, statement of work, and reconciliation of invoicing to ceiling limits.
The attached Appendix 1 is the LHIN Report on Consultant Use which the LHIN has undertaken for the period April 1, 2015 to March 31, 2016.
Appendix 1: Board Report Item 4.2 Report on Use of Consultants - April 1, 2015 to March 31, 2016
Procurement Value Consultant Selection Modifications to (A+B+C) Process (Open Contract Term Agreement (if yes, did the A=Original Value Competitive, Invitational No. Consultant Firm Name Name and Title of Consulting Contract (If the contract term has been extended please include the procurement documents permit B=Value of Amendments C=Total Competitive, Non‐competitive original contract term and the amended contract term) modifications to the term or Procurement Value – If non‐competitive value of the agreement?) Total Paid ($) explanation required)
Open Competitive Contract allows for 1 Critical Care Lead Dr. Michael Sharp (ID#: SWccl_02172014) Apr 1, 2015 ‐ Mar 31, 2016$ 75,000.00 extensions EM Direct Inc. (Dr. Jonathan Dreyer) Open Competitive Contract allows for 2 Emergency Department Lead (ID#: LHIN_EDL_005_012) Apr 1, 2015 ‐ Sept 30, 2016$ 75,000.00 extensions HR Recruitment Support HR Associates (ID#: SWrss‐070513) Open Competitive Contract allows for 3 Services Apr 1, 2015 ‐ June 30, 2016$ 55,800.00 extensions S.S Gill Medicine Professional Corporation (Dr. Open Competitive Contract allows for Satinderpal (Paul) Gill) extensions 4 Primary Care Co‐Lead ‐ DRCC (ID#: SW_pcl_08142014 Mar 1, 2014 ‐ Mar 31, 2016$ 75,000.00 Schacter Medicine Professional Corp (Dr. Open Competitive Contract allows for 5 Primary Care Lead Gordon Schacter) (ID# SW_pcl_07142014) Apr 1, 2015 ‐ Mar 31, 2016$ 75,000.00 extensions Invitational No Community Report (Bulletin) ‐ Seed Communications Inc Competitive under 6 Design (ID#: Communications) Nov 27, 2015 ‐ Mar 31, 2016$ 8,575.00 $25,000.00 Patient Experience Survey and Open Competitive Contract allows for 7 Report MASS LBP Inc. (ID#: PtExp2015‐01) Nov 21, 2014 ‐ Oct 30, 2015$ 15,436.00 extensions Moist Medicine Professional Corporation (Dr. Open Competitive Contract allows for Louise Moist) extensions 8 Internal Medicine Lead ‐ DRCC (ID#: Corporate Services) Feb 1, 2016 ‐ Mar 31, 2017$ 75,000.00 James R MacLean Medicine Professional Open Competitive Contract allows for Corporation (Dr. James MacLean) extensions 9 Primary Care Co‐Lead ‐ DRCC (ID#: Corporate Services) Dec 14, 2015 ‐ Mar 31, 2017$ 75,000.00 Invitational No Facilitation Support Services ‐ Competitive under Hospital/CCAC Leadership Leading Edge Group, John Whelton $25,000.00 10 Forum CEO/CNE/Chiefs Retreat (ID#: Management) Oct 16, 2015‐ Nov 16, 2016$ 5,950.00 Invitational Contract allows for Competitive under extensions 11 Transition Accounting Services Jennifer Roedding (ID#: Corporate Services) Jan 11, 2016 ‐ Mar 27, 2016$ 25,000.00 $25,000.00 Invitational No Quality Thru Improvement Paula Blackstien‐Hirsh Competitive under 12 Session Facilitator (ID#: System Design and Integration) Mar 1 2016 ‐ Mar 1, 2016$ 2,500.00 $25,000.00
Agenda Item 4.4
Report to the Board of Directors Back Office Collaboration and Integration Project - Update
Meeting Date: June 21, 2016
Submitted By: Mark Brintnell, Senior Director, Performance & Accountability
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Purpose of Report The information contained in this report is meant to provide the LHIN Board with an update on the Back Office Collaboration and Integration Project (BOCIP) work to date and the planned next steps as the project moves into Phase II.
Background The purpose of the BOCIP is to focus on enabling effective and efficient use of system resources to achieve the highest quality back office services making the best use of public resources to create readiness for future health system transformation. BOCIP objectives: Improved accuracy and reduced errors related to service activity and financial reporting requirements. Improved trust, transparency and effective communication between and amongst health service providers Ability to meet or exceed established best practices within their organization and across sectors Increase business intelligence and decision making at the health service provider level Streamline processes and eliminate/reduce duplication
The BOCIP was positioned to be worked on over the three year term of the current Integrated Health Service Plan 2016-19. BOCIP Phase I focused on leveraging health service provider and external expert resources to define best practices and minimum standards in the seven (7) identified administrative service areas:
1. Financial Management 2. Information Technology and Support 3. Materials Management 4. Human Resources 5. Risk Management & Privacy
Report to the Board of Directors- BOCIP Page 2
6. Legal services 7. Facilities Management
A BOCIP Steering Committee of health service provider leaders was created to provide oversight to the project, guide and lead change efforts, foster collaboration both at the system-wide level and within targeted implementation initiatives in order to inform and operationalize the recommendations related to BOCIP. In addition, working groups were established with content experts from across sectors (approx. 56 people directly engaged) to inform the development of the best practices and minimum standards.
A Final Report (attached) was received by the LHIN providing 368 Minimum Business Process Standards across the seven administrative areas and key implementation considerations. The Final Report was posted to the LHIN website and shared with all LHIN-funded health service providers.
During Phase I, the LHIN kept health service providers informed of progress through communiques. A LHIN-wide webinar was held on May 25, 2016 to share the Final Report and provide Phase I highlights and outline the approach to Phase II.
Phase II is focused on implementation and will be guided by the LHIN assisting providers achieve minimum standards and working towards best practices, creating efficiencies and investing these into front-line care, and leveraging current and new resources to achieve results. The LHIN will need to consider capacity and change stemming from the Patients First implementation and other key streams of work.
Next Steps The LHIN will need to take a practical approach and select a few (i.e. 2-3) administrative areas to begin implementation. Consideration will need to be given to capacity with the system to undertake the work, opportunities to achieve the objectives, leveraging current best practices, number of minimum standards and best practices (i.e. 368), number of health service provider’s involved, current environment and capacity, etc. The LHIN will issue a survey in June to all heath service providers seeking their input on which administrative area changes will be of most benefit to their sector and organization and asking them to rank the administrative areas in terms of implementation importance.
The LHIN will continue to work with the Steering Committee to confirm the targeted administrative areas for Phase II implementation and put in place a tactical plan to achieve results. Phase II is expected to begin in September 2016.
Attachment – Back Office Collaboration and Integration Project Final Report, March 31, 2016
End. Back Office Collaboration and Integration Project (BOCIP) South West LHIN
Final Report March 31, 2016 Contents
Ontario’s Current Healthcare Landscape 3
Context and Overview for Back Office Integration and Collaboration Project 6
Implementation Considerations Identified by Sector Stakeholders 9
Lessons Learned from Other Jurisdictions 15
Looking Forward to Phase II 19
Appendices 22
2 Ontario’s Current Healthcare Landscape
3 Ontario’s health sector continues to evolve towards an increasingly quality driven, person-centered integrated system
The commitment to heath system transformation in Ontario is clear. Since 2006, there have been significant changes in how healthcare is administered, funded and measured. The province has invested and continues to focus on improving quality, patient/resident/client and community engagement, integration and innovation in service delivery. With this strategic focus in mind, the Ministry of Health and Long Term Care (MOHLTC) continues to be committed to upholding key tenets of universality, improved access and delivery of the highest quality of care for citizens within Ontario –while realizing greater value for the dollars invested in healthcare services. The province has defined four goals that have been central to their strategic direction for the past decade, including: Access Inform Patient / Resident / Client Connect Quality In support of their commitment to these principles, the MOHLTC released a Discussion Paper in December 2015 to draw on the knowledge of the industry in responding to critical changes that are anticipated to highly impact the industry. In efforts to reduce gaps and strengthen patient/resident/client-centered care, the MOHLTC proposed expanding the role of Local Health Integration Networks (LHINs). Specifically, they have proposed the LHINs to lead:
More effective integration of services and greater LHIN to take a stronger leadership role to drive better 1 equity access and consistency of services within their region Timely access to primary care and seamless links Enabling regional coordination of primary care planning 2 between primacy care and other services and performance management More consistent and accessible home and community Strengthen accountability and integration of home and 3 care community care to improve access to services Stronger links between population and public health Integrate local population and public health planning with 4 and other services other health services for knowledge continuity
As the South West LHIN (SW LHIN) continues to work together to improve the experience of care for people who use health care services and to ensure the sustainability of those services, the SW LHIN is committed to advancing a number of integration strategies. One of those strategies is the Back Office Collaboration and Integration Project (BOCIP). 4 Together with its health service providers, the SW LHIN continues to be focused on undertaking transformational change that strengthens integration and enables greater value for its communities
As the SW LHIN continues to work together with its Health Service Providers (HSPs) to improve the experience of care for patient/resident/clients within their jurisdiction, there is an increasing focus on strategically integrating services to improve efficiencies. One of those strategies is the BOCIP. The BOCIP will focus on enabling effective and efficient use of system resources to achieve the highest quality back office services making the best use of public resources to create readiness for future health system transformation.
Phase 1: 2015/16 Phase 2: 2016/17 – 2018/19
• Phase 1 of the project will leverage expert resources to • Phase 2 of the project will involve a current state define industry best practices and develop minimum assessment/survey to gain an understanding of where all standards in the seven administrative service areas. SW LHIN funded agencies currently stand against the • The best practices and minimum standards will include identified (phase 1) best practices and minimum standards relevance and understanding to the Mental Health and in each of the 6 administrative areas Addictions, Hospital, Community Support Services, • Leveraging the report that defines the best practices and Community Care Access Centre, Community Health Centre minimum standards in the 6 administrative areas and the and Long-Term Care Home sectors. current state information, the SW LHIN will define the • Regardless of current practices, understanding what the expectations for LHIN funded agencies to move towards practice is and how the LHIN may assist providers in minimum standards and/or best practices achieving best practice is the goal. • LHIN funded health service providers will have to move towards defined expectations by end of the 2016-2019 Integrated Health Service Plan period (by March 31, 2019)
5 Context and Overview for Back Office Integration and Collaboration Project (BOCIP)
6 The BOCIP was initiated by the SW LHIN to optimize the delivery of health care services across the region
Phase I: December 2015 – March 2016
Project Objectives The objectives of the BOCIP project are to assist health service providers across the SW LHIN in achieving: Improved accuracy and reduced errors related to reporting requirements. Improved trust, transparency and effective communication between and amongst Health Service Providers (HSPs) Increase in cross sector relationships To meet or exceed established leading practices within their organization Increase business intelligence and decision making at the HSP level Streamline processes and eliminate/reduce duplication
Project Scope The scope of the integration and/or collaboration efforts has yet to be defined, however there are 6 administrative areas that were identified by the BOCIP Steering Committee and represented by Sub Committees for this engagement: Financial Management Information Technology and Support Materials Management Human Resources Legal Services, Risk Management and Privacy Facilities Management
Project Approach and Deliverables For Phase I of the BOCIP, the SW LHIN engaged HSPs across the region to represent each sector that may participate in the integration and/or collaboration efforts. The approach included 3 phases resulting in 2 key deliverables.
Approach Deliverables Validate Identify Final Report with Define Leading Leading Implementation 1 Leading Practices 2 Implementation Practices Practices Considerations Considerations
7 The resulting Inventory of Business Process Practices offers the SW LHIN a repository of knowledge that has been reviewed and agreed upon by local stakeholders
The Sub Committee sessions enabled the SW LHIN to receive feedback and insights from a line by line review of the relevance and applicability of the proposed minimum standards through leading practices. The dialogue offered valuable insights on the reasonability of the minimum standards and considerations for implementation that will support the strategic design of the BOCIP initiative that is anticipated to occur in Phase II. Data Inputs Data Outputs
Business Process Standards from Deloitte’s Leading 368 Practice Database
Minimum Business 1 Leading Practices Sub Committee Sessions 368 Process Standards 6 Chaired by Steering Validated Committee Members *Provided in a separate excel document.
Stakeholders Engaged with 56 Cross Sector Representation
Interviews with Other Key Lessons Learned from 4 Jurisdiction Leaders 6 Other Jurisdictions Final Report with 2 Implementation Considerations Touch Points with Local Implementation Stakeholders with Cross Considerations from Local 12 Sector Representation 4 Stakeholders
8 Implementation Considerations Identified by Sector Stakeholders
9 Sub Committees clearly identified the need to carefully consider the composition and characteristics of each sector and HSP when defining the strategy for integrated services across the LHIN
Key themes emerged through the dialogue with Sub Committees that provide valuable insight into the needs of local stakeholders when considering BOCIP. The Members of the Sub Committees focused on defining relevant implementation considerations for the SW LHIN to consider when determining the strategy for a transformation within the region. The implementation considerations (“theme”) that were commonly understood across administrative areas and within sectors has been provided with a detailed description and implications for BOCIP.
Variance in size, complexity and capacity to engage in an integrated/shared services model
Geographical implications and existing points of integration
Optimal scope of services/functions for future integration
Implementation Considerations Understanding the value of future integration
10 Assessing HSPs current state of operations prior to integration will enable strategic navigation of the breadth of needs across the region
Variance in size, complexity and capacity to engage in an integrated/shared services model
Sub Committee members identified the need for BOCIP to consider the uniqueness of each organization across the LHIN due to the broad variation in size and complexity of the service operating models, as well as the breadth of capacity for change within each organization.
• The variance in size and complexity (e.g. governance structure, composition of service offerings, cultural and ethnical differences, etc.) of organizations both within and across sectors will determine their ability to support and leverage a shared services model. Equally, this will result in organizations receiving different benefits and/or if a benefit is received at all from a shared services model. • The capabilities of each organization to support the integration activities vary by organization, including the implications for unionized versus non-unionized employees within the proposed model. • There are various models of ownership that currently exist across each sector (e.g. privately owned organizations). • A rigorous current state assessment needs to be performed to understand the context of each organization across the region, providing the SW LHIN with insight into the magnitude of difference in size and complexity of the organizations within the LHIN and enabling key insights to be carried forward into the design and strategic approach to the BOCIP.
• The BOCIP strategic planning process should carefully consider how the sectors can collaborate, coordinate and/or leverage internal capabilities to address the needs of the situation and/or organization, the community being served, and the population/clientele being served through a integrated/shared services model. Key • It will be important to continue to engage representative stakeholders across the sector to design the approach for
Takeaways integration/shared services.
11 Understanding the population and the environment being served by the HSPs and their existing integration structure will accelerate the delivery of a future state integration model
Geographical implications and existing points of integration
The composition of the Health Service Providers (HSP) within the SW LHIN covers both rural and urban regions, resulting in a mix of enablers and barriers for HSPs as they deliver their respective services. As a means to address some of these challenges, select organizations across the region have started to integrate their services to alleviate pressures on certain business functions within select administrative areas. • The BOCIP team will need to assess the existing scope of relationships to determine how to leverage existing integration structures for the future state of SW LHIN. For example, consideration of how the Community Heath Centre's (CHC) and Community Care Access Centre's (CCAC) currently leverage a platform provided through their respective provincial associations, London’s support serving partner hospitals through their Information Technology Services (ITS), and HMMS offering supply chain services for hospitals. • As rural and urban settings offer different opportunities and challenges for service delivery, an assessment of how integrated services can further alleviate the barriers to access that exist for rural areas must be considered. Examples of such challenges include: network connectivity, reliability of services, access to technical expertise, etc. • The BOCIP requires a clear understanding of the business processes and associated resources that deliver these functions, including resources from both head count and FTE perspective.
• Acknowledging and accommodating for the rural/urban variation across the SW LHIN will enable the BOCIP strategy planning process to identify and define a future state model that optimizes the capabilities of the HSPs across the region. Key • Consider leveraging existing points of integration to enable the SW LHIN to accelerate the implementation of the
Takeaways proposed future state model, depending on the proposed scope for integration.
12 Identifying and prioritizing the business processes that could benefit with integration is critical in defining success for the future state model
Optimal scope of services/functions for future integration
The Sub Committee members have identified the need for the future integrated model to seek to ensure that the added complexity of integrated/shared services does not inhibit the execution of necessary activities with any specific organization (e.g., ability to adhere to accreditation requirements or to deliver self-service repairs for smaller organizations). • The Sub Committee members have proposed the need to consider what integration means to the SW LHIN and its stakeholders; understanding that integration is a continuum of shared practices that may go beyond “becoming one”. • A clear focus on the targeted benefits and/or expected outcomes for an administrative areas of business function must be considered to enable optimal outcomes and benefits realization. • There are numerous options for how BOCIP could design their future state integration model. Critical consideration of what administrative areas will benefit most from integration, which business processes should and/or could be included and if/how to leverage existing capabilities will be a critical success factor for the initiative.
• A well-defined current state assessment will enable the SW LHIN to gain a clear understanding of the scope of services and processes within any given function within the region, thus enabling identification of the business process/functions that are appropriate for integration. Key • It may be important to create an integration design framework that offers services along this proposed “spectrum
Takeaways of integration” to enable viable and efficient decisions for the region.
13 Collaborating with representative stakeholders to clearly define the value of integration for each sector and administrative area will enable future buy in and adoption by local stakeholders
Understanding the value of future integration
Offering a clear understanding of the value for future integration within the region, specific to the selected administrative areas and sectors, will enable a stronger degree of adoption by impacted personnel and organizations. Through this initial phase that required stakeholder engagement across sectors, it is clear that Sub Committee members understand the potential benefits of an integrated/shared services delivery model, however also expressed the importance of careful consideration as to the value the future service integration would provide to each of the stakeholder groups across the region.
• By offering a clear understanding of the value for the future integration, there is increased likelihood of support for the integrated model • Carefully consider and articulate the added value of proposed changes to ensure that all stakeholders agree to the added value and goal for improving patient/resident/client care. • Consider leveraging successful models and standardization that has been delivered within the region on a smaller scale. • Consider the environment surrounding the SW LHIN within Ontario and the potential implications this changing landscape may have on the defined value and vision of integration within the region
• Communicating a clear understanding of the value of integration will support the implementation of the proposed integration model, as the justification and drivers for integration will have been socialized across the vast region in advance of the transformational change. Key • Consideration of the broader provincial context may impact and/or enable the region’s ability to realize an
Takeaways integrated model of service delivery, as well as administrative priorities.
14 Lessons Learned from Other Jurisdictions
15 To offer insights from other jurisdictions in Canada, industry leaders were interviewed across 4 jurisdictions who have recently engaged in an integrated/shared service model within their region
Jurisdictions were selected based on their similarity in size and composition of the geographical region or due to their similarity in approach to delivering shared services. The purpose of the jurisdictional scan was to identify lessons learned by peer organizations that the SW LHIN may consider for the BOCIP. The following section provides an understanding of the key lessons learned across jurisdictions and the implications for BOCIP, with the details of the jurisdictional scan found in Appendix E.
Ontario Saskatchewan
Newfoundland
Nova Scotia
Key Lessons Learned
Governance Understanding Sector-wide Business Project Team and Current State Targeting Stakeholder Case Development Leadership and Service Quick Wins Engagement Definition and Retention Alignment Requirements
16 The jurisdictions selected shared experiential insights for the SW LHIN to consider as the next phases of the project are considered and defined
Lesson Learned Description of Lesson Learned Implications for the SW LHIN
Focusing early work effort on carefully designing the governance model and aligning leadership across the A range of governance structures were implemented region will provide the SW LHIN with a strong foundation across the jurisdictions interviewed, notably shifting away throughout the duration of the project. Governance and from ‘representative’ governance to competency focused Leadership governance models. To inform the governance model Considering the breadth of the region and the diversity of Alignment developed within the various integrated/shared services stakeholders involved, the future governing model should models, a clear understanding of the vision for integration enable the integrated model to put into place the required was determined. management/operational structures and processes, and navigate challenges and obstacles as they arise.
Developing a business case will support the SW LHIN in determining the desired outcomes of an integrated model for their region, providing specific performance indicators Defining a business case enabled the jurisdictions to be that may be tracked for benefits realization throughout the able to clearly define why they were undertaking the Business Case duration of the project. integration and what benefits they sought to achieve. The Definition benefits included consideration of both financial incentives Benefits should be clearly defined and should go beyond and changes to quality of service delivery. financial considerations, but also take into account advances in service quality and practices, and other considerations that may be identified.
Continued sector-wide stakeholder engagement across Early and broad stakeholder engagement across relevant Sector-wide the SW LHIN is anticipated to enable early buy in through sectors enabled each region to facilitate buy in, determine Stakeholder ensuring the issues and challenges of the model design critical issues, and identify champions to support the Engagement are addressed prior to broader socialization and magnitude of change associated with this type of project. implementation.
17 The jurisdictions selected shared experiential insights for the SW LHIN to consider as the next phases of the project are considered and defined
Lesson Learned Description of Lesson Learned Implications for the SW LHIN
The current state assessment will enable the SW LHIN to understand In preparation for a change of this magnitude, the the areas that already have integration or shared services in place jurisdictions took the time to assess and understand such that these established capabilities may be leveraged moving Understanding the specific operations and context of current state forward. Current State and for various HSPs across the sectors. Although a Service considerable investment, a current state In addition, the SW LHIN will be able to accurately determine the Requirements assessment enables the region to gain early support required for each organization during the transformation. This commitment to the future state model. will better define an optimal scope for the integrated service model within each administrative area.
Early consideration of the strategic approach to talent acquisition, Planning for project team development and talent development and retention will enable the SW LHIN and the HSPs Project Team acquisition / retention through critical project across the region to prepare a project team that is capable of holding Development and milestones was identified as a challenge for the responsibility for driving the BOCIP forward. It will be important for Retention jurisdictions and noted as a consideration for others participating HSPs to recognize their internal capacity constraints to plan for. when committing to participating and being involved in BOCIP work streams. Taking a continuous improvement approach to implementation creates the opportunity to learn and improve together. To this end, defining and targeting quick wins or a clear starting point for integration will be critical. BOCIP transformations can be large and Understanding where to start and identifying “quick having a clear roadmap, built on a strong vision and understanding of wins” was perceived as a means for jurisdictions to the current state will enable the LHIN and its HSPs to better Targeting Quick gain initial momentum, realize success and understand where they might start to optimize success and learnings; Wins developing learnings that inform the broader journey these learnings can inform the ongoing BOCIP transformation journey to back office integration and shared services and efforts. models. Learning from other jurisdictions, the SW LHIN can leverage this approach to more effectively manage the integration of different functions and/or services over time. 18 Looking Forward to Phase II
19 The SW LHIN has made progress in preparing for the next phases of the BOCIP
BOCIP Progress to Date
In Phase 1 of the BOCIP, Deloitte supported the SW LHIN in engaging HSP representatives across the SW LHIN to:
Establish and work with 6 Sub Committees comprised of 56 stakeholders representing each sector across the SW LHIN;
Create a shared understanding of the minimum standard for 368 practices within an Inventory of Business Process Practices. These practices are representative of the business processes in scope for back office functions that span the 6 administrative areas identified for potential integration;
Gather from representative stakeholders 4 key themes that may be considered during implementation to facilitate a deeper understanding of the critical success factors that may be required to include in the design and delivery of a potential integrated/shared services model; and
Share 6 lessons learned gathered through interviews with other jurisdictions who have recently engaged in an integrated/shared service model within their region.
With the completion of Phase 1, there is now a foundation upon which the LHIN and HSPs can continue to build on. More specifically, as result of this work the following key foundational elements have been realized:
• An established base of standards and leading practices maturity models across the in-scope administrative functional areas that can now be used to both develop a shared understanding of current practices and operational context across the LHIN, but also serve as a tool that can be used to articulate a vision and measure progress as the BOCIP transformation process evolves over time;
• Insights and learnings from others have been gathered to inform the strategies and approach to moving the BOCIP initiative forward;
• The development of cross-sectoral relationships through the sub-committee process that can serve as a key resource to ensure that the appropriate subject matter expertise required to shape future operating and service delivery models for the respective administrative areas
20 Four key activities are recommended for the SW LHIN and the BOCIP Project Steering Committee to consider for Phase II
The next phase of this project should define the current state to determine feasibility and practicality of moving forward with an integrated and/or shared services model. At this point in the project, there is not enough of an understanding of the current landscape to assess the feasibility and practicality of pursuing integration within one or more of the identified administrative areas. Leveraging lessons learned from other jurisdictions, understanding the current environment for
Define the each HSP will be a critical factor in the success of this initiative. Current State
Considering each of the implementation considerations raised by the Sub-Committees members, the BOCIP needs to determine what business processes will benefit most from an integrated service delivery model. Careful consideration of how the sectors can collaborate, coordinate and/or leverage internal capabilities will need to be discussed to ensure the strategy is relative to the situation and/or organization, to the community being served, and to the population/clientele Strategy Determine Integration being served.
Due to the complexity and magnitude of the transformation being proposed through an integrated services model – across one or more administrative areas – early establishment of the governing structure for an integrated service model is recommended to ensure streamlined communication and direction to all stakeholders within the region. Albeit dependent on the integration strategy being defined, a clear governance model will enable the region to stay focused on Structure Determine
Governance realizing the outcomes defined for the project.
Following the determination of key decisions as defined above for this complex transformation, the SW LHIN will need to consider their approach to communicating future changes to HSPs and their employees region-wide. To support successful adoption and buy in of these stakeholders, it will be important to determine a clear and comprehensive Define
Strategy communication strategy for the project as it progresses forward. Communication
21 Appendices
22 Appendix A: Steering Committee Members
23 Project Advisory | BOCIP Steering Committee Members
The Project Advisory (Steering Committee) panel responsible for determining the requirements for the deliverables, making decisions if/as required and reviewing the documents for sign off. The current membership includes:
Name Sector Representing Organization Email
Judi Fisher Community Support Services ED, Cheshire Homes of London [email protected]
Brian Dunne Community Support Services ED, Participation House [email protected]
ED, Choices for Change: Alcohol, Drug & Gambling Catherine Hardman Mental Health & Addictions [email protected] Counselling Centre
Heather DeBruyn Mental Health & Addictions ED, Canadian Mental Health Association (CMHA) Elgin [email protected]
Andy Kroeker Community Health Centres ED, West Elgin Community Health Centre [email protected]
Community Care Access Centre Hilary Anderson Senior Director Corporate Services/CFO, SWCCAC [email protected] (CCAC)
Lance Thurston Hospital President and CEO, Grey Bruce Health Services [email protected]
Chief Financial Officer and Chief Information Officer, Tim Lewis Hospital [email protected] Listowel Wingham Hospital Alliance [email protected] Megan Garland Long-Term Care Homes Administrator om Steve Crawford Long-Term Care Homes CEO, McCormick Home [email protected] Senior Director, Performance & Accountability South Mark Brintnell LHIN [email protected] West LHIN
Kelly Simpson LHIN System Design & Integration Lead, South West LHIN [email protected]
System Design & Integration Specialist, South West Rebecca McKee LHIN [email protected] LHIN Josh Clark LHIN Financial Analyst, South West LHIN [email protected] Deloitte Young Lee Partner [email protected] Deloitte Julia Roy [email protected] Deloitte Viswanathan Nagarajan [email protected]
24 Appendix B: Detailed Project Approach and Schedule
25 During Phase I, the SW LHIN engaged Sub Committees to have local ownership of the minimum standards defined for each business process across the administrative areas Approach to Phase I
The approach to Phase I of BOCIP required local stakeholders to define and validate leading practices and minimum standards in each of the identified 6 administrative areas, taking into consideration the variances across hospitals, long-term care homes, home and community care and community health centres. The stakeholders were actively engaged to apply their experience to the proposed Inventory of Business Process Practices in order to design a foundation of minimum standards that are relevant and applicable for the region during the next phases of work. In addition, the Sub-Committee working groups offered insights into the high level risks and/or barriers to implementing the proposed standards across each administrative area.
Identify Implementation Define Leading Practices Validate Leading Practices Considerations • Defined practice continuum from • Validated and socialized practices to understand the • Identified risks/barriers to lagging to leading and illustrate specific context of each sector and adjust the models implementing the defined minimum IndustryPrint™ process flow through accordingly. Additional requirements specific to each standards across each administrative research and interviews sector were added as necessary. area
Data Inputs Data Outputs
Current State Deloitte Leading Interviews with Final Report with Documentation Practice Other Leading Practices Implementation from SW LHIN Database Jurisdictions Considerations • Current baseline • Insights on the • Insights for 4-5 • Defined continuum of • Recommendations were activity across continuum of leading interviews with practices to support the defined to consider with strategy, service practice across the 6 stakeholders across SW LHIN in Phase 2, regards to risks and/or delivery, talent, administrative areas the continuum of identifying the relative barriers for operations and practice to determine performance within the implementation of desired technology from SW leading practices spectrum of leading practice LHIN due diligence used in other versus lagging practices documentation jurisdictions across across the 6 Canada for the 6 administrative areas administrative areas
26 Phase I of the BOCIP engaged 56 stakeholders across 6 administrative areas to validate an inventory of business process practices
Project Timeline: Phase 1
Engaged Chairs to Steering Committee Meeting #2 – prepare for Sub Review Outcome of Sub Committee workshops Initiate Phase 1: Committee Workshops Identification of Defined initial draft Delivered 6 Sub Steering Committee Minimum Standards of Inventory of Key Committee workshops Meeting #3: Final to Leading Practices Business Process with 56 stakeholders Presentation [Out of Scope] Steering Practices Sub Phase 2: Committee Incorporate feedback Committee Development of Back Meeting #1 – into inventory with 368 Follow Up Office Collaboration Kick Off validated standards Meetings and Integration Framework Timeline
December January February March April FY 15-16 FY 16-17
FY15-16 FY16-17 Key Decision on Scope Today’s Meeting
Project Achievements
The key project achievements for Phase I of the BOCIP included: Conducted the three Steering Committee meetings to determine and report on the validated the scope of this engagement Prepared an Inventory of Key Business Process Practices that spanned the 6 administrative areas within scope for this engagement, including: Financial Management, Information Technology and Support, Materials Management, Human Resources, Facilities Management, and Legal Services, Risk Management and Privacy Conducted 6 Sub Committee sessions, along with follow up sessions, that engaged 56 subject matter experts (SMEs) across the relevant administrative areas Validated 368 standards that identified the minimum reasonable standard for the SW LHIN according to stakeholder consensus
27 Phase I spanned three months, starting in December 2015 and ending in March 2016
Project Schedule With the Steering Committee’s input during the project kick-off meeting and to offer greater insight into our approach, a timeline was developed that highlights the key activities that were executed throughout the 13 week engagement.
The table below provides an overview of the key sessions, objectives, proposed date and format for the project timeline.
Stakeholder Group Objectives for Engagement Format / Estimated Timing Timelines
• Introduce and orient about the project • Introduce and orient to the project; present the leading practices; gather stakeholder’s • In person Sub-Committee #1 perspective on the applicability/specialty • February 2nd - 10th (6 sessions) considerations of the practice continuum • Up to 2 sessions a day @ 2-3 within their administrative areas; and hours per session identify the risks/barriers to obtain minimum standards or leading practices
• To review outputs from Sub-Committee sessions, to understand the risks/barriers Steering Committee # 2 • 2 hours in-person • 2-4pm, February 26th identified by the Sub-Committees and to gather strategic considerations.
• To review recommendations for each Steering Committee # 3 administrative area and provide feedback • 2 hours in-person • 2-4pm, March 29th
28 Appendix C: Detailed Project Scope
29 The relevant business processes for Human Resources as validated by the Sub Committee includes,
HR (Employee Data Staff Recruitment and and Job Data Workforce Planning Retention Administration)
Employee Succession Planning Compensation and and Management Labor Relations Benefits Management
Learning and HR Programs and Organization Policies Development
30 Functions / Business Processes within Human Resources
The following table provides a description for each function / business process identified for Human Resources.
Function / Business Process Description HR (Employee Data and Job Data Personnel record keeping; Human Resources administration Administration) Manage recruitment; Manage new hires; Performance management; Alumni management; Staff Recruitment and Retention Employee satisfaction Plan for resource fluctuations and effectively manage supply and demand within the Workforce Planning organization
Succession Planning & Management Plan for resource separation to enable knowledge capture and retention
Develop and maintain job evaluation tools; Develop, implement and administer salary Employee Compensation and Benefits scales and benefit plans; Assign employees to relevant occupational classes / groups; Management Maintain an employee position tracking system; Manage Compensation; Manage Benefits
Liaise between management and employee groups; Problem-solving and Mediation; Manage employee relations, including internal equity programs and/or union activities. Labour Relations Manage disciplinary measures and grievances, investigate complaints, and apply corrective action where required.
Provision of general orientation; Management / leadership training; Other employee group Learning and Organization Development training; Manage career development
Define a human resources strategy for the organization that is aligned with organization's business goals. Develop specific programs and policies that will support the strategy. HR Programs and Policies Analyze internal and external data and make recommendations for organizational change. Facilitate and manage the change.
31 The relevant business processes for Facilities Management as validated by the Sub Committee includes,
Manage Facilities Operations Housekeeping Security and Maintenance Services
Utilities Maintenance Waste Management
32 Functions / Business Processes within Facilities Management
The following table provides a description for each function / business process identified for Facilities Management.
Function / Business Process Description
The function pertaining to the general distribution and monitoring of building service Facilities Operations and Maintenance systems throughout the health service organization, including fire and safety.
Managing of housekeeping and linens-related processes including organizational strategy and plan, business case development, budgets, performance management and vendor Manage Housekeeping Services selection. This function may be outsourced to a corporate provider or managed by an internal department.
The function pertaining to the protection of service recipients, visitors, staff, their effects; and the grounds, building, equipment, and supplies of the health service organization, and Security control of access to health service organization areas. Includes all similar services procured on a purchased service basis.
The function pertaining to the general servicing, repair and maintenance of the grounds of the health service organization. The function pertaining to the general servicing, repair and Utilities Maintenance maintenance of the buildings and maintenance of service/major equipment of the health service organization. Includes all similar services procured on a purchased service basis.
The function pertaining to the maintenance and operation of an in-house incinerator for the Waste Management purpose of eliminating contaminated or bio-hazardous waste.
33 The relevant business processes for Materials Management as validated by the Sub Committee includes,
Management and Management of Procurement Vendor Management Development of Supply Categories Suppliers
Inventory Planning Inventory Strategy Demand Planning Distribution Planning and Management
Managing Managing Processing Returns Processing Orders Warehousing Transportation
34 Functions / Business Processes within Materials Management
The following table provides a description for each function / business process identified for Materials Management
Function / Business Process Description
Create requisition and obtain approval; Create Purchase Order; Receive and verify product; Authorize supplier payment; Develop procurement vision and mission; Define required capabilities (Organization, Process and Technology); Define sourcing strategy by product category; Analyze Procurement spend and assess opportunity; Analyze supply market and qualify suppliers; Conduct RFx / tenders / auctions and optimize bid; Negotiate contract; Select and activate supplier; Finalize Key Performance Indicators (KPI) and implement contract
Vendor Management Manage Vendor Listing
Management and Development of Segment suppliers; Measure and drive performance; Conduct supplier reviews; Terminate / Suppliers transition suppliers; Track Continuous Improvement
Develop category strategy; Manage category price; Manage category risk; Integrate category supply Management of Supply Categories chain
Inventory Strategy Develop vision for inventory management; Develop inventory policy
Demand Planning RHA level forecasting; Demand sensing ; Customer (Units / Wards) collaboration
Track inventory; Plan and manage inventory; Perform inventory control; Manage all aspects of Inventory Planning and Management inventory storage, movement and levels for raw materials and finished goods.
Distribution Planning Plan distribution requirements; Deploy constrained supply and publish plan
35 Functions / Business Processes within Materials Management
The following table provides a description for each function / business process identified for Materials Management
Function / Business Process Description
Process inquiry and quote – term, policies and procedures; Receive, enter and validate order; Check for inventory availability, reserve inventory and determine delivery date; Release and consolidate Processing Orders orders; Generate invoice and charge wards / units (if applicable); Process complaints and inquiries; Respond to internal material requests.
Perform returns planning; Manage returns policies and procedures; Execute processing of returns, Processing Returns recalls and repairs
Receive product from source (supplier); Pick product; Pack and label shipment; Manage warehouse Managing Warehousing operations
Build loads; Route shipments; Select, rate and schedule shipments; Load vehicle and generate Managing Transportation shipping documents; Deliver product to customer (other stores and units / wards); Manage and operate transportation suppliers; Manage freight pay and audit processes
36 The relevant business processes for Financial Management as validated by the Sub Committee includes,
Finance Administration and Accounts Receivable Accounts Payables General Accounting
Asset Security Payroll Budget Control Management
37 Functions / Business Processes within Financial Management
The following table provides a description for each function / business process identified for Financial Management:
Function / Business Process Description
Finance Administration and General Recording and reporting of the financial and statistical aspects of the health service organization's Accounting activities
Accounts Receivable Recording, billing, and collection of all accounts receivable
Accounts Payables Recording, classifying, and discharge of liabilities
Payroll Processing of payroll data
Budgeting, monitoring, reporting and analysis of planned and actual activities; manages and Budget Control prioritizes capital projects
Protection and management of organizational financial assets; Development and enforcement of the Asset Security Management policies and procedures for their safe and effective use
38 The relevant business processes for Information Technology and Support as validated by the Sub Committee includes,
Information Technology and Project Delivery Project Portfolio Telecommunications Management Management Strategy
New System Service Continuity Internal Training Selection, Integration Management and Installation
Network & Data Management & Security & Privacy Infrastructure Support Storage
39 Functions / Business Processes within Information Technology & Support
The following table provides a description for each function / business process identified for Information Technology & Support:
Function / Business Process Description
Long-term strategic vision of the Information Technology Telecommunications unit and how it Information Technology and furthers business goals; Development and review of standards and enterprise architecture to support Telecommunications Strategy business needs
Planning, management and closure of Information Technology and Telecommunications projects to Project Delivery Management help monitor results in support of business needs
Planning, management and closure of Information Technology and Telecommunications programs Project Portfolio Management to help monitor results in support of business needs
Assessing business needs Information Technology and Telecommunications hardware and software; Teaching business users to productively use Information Technology and Internal Training Telecommunications hardware and software; Development of applications and services to support business needs
Maintain redundant / highly available systems and data stores; Support business continuity or Service Continuity Management recovery at acceptable levels during or after business interruptions
New System Selection, Integration and Selecting preferred system and service providers; Managing the implementation of sourced Installation solutions
Protection and management of organizational assets; Development and enforcement of the policies Security & Privacy and procedures for their safe and effective use
Network & Infrastructure Support Maintaining and supporting the network and integration technology
Maintaining and supporting the data stores and infrastructure that support the enterprise and Data Management & Storage business systems
40 The relevant business processes for Legal Services, Risk Management and Privacy as validated by the Sub Committee includes,
Risk Infrastructure Risk Governance Risk Ownership
Risk and Management
Information HR / Labour and Finance / Accounting Technology (IT) Employment Legal Contracting / Supportive Housing / Records Management Procurement Housing Operations / FOI Response Team
Policies and Procedures and Communications Controls Privacy
41 Functions / Business Processes within Risk Management
The following table provides a description for each function / business process identified for Legal Services and Risk Management:
Function / Business Process Description
The Board of Directors requests that organizational risk management practices are appropriately Risk Governance transparent and visible
An organization-level risk management infrastructure is established by Executive Management to Risk Infrastructure and Management support the performance of risk responsibilities
Health Service Provider Business Units (departments, wards, etc.) are responsible for their Risk Ownership performance and managing business-specific risks with Executive Management's risk framework
42 Functions / Business Processes within Legal Services
The following table provides a description for each function / business process identified for Legal Services and Risk Management:
Function / Business Process Description
Information Technology (IT) Legal services relating to IT
HR / Labour and Employment Legal services relating to HR / Labor and Employment
Finance / Accounting Legal services relating to Finance / Accounting
Contracting / Procurement Legal services relating to Contracting / Procurement
Supportive Housing / Housing Legal services related to Supportive Housing / Housing Operations Operations
Records Management / FOI Response Legal services related to Records Management / FOI Response Team Team
43 Functions / Business Processes within Privacy
The following table provides a description for each function / business process identified for Privacy:
Function / Business Process Description
Policy Documentation, Policy Communication, Assignment of Responsibility and Accountability for Policies, Privacy Policies, Communication to Individuals, Consequences of Denying or Withdrawing Policies and Communications Consent, Types of Personal Information Collected and Methods of Collection, Communication to Third Parties
Review and Approval, Consistency of Privacy Policies and Procedures With Laws and Regulations, Personal Information Identification and Classification, Risk Assessment, Infrastructure and Systems Management, Privacy Incident and Breach Management, Supporting Resources, Qualifications of Personnel, Privacy Training and Awareness, Changes in Business and Regulatory Environments, Entities and Activities Covered, Implicit or Explicit Consent, Consent for New Purposes and Uses, Procedures and Controls Consent to Online Data Transfers to/from an Individual's Computer, Information Developed About Individuals, Use of Personal Information, Retention of Personal Information, Disposal, Destruction and Redaction of Personal Information, Access by Individuals to Their Personal Information, Confirmation of an Individual's Identity, Denial of Access, Updating or Correcting Personal Information, Statement of Disagreement, Disclosure of Personal Information, Protection of Personal Information, New Purposes and Uses, etc.
44 Appendix D: Outputs of Sub Committee Sessions
45 Agenda for Sub Committee Workshops
As part of BOCIP, this workshop has been designed validate the definition of a Leading Practices Repository for the functions within each administrative area across the SW LHIN. Members of the community, including representation across sectors, have been engaged to the following activities:
TIME LEAD AGENDA ITEM
9:00am Chair Welcome and Introductions
Project Overview and Workshop Expectations • Provide an overview of the process and project activities to date • Provide an understanding of the expectations related to this project within the context of the transformation 9:05am Deloitte agenda currently undergoing within the industry • Review the role of Sub Committee members –reference Term of Reference • Define objectives and outputs of today’s workshop
Validate Relevant Business Processes 9:15am Deloitte • Review and validate the business process identified for the relevant administrative area
Review/Validate the Minimum Standards • Present the maturity scale associated with each business process • Outline any feedback received from pre-read materials • Achieve consensus on the reasonability of each minimum standards (identified as the “standard” level on the 9:35am Deloitte maturity scale) • Discuss/identify any specialty considerations that are required for each business process within the health industry Identify Implementation Considerations • Identify implementation considerations (e.g. risks/barriers) to obtaining minimum standards for each business process within the administrative area
11:50am Chair Closing Roundtable
46 Workshop Objectives and Guidelines for Standards Validation
To understand the Terms of Reference, the objectives of the workshop and the expectations related to this project within the context of the transformation agenda currently undergoing within the industry To validate that all relevant business processes are included within each administrative area
Workshop To review/validate the minimum standards as defined on the maturity scale – including industry Objectives agnostic lagging to leading practices To gather the perspectives of the Sub Committee Member’s on sector specific considerations that need to be reflected for the various business process standards within each administrative areas To identify the implementation considerations (including risks/barriers) for integrating the functions within the administrative area
Maturity Level Definition Indicates the lowest level of maturity, often limiting the opportunity for improvement of the Lagging Practice Understanding process/practice due to industries advanced positioning relative to the current state the Practice Maturity Scale Indicates the level of maturity where the function has set standard processes, which are Used within the Standard Practice established and improved over time. These standard processes are used to establish consistency across the function. Inventory of Business Indicates a level of maturity where a consistent approach to practice is used across the Advanced Practice Process organization, delivering an acceptable level of performance and return on investment. Practices Indicates a level of maturity where a consistent approach to practice is used and is on-par Leading Practice with latest industry developments. The processes are governed by regular checks and controls.
47 Understanding the Terms of Reference for Sub Committee Members
Sub Committee Member’s Role Guiding principles
1. To review and submit feedback on the pre-read Each Sub Committee member is not to represent materials prior to the workshop 1 their organization, but rather to represent the 2. To actively participate in the workshop to share their spectrum of organizations within the sector. knowledge and insights during the discussion 3. To review and confirm acceptance of the refined The maturity scale will define practice standards Leading Practice Inventory following the workshop that are industry agnostic, with any sector 2 specific considerations to be documented for consideration during implementation.
The discussion will focus on validating the reasonability of the minimum standard 3 identified within the maturity scale (i.e. the practice standards identified under ‘Standard’ in Each change to the Inventory of Business Process the maturity scale). Practices will be performed if general consensus is achieved by the Sub Committee. The discussion is not intended to focus on 4 current state or on future state, as the strategic approach to implementation is for Phase 2 of this project work.
48 Appendix E: Outputs from the Jurisdiction Scan
49 To offer insights from other jurisdictions in Canada, three interviews were conducted with industry leaders
Three interviews were conducted with other jurisdictions that were proposed and agreed to with SW LHIN. The purpose of the review was to identify lessons learned by peer organizations as they have embarked on, or implemented, similar service integration initiatives.
Jurisdictions Saskatchewan Nova Scotia Newfoundland Ontario
Population*: 1.13M Population*: 942,926 Population*: 526,977 Population: 13.6M
• Saskatchewan is a leader in • Similar population size and • Similar population size and • Ontario is advanced Canada for shared services composition composition considered a leader in integration and service • Key drivers for integration • Key drivers for integration delivering healthcare services delivery were financial imperative and were financial considerations using a shared services • Key drivers for integration a provincial mandate to improve efficiencies for model, although delivery is were provincial incentive for expressing the desire for HSPs considering their vast currently in “pockets” financial sustainability and to Nova Scotia to consolidate to geographical service area • Key drivers for integration are act as one to optimize the improve efficiencies • Moving to a shared services financial sustainability and patient/resident/client • Merged Services Nova model province-wide viability of delivering equitable experience and Scotia (MSNS) • Newfoundland has not yet access to care across the patient/resident/client health • Nova Scotia consolidated their implemented integrated or broad geographical landscape outcomes Supply Chain in 2012 and shared services, however has • The focus and known • Shared Services since then, is in various gone through a successes to date for shared Saskatchewan (3sHealth) stages of delivering integrated strategic/current state services has been on Supply • Saskatchewan has services for IT and assessment to identify which Chain and some back office IT consolidated their payroll and Telecommunications and functions are most appropriate integration. Examples include Linens business processes, Human Resources for shared services within the Mohawk, SSW, HMMS, and is in the process of province COPA, and TransForm. planning 8 other • Top four areas of focus were administrative areas: identified as Human Transcription Services, ERP, Resources, Finance, IT and IT/IM, Medical Lab, Medical Supply Chain Imaging, Environmental • Supply Chain will go first Services, Supply Chain and *In comparison,Enterprise Risk the SW Management LHIN has a population of 962,539. 50 **New Brunswick is another region of interest that was unable to discuss their activity at this time. The interviews focused on identifying the key challenges and barriers to integration experienced by other jurisdictions and to identify lessons learned to be considered for BOCIP
Key Lines of Inquiry Key Lessons Learned Understanding Their Context Introduction 1. What is the current state of integrated services in your region now? 2. What was your role in the integration of services? Sector-wide Business Case Stakeholder Prior to integration of services Definition 3. What were the drivers for your region to integrate services? Engagement 4. What were the key activities undertaken to prepare for the integration? 5. What were the key decisions that were made prior to the Governance integration? How did you determine which services to integrate versus those to remain status quo? and 6. What stakeholders were involved, and how? Leadership 7. How did you handle regional governance decisions? Alignment
During the process of integrating services 8. What are the challenges and barriers you experienced while moving into a shared services model? Did these challenges and/or Project Team Targeting Quick barriers differ by administrative area? Development Wins 9. How did you handle cross sectorial differences? and Retention
Following the integration 10. What lessons were learned from bringing together significant Understanding players within the health sector? Current State 11. What would you have done differently? and Service 12. What would you have done the same? Requirements 13. What advice would you provide your colleagues prior to performing the same initiative?
51 Saskatchewan 3S Health
Background: For a number of years, certain parts of payroll, benefits administration and some contracting services are integrated across Saskatchewan health care services. There is a well establish Board to support the continued efforts to integrate additional services across the region, and a current initiative to define the business cases for 8 additional administrative areas, including: transcription services, ERP, IT/IM, Medical Laboratory services, Medical Imaging, Environmental Services, Supply Chain and Enterprise Risk Management services. 3S has currently landed on a decision for their approach to environmental services, but the implementation is not yet complete.
Drivers for Integration Key Activities Executed to Support Integration • There was a burning platform with the provincial government to • Developed a multi-layered governance structure that engaged identify means for financial sustainability for healthcare across representation across the province, including: accountability with the province the Ministry; a Governing Council; the 3S Board; and a Council of • A review identified the best ways to put patient/resident/clients CEOs first in the delivery of services within the province, and resulted • A charter identified the key principles that leadership had and in a recommendation for shared services would agree to abide by throughout the duration of the engagement (e.g., no one could opt out, no one organization would be impacted by the change alone)
Challenges / Barriers to Implementation Enablers to Implementation • A complex model for governance was used by 3S Health • CEOs across the province signed the charter to agree on how during the implementation of their early integration initiatives. they would work together throughout the duration of the Although not recommended, this model did enable the region to engagement have broad buy in and engagement that eased the process • Business cases were developed as the foundation to decision during implementation. making on which administrative and/or clinical areas would be • Predefined means to fund the solutions identified in the integrated first. The decision enabled the region to explore different business cases is recommended. Momentum to integrate was models of service delivery that included outsourcing and/or lost in Saskatchewan as funding was not predefined internal/union service delivery. • 3S Health experienced some challenges in receiving a clear • The initial service to be integrated – Linens – was designed on a definition of the vision from regional and provincial bodies. business case that required outsourcing, require the province to This lack of clarity with respect to the vision limited the trust closely align with the unions in a collaborative setting. Although stakeholders' had in the process and negatively affected unintentional, this publically delivered option has become a stakeholder buy-in strategic approach for the region as the unions are motivated to renegotiate public bargains to make future business cases more competitive
52 Nova Scotia Merged Services Nova Scotia
Background: Nova Scotia (NS) is well on its way to integrating their administrative areas across the province. Initiated in 2012, the province rolled out Supply Chain integration for strategic sourcing. Since the recent provincial election, this has been occurring concurrently to the integration of the District Health Authorities into one, centralized Health Authority for the province. The scope of investigation for which administrative areas could be integrated in Nova Scotia included: Supply Chain, IT and Telecommunications, Clinical Application Management and Human Resources.
Drivers for Integration Key Activities Executed to Support Integration • An emerging financial imperative for the province to identify • Established sponsorship across all relevant organizations cost savings through improved efficiency of service delivery • Ensured representation from relevant stakeholders for decision • A strategic agenda defined by the government making (e.g., included representation for each of the services, across geographies, with respected leadership) • Designed guiding principles that were consistently referenced throughout the process • Engaged relevant Boards if/as necessary to support decision making
Challenges / Barriers to Implementation Enablers to Implementation • "Many organizations and services are unionized in Nova • Ensured organizations understood and agreed with the current Scotia. This presents a challenging labour environment for state assessment service integration“ • Engaged sponsors who were held accountable for outcomes • Wide-spread interest in governance, service and service • Initiated the integration efforts within early adopter level agreements (SLAs) by stakeholders meant that the organizations prior to the larger collective being ready leadership team encountered a need for clear and consistent • Identified representative stakeholders across sectors and communications to mitigate issues/risks geographies • The team learned the importance of frequent and quality • Committed dedicated resources to change management and engagement with Boards communications early in the integration process • There was a investment required to maintain the team throughout the duration of the project • There was an inability to complete and/or execute on activities in a silo
53 Newfoundland Health Shared Services Strategy
Background: The Province of Newfoundland and Labrador completed a detailed spend analysis on their supply chain business functions as a means to identify financial savings for the province. As an outcome of this analysis, ~$26M in savings were found, identifying means to save financial resources through improving how they procure and source supplies for health related services. It was noted that additional savings may be generated if a broader shared services model was implemented across the health regions and as such, a review was completed on 17 administrative areas province wide in order to identify the optimal areas to focus on to realize efficiencies and effectiveness for the province.
Drivers for Integration Key Activities Executed to Support Integration • The province recognized the need to enable system • Assembled a provincial Steering Committee comprised of sustainability as their per capita spending had reached the government and RHA leaders (e.g., Deputy Minister, ADM, RHA second highest in country CEOs) • There is redundancy in the system with four regional health • Developed a provincial health shared services strategy, including authorities for a relatively small population to manage an implementation plan • An emerging financial imperative for the province to identify cost • Developed and maintained a clear focus on supply chain as a savings through improved efficiency of service delivery starting point, followed by HR, Finance and IT • The province was facing issues with service quality due to challenges in consistency of practice.
Challenges / Barriers to Implementation Enablers to Implementation • The strategic assessment for integrated services occurred during • There was a provincial steering committee (similar to BOCIP) a challenging political cycle, as the province was less than a that had strong executive presence and support; offering buy in on year from an election resulting in: the project that support the decision making process in developing o Resistance to advance integration efforts from a political the integration strategy perspective • The integration initiative had government support (similar to the o Loss of continuity between governments and changes in LHINs endorsement) that drove momentum and collaboration leadership efforts • A large and vast geographical area that requires the balancing • There was a clear driver and articulation of the value integrated of urban with rural/remote community interests services would offer the region • Regional will to consolidate into one location was/is not united, as there was interest in delivering some services across the province. This decentralized model reduces consolidation and efficiency. • There is limited organizational capacity to implement the work required
54 Ontario Numerous and varied shared services and/or integrated service delivery models Background: Ontario is experiencing integration efforts across the province in both clinical and non-clinical administrative areas; however, there has not been a province wide or region-wide initiative to date. There are pockets of integration that have been realized within sector specific agencies and/or groups of agencies including examples such as: back office technology integration (e.g. TransForm), information system integration for across a sector (e.g. CHRIS within the Community Health Services Sector) and process integration for Supply Chain (e.g. HMMS).
Drivers for Integration Areas of Integration in Ontario • Similar to other jurisdictions, Ontario’s drivers for integrating • Sector specific organizations are supporting specific functions that services in healthcare are to maximize the value of the may be more difficult for organizations to support due to resources used to deliver high quality services size/complexity and/or where it is more beneficial to be centralized • The provincial strategic approach to delivering health care (e.g. OACCAC support of the CCACs, AOHC support of CHCs) services has taken a stronger focus on leveraging resources • Shared services are supporting sector specific functions such as across organizations if/when possible to reduce redundancy and procurement to standardize processes (e.g. HMMS) or back office increase efficiencies integration (e.g. TransForm) • The province has been pushing an agenda that drives fiscal • Managed services are also a common governing structure through responsibility in efforts to improve cost savings in healthcare which back office integrations have been established (e.g. North service delivery Simcoe Muskoka CCAC support of CSS sector)
Enablers to Implementation
Challenges / Barriers to Implementation • Integration and/or shared services can be designed to generate efficiencies in different ways, thus resulting in multiple ways to • The governance structures for integrated or shared services meet the needs of the provincial agenda. Examples of this include has been challenging for Ontario, as the province as a whole has Ontario’s way of integrating/sharing services across sectors, within a more complex governing structure that impacts integration LHINs, across LHINs within a specific function, etc.. vehicles as they come together • Ontario has supported integration to occur through legislation • There is a large variation in the size of organizations across enablement the province and within the sectors, resulting in challenges to • Ability to establish governing models for not for profit shared define integration models that suit the needs of each capital organizations (e.g. COHPA, Plexxus, Transform, Shared participating organization (e.g. Mohawk) Services West, 3SO Health) or other Joint Venture/managed • There is a strong need to consider and accommodate the impact services structures (e.g. HMMS) of labour relations within integration model design (i.e. consider • Participating organizations within Ontario have been willing to requirements for union versus non-unionized employees) commit to long-term initiatives, as these services are often a • A large amount of capital investment is required to create the minimum of 5-7 years infrastructure to support integrated/shared services
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Agenda Item 4.5 Report to the Board of Directors 2016 Quality Symposium
Meeting Date: June 15, 2016
Submitted By: Ashley Jackson, Director, Communications and Community Engagement Teresa Lannin, Communications and Community Engagement Specialist
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Purpose:
To provide an update on the South West LHIN Quality Symposium which was held in Stratford on June 2, 2016. The event had 432 participants, and 246 evaluations were collected. This feedback will be used in the planning and development of a future Quality Symposium.
Objectives Met: Offered an affordable, accessible and valuable continuing education opportunity for participants. 81% of evaluations strongly agreed or somewhat agreed: o I know more about key quality strategies and initiatives. 99% of respondents stated they enjoyed the event. “Continue with outstanding speakers.” “The format and quality of the speakers should be same next year.” “This year was the most informative symposium I’ve been to so far.” “Judith stole the day.” “By far and away, the format was the best of all the previous Symposiums.” “The videos were quite good. I would continue with this and maybe add more.” “Keep up the good work!” “One of the best events I’ve attended in a long time.” “I like that agencies are encouraged to be innovative and creative. The panelists were fantastic and I would love to see them back again.”
Maintained attendance from previous events (approx. 400 people) with representatives from across the LHIN geography from a broad range of sectors.
Report to the Board of Directors- 2016 Quality Symposium Page 2
14% increase in attendance: 432 (2016) vs. 379 (2015) vs. 350 (2014) 2% decrease in evaluation response rate: 66% (2015) vs. 56% (2015) Maintained attendance from a broad range of sectors: o 2014: 6% CCAC, 25% CSS, 3% CHC, 16% Hospital, 19% LTC, 9% MH&A o 2015: 8% CCAC, 22% CSS, 2% CHC, 15% Hospital, 20% LTC 15% MH&A o 2016: 3% CCAC, 22% CSS, 3% CHC , 23% Hospital,17% LTC, 10% MH&A 32% of those who completed evaluations were attending the Symposium for the first time. This year’s evaluation was adjusted to understand what is attracting attendees. When asked why guests were attending the Symposium: o 72% attended to learn about quality strategies o 46% were drawn to the speakers o 30% were looking for an update on LHIN business o 1% attended to obtain a CCHL credit o 9% are new to their roles
Created opportunities to exchange ideas and move forward on the common goal of more integrated, high quality care for Ontarians.
71% of evaluations strongly agreed or somewhat agreed: o After today I am in a better position to lead and support system-level change 88% of evaluations strongly agreed or somewhat agreed: o There was enough time for discussion and feedback
Increased the quantity of earned media by creating social visual experiences and aligning social opportunities where it would most benefit attendees and partners.
@SouthWestLHIN #swquality2016 o 195 retweets (35% increase from 2015:143 retweets) o 82 favourites (32% increase from 2015: 62 favourites) o 11 replies [engaged conversation] (35% decrease from 2015: 17 replies) o Unique reach – 76, 546 twitter uses (22% increase from 2015: 62,641 twitter users) o Total reach 924,896 impressions (38% increase from 2015: 671,949 impressions)
Approximately 76,000 people were directly following our twitter and reading our tweets. And because of the retweets, favourites and replies - the spread to others’ social accounts grew to a total reach of 924, 896 people who saw Quality Symposium tweets in their news feeds.
Summary of findings from evaluation comments
The format and organization worked well, and participants expressed appreciation for the shorter day to allow for travel time. Participants told us they liked Judith John’s personal story and success story videos. They proved to be an effective way to hear the patient/client/resident voice throughout the day. Participants want to leave feeling inspired and motivated. Feedback tells us speakers must focus on quality strategies to really engage the audience. Ensure speakers can deliver on connecting their perspective to the theme. Speakers need to embody the theme in their presentations. There is a desire to hear from a rural voices, health promotion/disease prevention, end of life care, as well as the mental health sector. Continue to offer spotlights on organizations that are championing quality improvement strategies. Provide tools and techniques that attendees can take back with them. Set a target number for patient and family advisory representatives and ensure they are in the audience.
Agenda item 4.6 Report to the Board of Directors Health Links
Meeting Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director Kristy McQueen, System Design and Integration Lead Sue McCutcheon, Health Links Lead
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Purpose: To ensure the South West LHIN Board of Directors is kept appraised of status of implementation of the Health Links approach to Coordinated Care Planning in the South West.
Health Links Implementation “Our Aim is to support patients and their families with high care needs to be able to live well in their community and reduce avoidable healthcare utilization.”
The Health Links Leadership Collaborative is continuing to support spread of the Health Links approach to Coordinated Care Planning by: Hearing and discussing a patient story regarding coordinated care planning at each meeting - This month, the South Grey Bruce Health Link presented a patient story of an older woman who was having difficulty controlling her pain in the community and was also in the process of moving to Long Term Care. We heard how important it was to have the community and LTC Teams come together to plan with the patient and family in order to help meet her goal of pain control. Working with groups who have a similar aim to support people with high care needs - For example, people who are being supported through end of life care or are transitioning home from hospital with many complex care needs, now have access to the Coordinated Care Planning approach of Health Links. Also, all patients who are part of the Connecting Care to Home (CC2H) project are supported with a Health Links Coordinated Care Plan. Working with Dr. Rob Annis and the newly formed Clinical Quality Table to partner to ensure the Health Links approach to care planning and the Health Links Learning Collaborative continues to support spread of best practices in the South West Reviewing the research and literature on physician engagement so that strategies are as creative as possible in engaging physicians and nurse practitioners to improve the way care is planned with patients and their families Supporting the Health Links Learning Collaborative planning for the fall of 2016
Report to the Board of Directors Page 2
How many people are being supported with Coordinated Care Plans using the Health Links approach in the South West? As of the end of April 2016, 323 people in the South West LHIN have been supported with a Coordinated Care Plan. 114 in Huron Perth 138 in London Middlesex 34 in North Grey Bruce 37 in South Grey Bruce
What is each Health Link geography working on and planning to do? Huron Perth Implementation of Sustainability Plan The Huron Perth Health Link Steering Committee has committed to continue to support implementation of the Health Links approach The Spread and Sustainability Advisory Group continues to ensure that the processes of coordinated care planning work for the patients and front line providers Leaders in Huron Perth are also offering regular opportunities for providers involved in the care planning process to come together to celebrate success and problem solve together
London Middlesex Implementation is Progressing London Middlesex continues, with high energy, to work with patients, their families and providers to coordinate care across the system The Health Link Steering Committee in London Middlesex is supporting improved understanding of the experience of coordinated care planning through in-depth interviews with patients and providers
North and South Grey Bruce Implementation is Progressing Both North and South Grey Bruce are actively working with stakeholders to implement action teams to ensure that care processes continue to be improved In collaborative with the Grey Bruce Public Health Unit, workshops on poverty were held for Primary Care and other providers with the purpose of building knowledge of how to screen and intervene with patients who are having trouble making ends meet at the end of the month. Workshops were led by Dr. Goel from the Ontario College of Family Physicians.
Oxford and Elgin ‘Gearing up’ in Anticipation of Funding Both Oxford and Elgin Health Links have groups working on getting ready for
implementation, once project funding becomes available
What can you do to help? 1. Continue to actively look for linkages with the Health Links in your decision making. 2. As the implementation of the Health Links approach requires organizations supporting their staff to work in a collaborative and transparent manner, continue to find ways to build shared accountability at the governance level.
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Report to the Board of Directors Agenda item 4.7 Senior Leadership Report
Meeting Date: June 21, 2016
Submitted By: Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, System Design and Integration Mark Brintnell, Senior Director, Performance and Accountability Ashley Jackson, Director, Communications & Community Engagement Lorri Lowe, Controller & Manager of Corporate Services
Submitted To: Board of Directors Board Committee
Purpose: Information Decision
French Language Services Update
The French Language Services Commissioner recently released two key reports: A “Special Report, Active Offer of Services in French: The Cornerstone for Achieving the Objectives of Ontario’s French Language Services Act”; and 2015-16 Annual Report - FSLA 2.0
Special report of the Commissioner for French Language Services
The report identifies the importance of an active offer of services in French, in particular for vulnerable population groups. It also notes the weaknesses of the current system. A lot of research went into the development of this document which also references practices in other Canadian jurisdictions.
The Commissioner makes 3 recommendations: 1. That the Minister Responsible for Francophone Affairs propose an amendment to the French Language Services Act to include a provision relating to the obligation of active offer. The amendment should come into force no later than May 2018; 2. That ministries, government agencies and institutions subject to the Act produce and submit to the Office of Francophone Affairs an action plan setting forth clear directives and best practices to guide directors and managers responsible for implementing the active offer of services in French. 3. That the Office of Francophone Affairs promotes collaborative measures, in a recurring and cyclical manner, to government agencies and institutions subject to the Act, in order to facilitate its implementation as part of a Provincial Strategy on the Active Offer of French-language services. The development and implementation of this Strategy should
Report to the Board of Directors- Senior Leadership Update Page 2
be done in conjunction with partners experienced in this domain, for the purpose of facilitating the achievement of objectives.
The French Language Services Toolkit (available in both English and French) developed by the Erie St Clair and South West LHINs is cited 3 times in the report (on pages 16, 23 and 41) and is noted as a best practice.
The full report can be found at the following links: http://csfontario.ca/wp-content/uploads/2016/05/csf_rapport_special_2016.pdf http://csfontario.ca/wp-content/uploads/2016/05/flsc_special_report_2016.pdf
2015-16 Annual report – FLSA 2.0
2016 marks the 30th anniversary of the French Language Services Act and the French Language Commissioner has devoted his ninth Annual Report to present a blueprint for a comprehensive revision of the act.
In this report, the Commissioner explains and demonstrate that there is a need for reviewing and redefine concepts of services and communications in the Act and use of more modern definition, as it relate to technologies and social media. He also suggests clarifying and adjusting the roles and responsibilities of key players in implementing and enforcing the act such as: The minister responsible for the Office of Francophone Affairs The Office of Francophone Affairs The French Language Services Coordinators A new advisory council of Francophone affairs and his own role
The Commissioner made the following 3 recommendations: 1. The Commissioner recommends that the Minister Responsible for Francophone Affairs propose to the legislative Assembly a comprehensive revision of the French Language Services Act, which should include, but not be limited to, the following issues covered in this report. (listed as issues are purpose of the act, inclusive definition of francophone, consultation with francophone community, designation of areas, designation of agencies, Active Offer, etc.) 2. The Commissioner recommends that the Minister Responsible for Francophone Affairs initiate the process of revising the French Language Services Act during the current Session of Parliament, no later than the fall of 2016, as part of the Act’s 30th anniversary. 3. The Commissioner recommends that the Minister Responsible for the Francophone Affairs launch, without delay, a mechanism for consulting the residents of Ontario, particularly the Francophone community, as first step in the process of revisiting the French Language Act.
The links to the 2015-16 Annual Report are provided below: http://csfontario.ca/wp-content/uploads/2016/05/FLSC_Annual_Report_2015-2016.pdf http://csfontario.ca/wp-content/uploads/2016/05/CSF_Rapport_Annuel_2015-2016.pdf
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Report to the Board of Directors- Senior Leadership Update Page 3
LHIN Staffing Update Laura Deyell joined the South West LHIN team on Monday, June 6, as the System Design and Integration - Program Assistant. Laura will support the Seniors and Adults with Complex Needs, Mental Health and Addiction, Aboriginal Health and French Language teams. Most recently, Laura worked at Elgin St. Thomas Public Health as a program assistant and prior to that held a number of positions with Bereaved Families of Ontario. She is very interested in being part of improving the health care system. She has a Bachelor of Arts from the University of Waterloo.
3
BILL 210, PATIENTS FIRST ACT
Update to South West LHIN Board of Directors June 21, 2016 Discussion Points
• Articulating the Future Vision • Overview of the Legislation • High-level overview of implementation work streams • Early thoughts on sub-region formation • Next steps • Questions & Discussion
2 Vision for Integrated Care at the Local Level
3 4 Ontario’s Health System at Transition: Anticipated Spring 2017 (if Bill is passed)
Goal: Patients Receive Integrated, Accessible Care of Consistently High Quality
Standards of Care
Integrated Care Boards of Health Sub‐Regions Integrated Clinical Council Primary Care Home & Community French Language to develop Care Hospitals Health Planning standards Addictions & Mental Health Entities Long‐term Care Homes Community Support Services First Nations & Indigenous Local Health Integration Networks Engagement
LHIN Shared Services Organization to Support All LHINs Patient and Family Advisory Council
Health Quality Ontario Ministry of Health and Long‐Term Care
5 Patients First Act – Vision in a sentence
“The overall vision of the Patients First Act is to improve access to health care services by giving patients and their families faster and better access to care, and putting them at the centre of an integrated health system”.
6 Patients First Act
7 Acts Amended by the Patients First Act
• The bill containing the Patients First Act, 2016 proposes amendments to LHSIA and the Home Care and Community Services Act, 1994 (HCCSA) to expand the mandate and role for the LHINs. If the bill were passed by the Ontario Legislature:
• The Community Care Access Corporations Act (CCAC Act) would be repealed once the transfer of functions from the CCACs to the LHINs is complete.
• Complementary and consequential amendments to the following Acts would be required: Health Protection and Promotion Act (HPPA) Commitment to the Future of Medicare Act (CFMA) Health Insurance Act, (HIA) Personal Health Information Protection Act, 2004 (PHIPA) Excellent Care for All Act, 2010 (ECFAA) Public Hospitals Act, (PHA) Ombudsman Act, (OA) Private Hospitals Act
• Other statutes would be amended, as necessary, to remove references to CCACs.
Key Potential Legislative Changes LHSIA HCCSA CCAC Act HPPA ECFAA Expand the LHIN Allow the Minister Repeal the Act to Establish Support the mandate and to approve LHINs reflect the wind engagement establishment of an oversight powers to provide home down of the requirements for integrated clinical and establish sub- and community CCACs LHINs and local care council regions services (directly boards of health or through contracts with service providers)
8 Summary of Proposed Amendments (1) Part 1: LHIN Governance and Mandate If the bill is passed by the Ontario Legislature, the proposed amendments would:
1. LHIN Objects • Amend LHIN objects to reflect LHINs’ expanded mandate, including authority to deliver home care services currently provided by the CCACs and to coordinate community services, as well as to promote health equity and reduce health disparities and inequities in planning, design, delivery and evaluation of health services. 2. Additional Health Service Providers • Allow LHINs to fund and have accountability relationships with additional Health Service Providers (HSPs), including Family Health Teams (non‐physician funding), Aboriginal Health Access Centres, hospices, and nurse‐practitioner‐led clinics. 3. LHIN Sub‐Regions • Require LHINs to establish sub‐regions as the focal point for local planning and performance monitoring and management.
4. LHIN Governance • Expand LHIN board membership from 9 to 12 members to reflect the expanded mandate. • Change the total length of time a person may be Board Chair (e.g., may exceed a maximum of six years when a person is appointed as a Board Chair after having served at least three years as a member).
5. Shared Services Entity • Allow for the establishment, by regulation, of a shared services entity to support LHINs with the necessary shared services (e.g., payroll, financial, IT services and supports). 6. Patient and Family Advisory Committees • Require each LHIN to have one or more Patient and Family Advisory Committees to support community engagement. 9 Summary of Proposed Amendments (2) Part 2: Primary Care If the bill is passed by the Ontario Legislature, the proposed amendments would:
• Add primary care models (not physicians) as HSPs funded by LHINs. • Add “physician resources” to planning objects of LHINs. • Give LHINs the ability to act on behalf of the Minister to monitor and manage (but not negotiate) contracts with physicians. • Add regulation‐making authority to require physicians to notify LHINs of practice changes (e.g., upcoming retirement).
Part 3: Home and Community Care If the bill is passed by the Ontario Legislature, the proposed amendments would: 1. LHINs to Provide Home and Community Services • Give the Minister the authority to order the transfer of CCAC staff and assets to LHINs. • Following a Minister’s order, LHINs would assume responsibility for the management and delivery of home and community care (directly or through contracts with service providers), including the placement of patients into long‐term care homes.
2. Labour Considerations • LHINs would become successor employers under collective agreements. • LHINs would establish an integrated management structure.
3. Wind Down CCACs • Dissolve CCACs by Minister’s order after CCAC staff and assets have been transferred to the LHINs.
10 Summary of Proposed Amendments (3) Part 4: Public Health If the bill is passed by the Ontario Legislature, the proposed amendments would: 1. Population and Public Health Planning • Establish a formal relationship between LHINs and local boards of health to support joint health services planning. Part 5: Enhanced Oversight and Accountability If the bill is passed by the Ontario Legislature, the proposed amendments would: 1. Enhanced LHIN Oversight • Give LHINs the ability to issue directives, investigate and supervise health service providers, as necessary, with the exception of hospitals (only ability to issue directives and investigate) and long‐term care homes. 2. Enhanced Minister Oversight • Give the Minister the ability to issue directives, investigate, or supervise LHINs, as well as enhanced power to issue directives to public and private hospitals. The Minister would also have the authority to set standards for LHINs and health service providers. Part 6: Complementary Legislative Changes If the bill is passed by the Ontario Legislature, the proposed amendments would: 1. Integrated Clinical Care Council • Allow for an integrated clinical care council to be established within Health Quality Ontario to develop and make recommendations to the Minister on clinical standards in priority areas (e.g. home care, primary care). 2. Patient Ombudsman • Give the Patient Ombudsman oversight of complaints regarding home and community care and related health service functions provided or arranged by the LHINs. The Provincial Ombudsman would retain oversight over LHINs in their services planning and other functions not related to health services delivery. 3. Provincial Patient and Family Advisory Council CONFIDENTIAL • Allow for the establishment of a provincial Patient and Family Advisory Council (PFAC). 11 Implications for Francophone and Indigenous Communities
Francophone Patients and Communities • LHINs are subject to the French Language Services Act (FLSA), which means that the rights of CCAC clients to reasonable access to service in French would be preserved.
Indigenous Engagement Strategy • At the release of the Patients First proposal, Indigenous partners stressed the need for respectful engagement to address the complex relationships between Indigenous peoples and the health care system that has contributed to poor health outcomes, and to address lack of effective Indigenous engagement when the LHINs were created in 2007. • The Ministry is proposing distinct processes for First Nations, Métis and Urban Aboriginal partners to ensure effective engagement processes that are respectful. This will take place in parallel to the proposed legislative changes. • The Ministry is working on a longer-term collaborative process with First Nations partners to achieve transformative change that respects a government-to- government relationship with First Nations.
12 Phases of critical activity through to future state
Pre-enactment of Legislation Post-enactment of Legislation Legislation Legislation Legislation Towards a introduced Proclaimed implemented future state
13 How a bill becomes a law
14 How a bill becomes a law
15 How a bill becomes a law
16 Provincial work streams - Milestones
17 Provincial work streams – under development 1. LHIN governance Establish a governance and accountability structure that reflects the expanded mandate of LHINs
2. LHIN management Establish and implement a common management structure that reflects the expanded LHIN role, including clinical and administrative roles
3. LHIN corporate services entity Establish a corporate services entity for the purpose of providing shared services support to LHINs to undertake their expanded mandate, and providing support throughout CCAC wind- down
4. LHIN capacity and readiness Identify critical elements of readiness, conduct readiness assessments, and ensure tools are in place to support LHIN capacity and readiness
5. Sub-region formation (K Gillis participating) Establish sub-regions within LHINs to serve as the focal point for population-based planning, service alignment and integration, and performance improvement 18 Provincial work streams – under development 6. Clinical leadership Develop and implement a clinical leadership model for LHINs, as well as an integrated clinical and administrative leadership model for sub-regions
7. Integrated Clinical Care Council (ICCC) Establish ICCC at HQO to develop clinical care standards and outcome based performance measures
8. Unionized workforce (CEO support by M. Barrett) Enable a successful transition from separate LHINs and CCACs to an integrated workforce with continuity in collective agreements, union representation, and patient care. Work with partners to lay foundations for post-transition policy and delivery changes to support patient care
9. Performance and data (M. Brintnell participating) Develop an integrated performance measurement framework, including an approach to collecting, analyzing, and reporting healthcare performance information to support LHIN Renewal
19 Provincial work streams – under development
10. Primary care (K. Gillis participating) Implementation of priority activities to expand the role of LHINs to include primary care planning (including HHR), performance monitoring, enhancing access to primary care
11. Home and community care Enable LHINs to assume leadership responsibility for home and community care with a focus on sub-regions, and have the capacity to support the ongoing implementation of Patients First: A Roadmap to Strengthen Home and Community Care
12. Public Health (CEO Lead M. Barrett) Enable the establishment of processes and structures that support successful formal linkages between LHINs and boards of health to leverage population and public health expertise
13. French language services
14. Indigenous populations
20 Early Thoughts
21 Sub-Region Planning – Early Thoughts
• Strong history of relationships in each sub-region geography
• Focal point for local planning and service delivery is anticipated to be at the sub-region level in alignment with an overall LHIN strategy and approach
• South West LHIN is committed to work with partners and the government to achieve a health care system that meets the needs of patients
• Implementation of LHIN-wide and Provincial guidelines could occur at the sub-region level
• Consultation on Sub-Regions
22 Sub-Region Planning – Early Thoughts (cont’d)
• There is a need to recognize and plan for the natural flow of patients between our LHIN and bordering LHINs
• Area provider tables could play a role in informing sub-region tables • Representatives from all sectors as members • Decision making level of organizations present • Mechanisms for communication to all local health service providers in place • Ensuring patient/family voice included
• The LHIN would use sub-region integration tables to inform decisions and prioritize, however the tables would not have funding responsibilities.
23 24 Organizational development and change management • The South West LHIN will revisit the Organizational Development Plan which outlines how we as an organization can achieve a strong, cohesive, outcome driven team. • Our Shared Values • We are Leaders • We are a Team • We all have Talent • How we are Structured • The Strategy that guides us • Our System provides tools and resources
• The LHIN will provide change management support through the LHIN-CCAC integration to address emotional change, organizational change and system change
25 Next steps
• Recognizing consultation to date has been crucial to the development of the proposed Patients First Act, the Ministry and LHINs will continue to consult with the health sector – summer consultation sessions being planned • The legislative process would also provide for opportunities to consult on the proposed legislative amendments • Legislation is only one part of the ongoing evolution of the Ontario health care system to support the Patients First: Action Plan for Health Care • Internal LHIN commitments include regular staff surveys, monthly updates at staff meeting, and interim written update at the end of the month • Develop work plan for implementation at both provincial and local level • Develop communications and stakeholder engagement plan • Legislature resumes on September 12, 2016
26 27
Item: 6.1 Report to the Board of Directors 2016-2017 Annual Business Plan (ABP)
Meeting Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director, System Design and Integration
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
______Suggested Motion: THAT the South West LHIN Board of Directors approves the 2016-17 Annual Business Plan for submission to the Ministry of Health and Long-Term Care.
Purpose: The Annual Business Plan (ABP) is a key component of the ministry/LHIN accountability framework and aligns with the ministry’s Action Plan for Health and the 2016-19 IHSP. On March 11, 2016 the Board approved the 2016-17 draft Annual Business Plan (ABP). Since the approval, the LHIN submitted the draft plan and received Ministry feedback regarding the plan. The Ministry’s feedback identified that the plan included all the required components for a government agency and that it aligns well to our Integrated Health Service Plan setting out clear priorities, strategies and goals.
Adjustments to the draft Annual Business Plan With the receipt of the Ministry’s feedback and introduction of the proposed Patients First Act in the legislature, changes have been made to the main body and appendices and a final version is being brought forward to the Board of Directors for approval. The changes have been tracked in the attached documents so that the LHIN Board can easily identify changes made to the plan since the Board last reviewed in March.
Key enhancements include updated financials as these were not available in March, emphasizing the plan’s alignment to the French Language Services Act, and better reflecting key components of the Patients First direction as described in the proposed Act. To ensure alignment between our new IHSP and health system renewal, and sufficient capacity of LHIN staff and Health Service Providers to support the renewal agenda, LHIN staff have reviewed and adjusted timelines and staging of some of the initiatives contained in the 2016-17 ABP.
Next Steps: Following final Board approval and submission to the Ministry of Health, the ministry will conduct one final review before recommending the ABPs to the Minister of Health and Long- Term Care for approval.
South West Local Health Integration Network
Annual Business Plan 2016/17
June 21March 11, 2016
South West LHIN 2016/17 Draft Annual Business Plan 1
TABLE OF CONTENTS
TRANSMITTAL LETTER ...... 3 1.0 CONTEXT ...... 5 1.1 Mandate of the South West LHIN ...... 5 1.2 Goals of the Organization ...... 5 1.3 Our Context ...... 6 1.4 Overview of 2016-2019 Integrated Health Service Plan ...... 7 2.0 CORE CONTENT ...... 8 2.1 IHSP Implementation Strategies ...... 8 2.2 IHSP Priorities and Initiatives ...... 98 2.3 Monitoring Progress and Measuring Results ...... 109 2.4 Accountability ...... 1110 3.0 LHIN OPERATIONS ...... Error! Bookmark not defined.11 3.1 Operations Spending Plan ...... 1211 3.2 Staffing Plan ...... Error! Bookmark not defined.14 4.0 COMMUNICATIONS AND COMMUNITY ENGAGEMENT ...... 1215 4.1 Communications Plan ...... 1615 4.2 Community Engagement ...... 2120
APPENDIX A: Organizational Development Plan APPENDIX B: Summary of IHSP Implementation Strategies APPENDIX C: Summary of IHSP Priorities and Initiatives APPENDIX D: Anticipated Progress – Priorities and Initiatives APPENDIX E: LHIN Committee and Network Relationships APPENDIX F: Performance Measures at the System and Priority Level APPENDIX G: Integration Activities APPENDIX H: Capital Projects
South West LHIN 2016/17 Draft Annual Business Plan 2
TRANSMITTAL LETTER
To: Nancy NaylorTim Hadwen, Assistant Deputy Minister Health System Accountability and Performance Division
Subject: South West Local Health Integration Network – Annual Business Plan, 2016/17
I am pleased to submit the South West LHIN’s 2016/17 Annual Business Plan, which details our action plans and key activities for the coming fiscal year.
This plan clearly defines the actions the LHIN, in partnership with health service providers, will take to improve the health outcomes of the people and patients within local geographies. Because of the dedication of our health service providers, there have been many successes that have resulted in improvements to the health system. But there is more work to do.
As you know, over the past decade, Ontario’s health care system has improved significantly Formatted: Default with reduced hospital wait times, improved access to primary care, and more care for people at home. However, there are still a number of areas where we need to do more. To support continued improvements to our health care system, To address these changes, Ontario introduced the proposed Patients First Act on June 2, 2016, Ontario that, if passed, will enable the continued evolution of locally integrated patient-centred health care delivery.next stage of the Patients First Action Plan for Health Care. To address these areas, we are pleased that the Ministry of Health and Long-Term Care released its “Patients First: A Proposal to Strengthen Patient-Centred Health Care” discussion paper in December 2015.
This year marks the first year implementing our Integrated Health Service Plan (IHSP) 2016- 19 that guides us not only in achieving the vision outlined in our Health System Design Blueprint: Vision 2022, but also in carrying out the structural changes that may be ahead. We will work with local system partners and our provincial partners to move transformationhealth system renewal forward.
The IHSP identifies strategic directions and steps required to make our overall vision of an improved health system a reality. After extensive engagement with stakeholders, health service providers and the general public throughout 2015, we established seven priorities to enhance population health, experience of care and value for money in the South West.
The IHSP’s initiatives and actions fully align with provincial priorities and supports Ontario’s plan for transformational change for the health system as detailed in Patients First: Ontario’s Action Plan for Health Care. The South West LHIN is also committed to achieving working with the governments in its proposed plan for structural reform as outlined in the discussion paper Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario and the recently introduced Patients First Act while ensuring the continued delivery of high quality care to the people in our LHIN.
South West LHIN 2016/17 Draft Annual Business Plan 3
The South West LHIN Board continues to meet regularly with health service provider governors and our communities to promote integration, service coordination and quality improvement. We also have a strong online presence that fosters dialogue, transparency and accountability with valued partners and community members.
In working with the Ministry of Health and Long-Term Care and health service providers, we are ready and well-positioned to continue our efforts to improve health care in the South West LHIN and throughout Ontario. We are committed to our strategic plan deliverables and the work that is needed to improve the health of our communities.
Sincerely,
Jeff Low, Chair South West LHIN Board of Directors cc: Michael Barrett, CEO, South West LHIN
South West LHIN 2016/17 Draft Annual Business Plan 4
1.0 CONTEXT
1.1 Mandate of the South West LHIN Across Ontario, Local Health Integration Networks (LHINs), along with health service providers and partners, have the important responsibility of transforming the health system to put patients, clients, residents and caregivers at the centre of the system.
As outlined in the “Patients First: A Proposal to Strengthen Patient-Centred Health Care” discussion paper and the proposed Patients First Act, the province is calling for structural reform across the system to improve access, and ensure equity for all people needing health care. LHINs are prepared to deliver on this commitment to innovative system change and plans to transform the system are well underway.
To help guide this transformation, all LHINs produce a three year plan for the local health system. The plan, called an Integrated Health Service Plan (IHSP), identifies key strategies, priorities and outcomes required to make our overall vision of an improved health system a reality. The plan sets out both our goals for the health system and the direction for all health service providers over the next three years.
The South West LHIN shares the provincial view of better patient care through better value from our health care dollars, outlined in Patients First: Ontario’s Action Plan for Health Care. Our mission is to bring people and organizations together to build a health system that balances quality, access and sustainability to achieve better health outcomes.
The South West LHIN is also guided by our long-range plan, the Health System Design Blueprint, which works towards achieving an integrated health system of care by 2022. Our LHIN has committed to the pursuit of three system-level goals: Population Health Experience of Care Value for Money
These goals, aligned with Ontario’s Action Plan for Health Care set the direction for development of the Integrated Health Service Plan (IHSP) 2016-19. The 2016/17 Annual Business Plan (ABP) marks the first year of our 2016-19 IHSP. Over the next year, the South West LHIN will continue to progress actions from the previous IHSP, while implementing new initiatives and strategies associated with our next three year plan for 2016-19 and the direction outlined in the proposed Patients First Discussion PaperAct which, if passed, will enable the continued evolution of locally integrated patient-centred health care delivery next stage of the Patients First Action Plan for Health Care.propose structural reform and the transformation of the health system.
1.2 Goals of the Organization NOTE: The goals of the South West LHIN will align with the LHIN CEO Performance Objectives – these goals will be considered by the LHIN Board at its March meeting, and once approved by the Board, will be integrated into this section of the Annual Business Plan.
South West LHIN 2016/17 Draft Annual Business Plan 5
The following goals and objectives have been identified for 2016/17: Goals and Formatted: Font: (Default) Arial Objectives for 2016 -– 2017 Formatted: Font: (Default) Arial
1.0 Health System is Transformed 1.1 Provide leadership and direction to implement the MOHLTC’s proposed Patients First Discussion PaperAct 1.2 Create sub regions-LHIN areas to advance integration across all areas of the health system 1.3 Prepare for the integration of the operations and governance of the South West CCAC into the South West LHIN by April 1, 2017 1.4 Transfer accountability and funding forBuild stronger links to Population Health and Public Health Units to the LHIN 1.5 Integrate the planning and performance management of primary care into the South West LHIN 1.6 Advance the strategic directions of the 2016-2019 IHSP to create an integrated system for all 1.7 Engage and inform communities within the South West LHIN 1.8 Assist in the creation of an effective governance structure for the enhanced LHIN 1.9 Lead provincial health initiatives on behalf of the LHIN system
2.0 Enhanced LHIN is a high-performing workplace of choice 2.1 Create a new organizational structure for the enhanced South West LHIN 2.2 Engage staff effectively during the transformation process
3.0 Taxpayer has assurance of value for money 3.1 Evaluate and improve health system performance 3.2 Optimize resources
Appendix A will be referenced.
In addition to these goals and objectives, Appendix A describes the LHIN’s current organizational development plan.
1.3 Our Context The South West LHIN population receives services from an array of LHIN and non-LHIN funded organizations across the community, long-term care and acute health sectors. Residents rely on these organizations for a variety of needs including home/social support, episodic, chronic and long-term care.
The following LHIN-funded organizations play a critical role in delivering services to its residents: 20 hospital corporations (33 sites) 78 long-term care homes 5 community health centres 1 Community Care Access Centre (South West CCAC) South West LHIN 2016/17 Draft Annual Business Plan 6
54 agencies provide community support services 14 agencies provide assisted living supportive housing services 24 agencies provide mental health services 10 agencies provide addictions services 3 agencies provide acquired brain injury services
In addition, non-LHIN funded organizations (such as family health teams, family health organizations, family health networks, solo-physician offices, public health units, emergency medical services and labs) play a critical role in the delivery of primary care services.
It is estimated that there are 850 primary care physicians and 66 primary care groups (e.g. family health teams, family health organizations, etc.) in the South West LHIN. While these services do not currently fall under the LHIN’s mandate, we are actively working to understand and partner with primary care providers to advance integration and coordination across the health continuum and make improvements to the local system.
An environmental scan was completed as part of IHSP 2016-19.
1.4 Overview of 2016-2019 Integrated Health Service Plan In developing the South West LHIN’s IHSP for 2016 to 2019, we identified the need to use a clear and consistent organizing framework that will also be used in all future plans. This will ensure that progress towards our long-term vision for the health system can be tracked over time and clearly communicated to all partners.
Consistent with our vision – A health system that helps people stay healthy, delivers good care to them when they get sick and will be there for their children and grandchildren – we adopted the Institute for Healthcare Improvement’s Triple Aim framework. These themes have always been a part of our IHSPs and are present in many health care plans from jurisdictions around the world.1 In fact our vision’s three key components – population health, experience of care, and value for money – reflect the dimensions of the Triple Aim framework.
Our collective plan for 2016 to 2019 outlines the strategies and priority populations all organizations, sectors and networks will need to consider in their strategic and operational plans to collectively advance health system changes for the South West LHIN. The IHSP provides an overview of Ontario’s Patients First: Action Plan for Health Care, the South West LHIN’s vision and plan for the local health system, and details on how we demonstrate and measure success in the LHIN.
In alignment with provincial priorities, the IHSP 2016-19 identifies priorities, strategies, initiatives and measures that work towards making key improvements over the three year period.
1 Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012. (Available on www.IHI.org) South West LHIN 2016/17 Draft Annual Business Plan 7
The IHSP system view describes the pursuit of population health, experience of care, and value for money, advancing five implementation strategies with a focus on seven priorities to ensure an integrated system of care for all LHIN residents with an emphasis on the following populations: • Aboriginal populations (includes: people who identify with First Nations, Inuit and Métis communities.) • Francophone populations (includes: those persons whose mother tongue is French, plus those whose mother tongue is neither French nor English but have a particular knowledge of French as an Official Language and use French at home) • People who are frail and/or have medically complex conditions/disabilities (includes: seniors and adults with complex needs at high risk for losing their independence or experiencing functional decline, children and transitional age youth living with medical complexity, people living in long-term care homes and individuals approaching end of life) • People living with mental health and/or addiction issues (includes: people who experience mental health and/or addiction challenges such as depression, anxiety, schizophrenia, mood disorders, dementia, responsive behaviours, substance abuse, and those who experience homelessness and/or contact with the legal system due to their mental health and addiction challenges) • People living with or at risk of chronic disease(s) (includes: people living with or at risk of one or more chronic diseases or conditions such as diabetes, arthritis, asthma, cancer, chronic obstructive pulmonary disease, high blood pressure, heart disease, and those who live with the effects of stroke)
2.0 CORE CONTENT
2.1 IHSP Implementation Strategies To succeed in transforming the health care system, all health service providers and the LHIN must share a collective plan of action. Appendix B summarizes the five implementation strategies, their associated plans of action and identifies the ways in which these implementation strategies will be executed to drive future system improvements.
Every quarter, LHIN staff will assess the progress of these plans of action over the 3-year timeline. This will inform part of the LHINs quarterly reporting to the Ministry, the LHIN Board and the public.
Simultaneously embedding the following key strategies in all the work we do together to implement provincial, LHIN wide, and priority initiatives will ensure we achieve our vision at a system level: Health equity: Consistently apply a Health equity lens to enable access to quality care. eHealth and Technology: Leverage and expand the use of eHealth technologies to access and exchange health information, inform effective decision making, and enhance “hands on” care. Integration and Collaboration:Work together to better organize and connect services to meet the needs of the population and ensure optimal use of resources. Quality Improvement and Innovation: Partner with LHIN residents to understand their experiences of care and continuously collaborate with them to co-design improvements, South West LHIN 2016/17 Draft Annual Business Plan 8
broadly share quality evidence and best practices and demonstrate quality outcomes across the health care system. Transparency and Accountability: Strive for transparent decision-making and better performance by reporting on measures of success and holding individuals and organizations accountable for results.
2.2 IHSP Priorities and Initiatives Over the next three years the South West LHIN will advance seven key priorities that align with provincial directions. Appendix C summarizes the seven priorities, their outcome objectives, planned initiatives to meet these objectives and how success will be measured. In addition, Appendix D describes the anticipated progress of each initiative. Appendix E describes key Committee and Network partnership and accountability relationships that exist to advance the work while Appendix G and H provide the status of integrations and capital initiatives. In alignment with the French Language Services Act and the desire to support improvements to the health of AboriginalIndigenous populations, the LHIN has specifically focused a number of improvement efforts to achieve better health outcomes for these populations as well as creating LHIN wide supports for health service providers including the French Language Services toolkit and Indigenous Cultural Competency Training. The Erie St.Clair/South West French Language Health Planning Entity and the South West LHIN Aboriginal Health Advisory Committee perform critical advisory roles to these improvement efforts.
The seven priorities include: Ensuring primary health care is strengthened and linking with the broader health care system Optimizing the health of people and caregivers living at home, in long-term care and in other community settings2 Supporting people in preventing and managing chronic conditions Strengthening mental health and addiction services and their relationship with other partners Ensuring timely access to hospital-based care at the LHIN-wide, multi-community, and local level Enabling a rehabilitative approach across the care continuum Putting people with life-limiting illnesses and their families at the centre of hospice palliative care
To help understand the risks associated with implementing each initiative, the LHIN considers human resource availability and capability, funding availability, leadership champions, technological challenges, project management challenges, level of stakeholder commitment and challenges associated with change. Multiple risks are often associated with each initiative, which then requires careful planning and staging to assist with mitigating those risks.
2 People living in community settings may also include those in temporary living accommodations, or who may be experiencing homelessness South West LHIN 2016/17 Draft Annual Business Plan 9
2.3 Monitoring Progress and Measuring Results
The South West LHIN approaches performance setting and management and improvement using a consistent method to planning, implementing, monitoring and measuring by leveraging and applying consistent processes, tools and mechanisms to demonstrate success as well as identify opportunities for further improvement.
The LHIN will continue to measure the performance of the health system to determine if we are successful in achieving these goals by monitoring big dot outcomes and system measures aligned to each IHSP priority. Refer to IHSP forOur big dot and system measures listing can be found in our IHSP 2016-19.
Reporting and Monitoring Progress and Performance The responsibility to monitor progress and achieve results is a shared responsibility of HSPs and the LHIN. LHIN staff are aligned to IHSP priorities and initiatives and HSPs to ensure planning, implementing, measuring, and communication functions are met including involvement of other internal and external team members as required. An Aalignment Tteam monitors system and priority performance, informs future direction setting, creates alignment and ensures the consistent coordination and implementation (internal/external) of initiatives and processes; ensuring continuous feedback mechanisms and effective “on the ground” execution. System level performance results are reported to the South West LHIN Board of Directors quarterly, and this information is publicly available. Strategic Performance Reviews are also held quarterly in order to review progress. Robust use of standardized project management tools, processes and technology (e.g. Situation, Background, Assessment, Recommendation (SBAR) template, Integrated Project Management Document, Quality Improvement Tools (Driver Diagrams, Measurement Plans, etc), SharePoint, Customer Relationship Management (CRM), and Expert Choice) Regular submission and review of project status reports that include performance indicators and measures, achievement of milestones, and identification of risks. Close-out reports are submitted at completion of the projects Regular review and communication of performance measures at the system and priority levels (see Appendix F) with LHIN staff, Board, and Health Service Providers to monitor progress and identify key actions for improvement Execution of regularly scheduled Value for Money assessments Optimization of data access processes, utilization and analysis
Driving Quality Improvement Focused efforts to leverage Quality Improvement Plans (QIPs) and Quality Based Procedures (QBPs) to increase collective impact by informing, influencing and prioritizing cross-sector improvement work Use of standardized improvement tools and templates, including the South West LHIN Quality Improvement Enabling Framework (QIEF) when implementing large scale projects Leverage and spread of the provincial IDEAs program, and improvement methodology including process management, problem solving, supporting capacity building by targeting
South West LHIN 2016/17 Draft Annual Business Plan 10
projects for participation in IDEAs, as well as LHIN improvement tools and frameworks, including Experience Based Design Reduce variation and drive the use of evidence in supporting initiatives Empower patients and families to contribute to local health system design Continue to facilitate knowledge transfer through our annual Quality Symposium and recognition awards Increase quality improvement education and training to enhance capability and capacity
2.4 Accountability
As LHINs work with health service providers (HSP) to create a more integrated, sustainable, person-centered and results-driven local health care system, they must also ensure current and future fiscal resources are spent wisely on services and programs.
The Local Health System Integration Act, 2006 (LHSIA) provides for a Ministry-LHIN Accountability Agreement (MLAA), which establishes the accountability expectations associated with coordinating health care in local health systems and managing the health system at a local level effectively and efficiently. The standards, measures, and reporting requirements for this are provincially mandated. Obligations are articulated in the following areas:
1. Local health system management 2. Funding and allocations 3. Local health system performance 4. Integrated reporting
To align funding accountabilities and performance obligations within the health care system, LHINs enter into a Service Accountability Agreement (SAA) with each HSP. Currently, the South West LHIN manages ~187 SAAs with our hospitals, community sector agencies, and long-term care homes. The SAA supports the relationship between the LHIN and HSP and provides authority for the LHIN to fund a HSP and stipulates accountability and performance obligations for planning, integration and delivery of programs and services.
The SAAs have a strengthened performance improvement component that reflects both the individual service provision mandate of the provider and the provider’s contributions to system improvements as part of shared accountability. The HSP is responsible for managing its performance obligations and the LHIN is responsible for working with the HSP to achieve those ends.
The LHIN uses the SAA as an instrument to maintain clear lines of accountability and performance expectations for individual and collective HSPs, the initiatives they contribute to, and the outcomes the LHIN is striving to achieve at initiative and system levels. The LHIN monitors monthly and close-out project reports and quarterly HSP service accountability agreement performance, financial and service level compliance with pre-established targets. LHIN staff review these reports and initiate the appropriate level of follow up action if risks, issues and/or performance obligations are not on track or have not been met.
South West LHIN 2016/17 Draft Annual Business Plan 11
Health System Funding Reform (HSFR) is changing how services and programs are being funded, shifting funding between HSPs, and providing best practice information and new quality indicators. Working with HSPs the LHIN is ensuring that service utilization and costs are aligned to the Health Based Allocation Model (HBAM) expected standards and that best practice and quality indicators as defined by Quality Based Procedures (QBP) clinical handbooks are adopted and monitored. Aligning programs and procedures to cost, practice and quality expectations is now a key clinical planning goal.
3.0 LHIN OPERATIONS
The If passed, the discussion paper Patients First: A Proposal to Strengthen Patient-Centred Health Care in OntarioAct would improve access to health care services by giving patients and their families faster and better access to care and putting them at the centre of a truly integrated health system. details proposed structural changes to Ontario’s health care system which are designed to strengthen patient-centred care and deliver high-quality, consistent and integrated health services to all Ontarians. It is anticipated that the proposed changes will be implemented by April 2017 and that the 2016/17 fiscal year will be dedicated to ensuring that the LHIN and other impacted organizations are well prepared for implementation of the changes.
The Patients First Act would give Ontario’s 14 local health integration networks (LHINs) an expanded role, including in primary care and home and community care. At present, LHINs lack the mandate and tools to hold other parts of the local system accountable. With an expanded mandate, the South West LHIN would: establish 5 sub-regions as the focal point for integrated service planning and delivery; be responsible for primary care planning and performance management, directly manage the delivery of home and community care by integrating the South West CCAC into the LHIN, and establish a formal relationship with assume accountability and funding for public health units to strengthen health system planning.
As the above changes are advanced and the LHIN role expands, the LHIN will be working diligently to create an enhanced LHIN that is a high-performing workplace of choice.
To guide these early stages of change, the South West LHIN will put a project structure in place by April 1, 2016. This will include creating: creating a project team to implement the vision, establishing an executive committee to oversee and govern the transition including , a patient and family representationadvisory group to ensure that change efforts are guided by and responsive to the needs and expectations of those who rely on the health care system, engaging a broad multi-sector health service provider advisory groups to provide advice to act as advisors to the transition planning at the local level, and creating an internal team to implement the required organizational changes while beginning to lead and support staff through change. South West LHIN 2016/17 Draft Annual Business Plan 12
A core set of sub-LHIN metrics will support the case for change and ensure the success of transformation activities.
3.1 Operations Spending Plan Commented [G1]: Lorri has updated
Template B: LHIN Operations Spending Plan
2016/17 2017/18 LHIN Operations Sub-Category 2015/16 2015/16 Planned Planned ($) Actual Allocation Expenses Expenses
Salaries and Wages 3,929,061 3,849,683 3,849,683 3,849,683 Employee Benefits
HOOPP 361,810 346,490 346,490 346,490
Other Benefits 490,839 461,186 461,186 461,186
Total Employee Benefits 852,649 807,676 807,676 807,676 Transportation and Communication
Staff Travel 84,032 73,000 73,000 73,000
Governance Travel 29,136 25,800 25,800 25,800 Communications - - - - Other Benefits - - - -
Total Transportation and Communication 113,168 98,800 98,800 98,800 Services Accomodation (Lease costs plus other Accom exp) 325,924 306,081 306,081 306,081 Advertising & Public Relations - - - - Banking 719 600 600 600
Community Engagement 68,182 100,418 100,418 100,418
Consulting Fees 78,934 13,900 13,900 13,900
Equipment Rentals 18,697 50,000 50,000 50,000
Governance Per Diems 120,807 116,400 116,400 116,400
LSSO Shared Costs & LHINC 428,521 436,840 436,840 436,840
Other Meeting Expenses 45,805 25,750 25,750 25,750
Other Governance Costs 17,925 37,800 37,800 37,800
Printing & Translation 12,721 49,500 49,500 49,500
Staff Development 68,397 81,000 81,000 81,000 South West LHIN 2016/17 Draft Annual Business Plan 13
Recruitment 84,067 10,000 10,000 10,000
Other overhead expenses 52,302 65,544 65,544 65,544
DRCC Physician Leads 112,056 190,000 190,000 190,000
Total Services 1,435,059 1,483,833 1,483,833 1,483,833 Supplies and Equipment
IT Equipment 64,176 30,000 30,000 30,000
Office Supplies & Purchased Equipment 32,475 35,250 35,250 35,250
Total Supplies and Equipment 96,651 65,250 65,250 65,250
LHIN Operations: Total Planned Expense 6,426,587 6,305,242 6,305,242 6,305,242
Annual Funding Target 6,305,242 6,305,242 6,305,242 Variance - - -
Notes 1. Includes DRCC, FLS, Aboriginal, and ER/ALC FTEs 2.Implementation of directions contained in the Patients First Discussion PaperAct released in December 2015introduced in June 2016 would impact Operations Spending Plan beyond 2016/17
3.2 Staffing Plan Commented [G2]: Lorri has update
Template C: LHIN Staffing Plan (Full-Time Equivalents)
2015/16 2016/17 2017/18 2018/19 Actual Forecast Forecast Forecast Position Title FTEs FTEs FTEs FTEs Administrative Assistant to Senior Director 2.0 2.0 2.0 2.0 Business Assistant 1.0 1.0 1.0 1.0 Chief Executive Officer 1.0 1.0 1.0 1.0 Communication & Community Engagement Specialist 2.0 2.0 2.0 2.0 Communication & Web Specialist 1.0 1.0 1.0 1.0 Controller / Manager of Corporate Services 1.0 1.0 1.0 1.0 Corporate Services & HR Assistant 1.0 1.0 1.0 1.0 Director, Communications & Community Engagement 1.0 1.0 1.0 1.0 Executive Office Assistant 1.0 1.0 1.0 1.0 Executive Office Coordinator to CEO 1.0 1.0 1.0 1.0 Financial Analyst (one contract) 5.0 4.0 4.0 4.0
South West LHIN 2016/17 Draft Annual Business Plan 14
Financial Coordinator (contract) - 1.0 1.0 1.0 Health Data & Performance Analyst (Initiative funding 1 FTE) 2.6 2.6 2.6 2.6 Performance Improvement Lead 1.0 1.0 1.0 1.0 Program Assistant 3.0 3.0 3.0 3.0 Program Lead 1.0 1.0 1.0 1.0 Project Coordinator (contract) - - - - Quality Specialist 1.0 1.0 1.0 1.0 Quality Improvement Lead 1.0 1.0 1.0 1.0 Receptionist 1.0 1.0 1.0 1.0 Senior Director 2.0 2.0 2.0 2.0 System Design & Integration Lead 4.0 4.0 4.0 4.0 System Design & Integration Specialist: Planners 4.0 4.0 4.0 4.0 Team Lead, Finance 1.0 1.0 1.0 1.0 Team Lead, Performance Improvement 1.0 1.0 1.0 1.0 Team Lead, System Design & Integration 1.0 1.0 1.0 1.0 French Language Coordinator (Initiative funding) 1.0 1.0 1.0 1.0 Aboriginal Lead (Initiative funding) 1.0 1.0 1.0 1.0
Total FTEs 42.6 42.6 42.6 42.6
Includes DRCC, FLS, Aboriginal, and ER/ALC FTEs
South West LHIN 2016/17 Draft Annual Business Plan 15
4.0 COMMUNICATIONS AND COMMUNITY ENGAGEMENT
4.1 Communications Plan
Communications Goal Communities within the LHIN are informed and engaged on the actions the LHIN, in partnership with health service partners, will take to enhance health care delivery for all residents of our LHIN.
Communications Objectives Promote the contents of the Annual Business Plan for 2016/17 and how the LHIN is working to create a sustainable and accountable health system. Offer opportunities for key audiences to engage with the LHIN to build a better understanding of how they can align to the Annual Business Plan and more broadly with the IHSP. Offer opportunities for dialogue with health service providers and other system partners as planning for health system transformation associated with the proposed Patients First Formatted: Font: Italic Discussion PaperAct unfolds over the coming months. Uphold the LHIN’s commitment to be open, transparent, and accessible to the public on LHIN priorities and initiatives.
Context All communications and engagement products/activities align with provincial priorities. This includes those priorities listed in the mandate letter addressed to the Minister of Health and Long-Term Care. Initiatives and programs build on the Ministry’s Patients First: Action Plan for Health Care, which focuses on four key objectives: improve access, connect services, support people and patients, and protect our universal public health care system. Patients First: A Roadmap to Strengthen Home and Community Care is the first phase of the Action Plan to remakeis a 10-point plan to strengthen the home and community care sector over the next three years.
In December 2015 the Ministry of Health and Long-Term Care issued Patients First: A proposal to strengthen patient-centred health care in Ontario, outlining . This paper outlines Formatted: Font: Not Italic proposed structural changes to the health care system. and seeks input on the proposal and advice about how to successfully plan for and implement the approach. The Ministry will be actively engaged in conversation about the proposal in a variety of forums.b
Communications and community engagement form a vital public service where the LHIN has a duty to provide information and listen to the public it serves. This contributes to building a system that better understands and meets the needs of our patients. The South West LHIN’s core communications activities include: Opportunities for audiences to participate in engagement around core business activities for the South West LHIN. Frequent communications with audiences on the activities of the LHIN and results being achieved. An active online presence to connect and interact with audiences, allow 24-hour access to information, and help foster public dialogue. South West LHIN 2016/17 Draft Annual Business Plan 16
Strong relationships with media with every effort made to accommodate requests for both information and interviews. Prompt, courteous and responsive person-focused customer service.
Audiences Primary Health Service Providers, funded and non-funded Priorities: primary health care, home and community care, long-term care, managing chronic conditions, mental health and addiction services, hospital-based care, rehabilitative services and hospice palliative care Governance leaders Public (patients, clients, residents and caregivers)
Secondary LHIN staff Elected officials (federal, provincial and municipal) Media
Key Messages
Patients First
The “Patients First: A Proposal to Strengthen Patient-Centred Health Care” discussion paper, released on December 17, 2015, calls for structural reform across the system to increase equitable access for all people needing health care. Under the proposal, LHINs would take the lead in integrating health services at the local level. LHINs would be responsible for working with providers across the care continuum to improve access to high-quality and consistent care, and to make the system easier to navigate – for all Ontarians. With greater responsibility for primary care, home and community care, and public health and planning, LHINs would be better positioned to create a more integrated, patient- centred health system in our local areas. On June 2, 2016, Bill 210, an act to amend various Acts in the interest of patient-centred care, was introduced at first reading and has been given the title, the Patients First Act, 2016. The Act, if passed by the Ontario Legislature, would amend the Local Health System Integration Act, 2006 (LHSIA) and the Home Care and Community Services Act, 1994 (HCCSA), among other statues. If passed, the Patients First Act will enable the next stage of the Patients First Action Plan for Health Care. The Patients First Act would give Ontario’s 14 local health integration networks (LHINs) an expanded role, which includes a greater mandate for both primary care and home and community care. If passed, the legislation would improve access to health care services by giving patients and their families faster and better access to care and putting them at the centre of a truly integrated health system. We look forward to building on our progress to date and leveraging our expertise, as we move towards achieving an integrated health system in Ontario. South West LHIN 2016/17 Draft Annual Business Plan 17
These proposed changes would enhance our ability to truly integrate our local health care system for the benefit of patients. The Patients First: Action Plan for Health Care, released in February 2015, sets clear and ambitious goals for Ontario’s health care system in order to put patients at the centre of our health care system by improving the health care experience: Access o Improve access - providing faster access to the right care. Connect o Connect services - delivering better coordinated and integrated care in the community closer to home; providing better home and community care. Inform o Support people and patients - providing the education, information and transparency Ontarians need to make the right decisions about their health. Protect o Protect our universal public health care system - making decisions based on value and quality, to sustain the system for generations to come. As the next logical step in the Patients First Action Plan, Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario proposes a path toward providing better access to care no matter where you live by better connecting health care services.
LHINs
We are building a system that better understands and meets the needs of patients – no matter their background, their income, or where they live. Patients, clients and residents belong at the heart of the health care system. Health Ssystem transformation renewal that improves equitable access to high quality, patient-centred care for all population groups is the right thing to do. Redesigning health care is undeniably one of the most important responsibilities we must uphold in order to place the needs of patients, clients and residents first in Ontario. We must work together to explore every opportunity available to us to provide better care for the patients, clients and residents we serve across the South West LHIN. The health system’s long-term success depends on attaining quality care, improved health and better value.
Implementation Strategies
Health equity Every person, no matter who they are, where they live or how much money they make, deserves health services that address the barriers that are often experienced by certain populations
Integration and A fully integrated system from end-to-end means individuals and collaboration organizations intentionally work together to better organize and connect services to meet the needs of the population and ensure optimal use of resources. We must align services and processes so that the health care system is coordinated, accessible and high quality.
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All health service providers must identify opportunities to integrate services for the benefit of the people we serve and the health system.
Accountability and LHINs have built a strong foundation of transparency, transparency performance and accountability as these are fundamental expectations of what Ontarians want from their health care system. The LHIN strives to ensure that health care dollars are spent efficiently and effectively, yielding the best results possible and overall value for money.
Quality improvement Creating a culture that is relentless in its pursuit of quality and innovation improvement requires stakeholders to be continuously involved in improving the experience of care of those who use health care services. We must work together to improve experiences of care, implement required changes, study results and make refinements.
eHealth and Using innovative information and clinical technologies in health technology care is a key contributor in advancing health care quality in the LHIN. eHealth technologies allow for access to and exchange of health information, inform effective decision making, and enhance “hands-on” care
Priorities
Stronger primary Organized around a defined population, patient-centred care health care that is requires different parts of the health system to be integrated and linked with the coordinated to meet the needs and preferences of individuals and broader health care families. system A significant focus for the LHIN will be to work with the Ministry to implement a multi-year reform strategy in collaboration with primary care providers and other partners to strengthen primary care across the South West LHIN.
Optimized health for A significant focus continues to be on meeting the needs of people people and who are frail, have medically complex conditions/disabilities, caregivers living at and/or live with chronic diseases. home, in long-term We will work to transform home and community care, building on care and in other efforts in the community to improve access to coordinated, community settings integrated, quality care for nursing, personal support, therapies, day programs and supportive housing as well as ongoing efforts to address disparities between old and new long-term care homes.
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Supporting people in Ontario recognizes the need for greater coordination of care for preventing and people with multiple complex conditions. managing chronic By strengthening local partnerships where care providers work conditions together to coordinate quality care for patients with complex needs, the LHIN and health service providers will be able to better support people in preventing and appropriately managing chronic conditions.
Stronger mental To deliver high quality care to people and their caregivers who are health and addiction impacted by mental health, addictions, and/or responsive services and behaviours, the LHIN and health service providers will ensure relationships with services and supports in mental health and addictions are easier other partners to access and continually improving.
Timely access to A significant focus for the LHIN is to optimize hospital-based hospital-based care resources in order to build capacity and access to quality at the LHIN-wide, treatment and care throughout the LHIN. multi-community, To maintain high quality, publicly accessible and cost-effective and local level hospital care, the LHIN also continues to move forward with implementing Health System Funding Reform (HSFR) within the hospital and CCAC sectors.
A rehabilitative For those suffering from injury, illness, or chronic disease, approach across the equitable access to quality rehabilitative services will support care continuum better patient experience, clinical outcomes, and transitions of care by optimizing the physical, mental and social well-being of individuals.
People with life- Improving equitable access to coordinated, effective, efficient limiting illnesses and quality services and supports will place individuals with life-limiting their families at the illnesses and their families at the centre of care to optimize their centre of hospice quality of life. palliative care
Stategic Approach All communications will reflect our core vision, mission and values and they will be shared in a way that is clear, relevant and useful. The LHIN will employ a variety of ways and means to communicate and provide information in a variety of formats to accommodate diverse audiences and geographies in the South West LHIN. While the draft legislation makes its way through the legislature, the South West LHIN will continue to engage and consult with patients, caregivers, health care providers, stakeholder associations, Indigenous peoples and other system partners to gather feedback on the proposed legislation.
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As LHINs prepare to deliver on the commitment to structural reform cacross the system, any plans to inform or engage health service providers on the IHSP will first consider ongoing work to transform the system. Communications planning and delivery will be equitable and reflect best practices for both the health sector and communications – delivered in a way that consistently honours the LHIN’s commitment to equity and person-centred care. o Support French Language and Aboriginal engagement as required o Offer resources and information in French on demand o Maintain access to information online in French Work will continue with other LHINs when necessary to make sure there is a consistent approach that is adapted to reflect the local environment. Communications will adhere to the policies of the Ministry of Health and Long-Term Care as outlined in the MOHLTC-LHIN Memorandum of Understanding and the Ministry-LHIN Accountability Agreement (MLAA).
Tactics The communication and engagement tactics flow from the overarching communications plan that guides and aligns all audience- and initiative-specific communications plans. The South West LHIN will employ a variety of ways and means to communicate to accommodate the diverse needs of our audiences.
Offer significant opportunities for audiences to participate in engagement around core business activities for the South West LHIN. Communicate frequently with audiences on the activities of the LHIN and results being achieved. o Annual Report (2015/16), Community Bulletin (2015/16), Exchange Newsletter o Area Provider Table updates o Report on Performance Scorecard and performance indicators on website Maintain an active online presence using Southwestlhin.on.ca, Twitter, Facebook, YouTube Meet and liaise with MPPs in the South West on an ongoing basis to provide updates on the activities of the LHIN. Prepare events and announcements as required to inform the public about significant South West LHIN initiatives or investments. Engage employees using effective internal communications
4.2 Community Engagement Offer significant opportunities for partners to participate in engagement around core business activities for the South West LHIN. Quality Symposium (June 2016) Governance education sessions (Fall 2016) Board meetings (held in a different community each month) Congresses and forums (through the year) Local evening network sessions (held every other month) Advisory groups, committees, liaisons (ongoing)
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Targeted engagement for prioritiy audiences around significant South West LHIN or provinicial initiatives (as required)
Offer opportunities for dialogue with health service providers and other system partners as planning for health system transformation the proposed Patients First Act under the Patients First: Action Plan for Health Care unfolds over the coming months.
Evaluation Assess feedback (phone calls, emails, social and web traffic) after distributing key publications Assess turnaround time, tone and number of customer service calls and media inquiries. Ongoing monitoring of overall satisfaction, number of events each year, number of participants, achievement of objectives. Ongoing monitoring of media coverage, social conversation, stakeholder feedback and public inquiries log. Analytics and engagement rates (website, newsletter and social media)
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WE ARE A TEAM To be a high performing team, we must have a culture that is aligned, dynamic, and engaged: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Use engagement strategy tools and continue to support the Kolbe / StrengthsFinder assessments and reports are conducted on new engagement of all staff employees and shared with employees and leaders Break down barriers between functional and cross-functional The overall score of team vitality continues to improve teams to encourage open communication and the strengthening of internal relationships Embed and encourage a no-blame culture where continuous The behaviours within LEADS domains “Lead Self” and “Engage Others” are reflection is commonplace and continuous improvement is our modelled by team members collective goal Create opportunities for, and proactively encourage, all staff to The behaviours within LEADS domain “Engage Others” are modelled by team learn and share knowledge members Meetings are more effective Principles of effective meetings are implemented and meetings become more effective
THE STRATEGY THAT GUIDES US What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Ensure there is human capacity and capability to support the The LHIN meets 95% of the annual goals of the ABP as outlined in the IHSP organization's goals and objectives Provide structure, compensation, policies, standards, reward HR policies and procedures are reviewed annually systems, benefit programs and grievance handling Pan-LHIN CEOs review merit process and salary structure annually Cultivate a culture where staff want to come to work I am satisfied with my decision to work here >= 3.93 I feel more committed to a career with the organization this year than I did a year ago >= 2.95 Shift from an organization building credibility to a learning The organization encourages me to offer innovative ideas to improve our culture where we can improve quality and performance using performance >= 3.21 quality assurance techniques Create an appropriate work environment that complies with I can depend on the integrity of my leader >= 4.13 legislation and is sensitive to both management's and I am satisfied with the Senior Leadership’s execution and implementation of employees' needs the organization’s strategy >= 3.49
HOW WE ARE STRUCTURED To be the facilitator of collaboration, cooperation, and coalitions among diverse groups and perspectives aimed to improve health outcomes: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Flexible to address emerging initiatives and provincial Overall organization goals and objectives are communicated regularly >= 3.77 directions and ability to grow Understand individual, team and organizational responsibilities I understand what the team needs to do to achieve its goals >= 4.07 Availability of leaders to effectively coach, delegate, direct, and My leader coaches and helps me to continuously develop my skills >=3.68 support My leader provides me regular feedback about my performance >= 3.97 I receive recognition from my leader for a job well done >= 3.92 My leader is available when I need them >= 3.87
OUR SYSTEM PROVIDES TOOLS AND RESOURCES To provide employees with the tools & resources – including policies and procedures – in order to effectively and efficiently complete their work to achieve the goals and objectives of the organization: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Ensure staff are appropriately train on existing and new tools, New systems and processes are adopted by employees 100% process and technologies so they can maximize their use to I receive the training I need to do my job >= 3.88 move the work of the LHIN forward I have the equipment & tools needed to do my job >= 4.07 Replace manual processes with electronic systems and Processes are reviewed annually automate workflows and implement systems that integrate well IT requirements are clearly communicated to LSSO together to provide a cohesive user experience and reduce I feel comfortable suggesting ideas to improve our processes and products >= manual duplication 3.37 Monitor, evaluate, and improve internal policies and procedures I have access to the appropriate policies and procedures to do my job >= 4.53 to ensure adherence to government directives and reporting requirements Keep IT systems and business applications at current vendor- Annually laptops and cell phones are refreshed on a 3-year cycle supported versions Upgrade software in a timely manner to ensure the latest vendor-supported versions are in use
DRAFT
Organizational Development Plan 2015/16
“A Healthier Tomorrow”
Rollout December 2015
November 2015
PURPOSE Our Organizational Development (OD) Plan outlines how we as an organization can achieve a strong, cohesive, outcome driven team to meet the goals of the South West LHIN. The goals of the organization, outlined below, guide what we do, how we are driven, and ensure the LHIN can deliver on its mandate. The organization’s goals are to:
effectively manage and transform the health system; inform and engage the communities within the LHIN; optimize resources; and continuously improve the organization.
Under each of these goals, there are several objectives and measures of success that will be used to determine our progress in advancing our organization. The goals of the organization are further defined through the Integrated Health Service Plan (IHSP), the Annual Business Plan (ABP), the obligations of the Ministry-LHIN Performance Agreement (MLPA), and the OD Plan. Since 2005 the South West LHIN has led the planning and implementation of initiatives to transform the health system.
Our OD Plan supports LHIN employees in achieving current provincial and South West LHIN plans. LHIN employees play a key role in achieving the objectives of these transformational plans. The fiscal year 2015/16 will be the initial launch of the OD Plan and is aligned to the IHSP. The OD Plan outcome measures will be reviewed annually and updated as required. As this Plan is implemented, best practices will be identified and refined in a spirit of continuous improvement. The progress of goals will be visually displayed to employees.
OVERVIEW The seven elements of the Organizational Development Plan are the competencies, skills, and resources required to achieve the goals of the organization. The LEADS in a Caring Environment framework takes the black and white competencies (skills that look the same for each individual) and adds the grey capabilities (behaviours like how to motivate and are different for each individual) and develops strong leaders essential to improving the healthcare system.
The seven Elements1 include: Our shared values Our values are the guiding principles that drive our behavior and actions as people and as an organization.
Who we are What we do (Our foundation) We are leaders How we are structured Shared leadership will empower individuals and embed leadership The organization, infrastructure and governance of the LHIN. in the culture. The strategy that guides us We are a team We will evolve and adapt to be effective in achieving our Everyone on the team is moving in the same direction. The team’s objectives. time and energy is aligned. Our system provides tools and resources We all have talent The tools, resources and processes that will help us meet our Nurturing excellence will foster engaged employees who are objectives. fulfilled and work to their full potential.
The five domains of the LEADS include:
Achieve Results: Leaders who Set Direction, Strategically Align Decisions with Vision, Values, and Evidence, Take Action to Implement Decisions, and Assess and Evaluate. Lead Self: Leaders who are Self-Aware, Manages Self, Develops Develop Coalitions: Leaders who Purposefully Build Others, and Demonstrates Character. Partnerships and Networks to Create Results, Demonstrate a Commitment to Customers and Service, Mobilize Knowledge, and Navigate Socio-Political Environments.
Engage Others: Leaders who Foster Development of Others, Systems Transformation: Leaders who Demonstrate Systems / Contribute to the Creation of Healthy Organization, Communicate Critical Thinking, Encourage and Support Innovation, Orient Effectively, and Build Effective Teams. Themselves Strategically to the Future, and Champion and orchestrate Change.
1 The OD Plan was developed using the McKinsey 7-S model as a framework OUR OBJECTIVES & KEY OUTCOMES
OUR SHARED VALUES To create a sense of belonging and harness commitment and talent: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Promote and develop a culture of excellence, commitment and During my time with the LHIN, the organization has demonstrated the respect principles & elements of a Workplace of Choice >= 3.553 During my time with the LHIN, the organizational culture has moved towards being more positive >= 3.58 Provide an environment where all staff can excel, flourish and GallopQ122 mean score >= 3.95 (4.00 or more indicates a highly engaged succeed workforce) Facilitate achieving the LHIN’s mission and vision and foster a I understand the LHIN’s vision and mission >= 4.64 culture that reflects the organization’s values The mission or purpose of the LHIN makes me feel my job is important >= 3.95 Provide an environment where teams can strive and achieve The individuals in my functional team model the 5 Team Responsibilities >= their team mandates and weave the 5 team responsibilities into 2.30 our culture The individuals in my portfolio team model the 5 Team Responsibilities >= 2.27 The Senior Leadership Team models the 5 Team Responsibilities >= 3.24 100% of team mandates are updated by March 2016
WE ARE LEADERS To define our leadership style and develop leadership at all levels: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Adopt the LEADS capability framework into our culture and LEADS Five domain workshops and 360 Assessments are phased into the emphasize leadership development organization by March 2017 Create learning development plans that focus on the LEADS 100% Employees feel they are modelling the LEADS behaviours / capabilities capabilities 95% Employees rate the 360 Diagnostic Assessment tool as effective 100% Senior leaders incorporate the LEADS learning plans into their 2016/17 performance plans and access their training allocations 100% Employees incorporate the LEADS learning plans into their 2017/18 performance plans and access their training allocations Define the scope of decision-making for all LHIN staff through The RASCI tool is utilized and refreshed annually to align with organizational the RASCI tool changes Cultivate a climate where initiative on assignments is Use of the term “micromanagement” is no longer part of the culture acknowledged People leaders are effective and give employees discretion and My leader has the necessary people management skills to manage our team autonomy over their tasks >= 3.71 My leader effectively handles crisis situations >= 3.97
WE ALL HAVE TALENT To grow our talent and recognize our employees: What are we trying to achieve? How will we monitor progress? Goals/Objectives: Key Outcomes: Support and challenge others to achieve professional goals 85% Employees utilized professional development allocation My leader reinforces a learning culture >=4.00 Maintain staff retention within industry standards Annual staff turnover is < 10% Continue to implement and enhance the staff professional LEADS 360 assessment becomes part of the annual learning and development program in alignment with current policy and development plan and is linked to LEADS capabilities and performance procedures starting in 2017/18 Build a workplace culture where staff have the support and The behaviours within LEADS domains “Develop Coalitions” and “System skills to operate and innovate at a local level by enhancing and Transformation” are modelled by team members expanding the use of LEADS Ensure LHIN employees are fairly compensated compared to LHINs participate in the pan-LHIN Market Compensation Review to determine similar roles in Ontario the level of pay equity compared to the industry by March 2016
Support internal capacity building related to improvement # of staff trained in IDEAs (2 day); IDEAs (9day Advanced) # of staff participating as Alumni Mentors # of projects submitted for 9 day advanced acceptance % of projects accepted for 9 day advanced program # of awards
2 GallopQ12 questions measure employee engagement 3 Key Outcomes include questions in the staff engagement survey and represent prior benchmark scores THE STRATEGY THAT GUIDES US The LHIN’s strategic directions and objectives are defined through the IHSP and the obligations of the MLPA. Our strategy helps us to set priorities, focus our resources and make sure we are working towards common goals. The OD Plan defines the people and organization goals.
People Goals The LHIN is committed to providing guidance, training, leadership, tools & resources to all team members to create a strong, cohesive, outcome-driven team. The LHIN strives to achieve its goals of building team effectiveness and stronger organizational culture to become firmly positioned as a Workplace of Choice.
Organization Goals The four goals of the South West LHIN organization guide what we do, how we are driven, and ensure the LHIN can deliver on its mandate. As stated earlier in this documents, the goals are to: Effectively manage and transform the health system Inform and engage the communities within the LHIN Optimize resources Continuously improve the organization
What will we need to do? Finalize and implement strategies identified in the OD Plan to ensure employee engagement and commitment to the organization. Support autonomy and empower decision makers, hold staff accountable, listen and support. Use the training from the LEADS framework to begin changing the culture from building credibility to a learning culture.
HOW WE ARE STRUCTURED The LHIN is structured to support the goals of the IHSP. The organization is structured in a way to help achieve our goals and ensure the pieces of the LHIN fit together strategically.
Board of Directors The board of directors is entrusted with the stewardship of the resources to oversee the planning, coordination, integration, and funding of health service providers. The board regularly monitors and discusses its own process and performance to ensure continuity of board improvements and the ability of members to govern. This includes completing an annual board evaluation process.
Chief Executive Officer As the sole employee of the South West LHIN board of directors, the Chief Executive Officer (CEO) is charged with ensuring the administrative and organizational integrity of the organization. No single board member or committee has authority over the CEO – this responsibility rests with the entire board.
Senior Leadership The senior leadership team is comprised of the CEO, two senior directors, the director of communications and community engagement, and the controller / manager, corporate services. The performance objectives of the CEO and the goals of the organization are cascaded down through the organization through the work of the senior leadership team. To be successful in moving the LHIN mandate forward, the senior leadership team must provide strong, cohesive, consistent support to staff.
Teams The LHIN teams comprise functional and cross-functional teams. Teams are aligned with the broader organization work under a team mandate – a concise, clear definition of why the team exists and what needs to be accomplished. Where performance plans describe what individual members of the team will do; a mandate is a statement that addresses only what the team must do together.
What will we need to do? Revisit team mandates by March 2016 to ensure alignment with the 2016-19 IHSP. Evaluate the organization structure for improved performance management, and to allow senior leaders the time for better coaching and supporting opportunities between leaders and direct reports.
OUR SYSTEM PROVIDES TOOLS AND RESOURCES There are 14 LHINs in Ontario that together offer a core pan-LHIN Information technology (IT) system for all 14 LHINs The South West LHIN is responsible for our local systems, processes and tools while leveraging the pan-LHIN infrastructure, resources and tools.
What will we need to do? The LHIN will strive to engage and train staff during the rollout of CRM while managing the changes and impact to staff and their roles. Align CRM and the PMO working groups into one working group. Evaluate the project management tool and determine next steps. Introduce a suggestion box to allow staff to provide ideas for opportunities for improvements.
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OUR SHARED VALUES Our values are the guiding principles that drive our behavior and actions as people and as an organization. Over the next year (2015/2016), the five (5) team responsibilities3 and the behaviours will be woven into the culture. Our team will lead the work to achieve the LHIN’s internal goals – build team effectiveness and strengthen organizational culture – to become firmly positioned as a workplace of choice. It will take everyone in the organization working together to achieve our internal goals – we all have a role in implementing the OD Plan.
Refreshing the OD Plan to align with the overall direction of our organization’s mission, vision and values will continuously tighten the link between human needs with business needs. The people elements of the OD Plan are flexible to respond to opportunities, changes and risks in both external and internal environments.
Core Values Compassion – Our actions have real implications for people and communities Courage – We make difficult decisions and challenge the status quo when required Evidence-informed – Our decisions are guided by the best available information Innovation – We encourage and support new thinking and sharing new knowledge” Integrity – We act in a fair, consistent and unbiased manner Trust and Respect – We believe in mutual trust and respect Culture and Diversity – We respect the unique context, experiences, and needs of diverse populations and communities
What will we need to do? Continue to live the values of the organization demonstrated in our day-to-day behaviours Define the minimum expectations of team building to encourage continuous movement towards a positive, engaged culture
WE ARE LEADERS Shared leadership will maximize the human resources within our LHIN by empowering individuals and giving them an opportunity to demonstrate their leadership skills within their areas of expertise. The LHIN has adopted the LEADS in a Caring Environment framework and will begin work in 2015 to fully implement. The LEADS framework enhances the key skills, abilities, and knowledge required to lead at all levels of an organization. It aligns and consolidates the competency and capabilities frameworks and leadership strategies that are found in Canada’s health sector and other progressive organizations.
What will we need to do? Working with the Canadian College of Health Leaders, the LHIN will develop leaders in the organization using the LEADS in a Caring Environment framework. The following activities will commence in fiscal 2015/16: Host “Bringing LEADS to Life” workshop for senior leadership team Begin rolling out LEADS 360 Diagnostic Assessments o Senior Leadership Team target date November 2015 Phase I o LHIN employees target start date June 2016 Phase III LEADS coaches will meet with individual employees to debrief assessments and to share and discuss individual LEADS Learning Plans. Target start date January 2016 (SLT), October 2016 (Staff). Leadership styles (coaching, directing, delegating, and supporting) are defined and modelled
WE ARE A TEAM When we come together as a team we can benefit from team synergies – arriving at solutions and outcomes that are superior because of the contribution of the respective team members – no one individual possesses all of the skills, abilities, knowledge, and experience to achieve the optimal outcome independently – through the collective contributions of team members we are able to increase performance and address complex challenges. Everyone on the team is moving in the same direction – teamwork builds momentum, unity and support.
When a team is aligned, there is a clear understanding of purpose and it works to add value for both the organization and the client. The team’s processes, structure and performance measures are complementary. When there is healthy team dynamic people feel they’re adding value; doing meaningful work; rewarded in a way that matters; working with people they respect, etc. “Dynamic” is the culture and environment that supports employee engagement. Our work must include a culture of belonging and engagement. We value the achievements and contribution of all staff. Employee engagement is a key indicator of their involvement and dedication to the LHIN.
StrengthsFinder and Kolbe To help our people embrace their talents, improve productivity, enrich relationships and understand their team dynamics we have committed to talent development using both Strengths Finder and Kolbe as assessment tools. StrengthsFinder and Kolbe will be used to guide personal learning and will be one tool to help define how the organization works.
3 Five Team Responsibilities as defined by Knightsbridge: Start with a positive assumption / Add my full value / Amply other voices / Know when to say no / Keep conflict health
What will we need to do? Clearly define the expectations and minimum required use of Kolbe and StrengthsFinder Educate and remind staff on applying Kolbe and StrengthsFinder and for each to take responsibility resulting in all staff exceling Implement and use new processes and tools, like CRM, to create alignment and synergies within teams Gather, monitor, and summarize the Plan, Do, Study Act (PDSA) A small tests of change outcomes to address work life balance Develop consistent tools and processes to measure the effectiveness of teams
WE ALL HAVE TALENT It will be essential to create a culture where excellence is nurtured and “growing our own talent” is embraced. We need to be a workplace where employees feel valued and recognized for their contributions to the work of the organization. People who feel valued will want to come to work and want to continuously improve their knowledge, skills and competencies so they can be a contributing member of the LHIN. Leaders that have the skills and time to grow and support staff are essential in building a positive work environment. The overall goal is to make the LHIN a place where people want to come to work.
Valuing and Recognizing Employee Contribution Encourage employees to participate in workplace decisions and issues; Support employees to participate in the LHIN continuing education opportunities Celebrate team, individual and project successes; Capitalize on employee differences by supporting all employees to reach their full potential and use their strengths (Kolbe, StrengthsFinder, and 5 Team Responsibilities); Recognize employees as the LHIN’s most valuable resource; and Value employees' efforts and respect who they are and what they do.
What will we need to do? LEADS coaches will meet with individual employees assist them with developing Learning Plans. Target start date February 2016 (SLT) and October 2016 (staff). Establish a regular day of learning. Eg. Effective meetings, LEADS, etc. Using a recruitment specialist, recruit the most talented individuals for each position in the LHIN. Aim to recruit, select and retain talent, while operating in a diverse and inclusive environment. Schedule LEADS workshops focusing on each domain.
Appendix B: Summary of Implementation Strategies
Health Equity Work alongside health service providers to develop culturally competent Boards and organizations through Continuous Cultural Competency training (including ongoing Indigenous/Aboriginal cultural and linguistic competency training and Francophone cultural competency training) and board/staff development focused on increasing awareness about key equity issues. Continue to engage with key stakeholders and health service providers in developing an approach to equity and an implementation plan that outlines foundational equity expectations such as: deploying tools, training requirements, staff expertise, prominence of equity considerations in organizational strategic and operational plans, development and monitoring of equity indicators and targets as part of quality improvement, collection of socio‐demographic data/community profiles to advance equity, advancement of targeted equity initiatives, services and/or policies, and identification of best practices and resources. Apply an equity lens to decision‐making by developing guidelines to increase the application of the Health Equity Impact Assessment tool,[1] including when developing and accessing health programs and services and for all major financial decisions and integrations at the LHIN. Integration & Collaboration Work alongside Health service providers to pursue opportunities to transform the health system to integrate population and public health planning with other services to create stronger links to health promotion and disease prevention; to provide integrated, population‐based care by strengthening end to end integration at a multi‐community and local level across the South West LHIN Work alongside health service providers to pursue opportunities for Integrated Funding Models. This will promote high quality person‐centred care across the care continuum by bundling payment to encourage coordination of care, reduce variation of care pathways, increase efficiency, and improve outcomes.
Engage health service providers Work alongside health service providers in capacity planning activities to improve and increase access to care and use resources more efficiently by and act on opportunities to integrating/aligning services and resources. Continue to evaluate integration activities to ensure they are in the best interest of the public. Proposed integrations must demonstrate how they will positively impact on population health, experience of care and value for money. Proactively work with health service provider governance through Board‐to‐Board engagement to intentionally identify and support integration activities related to service, administration and governance
Provide tools to assist health service providers to continually assess quality of health services, organizational health, human resources, finances and performance outcomes to identify and successfully advance integration and collaboration opportunities. Work with health service providers to improve back office services, make the best use of public resources, and plan for future health system transformation.
Quality Improvement & Innovation Work with health service providers to develop a coordinated approach to engage people who receive services and determine experience of care measures.
Work alongside health service providers to implement best practices (e.g. Quality Based Procedures, Adult Day Program Redesign) and reduce variation within and among organizations to improve outcomes and value for money. Work with health service providers to advance quality outcomes for identified priorities and initiatives. Encourage health service providers to embed quality improvement within their organizations through processes such as accreditation and use tools such as the Quality Improvement Enabling Framework Continue to integrate and standardize improvement tools and templates into the LHIN’s project management approach.
Continue to acknowledge and stimulate quality improvement efforts through the LHIN’s annual quality symposium and awards. Work alongside health service providers to leverage provincial quality improvement learning opportunities (e.g. IDEAS program‐‐Improving and Driving Excellence across Sectors) by implementing an approach and roadmap to identify improvement projects. Engage a Quality Improvement community of practice to continue to build a culture of continuous quality improvement and broadly share quality evidence. Work alongside health service providers to consistently embed patient engagement approaches (e.g. Experience Based Design) to advance quality improvement. Provide leadership in establishing shared quality improvement strategies through Quality Improvement Plans across and within sectors to advance key priorities. Transparency & Accountability Work alongside health service providers to implement, evaluate, monitor, and enhance the impact of initiatives within each priority to improve the health of the focused population, their experience of care and the value for money for the care provided. Work with health service providers to optimize data processes to improve access, use and analysis of data to make data sharing for improvement easier and to communicate progress against measurement plans and benchmarking targets. Continue to implement and enhance value for money assessments of LHIN‐wide initiatives in order to understand impact of investments and direct alignment of initiatives to outcomes. Establish a plan to strengthen cross‐sector integration and shared accountability by leveraging Service Accountability Agreements (SAA) and enhanced improvement and compliance monitoring. Increase transparency with publicly‐available performance reporting, enhanced outcome‐based reporting aligned to key initiatives, and scorecards (system‐level and priority‐based) Improve public‐friendly communication and posting of information including key reports and performance results. eHealth/ Technology Optimize eHealth technologies (e.g. Telemedicine) for timelier access to services, reduced travel time and to avoid unnecessary transfers. Enhance Telehomecare to give people with chronic diseases the self‐management and remote communication methods to receive the care they need, right in their home.
Implement the regional clinical viewer, ClinicalConnect, to support high‐quality, safe and timely care allowing an individual’s healthcare information to be securely available to healthcare providers across the continuum of care. Implement eHealth tools (e.g. Health Links Care Coordination Tool) to allow clinicians to collaborate with other care team members and maintain shared, coordinated care plans. Advance hospital reporting systems so that primary care providers, specialists and nurse practitioners anywhere in Ontario can receive patient reports electronically from participating hospitals or Independent Health Facilities
Enhance eHealth technologies (e.g. Integrated Assessment Records) to improve collaboration among health service providers involved in an individual’s care through access to timely and secure assessment information. Implement eConsultation and eReferral processes to reduce unnecessary referrals to specialists and give primary care physicians more timely access to specialists. Implement a system to improve timely access to surgery.
Priorities for the Integrated Health Service Plan 2016‐19 (updated June 8, 2016) Ensuring primary health care is strengthened and linked with the broader health care system What are we trying to accomplish? Ensure equitable access to primary health care (including multidisciplinary care) by: enhancing inter‐professional collaboration between primary health care models and the broader integrated system of care and; supporting quality improvement initiatives that will improve health outcomes and the experience of care. Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To improve access to primary care Attachment to a primary care provider To improve early identification and intervention Access to weekend/ afterhours care Experience of Care Cancer Compliance Rates Reduce readmission rates for defined populations Influenza vaccination Rates To improve patient experience Experience of Care To improve care coordination throughout the journey of care Patient Involvement in Care Decisions Value for Money Primary Care Follow‐up Post Hospital Discharge To reduce unnecessary hospitalization Increased utilization of coordinated care plans To reduce avoidable emergency department visits or revisits Value for Money Hospital Readmission Rates Avoidable Emergency Department Visits Projects/Initiatives: Duration: Access to Primary Health Care: Improve access to primary health care by implementing recommendations from the Understanding Health Beyond 36 Months Inequities and Access to Primary Health Care in the South West LHIN Project and build capacity for Primary Care Partnering for Quality: Improve primary care provider capacity to identify patients with chronic conditions and support patients to provide Beyond 36 months chronic disease management Primary Care and Mental Health and Addictions (MH&A) strategy: Strengthen relationships between MH&A services and primary care and 25‐36 months increase service capacity with existing primary care structures eConsultation: Provide primary care physicians with more timely access to specialist input, potentially avoiding referrals for consultation 12‐24 months where applicable. Primary Care Network Structure: Continue to strengthen primary care network structure Beyond 36 months
Optimizing the health of people and caregivers living at home, in long‐term care and in other community settings1 What are we trying to accomplish? Improve the care experiences and optimizing the health of people and caregivers living at home, in long‐term care and in other community settings, being responsive to changing needs and supporting safe and independent living in a way that is sustainable/effective(ness) Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To increase adoption of evidence based care (High‐ Intensive Hospital to Home and Home First volumes Level) Independent seniors hospitalization rate (65+) To increase number of people receiving care in the In development: compliance to or adoption of care standards being developed for H&CC community policy changes
Experience of Care Experience of Care To increase access to inter‐professional teams (High‐ % of Home Care patients with complex needs who received their first personal support level) visit within 5 days of the date that they were authorized To improve access to integrated systems of care for % of home care patients who received their first nursing visit within 5 days of the date particular populations they were authorized To improve care coordination throughout the journey CCAC 90th percentile wait times from community for CCAC in‐home services of care In development: number of client transitions from CCAC and Community Support Services (CSS) and vice versa Value for Money % of home care clients with an unplanned, less urgent ED visit within the first 30 days of To reduce unnecessary variation in service delivery discharge from hospital To prevent unnecessary long‐term care admission % of home care clients who had an unplanned to readmission hospital within 30 days of discharge from hospital
Value for Money Alternate Level of Care (ALC) rate In development: standard service packages for like type services between CSS provision to low acuity clients and CCAC provision to moderate and high acuity patients
1 People living in community settings may also include those in temporary living accommodations, or who may be experiencing homelessness ** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Optimizing the health of people and caregivers living at home, in long‐term care and in other community settings1 Projects/Initiatives: Duration: Home and Community Care: Implement provincial home and community care road map and policy changes related to the provision of 25‐36 months Personal Support Services to support an integrated system of care Adult Day Programs (ADP): Enhance ADPs including specialized stroke programming and to ADP related transportation Beyond 36 months Transitional and Life‐Long Care Clinic Model: Spread model that improves transitions from the pediatric system of care to adult services 12‐24 months where families typically experience a significant loss of support Congregate Residential Living: Expand 24/7 assisted Living services for younger adults with complex needs 12‐24 months
Long‐Term Care (LTC) Home Redevelopment: Ensure equitable access, quality and safety for residents living in LTC Beyond 36 months
Assisted Living Hubs: Increase access to assisted living supports through implementation of hubs (multiple phases) Beyond 36 months Special Needs Strategy: Plan and implement coordinated care planning and integrated rehabilitation services across multiple ministries (Ministry of Children and Youth Services, Ministry of Community and Social Services, Ministry of Health and Long Term Care, Ministry of Beyond 36 months Education) for shared populations Dementia Care Strategy: Plan and implement the South West LHIN Dementia Strategy in alignment with the provincial dementia strategy Beyond 36 months
Oneida Long‐Term Care Empowerment: Transition the management of LTC admission process to Oneida First Nation Beyond 36 months Elder Abuse Strategy: Reduce abuse within the seniors community aligned with the goals identified in the Provincial Elder Abuse Strategy 25 – 36 months recommended by the Ontario Senior’s Secretariat and the South Western Ontario Regional Elder Abuse Network
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Supporting people in preventing and managing chronic conditions What are we trying to accomplish? Support people in the prevention and appropriate management of chronic conditions through optimizing care coordination, enhancing accessibility, maximizing provider collaboration, in a cost effective and efficient manner Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To reduce the burden the illness Chronic Disease Prevalence and Incidence To increase education and training Service utilization of self‐management and diabetes education programs Confidence scores for To improve self‐management among individuals patients with a Coordinated Care Plan
Experience of Care Experience of Care To improve system navigation and care Number of identified users with high care needs on active care plan coordination Primary care follow‐up post hospital discharge To improve patient experience Time from referral to home care visit for patients with high care needs Support and respect scores for patients with a coordinated care plan Value for Money To reduce unnecessary hospitalizations and Value for Money readmissions Hospital readmission rates To Increase care in the community Utilization of acute and ambulatory services for residents with active care plans Hospitalization rate for Ambulatory Care Sensitive Conditions Average cost of patients with high care needs (long term) Rate of ER visits best managed elsewhere Projects/Initiatives: Duration: LHIN wide Integrated Chronic Disease Prevention & Management Model: Develop model Less than 12 months Optimized Access for Chronic Condition Management Programs and Services: Develop/implement a model for coordinated access to Beyond 36 months diabetes management programs and services Expand and align model to programs and services for other chronic conditions as appropriate Integrated System of Care: Develop/implement standardized care pathways across the continuum for people with chronic conditions, 25‐36 months leveraging Health Links, Integrated Funding Models (IFMs) and Quality Based Procedures (QBP) best practice, reduce variation and increase standardization of best practices among and within system partners for vision care, wound care (including diabetes foot care), chronic kidney disease (CKD), congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Health Links: Support development and spread of the provincial Health Links coordinated care plan and associated electronic tools; Utilize 25‐36 months experience based design methods in improvement processes of each local Health Link as part of the Health Links program implementation Diabetic Foot Care Project: Continue the planning and implementation of foot care model 12‐ 24 months
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Supporting people in preventing and managing chronic conditions Tele‐homecare Program: Pilot and spread the use of tele‐homecare technologies for people with certain chronic conditions across the Less than 12 months LHIN using self‐management and remote communication tools people can use in their own homes South West Self‐Management Program: Build system capacity to support people to attain their goals for their health Beyond 36 months Francophone Chronic Disease Self‐Management: To enhance and/or build on services for the management and prevention of chronic 25 – 36 months diseases, in person or through Ontario Telemedicine Network (OTN) Culturally Safe Care for Aboriginal Populations: In partnership with First Nations, Aboriginal, and Metis people advance culturally safe Beyond 36 months chronic disease care including the planning and implementation of culturally safe approaches to Health Links Francophone Health Link Strategy: identify strategy to support Health Link implementation related to meeting the needs of the 25 – 36 months francophone population consistent with the Health Link, health equity impact assessment findings
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Strengthening mental health and addiction services and their relationship with other partners What are we trying to accomplish? Ensure services and supports are continually improving, easier to access and translate into high quality care where people and their caregivers, impacted by mental health and/or addictions and/or responsive behaviours can thrive. Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To reduce the burden of illness Access to primary care (TBD) To enhance capacity planning to increase the number Change in behavioural symptoms among Long‐Term Care (LTC) Home residents of people receiving care in the community [Behavioural Supports Ontario (BSO) legacy measure] Police & Emergency Medical Services (EMS) involvement/time on call (TBD) Experience of Care Mental illness hospitalization rate To improve access to integrated systems of care To improve patient experience Experience of Care Repeat unscheduled Emergency Room (ER) visits within 30 days – Mental Health Value for Money Repeat unscheduled ER visits within 30 days – Substance Abuse To optimize utilization of resources Access to inter‐professional teams e.g. follow‐up appointment booked within 30 days of To reduce unnecessary variation in service delivery discharge from hospital (before discharge) (TBD) 30 day readmission rates Wait‐times for access to services, specialists (e.g. mental health and addictions case management and community treatment for substance abuse from Connex) Patient experience: [future: from Ontario Perceptions of Care (OPOC)]
Value for Money Service efficiency: unit cost or Intensive Case Management (ICM) measure LTC Home transfer rate to ED for behavioural/mental health conditions (Form 1) – may need to refine [e.g. by Canadian Triage and Acuity Scale (CTAS)] Number of Alternate Level of Care (ALC) Days and Cases with Behavioural and Mental Health Specialized Needs & Barriers Prevent unnecessary LTC admission (TBD)
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Strengthening mental health and addiction services and their relationship with other partners Projects/Initiatives: Duration: Mental Health and Addictions (MH&A) Crisis Services: Continue to refine what the crisis services needs are in each geographic area to ensure equitable access, consistency and quality of crisis services across the LHIN and reduce reliance on police and emergency 12‐24 months departments(EDs) for those experiencing a crisis MH&A Supportive Housing: Implement provincial program and leverage municipal partnerships to increase supports within housing 25‐36 months MH&A: Care Pathways: Develop/implement standardized care pathways for people with mental health and/or addiction issues and for 25‐36 months people with high needs responsive behaviours MH&A Services Standardization: Develop recommendations for service alignment and potential investments based on a review of present 25‐36 months capacity, function and utilization of MH&A services Intensive MH&A Case Management: Evaluate pilot program / evidence based model to create sustainable outcomes for spread 12‐24 months consideration Coordinated Access for MH&A Services: Continue to implement and improve coordinated screening & intake and waitlist processes to Less than 12 streamline access to services as well as create a common portal of entry for people accessing mental health and addiction services. months Facilitate the coordination of Aboriginal MH&A services with main stream MH&A services Ontario Perceptions of Care (OPOC) Tool: Implement the OPOC tool which seeks to understand and improve experience of care for people 12‐24 months impacted by mental health and/or addiction issues MH&A Peer Support Strategy: Development and implement a Regional Peer Support strategy based on the recommendations in the 12‐24 months “Development of a Peer Support Strategy for the South West LHIN” 2015 report. Strategy for Moderate Mental Illness: Develop a strategy to respond to the increasing demand for services from moderately mentally ill 12‐24 months clients and identify the role of primary care in supporting individuals with mild to moderate mental health problems. Emergency Department (ED) Mental Health Access and Flow: Formalize processes to enable the safe and timely referral, assessment and 12‐24 months repatriation of Form 1 Mental Health patients from Emergency Departments to appropriate Mental Health Services and Schedule 1 facilities New Staged Screening and Assessment Screening for Addictions: Improve the screening and assessment of clients receiving substance use services through the implementation of a staged protocol across the South West LHIN and support sustainable implementation through 12‐24 months coaching, fidelity monitoring and evaluation. MH&A Education Strategy: Conduct an education needs and readiness assessment for MH&A providers to identify key topics and priority 12‐24 months areas for education Long‐Term Care Home Specialized Units: Implement process to create specialized units for people with responsive behaviours Beyond 36 months Behavioural Supports Ontario (BSO) System of Care: Continue to meet the needs of older adults with or at risk of responsive behaviours due to mental health and addictions, dementia, or other neurological conditions to maintain or improve their quality of life and that of their Beyond 36 months caregivers by improving equitable access to coordinated, effective and efficient services and supports Francophone Strategy: Ensure French language service capacity for key service functions (case management, counseling, crisis response, treatment, tier/bedded capacity, maintenance, family services and support); Optimize MH&A service delivery, including BSO, for the 25‐36 months Francophone population in London
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Ensuring timely access to hospital‐based care, LHIN‐wide, multi‐community, and local level What are we trying to accomplish? Timely access to high quality, effective and efficient hospital‐based treatment and care appropriately aligned at the LHIN‐wide, multi‐community and local level Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To increase adoption of evidence based care % of hospitals have implemented (or are in progress) to address issues of delirium (target 100%) Experience of Care % of hospitals have participated in regional SFH activities (networking days, webcasts, and To decrease wait times for access to services, steering committee) (target 100%) specialists and/or procedures % of hospitals will participate in the provincial ACTION program and those hospitals will To improve patient experience showcase their work in a SW LHIN forum to build capacity, share learnings across the region To improve care coordination throughout the (target 75%) journey of care QBP implementation progress, adoption of QBP best practice/ clinical best practice pathways (Survey) (TBD) Value for Money To optimize utilization of resources Experience of Care Rate of readmissions to hospital within 30 days for selected Case Mix Groups (CMGs) % of cases completed in target wait time: CT, MRI, hip, knee, cancer, cardiac, cataract Timeliness of discharge summary communication within 48 hours Maintaining access and discharge practices in peak periods: admission/discharge throughput Length of stay for patients in emergency departments Time to inpatient bed, ICU avoidable days % Life or Limb transfers in 4 hours % of hospitals have patient experience as a measure in their quality improvement plans (target 100%)
Value for Money Actual to expected Hospital Based Allocation Methodology (HBAM) cost (CCC, rehab, ED, acute/day surgery) Actual to expected cost for key identified clinical services planning streams Actual to expected cost for select Quality Based Procedures Actual to expected length of stay ALC throughput Wait Times & QBP volumes: allocated versus completed ** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Ensuring timely access to hospital‐based care, LHIN‐wide, multi‐community, and local level Projects/Initiatives: Duration: Clinical Services Planning: Develop a coordinated and standardized approach to the implementation of Quality Based Procedures, patient care planning, admission/discharge/transition processes and capacity planning across the continuum of care to ensure implementation of 25‐36 months the recommendations related to Stroke (hospital and community based care), vision care, perinatal care, and diagnostic imaging; including the development, implementation and spread of Integrated Funding Models (IFMs) based on experience from CHF and COPD. Waitlist Management Strategies: Implement a surgical eBooking, wait list management, automated (complex) WTIS reporting and pre‐op 25‐36 months standardization system. Investigate strategies to improve Wait 1 and Wait 2 in priority areas Critical Care Strategy (Critical Care Services Ontario): Improve timely access and quality of care through capacity management 12 – 24 months (PHRS), sustainability of Life or Limb – No Refusal Policy, and implementation of clinical best practice guidelines. Chronic Mechanical Ventilation (CMV) System of Care: Implementation of CMV recommendations across continuum of care (Acute, Sub‐ 12‐24 months Acute, Community) and LTV feasibility study, exploration of new service delivery models and standardize data capture and reporting. Senior Friendly Hospital Strategy: Grow and sustain Senior Friendly Hospital strategy (organizational support, processes of care, emotional 12‐24 months and behavioral environment, ethics in clinical care and research, physical environment) Patient Flow Strategies: Optimize patient flow (access, efficiency, effectiveness) within and across Hospitals. through a targeted improvement approach including establishment of a Learning Collaborative to align with the ED pay for results and knowledge transfer sites 0‐24 months to enable sustainability and spread of leading practices Antimicrobial Stewardship: Create opportunities to spread best practices for antimicrobial stewardship across hospitals to reduce hospital TBD acquired infections (e.g. C. difficile)
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Enabling a rehabilitative approach across the care continuum What are we trying to accomplish? Supporting improved patient experiences, clinical outcomes, and transitions through improved access , efficiency, effectiveness, quality, integration, value and equity in the delivery of rehabilitative services across the care continuum Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To improve early identification and Early identification & intervention (Assess and Restore ‐ TBD) intervention Change in Functional Independence Measure (FIM) score (TBD) LHIN‐wide implementation of assess and restore guidelines Experience of Care LHIN‐wide adoption of provincially standardized definitions and eligibility criteria for bedded rehabilitation To improve access to integrated systems of care for particular Experience of Care populations Falls in last 30 days among LTC home residents To improve patient experience Rate of ER visits resulting from falls (per 100,000 population 65 and over) Hip & Knee (Total Joint Replacement) Wait I Value for Money Hip & Knee (Total Joint Replacement) Patient Experience To reduce unnecessary variation in Assess and Restore measure (TBD) service delivery % of unplanned, less‐urgent ED visit within the first 30 days of discharge from hospital To improve service efficiency % of unplanned readmissions to hospital within 30 days of discharge To reduce unnecessary hospitalization Value for Money
% ALC days/rate for ALC rehab Length of stay efficiency % eligible patients in rehab beds Coordinated access: wait from referral to bed acceptance/decline Assess and restore—avoidable hospitalizations (TBD) Projects/Initiatives: Duration: Falls Prevention Strategy: Support spread of the South West Falls Prevention Strategy including opportunities to meet Francophone needs. 12‐24 months Rehabilitation Capacity Plan and Implementation: Plan and implement the adoption of provincially standardized bedded rehabilitation 12‐36 months definitions and eligibility criteria, and plan and implement a bedded rehabilitation capacity plan Community Physiotherapy Reform: transition funding and accountability for publicly funded physiotherapy clinics from MOHLTC to LHINS. 12‐24 months Coordinated Access: Support ongoing implementation and improvement of Coordinated Access thru CCAC. 12‐24 months Assess and Restore: Plan and implement the provincial Assess and Restore Guideline in collaboration with other LHINs and in alignment Beyond 36 months with Ministry of Health and Long‐Term Care expectations
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Putting people with life‐limiting illnesses and their families at the centre of hospice palliative care What are we trying to accomplish? To put individuals with life‐limiting illnesses and their families at the centre of care to optimize their quality of life by improving equitable access to coordinated, effective, efficient quality services and supports. Outcome Objectives: What will we measure to know we have been successful?
Population Health Population Health To improve early identification and Average Palliative Performance Scale (PPS) on Admission to residential hospice intervention Average Length of Stay (LOS) in residential hospice To reduce the burden of illness To increase # of people receiving care in the Experience of Care community % of palliative care clients receiving home support upon discharge (by region by Fiscal Quarter) % of Palliative care clients with hospital readmission within 30 days by region by Fiscal Quarter End of Life Report ‐ % of patients die in their place of choice Experience of Care In development: Long‐Term Care measure To increase access to inter‐professional teams Source of Admission to residential hospice To improve patient experience To improve care coordination throughout the Value for Money journey of care Palliative care length of stay (LOS) in acute care settings To support patient choice in place of death % of palliative care clients that were discharged from hospital that were seen in the ER within 30 days by region by Fiscal Quarter Value for Money % of palliative care clients that died in hospital by region by Fiscal Quarter To increase # of people receiving care in the Occupancy rate in residential hospice setting community Projects/Initiatives: Duration: Grey Bruce Hospice Palliative Care Outreach: Spread hospice palliative care secondary level outreach consultation support throughout the Beyond 36 months LHIN Integrated Hospice Palliative Care (HPC) System: Continue to develop an integrated system of HPC aligned with provincial Declaration of Beyond 36 months Partnership HPC Capacity Planning: Build and implement recommendations for bedded and non‐bedded palliative resources in a variety of care settings 12 – 24 months HPC Education: Develop and implement a strategic approach to educating providers and communities about HPC 12 – 24 months Aboriginal Approach to HPC: In partnership with First Nations, Aboriginal, and Metis people plan and implement culturally safe approaches Beyond 36 months to Aboriginal Hospice Palliative Care
** Indicators in the “how will we know we have been successful” section in italics may move to the Project/initiative level in the future
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Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
1 LHIN wide Integrated Chronic Disease Prevention & Chronic Disease Beyond 36 TBD 10% Initiate integrated into #3 Management Model: Develop model months
In alignment to the Patients First LHIN Chronic Disease Beyond 36 TBD 0% 1.1 ‐ 1.6 have been responsibilities, the LHIN will develop and months removed. Improving implement a LHIN ‐wide strategy to integrate alignment with public population and public health planning with other health has been services to create strong links to health promotion incorporated into the and disease prevention Integration and Collaboration Implementation Strategies
Plan and implement the Patients First sub‐LHIN Chronic Disease Beyond 36 TBD 0% strategy to integrate population and public health months planning with other servcies to create strong links to health promotion and disease prevention in Elgin County Plan and implement the Patients First sub‐LHIN Chronic Disease Beyond 36 TBD 0% strategy to integrate population and public health months planning with other servcies to create strong links to health promotion and disease prevention in Oxford County Plan and implement the Patients First sub‐LHIN Chronic Disease Beyond 36 TBD 0% strategy to integrate population and public health months planning with other servcies to create strong links to health promotion and disease prevention in London Middlesex Plan and implement the Patients First sub‐LHIN Chronic Disease Beyond 36 TBD 0% strategy to integrate population and public health months planning with other servcies to create strong links to health promotion and disease prevention in Grey Bruce
Appendix 4 Page 1 of 20 Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
Plan and implement the Patients First sub‐LHIN Chronic Disease Beyond 36 TBD 0% strategy to integrate population and public health months planning with other servcies to create strong links to health promotion and disease prevention in Huron Perth 2 Optimized Access for chronic condition Chronic Disease management programs and services: Develop/implement a model for coordinated access to diabetes management programs and services Expand and align model to programs and services for other chronic conditions as appropriate
2.1 Diabetes Coordinated Access Chronic Disease 12 to 24 March 31, 2017 10% Plan months 3 Integrated Chronic Disease System of Care: Chronic Disease Beyond 36 March 31, 2020 TBD 5% Initiate #1 and #3 integrated Develop/implement integrated chronic disease months into one initiative prevention and management strategies standardized care pathwaysacross the continum of care for people living with chronic conditions , leveraging Health Links, Integrated Funding Models (IFMs) and Quality Based Procedures (QBP) best practice, to improve access and coordination reduce variation and increase standardization of best practices among and within system partners. for vision care, wound care (including diabetes foot care), chronic kidney disease (CKD), congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD).
4 Health Links: Support development and spread of Chronic Disease 25 to 36 March 31, 2019 See sub‐ See sub‐ the provincial Health Links coordinated care plan months initiatives initiatives and associated electronic tools; Utilize experience based design methods in improvement processes of each local Health Link as part of the Health Links program implementation Appendix 4 Page 2 of 20 Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
4.1 London Middlesex Health Link implementation Chronic Disease 12 to 24 March 31, 2017 40% Execute months 4.2 North and South Grey Bruce Health Links Chronic Disease 12 to 24 March 31, 2017 10% Execute implementation months 4.3 Oxford Health Link implementation Chronic Disease 25 to 36 March 31, 2018 0% Not Started months 4.4 Elgin Health Links implementation Chronic Disease 25 to 36 March 31, 2018 0% Not Started months 5 Diabetic Foot Care Project: Continue the planning Chronic Disease 12 to 24 March 31, 2018 30% Execute deferring spread of and implementation of foot care model months TBD initiative to align with renewal timelines
6 Tele‐homecare Program: Pilot and spread the use of Chronic Disease Less than 12 March 31, 2017 60% Execute tele‐homecare technologies for people with certain months chronic conditions across the LHIN using self‐ management and remote communication tools people can use in their own homes 7 South West Self‐Management Program: Build Chronic Disease Beyond 36 TBD 90% Monitor system capacity to support people to attain their months goals for their health 8 Francophone Chronic Disease Self‐Management: Chronic Disease 25 to 36 March 31, 2019 0% Not Started To enhance and/or build on services for the months management and prevention of chronic diseases, in person or through Ontario Telemedicine Network (OTN)
9 Culturally Safe Care for Aboriginal populations: In Chronic Disease Beyond 36 TBD 10% Initiate partnership with First Nations, Aboriginal, and Metis months people advance culturally safe chronic disease care including the planning and implementation of culturally safe approaches to Health Links
Appendix 4 Page 3 of 20 Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
10 Francophone Health Link strategy: identify strategy Chronic Disease 25 to 36 March 31, 2019 10% Plan to support Health Link implementation related to months meeting the needs of the francophone population consistent with the Health Link, health equity impact assessment findings 11 Home and Community Care: Implement provincial Home LTC 25 to 36 March 31, 2019 10% Initiate home and community care road map and policy Community Months changes related to the provision of Personal Support Services to support an integrated system of care
11.1 In alignment to the Patients First LHIN Home LTC Beyond 36 TBD 0% Not Started responsibilities, the LHIN will develop and Community Months implement the LHIN‐wide strategy to transfer the essential home care functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system. 11.2 Plan and implement the Patients First sub‐LHIN Home LTC Beyond 36 TBD 0% Not Started strategy to transfer the essential home care Community Months functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system in Elgin County 11.3 Plan and implement the Patients First sub‐LHIN Home LTC Beyond 36 TBD 0% Not Started strategy to transfer the essential home care Community Months functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system in Oxford County 11.4 Plan and implement the Patients First sub‐LHIN Home LTC Beyond 36 TBD 0% Not Started strategy to transfer the essential home care Community Months functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system in London Middlesex Appendix 4 Page 4 of 20 Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
11.5 Plan and implement the Patients First sub‐LHIN Home LTC Beyond 36 TBD 0% Not Started strategy to transfer the essential home care Community Months functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system in Grey Bruce 11.6 Plan and implement the Patients First sub‐LHIN Home LTC Beyond 36 TBD 0% Not Started strategy to transfer the essential home care Community Months functions from the CCAC to the LHIN and integrate Care Coordinators within the appropriate areas of the health system in Huron Perth 11.7 Implementation of Collaborative Assessment Home LTC Less than 12 March 31, 2017 75% Plan and Referral Model Recommendations Community Months
12 Adult Day Programs (ADP): Enhance ADPs including Home LTC Beyond 36 March 31, 2020 20% See sub‐ specialized stroke programming and to ADP related Community Months initiatives transportation 12.1 Adult Day Program Redesign Review Home LTC 12 to 24 3/31/2017 25% Execute extending timeline due Community Months March 31, 2018 to limited capacity during health system renewal
12.2 ABI Specialized ADP: Kensington Village Home LTC 12 to 24 March 31, 2017 30% Plan Community Months
12.3 ADP Stroke Programming in the Community Home LTC Beyond 36 3/31/2020 0% Not Started extending timeline due linked with hospital‐based programming Community Months March 31, 2021 to limited capacity during health system renewal
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13 Transitional and Life‐Long Care Clinic Model: Spread Home LTC Beyond 36 3/31/2018 5% Not Started extending timeline due model that improves transitions from the pediatric Community Months March 31, 2019 to limited capacity system of care to adult services where families during health system typically experience a significant loss of support renewal
14 Congregate Residential Living: Expand 24/7 assisted Home LTC 12 to 24 3/31/2018 75% Not Started extending timeline due Living services for younger adults with complex Community Months March 31, 2019 to limited capacity needs during health system renewal
15 Long‐Term Care (LTC) Home Redevelopment: Home LTC Beyond 36 December 31, 2025 5% Plan Ensure equitable access, quality and safety for Community Months residents living in LTC
15.1 Support LTC Homes Planning to Redevelop Home LTC 25 to 36 March 31, 2019 5% Plan Immediately Community Months
16 Assisted Living Hubs: Increase access to assisted Home LTC Beyond 36 March 31, 2020 20% See sub‐ living supports through implementation of hubs Community Months initiatives (multiple phases) 16.1 Further Execution of AL Hubs in Phase 1 Home LTC Beyond 36 March 31, 2020 30% Execute Communities: Meaford, Woodstock, London, St. Community Months Thomas, Strathroy 16.2 Further Execution of AL Hubs in Phase 2 Home LTC Beyond 36 March 31, 2020 20% Execute Communities: Goderich, Kincardine, Listowel, Community Months Ingersoll, Tillsonburg, Stratford 16.3 Subsequent phasing of AL Hub implementation Home LTC Beyond 36 March 31, 2020 0% Not Started to cover IHSP cycle Community Months
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17 Special Needs Strategy: Plan and implement Home LTC 25 to 36 3/31/2020 0% Not Started accelerating timeline to coordinated care planning and integrated Community Months March 31, 2019 align with provincial rehabilitation services across multiple ministries timelines (Ministry of Children and Youth Services, Ministry of Community and Social Services, Ministry of Health and Long Term Care, Ministry of Education) for shared populations 18 Dementia Care Strategy: Plan and implement the Home LTC Beyond 36 March 31, 2020 5% Initiate South West LHIN Dementia Strategy in alignment Community Months with the provincial dementia strategy
19 Oneida Long‐Term Care empowerment: Transition Home LTC Beyond 36 March 31, 2020 0% Not Started the management of LTC admission process to Community Months Oneida First Nation 20 Elder Abuse Strategy: Reduce abuse within the Home LTC Beyond 36 3/31/2019 10% Initiate extending timeline due seniors community aligned with the goals identified Community months March 31, 2020 to limited capacity in the Provincial Elder Abuse Strategy recommended during health system by the Ontario Senior’s Secretariat and the South renewal Western Ontario Regional Elder Abuse Network
21 Grey Bruce Hospice Palliative Care Outreach: Hospice Palliative Beyond 36 March 31, 2020 See sub‐ See sub‐ Spread hospice palliative care secondary level Care Months initiatives initiatives outreach consultation support throughout LHIN
21.1 Grey Bruce HPC Outreach Model Hospice Palliative Less than 12 March 31, 2017 75% Monitor Care months
21.2 Oxford & Elgin HPC Outreach Hospice Palliative Less than 12 March 31, 2017 15% Execute Care months
21.3 Huron Perth & London Middlesex HPC Outreach Hospice Palliative 12 to 24 March 31, 2018 0% Not Started Care months
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22 Integrated Hospice Palliative Care (HPC) System: Hospice Palliative Beyond 36 March 31, 2020 40% Execute Continue to develop an integrated system of HPC Care Months aligned with provincial Declaration of Partnership 23 HPC Capacity Planning: Build and implement Hospice Palliative 25 to 36 March 31, 2019 25% Plan recommendations for bedded and non‐bedded Care months palliative resources in a variety of care settings 24 HPC Education: Develop and implement a strategic Hospice Palliative 12 to 24 March 31, 2018 10% Initiate approach to educating providers and communities Care Months about HPC 25 Aboriginal Approach to HPC: In partnership with Hospice Palliative 12 to 24 March 31, 2017 50% Plan First Nations, Aboriginal, and Metis people plan and Care months implement culturally safe approaches to Aboriginal Hospice Palliative Care
26 Clinical Services Planning: Develop a coordinated Hospital‐based 25 to 36 March 31, 2019 See sub‐ See sub‐ and standardized approach to the implementation Care months initiatives initiatives of Quality Based Procedures, patient care planning, admission/discharge/transition processes and capacity planning across the continuum of care to ensure implementation of the recommendations related to Stroke (hospital and community based care) vision care, perinatal care and diagnostic imaging; including the development, implementation and spread of Integrated Funding 26.1 Stroke Phase 1 ‐ Implementation and Evaluation Hospital‐based 12 to 24 March 31, 2018 25% Plan of Directional Recommendations Care months
26.2 Stroke Phase 2 ‐ Community Capacity Rehabilitative 25 to 36 March 31, 2019 15% Plan (Development and Implementation of Care months Recommendations)
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26.3 Vision Care ‐ Development of a case‐based Hospital‐based Less than 12 March 31, 2017 90% Plan approach to clinical decision‐making and Care months coordination of care to people with complex eye problems and people with complex medical conditions 26.4 Vision Care ‐ Development and testing of a Hospital‐based Less than 12 March 31, 2018 0% Not Started process to collect pre‐ and post‐cataract surgery Care months visual acuity scores as a way to measure the clinical outcome of cataract surgery
26.5 Vision Care ‐ Development and testing of a Hospital‐based Less than 12 March 31, 2018 0% Not Started strategy to improve visual screening rates Care months among people living with diabetes in the South West LHIN
26.6 Regional Medical Imaging Integrated Care Hospital‐based 12 to 24 March 31, 2018 5% Initiate project Care months
26.7 Orthopaedic System of Care Hospital‐based 12 to 24 TBD 5% Initiate added sub‐intitiative Care months
27 Waitlist Management Strategies: Implement a Hospital‐based 25 to 36 March 31, 2019 See sub‐ See sub‐ surgical eBooking, wait list management, automated Care months initiatives initiatives (complex) WTIS reporting and pre‐op standardization system. Investigate strategies to improve Wait 1 and Wait 2 in priority areas
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27.1 Cross‐LHIN Implementation of Novari Hospital‐based 25 to 36 March 31, 2019 10% Plan Care months
27.2 Wait 1 strategies: Improve access to acute care Primary Health 25 to 36 TBD 0% Not Started services through primary care implementation of Care months booking and scheduling of appointments in acute care; bring visibility to surgical waitlists in primary care offices with a focus on patient choice; investigate opportunities for improved waitlists through centralized booking/queuing
28 Critical Care Strategy (Critical Care Services Hospital‐based 12 to 24 June 31, 2019 100% Monitor Ontario): Improve timely access and quality of care Care months through capacity management (PHRS), sustainability of Life or Limb – No Refusal Policy, and implementation of clinical best practice guidelines.
29 Chronic Mechanical Ventilation (CMV) System of Hospital‐based 12 to 24 March 13, 2019 See sub‐ See sub‐ Care: Implementation of CMV recommendations Care months initiatives initiatives across continuum of care (Acute, Sub‐Acute, Community) and LTV feasibility study, exploration of new service delivery models and standardize data capture and reporting. 29.1 To document the barriers and resources required Home LTC Less than 12 March 31, 2017 90% Monitor by LTC Homes to support residents with Community months tracheotomies, chronic non‐invasive mechanical ventilation (NIV) and/or cough assist; to develop strategies to address barriers and develop care processes to support solutions.
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29.2 To work in partnership with the Ontario Hospital‐based Less than 12 March 31, 2017 90% Execute Ventilator Equipment Pool and Hamilton Health Care months Sciences Centre (operator of IDS) to identify the steps needed to link VEP and IDS data – primarily by using VEP patient identifiers and to take the necessary steps to create the interface.
29.3 To investigate the opportunity and implications Hospital‐based Less than 12 March 31, 2017 0% Not Started of using an Integrated Funding Model approach Care months to funding on‐going operations focused on adults living with CMV.
29.4 To support participation in the Institute for Hospital‐based 12 to 24 March 31, 2017 0% Not Started extending timeline due Healthcare Improvement’s (IHI) Open School to Care months June 31, 2017 to limited capacity enhance system planning and quality during health system improvements. renewal
30 Senior Friendly Hospital Strategy: Grow and sustain Hospital‐based 12 to 24 March 31, 2017 60% Execute Senior Friendly Hospital strategy (organizational Care months support, processes of care, emotional and behavioral environment, ethics in clinical care and research, physical environment)
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31 Patient Flow Strategies: Optimize patient flow Hospital‐based 12 to 24 April 1, 2018 30% Plan (access, efficiency, effectiveness) within and across Care Months Hospitals. through a targeted improvement approach including establishment of a Learning Collaborative to align with the ED pay for results and knowledge transfer sites to enable sustainability and spread of leading practices
32 Antimicrobial Stewardship: Create opportunities to Hospital‐based Less than 12 March 31, 2017 50% Plan spread best practices for antimicrobial stewardship Care months across hospitals to reduce hospital acquired infections (e.g. C. difficile)
33 Mental Health and Addictions (MH&A) Crisis Mental Health & 12 to 24 March 31, 2017 See sub‐ See sub‐ Services: Continue to refine what the crisis services Addictions months initiatives initiatives needs are in each geographic area to ensure equitable access, consistency and quality of crisis services across the LHIN and reduce reliance on police and emergency departments(EDs) for those experiencing a crisis 33.1 Crisis Centre: Completion of capital rennovations Mental Health & 12 to 24 TBD based on Capital 85% Execute to allow crisis stabilization beds to move to the Addictions Months Centre; monitoring of impact of new Centre
33.2 London Middlesex Enhanced Crisis Working Mental Health & 12 to 24 March 31, 2017 10% Initiate Group (phase 2): Continuted enhancement of Addictions Months partnership and QI related to how crisis services are provided, in coordination, in London Middlesex
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34 MH&A Supportive Housing: Implement provincial Mental Health & 25 to 36 March 31, 2019 See sub‐ See sub‐ program and leverage municipal partnerships to Addictions months initiatives initiatives increase supports within housing 34.1 2016/17 investments in support of the Mental Health & 12 to 24 March 31, 2017 0% Not Started implementation of the Mental Health & Addictions Months Addiction Strategy – Phase 2, 1,000 New Supportive Housing Units 34.2 Evaluation related to the 3 year Provincial Mental Health & 25 to 36 March 31, 2019 0% Not Started strategy impacts: Anticipate a provincial Addictions Months evaluation strategy re the 3 years of investments into the Province‐wide 1,000 Supportive Housing Units 35 MH&A: Care Pathways: Develop/implement Mental Health & 25 to 36 March 31, 2019 20% Plan standardized care pathways for people with mental Addictions months health and/or addiction issues and for people with high needs responsive behaviours
36 MH&A Services standardization: Develop Mental Health & 25 to 36 TBD See sub‐ See sub‐ recommendations for service alignment and Addictions months initiatives initiatives potential investments based on a review of present capacity, function and utilization of MH&A services
36.1 Crisis Standardization LHIN‐Wide Project: Mental Health & 12 to 24 March 31, 2018 10% Plan establishment of equitable access to MH&A Addictions Months Crisis services across the South West LHIN based on: Standardized service delivery criteria/ description; Consistent application of service expectations ; Targets (e.g. Staff/client ratios); Outcomes; and LHIN funding/functional centre 37 Intensive MH&A Case Management: Evaluate pilot Mental Health & 12 to 24 March 31, 2018 75% Monitor program / evidence based model to create Addictions months Appendix 4sustainable outcomes for spread consideration Page 13 of 20 Appendix2016‐2019 4 Annual Business Plan/ Integrated Health Service Plan Priorities & Initiatives Progress 2016/17 Initiative IHSP Initiative/Sub‐Initiative IHSP Priority Duration Planned End Date Progress (%) at Status at Notes/ Explanation Code Mar. 31, 2016 Mar. 31, 2016
38 Coordinated Access for MH&A Services: Continue Mental Health & Less than 12 March 31, 2017 50% Execute to implement and improve coordinated screening & Addictions months intake and waitlist processes to streamline access to services as well as create a common portal of entry for people accessing mental health and addiction services. Facilitate the coordination of Aboriginal MH&A services with main stream MH&A services
39 Ontario Perceptions of Care (OPOC) Tool: Mental Health & 12 to 24 March 31, 2018 20% Plan Implement the OPOC tool which seeks to Addictions months understand and improve experience of care for people impacted by mental health and/or addiction issues 40 MH&A Peer Support Strategy: Development and Mental Health & 12 to 24 March 31, 2018 10% Plan implement a Regional Peer Support strategy based Addictions months on the recommendations in the “Development of a Peer Support Strategy for the South West LHIN” 2015 report. 41 Strategy for Moderate Mental Illness: Develop a Mental Health & 12 to 24 3/31/2018March 31, 0% Not Started deferred to align with strategy to respond to the increasing demand for Addictions months 2019 pacing and staging of services from moderately mentally ill clients and work in portfolio identify the role of primary care in supporting individuals with mild to moderate mental health problems.
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42 Emergency Department (ED) Mental Health Access Mental Health & 12 to 24 March 31, 2018 30% Plan initiative description and Flow: Formalize processes to enable the safe Addictions months adjusted to reflect the and timely referral, assessment and repatriation of actual work occuring; ED Form 1 Mental Health patients from Emergency MH Access and Flow Departments to appropriate Mental Health Services project transitioned into and Schedule 1 facilities this initiative. Mental Health & Addictions Capacity Planning Phase 1: Conduct a current state review of Schedule 1 inpatient MH beds, review length of stay and occupancy rates, and identify opportunities to optimize resources. Standardize intake tools, surge protocols, and inter‐hospital referrals and repatriation of patients.
43 New Staged Screening and Assessment Screening Mental Health & 12 to 24 March 31, 2018 25% Initiate for Addictions: Improve the screening and Addictions months assessment of clients receiving substance use services through the implementation of a staged protocol across the South West LHIN and support sustainable implementation through coaching, fidelity monitoring and evaluation. 44 MH&A Education Strategy: Conduct an education Mental Health & 12 to 24 3/31/2018 0% Not Started deferred to align with needs and readiness assessment for MH&A Addictions months TBD pacing and staging of providers to identify key topics and priority areas for work in portfolio education
45 Long‐Term Care Home Specialized Units: Implement Mental Health & Beyond 36 TBD See sub‐ See sub‐ process to create specialized units for people with Addictions months initiatives initiatives responsive behaviours
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45.1 McGarrell Place: Creation of proposal to submit Mental Health & Beyond 36 TBD 50% Plan to Ministry to receive designation of specialized Addictions months unit, implementation and evaluation of unit
45.2 Development of other BSUs: With focus initially Mental Health & Beyond 36 TBD 20% Initiate in Grey Bruce and Middlesex, then spread to Addictions months Oxford, Elgin and Huron Perth, creation of proposals to submit to Ministry to receive designation of specialized units, implementation and evaluation of units
46 Behavioural Supports Ontario (BSO) System of Mental Health & Beyond 36 TBD 75% Execute Care: Continue to meet the needs of older adults Addictions months with or at risk of responsive behaviours due to mental health and addictions, dementia, or other neurological conditions to maintain or improve their quality of life and that of their caregivers by improving equitable access to coordinated, effective and efficient services and supports
new Grey Bruce MH&A Integration & Collaboration Mental Health & 12 to 24 March 31, 2018 10% Initiate added new intitiative Project: Working with MH&A Senior Leaders and Addictions months Boards in Grey Bruce to identify opportunities for Board to Board engagement, education and further integration of MH&A services to improve care. new Review the Continuum of Addictions Services: Mental Health & 12 to 24 March 31, 2018 10% Initiate added new intitiative Understanding of current state and identifying gaps Addictions months to ensure clients needs are met along the continuum of addictions (e.g. withdrawal management, managed alcohol, drug strategy, community treatment).
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new Current state review of withdrawal management Mental Health & Less than 12 March 31, 2017 0% Not Started added new intitiative and treatment services in London Middlesex (e.g. Addictions months methodone clinics, saboxone)
47 Francophone Strategy: Ensure French language Mental Health & 25 to 36 March 31, 2019 25% Plan service capacity for key service functions (case Addictions months management, counseling, crisis response, treatment, tier/bedded capacity, maintenance, family services and support); Optimize MH&A service delivery, including BSO, for the Francophone population in London
48 Access to Primary Health Care: Improve access to Primary Health Beyond 36 TBD 90% Plan primary health care by implementing Care months recommendations from the Understanding Health Inequities and Access to Primary Health Care in the South West LHIN Project and build capacity for Primary Care 48.1 In alignment to the Patients First LHIN Primary Health Beyond 36 TBD 5% Initiate responsibilities, the LHIN will develop and Care Months implement a LHIN‐wide strategy, working closely with patients, primary care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of each community 48.2 Plan and implement the Patients First sub‐LHIN Primary Health Beyond 36 TBD 0% Not Started strategy, working closely with patients, primary Care Months care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of Elgin County
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48.3 Plan and implement the Patients First sub‐LHIN Primary Health Beyond 36 TBD 0% Not Started strategy, working closely with patients, primary Care Months care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of Oxford County 48.4 Plan and implement the Patients First sub‐LHIN Primary Health Beyond 36 TBD 0% Not Started strategy, working closely with patients, primary Care Months care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of London Middlesex 48.5 Plan and implement the Patients First sub‐LHIN Primary Health Beyond 36 TBD 0% Not Started strategy, working closely with patients, primary Care Months care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of Grey Bruce 48.6 Plan and implement the Patients First sub‐LHIN Primary Health Beyond 36 TBD 0% Not Started strategy, working closely with patients, primary Care Months care leaders and providers to organize local primary care and to identify ways to improve care that is tailored to the needs of Huron Perth
49 Partnering for Quality: Improve primary care Primary Health Beyond 36 TBD 90% Monitor provider capacity to identify patients with chronic Care months conditions and support patients to provide chronic disease management
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50 Primary Care and Mental Health and Addictions Primary Health 25 to 36 3/31/2019 0% Not Started waiting to align with (MH&A) strategy: Strengthen relationships Care months TBD health system renewal between MH&A services and primary care and increase service capacity with existing primary care structures
51 eConsultation: Provide primary care physicians with Primary Health 12 to 24 TBD 15% Plan more timely access to specialist input, potentially Care months avoiding referrals for consultation where applicable.
52 Primary Care Network Structure: Continue to Primary Health Beyond 36 TBD 60% Execute strengthen primary care network structure Care months
53 Falls Prevention Strategy: Support spread of the Rehabilitative Less than 12 March 31, 2017 80% Monitor changed status from South West Falls Prevention Strategy including Care Months execute to monitor to opportunities to meet Francophone needs. reflect work to date
53.1 Creation of new Exercise & Falls Prevention Rehabilitative Less than 12 March 31, 2017 80% Monitor changed status from classes in Retirement Homes (through Care Months execute to monitor to Physiotherapy Reform) reflect work to date
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54 Rehabilitation Capacity Plan and Implementation: Rehabilitative 25 to 36 March 31, 2019 5% Plan Plan and implement the adoption of provincially Care Months standardized bedded rehabilitation definitions and eligibility criteria, and plan and implement a bedded rehabilitation capacity plan
55 Community Physiotherapy Reform: transition Rehabilitative 25 to 36 3/31/2017 0% Not Started extending timeline to funding and accountability for publicly funded Care Months March 31, 2018 align with provincial physiotherapy clinics from MOHLTC to LHINS. timelines
56 Coordinated Access: Support ongoing Rehabilitative 12 to 24 March 31, 2017 75% Execute implementation and improvement of Coordinated Care Months Access thru CCAC.
57 Assess and Restore: Plan and implement the Rehabilitative 25 to 36 March 31, 2018 20% Execute provincial Assess and Restore Guideline in Care Months collaboration with other LHINs and in alignment with Ministry of Health and Long‐Term Care expectations
Appendix 4 Page 20 of 20 South West LHIN Committee’s and Networks
Board to Board Reference Group South West LHIN
South West LHIN Multi LHIN
Large Scale, System South West Executive Advisory Panel Large Scale, System Change Initiatives with Change Initiatives with Accountability Mechanisms Accountability Mechanisms Health Links South West Ontario eHealth Behavioural Supports Ontario Group Sponsored by LHIN Sector Groups Area Provider Tables (APT) Oversight Committee Partnering for Quality LTCH Network Council APT co-Chairs South West Ontario eHealth South West Hospice Palliative Quality Advisory Group South West Addiction & Mental Elgin Health Services Council Delivery Council Care Network Aboriginal Committee Health Coalition Grey Bruce Integrated Health Erie St Clair/South West LHIN South West Rehabilitative Care Health System Funding Reform Community Support Services Coalition Liaison Committee (French South West Regional Falls Local Partnership Support & Development Council Huron Perth Area Provider Language) Prevention Hospital/CCAC/LHIN CEO South West Primary Care Council South West Ontario HealthLink South West Regional Wound Leadership Forum Network London Middlesex Health eHealth Coordinating Care Community Health Centres Providers Alliance Committee Critical Care Oxford County Health System Assess and Restore ER—Pay for Results Planning Cttee Senior Friendly Hospital Regional Integrated Decision Integrated Decision Support Support Operations Committee Oxford Hospital Joint Oversight Committee Other HSP Partnership Groups South West Self Management Strategy South West Assisted Living Network South West Clinical Quality South West Adult Day Program Network Group (CQT) Home At Last Network Long Term Ventilation Steering Committee Southern Network of Specialized Care South West Ontario Stroke Network Maternal Newborn Child and Youth Network Regional Renal Program Steering Committee Ontario Community Support Association - District A Data Quality Network Regional Operations Committee (Patient Flow) South West LHIN Diabetes Coordinating Committee Mental Health and Addiction Networks Partnership Relationship Accountability Relationship and Mechanism Revised June 14, 2016 IHSP 2016‐19 ‐ Measurement Plan
Measure Short Description the BIG DOTs
Self‐Reported Health Status: Proportion of respondents who reported their health as 'Excellent" or "Very Good" or "Good" Proportion of respondents who reported their health as 'Excellent" or "Very Good" Faster Access to Care: Proportion of priorities providing faster access to care when needed Proportion of key indicators aligned to populations with faster access to care when needed Satisfied With How Care Was Provided: Proportion of respondents who reported their most recent experience with their primary care provider as Proportion of respondents who reported their most recent experience with their primary care provider as "Excellent" or "Very Good" "Excellent" or "Very Good" Value realized by reducing proportion of unnecessary visits/readmissions to the hospitals Reducing proportion of unnecessary visits/readmissions to the hospitals MENTAL HEALTH AND ADDICTIONS
1 Wait Times for Case Management Average number of days an individual waits for the provision of case management services 2 Repeat unscheduled emergency visits within 30 days for mental health conditions Percent of repeat emergency visits following a visit for a mental health condition within 30 days 3 Repeat unscheduled emergency visits within 30 days for substance abuse conditions Percent of repeat emergency visits following a visit for a substance abuse condition 4 Rate of hospitalization for mental health illness Rate of individuals 18 years or older admitted to hospital for a mental illness (per 10,000 people) HOME AND COMMUNITY
5 5 day wait for Personal Support Worker service Proportion of complex patients who received their first personal support service within 5 days of the service authorization date 6 ALC rate Proportion of inpatient days in acute and post‐acute care settings that are spent as ALC in a specific time period Percentage of home care clients with complex needs who received their personal support visit within 5 days of the date that they were authorized for 7 Proportion of complex patients who received their first personal support service within 5 days of the service authorization date personal support services 8 Percentage of home care clients who received their nursing visit within 5 days of the date they were authorized for nursing services Proportion of complex patients who received their first nursing visit within 5 days of the service authorization date 90th percentile wait time from community for community care access centres (CCAC) in‐home services: Application from community setting to first CCAC 9 90th percentile wait time from application for service to first CCAC in‐home care visit service (excluding case management) 10 Percentage of alternate level of care (ALC) days Percentage of inpatient days where a physician has indicated that a patient occupying an acute care hospital bed has finished the acute care phase of their treatment 11 Percent of home care clients with an unplanned, less urgent Emergency Department visit within the first 30 days of discharge from hospital Percentage of home care patients who were seen for an unscheduled ED visit with less acuity within 30 days of being discharged from an inpatient setting CHRONIC DISEASE PREVENTION AND MANAGEMENT
12 Avoidable hospitalizations for Ambulatory Care Sensitive Conditions/100,000 pop age <75 Hospitalization rate for ambulatory care sensitive conditions 13 Readmissions within 30 days for selected HBAM Inpatient Grouper (HIG) conditions Risk‐adjusted readmission ratio within 30 days for patients with an acute inpatient hospital stay for select chronic conditions HOSPICE PALLIATIVE CARE
14 Percent of palliative care clients receiving home support upon discharge (by region by Fiscal Quarter) Proportion of palliative patients who were discharged home or to a home setting with support services HOSPITAL‐BASED SERVICES
15 Emergency Department wait time for complex patients The total ED length of stay where 9 out of 10 complex patients completed their visits 16 90th percentile emergency department length of stay for minor/uncomplicated patients 90th percentile wait time to receive care for non‐complex patients 17 Percent of priority 2, 3 and 4 cases completed within access target for computed tomography (CT) scan Percentage of priority 2, 3 and 4 CT scans completed within access target 18 Percent of priority 2, 3 and 4 cases completed within access target for magnetic resonance imaging (MRI) scan Percentage of priority 2, 3 and 4 MRI scans completed within access target 19 Percent of priority 2, 3 and 4 cases completed within access target for hip replacement Percentage of priority 2, 3 and 4 hip surgeries completed within access target 20 Percent of priority 2, 3 and 4 cases completed within access target for knee replacement Percentage of priority 2, 3 and 4 knee surgeries completed within access target 21 HBAM Cost/Service Efficiency (CCC, Rehab, ED, acute, day surgery + CCAC) Ratio between actual cost per unit of service and HBAM expected cost (average of the ratio for all HBAM hospitals – each component calculated separately) 22 Hospital Standardized Mortality Rate (HSMR) Ratio of the actual to expected number of deaths among patients in acute care hospitals PRIMARY CARE
23 Percent of patients able to see their primary care provider on the same or next day when they are sick Percent of patients able to see their primary care provider on the same or next day when they are sick 24 Avoidable Emergency Department visits Best Managed Elsewhere (per 1000 population aged 1‐74) Emergency visits for conditions that could be treated in alternative primary care setting 25 Post discharge follow‐up with primary care with‐in 7 days Percentage of patients who saw a primary care physician within seven days of an acute hospital discharge for select chronic conditions REHABILITATIVE CARE
26 Length of stay efficiency The average change in Total Function Score per day of client participation in the inpatient rehabilitation program APPENDIX G – Integration Activities
Many LHIN initiatives result in better integration of health services to benefit patients and families across the LHIN, however, integration activites may not always come forward as formal integrations. This section captures the formal integration processes that have been or will be brought forward to the LHIN Board for review, consistent with the legislation and protocols defined through LHSIA.
Initiative Brief Description Integration Type Anticipated Impact Est Timeline Huron Perth Vision 2013 is a multifaceted plan Health Service Realignment of Services 2010 – 2016/17 Healthcare to create a sustainable Provider Initiated Consolidation of adult outpatient physiotherapy from Implementation will Alliance (HPHA) healthcare system now and into Service Integration 4 sites to 2 sites completed in 2012 (Seaforth and continue into 2016/17 – Vision 2013 the future. The Vision 2013 Clinton sites). as there are planning process is based on four Interprofesional practice model of care dependencies on principles: Retain four sites with (implementation to be completed Dec. 2014) CCC/Rehab shifts viable roles; Ensure standards of Consolidation of cataracts at Clinton site (May 2014) associated with quality and safety; Support Bed Redistribution Access to Care. equitable standards of quality Redistribute beds amongst the sites to better utilize and patient safety for patients; capacity across the sites. Includes relocation of CCC Live within our means and Rehab beds and shifts in the number of medical and surgical beds to result in a net decrease of 17 beds. Access to Care: As part of the Access to Care South West LHIN This initiative will improve outcomes for patients and Phase 1 Realignment Complex (ATC) strategy to help people Facilitated Service families, and for the health system as a whole. It will: during fiscal 2014/15. Continuing Care move out of acute hospitals and Integration Develop the CCAC role as the one point of access Phase 1 realignment / Rehabilitation into other care settings as easier so that patients/clients across the South West completed by March Bed quickly, smoothly and safely as get the right care at the right time and place. 31, 2015. Realignment possible, the Complex Continuing Ensure that admission to CCC/Rehab beds is based on Phase 2 Care and Rehabilitation consistent assessment processes and criteria. Stage 1 shifts are (CCC/Rehab) initiative will ensure Ultimately, this work will reduce wait times and effectively complete. that these valuable services are improve utilization for CCC and rehab beds, and Future phases of provided consistently and reduce the number of patients designated as ALC. realignment will be equitably across the region. The goal is to provide the right care in the right place dependent on at the right time, which when combined with local refreshing the strategies, is anticipated to reduce the volume of projection model with alternate level of care days in the long term and more current data provide for the best possible outcomes for individuals and information. and their families Future data refreshes 1
Initiative Brief Description Integration Type Anticipated Impact Est Timeline will include information gained through the Evidence Informed Bedded Rehabilitation Capacity Plan, the Rehabilitative Care Alliance Bedded Definitions Framework Project and impacts of the Stroke Phase I Realignment Recommendations. Implement further realignment phases over next 2 – 4 years London Comprehensive community Health Service Currently 5 LHIN funded organizations and 2 non‐LHIN Crisis group has been Enhanced Crisis based crisis service to improve Provider Initiated funded organizations have partnered to provide a functioning as a team Services: the client experience, better Service Integration comprehensive continuum of crisis services including since November 2012, MH&A Crisis coordinate resources, streamline face: face, telephone, mobile and crisis beds. however the next Centre access to service, reduce ED The partners are now working to consolidate operating phase is the further repeat visits, reduce police resources and functions within 1 physical plant. It is development of crisis intervention, and provide the expected that the co‐location of London‐Middlesex beds and co‐located right care at the right time in the Enhanced Crisis Services will serve to divert visits to services. This phase is right place the ED and re‐direct residents of London‐Middlesex to still underway with community based Crisis Services. expected completion The desired result is to ensure that consumers receive date TBD (depending the right level of care, at the right time, in the right on Capital approval place to meet their needs with an overall expected process and related outcome of increased access to Mental Health and/or allocations). Addiction Services and a reduction in reliance on hospital based services.
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Initiative Brief Description Integration Type Anticipated Impact Est Timeline Back Office The BOCIP will focus on enabling South West LHIN Phase 1: 2015/16 2015/16 ‐ 2018/19 Collaboration effective and efficient use of Facilitated Service • Third party consultant will be engaged to leverage and Integration system resources to achieve the Integration expert resources and define best practices and minimum Project (BOCIP) highest quality back office standards in the seven (7) identified administrative services by identifying best service areas: practice parameters to inform 1. Financial Management [accounting, bookkeeping, provider back office operations payroll, management information system (MIS)] 2. Information Technology and Support 3. Materials Management (purchasing, contract management, logistics support) 4. Human Resources (recruitment, hiring, benefits management, training/learning management systems and labour relations) 5. Legal services 6. Risk Management and Privacy 7. Facilities Management
Phase 2: 2016/17 – 2018/19 • Conduct a current state assessment/survey to gain an understanding of where all South West LHIN funded agencies currently stand against the identified (phase 1) best practices and minimum standards in each of the 7 administrative areas • Leveraging the report that defines the best practices and minimum standards in the 7 administrative areas and the current state information, the South West LHIN will define the expectations for LHIN funded agencies to move towards minimum standards and/or best practices • LHIN funded health service providers will have to move towards defined expectations by end of the 2016‐2019 Integrated Health Service Plan period (by March 31, 2019) Integrated Patients with moderate intensity Integration through Improved quality outcomes for patients (e.g., keeping 2015/16 – 2017/18 Funding Model: needs related to COPD and CHF funding people at home, reducing ED visits, reducing Connect Care to discharged home from London readmissions, ALC) Home Improved patient, caregiver, and provider experience
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Initiative Brief Description Integration Type Anticipated Impact Est Timeline Health Sciences Centre will Improved efficiencies and value for money experience an integrated and coordinated system of care based on evidence‐based practice as they transition from hospital to the community for up to 60 days. Focused on integrating current hospital and CCAC funding, patients will be supported by an innovative eShift model that allows for remote monitoring of patients and other technology, 24/7 access to the clinical team, navigator, clinical care coordinator, dedicated home care provider, ambulatory clinics, and electronic medical record as well as connections with specialists and primary care. Palliative Care Realignment of current palliative Health Service Right care in the right place at the right time: It has The hospitals will Integration care beds and resources from an Provider Initiated been identified that there are patients in acute care begin to implement acute setting at LHSC to a non‐ Service Integration palliative care beds whose needs would be better met the bed transfer, acute setting at Parkwood outside of acute care. The outcome of this will better contingent on Institute, St. Joe’s. align resources to needs of the patients. approval and Patient experience: The renovation will create 18 completion of the single rooms in a home or hospice‐like environment Capital renovation. overlooking the grounds at Parkwood Institute. This Goal is to complete creates more privacy and a much more respectful, transition no later peaceful, patient‐centred environment for patients than June 30, 2016. and families. Grey Bruce Reduction and redistribution of Health Service Regional approach to care Currently working to Restorative Care restorative care beds across the Provider Initiated Coordinated Access via CCAC (standardized eligibility implement single Integration Grey Bruce area Service Integration criteria, one waitlist, one referral form) point of access (one Right care, right place (Home First) wait list) by July Improved utilization of existing resources 2016.Goal is to complete by April 1,
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Initiative Brief Description Integration Type Anticipated Impact Est Timeline SBGHC reduction of Restorative Care Beds from 10 to 5 2016 – monitoring (completed) into 2016/17 Hanover District Hospital creation of 2 Restorative Monitoring and Care Beds (completed) quality improvement GBHS Restorative Care Beds accessible within regional to continue 16/17. approach (completed) Mental Health & MH&A providers in the South To be confirmed: General MH&A information Goal is to be Addictions (Oxford, Elgin and Middlesex) are o Information and referral services completed by end of Coordinated working collaboratively to Health Service Request for access to treatment fiscal 2016/17 Access develop and implement a Provider Initiated o Direct calendar access to LHIN funded MH&A coordinated access model that Service Integration providers in South includes: o GAIN Short Screener in web‐based format for Coordinated screening and or screening and sharing of the screening intake process information with referral Shared calendar using South West LHIN Crisis support Facilitated Service Connex Ontario or other tool o Warm transfer protocols between provider and Coordinated waitlist relief Integration the participating crisis services (medium risk strategies referral to ED/Crisis Centre or warm transfer to Coordinated referral mobile crisis as appropriate and imminent or high process(es) risk to 911). Suicide risk assessment/violence risk Use of evidence based assessment screening and assessment o Supportive listening/brief intervention and tools including Internet, support through volunteers Gaming Disorder and Bilingual services as well as access to Language Line Problem Gambling Services, 24/7/365 offering translation to over 170 languages One number access for entire Possible growth of the model to other counties South including warm and/or LHINs transfers to local crisis teams Ability to book appointments in a shared electronic and electronic referrals to calendar for MH&A agencies community MH&A agencies Reduced wait time for intake and referral Improved access to services Increased percentage of clients who have been screened that have had a GAIN SS completed Reduced ED revisits / hospital readmissions Inceased collaboration between agencies 5
Initiative Brief Description Integration Type Anticipated Impact Est Timeline Shared processes improved Mental Health & Improving Existing Models of South West LHIN Enhanced Governance and infrastructure of CSIs Goal is to be Addictions Peer Peer Support at the sub‐LHIN Facilitated Service Strengthened PEER Network (Peers Envisioning and completed by end of Support level: A phased approach will be Integration Empowering Recovery across the South West) fiscal 2017/18 utilized to explore integration structure, with involvement of Mental Health & opportunities at the sub‐LHIN Addictions (MH&A) community partners to become level. the regional support for strategic oversight of peer Phase 1 (February 2016 – support June 2017) London‐ South West LHIN facilitated integration and Middlesex collaborations between CSIs and community MH&A Phase 2 (June 2016 – June organizations to implement formal linkages 2017) Oxford and Elgin Implement identified promising practices (identified Phase 3 (September 2016 – in the “Development of a Peer Support Strategy for June 2017) Huron Perth and the South West LHIN” report) Grey Bruce Prostate Cancer LHSC and SJHC are working Health Service A single point of access for suspect prostate cancer Pending motion at Diagnostic towards realignment of prostate Provider Initiated assessment designed according to Cancer Care June 21, 2016 South Assessment cancer diagnostic assessment Service Integration Ontario (CCO) best practice guidelines. West LHIN Board of Program resources from LHSC to SJHC Streamlined scheduling and coordination of Directors meeting, Integration diagnostic tests and consultations using a model goal is to be consistent with best practice and designed by the completed by late clinicians. summer 2016/17 The consolidation of diagnostic prostate biopsy procedures to SJHC. Patient navigation practice will be instituted to ensure relevant and timely information and support for the patients throughout the assessment process to treatment options including hospital based treatments of surgery, radiation and systemic therapy.
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APPENDIX H – Capital Projects
County Capital Project Background/Description Current Status
Hospital Capital Projects
Grey Grey Bruce Health The original submission proposed a new 72,000 square foot Rural Health Centre located in Markdale, Ontario on a Stage 2, Part A under MOHTLCLHIN review Services (GBHS) – green field site. This joint planning with GBHS South East Grey Community Health Centre and the South West LHIN Markdale Site followed the completion of functional and master planning for a hospital re-build project which was submitted to the Health Capital Investment Branch (HCIB) in October 2007 in response to a Planning and Design grant approved in Stage: Stage 2 May 2006. November 2011 – South West LHIN Board endorsed combined Stage 1 and 2, Part A for Rural Health Centre November 1, 2013 – GBHS submitted Markdale Rural Health Centre Scoping document to HCIB with options for the proposed project. The preferred option would defer the co-location of the CHC from the project, eliminate inpatient beds (creating short stay beds), and reduce the outpatient surgical program to a minor procedure service. The proposed facility will utilize approximately 47% less space than the original proposed option. September 16, 2014 – The ministry approved a new hospital for Markdale January 28, 2015 – LHIN received Stage 2 submission from GBHS June 21, 2016 – South West LHIN endorsed Stage 2, Part A
Bruce Grey Bruce Health The proposed Emergency and Laboratory (ED/LAB) Capital Redevelopment Project (CRP) at the Southampton site Stage 4.2 under MOHLTC reviewUnder Services (GBHS), of the GBHS involves a combined 9,700 square foot renovation and new addition. construction Southampton Site – The ministry’s commitment to support the implementation of the ED/LAB CRP is contingent on GBHS maintaining Emergency Department ED coverage at the Southampton site 24 hours per day and seven days per week until March 31, 2013. It is also and Laboratory Capital contingent on GBHS keeping the Southampton ED open with local coverage of at least 75% by March 31, 2012 and Redevelopment Project 100% by March 31, 2013. GBHS is required to submit a GBHS Board approved plan in regards to these Stage: Stage 54 requirements no later than October 15, 2011. August 2011 – Project received ministry support and will be subject to Legislative appropriation and all applicable approvals of the ministry September 26, 2012 – South West LHIN Board endorsed Stage 1, Part A April 23, 2013 – LHIN and GBHS received letter from ADM indicating approval to proceed to Stage 2 July 19, 2013 – LHIN received Stage 2 submission from GBHS December 11, 2013 – Alignment meeting #1 held between LHIN and HCIB to discuss comments and concerns from respective reviews of Stage 2 submission
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December 2013 – GBHS identified issue with ED physician coverage. A number of ED physicians recently left or reduced hours at the Southampton ED. GBHS has reapplied to the Emergency Department Coverage Demonstration Project to receive ED locum coverage as an interim measure. This is expected to be a temporary issue. GBHS had successfully met the previous condition set by HCIB of maintaining 24/7 ED coverage until March 31, 2013. January 21, 2014 – South West LHIN Board endorsed Stage 2, Part A submission March 2014 – Ministry approved Stage 2 submission Fall 2014 – Ministry approved Stage 3 submission Fall 2015 – Ministry approved Stage 4.1 submission
Bruce South Bruce Grey Health The two-phased redevelopment involves a single storey, two phased addition and demolition approach that would Rescaled Stage 1 submission and SBGHC is in Centre (SBGHC), connect existing hospital to the existing Medical clinic. In Phase One, programs considered ‘high priority’ for process of developing summary of instructure Kincardine Site – replacement would be built first – Emergency, Ambulatory Care, Pharmacy, Education and Diagnostics Imaging needsInfrastructure Pre-Capital submission Infrastructure Departments -- as well as a new Plant and Building Services Department. In Phase Two, replacement of the under MOHLTC review UpgradesRedevelopment remainder of the departments would occur, culminating in the construction of a new Inpatient wing and conclude Project with the demolition of all remaining building assets of the existing hospital. Stage: Pre-Capital May 26, 2010 – LHIN endorsed SBGHC Phase 1 – Option 1 Part A submission for a rebuild of the Kincardine site as outlined above March 2012 – Project was discontinued. September 2012 – SBGHC submitted a rescaled proposal that reduced the square footage. March 5, 2013 – LHIN sent letter to the HCIB confirming that the May 26, 2010 South West LHIN Board endorsement for Phase 1 (Stage 1) Part A submission still stands in relation to the rescaled submission. The rescaled submission was determined to be a similar submission but with decreased square footage. May 22, 2013 – LHIN received letter from HCIB with comments regarding Stage 1. No approval to proceed to Stage 2 was received. SBGHC response to HCIB comments was submitted to HCIB June 2013. The project did not advance to the Provincial Approved Projects list. August 14, 2014 – LHIN received revised submission from SBGHC. Rescaled project includes a rebuild of the ED and the redevelopment of Ambulatory Care Services, Diagnostic Imagining, and Laboratory, as well as a new Building Services department. LHIN staff reviewed the submission and determined that the original Board endorsement provided in May 2010 is still applicable given that the original Board endorsement provided in May 2010 is still applicable given that the affected programs and services are a subset of what was proposed in the original submission. June 5, 2015 – LHIN received a Pre-Capital submission from SBGHC for Infrastructure Renewal. This project did not have any program or service impacts requiring review by the LHIN. However, given the critical infrastructure requirements described in the submission and the potential for such infrastructure failures to significantly impact SBGHC Kincardine Site operations, the South West LHIN is supportive of the project for review and consideration for Capital funding by the Health Capital Investment Branch, Ministry of Health and Long-Term.
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Huron Wingham and District The redevelopment will be completed in four phases and is staged in such way that the highest priority programs WDH preparing Stage 4.1 under for MOHLTC Hospital (WDH) – Facility are accommodated in the first phase. Phase 1 aims to redevelop or add new construction in the areas of review Redevelopment Project Emergency, Surgical program, Ambulatory Care and Diagnostic Imaging in order to address deficiencies and inadequacies in the existing facility that supports these core services. Stage: Stage 4 September 26, 2012 – South West LHIN Board endorsed Pre-Capital, Part A submission January 24, 2013 – HCIB and LHIN decided that four WDH Self-Funded projects could be added to the current Pre- Capital submission provided there were no changes to programs or services and that the Self-Funded projects presented were consistent with the original 2009 Master Plan endorsed by South West LHIN Board March 12, 2013 – LHIN sent letter to HCIB indicating that, based on review of Self-Funded projects and 2009 Master Plan, there were no changes to programs and services and that the Self-Funded projects were consistent with the 2009 Master Plan. For these reasons, it was determined that the Pre-Capital submission does not need to go back to the South West LHIN Board for further endorsement. April 2013 – LHIN, HCIB, WDH met and agreed that the starting point for this Facility Redevelopment project (previously the Pre-Capital submission for ED/Ambulatory Care and the self-funded projects) should be considered Stage 2 as the content was consistent with the original Master Plan as previously approved by the South West LHIN Board October 2013 – LHIN received Stage 2 submission January 15, 2014 – Alignment meeting #1 held between LHIN and HCIB to discuss comments and concerns from respective reviews of Stage 2 submission March 18, 2014 – South West LHIN Board endorsed Stage 2, Part A submission August 14, 2014 – Ministry approved Stage 2 submission April 9, 2015 – Ministry approved Stage 3.2 submission February 9, 2016 – Ministry received Stage 4.1
Oxford Tillsonburg District Redevelopment Project Redevelopment Project Memorial Hospital Through Master Plan work, TDMH will examine programs and services to determine future scope of services and Pre-Capital, Part A under LHIN review (TDMH) Redevelopment opportunities for further integration over the next 10 and 20 years. It is anticipated “that services will not change
Stage: Pre-Capital drastically, but simply grow to accommodate community need (either unmet currently or due to a growth in population). Significant study will also be given to program/services that could be better provided in a community Infrastructure Renovation Project TDMH Infrastructure setting, if possible.” Renovation Project Project has been added to MOHLTC priority list January 26, 2011 – South West LHIN Board endorsed Pre-Capital submission Stage: Pre-Capital September 2012 – Submission put on hold pending the completion of Joint Services Planning underway in Oxford County May 28, 2014 – LHIN received letter from TDMH indicating that, given the completion of the Oxford Hospitals’ Joint Services Planning work, a revised Capital submission will be developed
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June 2014 – HCIB indicated that TDMH would be required to resubmit a revised Pre-Capital proposal February 15, 2015 – LHIN received Pre-Capital submission Infrastructure Renovation Project December 2012 – TDMH identified immediate infrastructure needs from above project in a Pre-Capital submission August 2013 – HCIB received Pre-Capital submission and project was added to the ministry prioritization list. HCIB and LHIN agreed that no formal review is required since only infrastructure items. LHIN sent letter of support for infrastructure needs.
Middlesex London Health Sciences Since its inception in 1972, the physical plant of the Medical Imaging (MI) Department, Radiology on the second Pre-Capital, Part B under MOHLTC review Centre (LHSC) – floor of University Hospital has remained essentially unchanged. The Department requires structural modifications Diagnostic Imaging to the physical plant in order to meet the following regulatory requirements and goals: Department Interim Renewal Plan Regulatory rules for radiation safety Stage: Pre-Capital Current standards in structural engineering Environmental safety including staff and patient safety (asbestos abatement, sewage drainage) Patient accessibility and privacy Better workflow for patient care April 2015 – LHIN received Pre-Capital, Part A submission from LHSC February 2016 – South West LHIN Board endorsed Pre-Capital, Part A submission
Middlesex London Health Sciences Located on the Victoria Hospital (VH) campus, the Paediatric Emergency Department (Paed ED) operates 24/7 and Pre-Capital, Part B under MOHLTC review Centre (LHSC) – serves as the Paediatric Trauma Centre for the Southwestern region. The Paed ED treats 2,300 to 2,500 patients Paediatric Emergency on a monthly basis. Department Addition In 2005, the Adult ED was relocated from LHSC’s South Street campus to VH and became collocated with the Paed Stage: Pre-Capital ED. With this collocation, access to both EDs is shared; the safety and security of paediatric patients can be negatively affected as they are exposed to events associated with the Adult ED patient population. Inadequate space and lack of capability to expand the Paed ED has also negatively impacted LHSC ability to continue to provide high-quality patient-centred care. As such, LHSC is proposing to establish a separate Paed ED at VH. The proposed new location for the Paed ED will require renovation of existing infrastructure (currently Paediatric General Clinics) and the development of new infrastructure (proposed building addition at the north face of the existing Children’s Hospital), both areas on Level 1. This location is in close proximity to most support services, such as Paediatric Diagnostic Imaging and Hospital Pharmacy. The new addition will also have decanting space for Paediatric General Clinics on Level 2. March 2015 – LHIN received Pre-Capital, Part A submission from LHSC March 2016 – South West LHIN Board endorsed Pre-Capital, Part A submission
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Middlesex London Health Sciences The LHSC submission addresses the need for facility redevelopment to accommodate current programs, not Stage 1, Part A under LHIN review. LHIN Centre (LHSC) – Post substantial expansion or changes to programs or services. The proposed redevelopment will allow LHSC to review of Part A expected to go to LHIN Board Milestone 2 address the needs of programs and services that were not considered as part of the Health System Restructuring of Directors following LHIN-MOHLTC Redevelopment Commission recommendations. Alignment meeting (date TBD). Stage: Stage 1 April 27, 2011 – South West LHIN Board endorsed Pre-Capital submission June 2013 – LHIN received Stage 1 submission
Middlesex St. Joseph’s Health Care The SJHC submission addresses the need for facility redevelopment to accommodate current programs, not Stage 1, Part A under LHIN review. LHIN – Post Milestone 2 substantial expansion or changes to programs or services. The proposed redevelopment will allow SJHC to review of Part A expected to go to LHIN Board Redevelopment address the needs of programs and services that were not considered as part of the Health System Restructuring of Directors following LHIN-HCIB Alignment Commission recommendations. meeting (date TBD). Stage: Stage 1 April 27, 2011 – South West LHIN Board endorsed Pre-Capital submission June 2013 – LHIN received Stage 1 submission
Middlesex St. Joseph’s Health Care The SJHC capital initiative is required to advance the Palliative Care voluntary integration between London Health Combined Stage 1 and 2, Part B under – Parkwood Site, Sciences Centre and SJHC reviewed by the South West LHIN Board of Directors in November, 2015. In alignment MOHTLC review Palliative Care Unit with the transfer of 4 Palliative Care beds from London Health Sciences Centre to Parkwood Institute, SJHC is planning to renovate a clinical unit to move their current palliative care beds from a unit that has 6 private rooms and Stage: Pre-Capital two ward rooms (14 beds in total) to create a unit that will have 18 funded single rooms. November 2015 – South West LHIN Board endorsed Pre-Capital submission April 2016 – South West LHIN Board endorsed combined Stage 1 and 2 submission, Part A
Elgin St. Thomas-Elgin Redevelopment Project Redevelopment Project: Under construction General Hospital The redevelopment project includes a new 15-bed acute mental health inpatient unit and an outpatient mental CT Scanner Renovations Project: MOHLTC (STEGH) – Emergency, health day hospital; new emergency, ambulatory care, surgical services, and central supply departments; and review pending Ambulatory and Mental improvements to the hospital’s main entrance and circulation through the hospital campus. Health Redevelopment Project July 22, 2009 – South West LHIN Board endorsed Phase 1 (Programs and Services component) Stage: Stage 5 August 7, 2012 – STEGH received MOH approval to proceed to Stage 2 planning for Emergency, Ambulatory and Mental Health Redevelopment Project (per rescoped submission) STEGH – Renovations for Replacement of CT October 2013 – LHIN received Stage 2 submission Scanner January 17, 2014 – Alignment meeting #1 held between LHIN and HCIB to discuss comments and concerns from Stage: Pre-Capital respective reviews of Stage 2 submission March 18, 2014 – South West LHIN Board endorsed Part A of the Stage 2 submission May 2, 2014 – Ministry approved Stage 2 submission Fall 2014 – Ministry approved Stage 3 submission
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March 2015 – Ministry approved Stage 4.1 submission CT Scanner Renovations When current renovation project is complete, renovate space to accommodate new replacement CT scanner.
Community Capital Projects
Oxford Woodstock and Area Woodstock and Area Community Health Centre (WACHC) submitted a Stage 1 proposal in December 2010 for a Stage 1 under MOHLTC reviewWACHC Community Health permanent site. populating new toolkit Centre – Redevelopment November 23, 2011 – South West LHIN Board endorsed Stage 1 proposal and confirmed additional funding for Stage: Stage 1New CHCP WACHC staff positions process October 16, 2012 – WACHC submitted an addendum to the Stage 1 submission indicating that the proposal is now an expansion to their interim clinic instead of a completely new site November 2, 2012 – HCIB confirmed that the South West LHIN’s original Letter of Endorsement dated November 23, 2011 is sufficient February 2013 – HCIB provided comments regarding the proposal October 31, 2013 – WACHC provided a response to HCIB’s comments September 2014 – HCIB and LHIN working with CHC to finalize revisions to submission October 2015 – WACHC submitted revised Stage 1; LHIN confirmed that previous endorsement still stands June 2016 – HCIB decision to move WACHC project into new Community Health Capital Policy and work with the new CHCP toolkit.
Middlesex London Intercommunity The London Intercommunity Health Centre (LIHC)’s submission addresses the need for facility redevelopment and Pre-Capital under MOHLTC review Health Centre – expansion to accommodate projected growth in current programs and services. Although renovations have been Leasehold Improvement made to the existing space to improve access to care for clients, there still remain significant limitations in the existing building that cannot be addressed without major renovations. Renovation of existing space would include Stage: Pre-Capital the following: Clinical services would be consolidated into one half of the building while renovations are underway in the other half, and vice versa. If required, clinical space may be rented and other community space (e.g., community centres, and churches) may be used for community programs. LIHC would work to minimize impact on clients through effective interdisciplinary team communication and planning. September 2011 – South West LHIN Board endorsed Pre-Capital, Part A submission November 2013 – LIHC submitted final Part B to HCIB March 31, 2014 – Ministry approved Pre-Capital submission Summer 2015 – Focus of project moved from renovation of existing location to redevelopment of a new location (TBD); LIHC advised to submit revised Pre-Capital proposal November 27, 2015 – LHIN received revised Pre-Capital submission
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December 15, 2015 – South West LHIN Board endorsed Pre-Capital, Part A submission
Middlesex Southwest Ontario As a result of new and expanded programming, Southwest Ontario Aboriginal Health Access Centre (SOAHAC) has SOAHAC preparing Stage 3.1 Aboriginal Health Access outgrown its original downtown London site. The current site is comprised of two old houses that were joined submissionStage 1 & 2, Part B under MOHLTC Centre – London Site together to make one building. The layout has produced significant challenges in the delivery of quality and review Project collaborative services. In July 2014, SOAHAC submitted a combined Stage 1 and 2 proposal for the relocation of client programs and administration from the current site to a nearby renovated location that will allow for an Stage: Combined Stage 1 integrated model of care, provide continuity of access for SOAHAC clients, and accommodate the growth of & 2 SOAHAC’s programs. April 21, 2015 – South West LHIN Board endorsed combined Stage 1 & 2, Part A April 15, 2016 – Ministry approved Stage 1 & 2
Middlesex Canadian Mental Health The Canadian Mental Health Association (CMHA) Middlesex, Mission Services of London, London District Distress CMHA preparing Stage 2 submissionStage 2, Association Middlesex Centre (LDDC), London Health Sciences Centre (LHSC), London Police Services (LPS), Addiction Services of Part A under LHIN review (CMHA) – Mental Health Thames Valley (ADSTV), St. Leonard's Community Services London and Region (SLCS) and London Community Crisis Centre Addiction Response Strategy (CAReS) are all partners of the London Middlesex Enhanced Mental Health Crisis and Case Management Services project. This is a collaborative project between community partners to develop a Stage: Stage 2 comprehensive community based crisis service aimed at realigning existing resources and delivering enhanced services for mental health and addiction clients in London-Middlesex to better coordinate those services that do exist as well as build new protocols for improved service delivery. The Capital project will include the renovation of a LHSC owned building (former Red Cross Building #24) on the Victoria Hospital site of LHSC for the development of a Crisis Centre which includes co-location of existing Mental Health and Addictions crisis services and space for crisis stabilization beds. May 20, 2014 – South West LHIN Board endorsed Pre-Capital, Part A submission November 9, 2015 – Ministry approved Pre-Capital submission; Project to move directly to Stage 2 June 2016 – LHIN received Stage 2 submission
Elgin Central Community Central CHC opened at its current site in October 2010. Since that time, there has been an ongoing demand for Pre-Capital, Part B under MOHTLC Health Centre – expanded programs and services to meet client needs. To meet these needs and provide more adequate, safe and reviewCentral CHC preparing Stage 3 Leasehold Improvement appropriate space for its clients, CCHC has undergone numerous small renovations and has found it necessary to submission provide many programs and services in offsite locations that are often inadequate in terms of size, suitability, and Stage: Pre-CapitalStage 3 location. For example, Central CHC currently uses three renovated spaces plus a garage/storage unit for the mobile unit; uses donated space from several community organizations (churches, libraries, other charities); and has rented space where necessary. The lack of co-location of programs and services makes it difficult for Central CHC staff to function as an interdisciplinary team and impacts the client experience. There are also multiple health and safety concerns with the present site, such as accessibility, asbestos, inadequate heating and ventilation, and fire safety issues. A move to a permanent and larger site will allow for more efficient work among the interdisciplinary team, will support integration of health services with other LHIN-funded service agencies, and has the potential to allow for
7 back office integration support through co-location with other LHIN-funded agencies. October 21, 2014 – South West LHIN Board endorsed Pre-Capital, Part A submission May 2016 – Ministry approval to move directly to Stage 3
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Agenda Item 6.2
Report to the Board of Directors Prostate Cancer Diagnostic Assessment Program Integration
Meeting Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director, System Design & Integration Doug Bickford, Program Lead Harpreet Brar, Health Data & Performance Analyst Scott Chambers, Finance Team Lead Jana Fear, System Design & Integration Specialist
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Suggested Motion
THAT the South West Local Health Integration Network (LHIN) Board of Directors does not wish to issue an integration decision regarding the proposed Prostate Cancer Diagnostic Assessment Program integration between London Health Sciences Centre and St. Joseph’s Health Care, London as described in the Formal Notice of Intended Voluntary Integration submitted to the South West LHIN by St. Joseph’s Health Care London and London Health Sciences Centre.
Purpose
The purpose of this report is to provide information to the South West LHIN Board of Directors to enable the Board to determine whether or not it wishes to issue an integration decision regarding the voluntary integration proposed by London Health Sciences Centre (LHSC) and St. Joseph’s Health Care, London (SJHC). This initiative is considered an integration as there will be a realignment of prostate cancer diagnostic assessment resources from LHSC to SJHC.
Alignment to 2016-19 Integrated Health Service Plan (IHSP)
Alignment to IHSP Priorities Ensuring primary health care is strengthened and linked with the broader health care system Optimizing the health of people and caregivers living at home, in long-term care, and in other community settings Supporting people in preventing and managing chronic conditions Strengthening mental health and addiction services and their relationship with other partners
Report to the Board of Directors – Prostate Cancer Diagnostic Assessment Program Integration Page 2
Ensuring timely access to hospital-based care at the LHIN-wide, multi-community, and local level Enabling a rehabilitative approach across the care continuum Putting people with life-limiting illnesses and their families at the centre of hospice palliative care
Alignment to IHSP Implementation Strategies Health Equity: Consistently apply a Health Equity lens to enable access to quality care Integration and Collaboration: Working together to better organize and connect services to meet the needs of the population and ensure optimal use of resources Quality Improvement and Innovation: Partner with LHIN residents to understand their experiences of care and continuously collaborate with them to co-design improvements, broadly share quality evidence and best practices and demonstrate quality outcomes across the health care system eHealth/ Technology: Leverage and expand the use of eHealth technologies to access and exchange health information, inform effective decision making, and enhance “hands on” care Transparency and Accountability: Strive for transparent decision-making and better performance by reporting on measures of success and holding people and organizations accountable for results
Impact on IHSP Big Dot Outcomes Self-reported health status Faster access to appropriate care Satisfied with how care was provided Value realized by reducing hospital visits and days
Background
Several years ago, the South West LHIN Cancer Surgery Improvement Project, under the leadership of Dr. Hassan Razvi and Maureen Solecki (past CEO of Grey Bruce Health Services), and supported by the South West Regional Cancer Program (SWRCP) and South West LHIN, resulted in significant improvement in timely access to cancer surgery services within the South West LHIN. This work included process improvements and capacity investment within each organization that resulted in significant improvement in most areas of surgical wait time performance across the region. Although development of a Prostate Cancer Diagnostic Assessment Program (pDAP) was a recommendation of the Cancer Surgery Wait Time Project, there was little traction and uptake of the concept at the time given that initial improvements were achieved through other project activities. Since then, however, Wait 1 and Wait 2 performance for prostate cancer surgery has continued to fall below target despite other tactics.
In July 2014, the executive sponsors of the initial work confirmed commitment to the further exploration of a centralized DAP model, located at SJHC, that would serve the London Middlesex communities. The model, including a realignment of prostate cancer diagnostic assessment resources from LHSC to SJHC, received final approval from Senior Leadership Teams and Boards of Directors at both SJHC and LHSC in in the Spring of 2016.
Objectives of the Integration
The pDAP at SJHC will include:
A single point of access for suspect prostate cancer assessment designed according to Cancer Care Ontario (CCO) best practice guidelines. Streamlined scheduling and coordination of diagnostic tests and consultations using a model consistent with best practice and designed by the clinicians. The consolidation of diagnostic prostate biopsy procedures to SJHC. Patient navigation practice will be instituted to ensure relevant and timely information and support for the patients throughout the assessment process to treatment options including hospital based treatments of surgery, radiation and systemic therapy.
Report to the Board of Directors – Prostate Cancer Diagnostic Assessment Program Integration Page 3
Issuing an Integration Decision
As outlined in Section 27 of the Local Health System Integration Act (LHSIA), 2006, upon receipt of a Notice of Integration the LHIN may consider if the proposed integration is in the public interest. This will include consideration of whether the proposed integration is consistent with the LHIN’s Integrated Health Service Plan and any other relevant matter as decided by the LHIN Board.
The Board then has two options:
1. LHIN does not object to intended integration: The LHSIA allows the LHIN 60 days to consider the notice of intended integration from a Health Service Provider (HSP). If the LHIN does not object to the intended integration, it may simply choose to take no action. In that case, after 60 days have elapsed from the day the HSP gave the LHIN notice, the provider may proceed with the integration. While the LHSIA does not require it to do so, the LHIN may choose to notify the HSP that it does not intend to issue a decision stopping the integration.
2. LHIN has concerns about intended integration: If the LHIN has concerns about the intended integration based on the notice from the HSP, it can take steps towards preventing the integration from proceeding. The LHIN must notify the HSP within 60 days of receiving the Notice of Integration that it proposes to issue a decision ordering the provider not to proceed with the integration. The LHIN must provide a copy of the proposed decision to the HSP and must make copies of the decision available to the public, also within the 60 day timeframe.
Analysis of the Proposed Integration
Impacts on Patients and Services (from public’s perspective): Plans have been designed to improve patient experience and satisfaction. There will be positive impacts to patients as resources will be aligned to needs and will provide increased access to prostate cancer diagnostic assessment. Overall capacity remains the same Consultation and engagement included the Regional Clinical Aboriginal Lead and Cancer Aboriginal Patient Navigator. A Health Equity Impact Assessment (HEIA) was completed and did not surface any significant unintended negative consequences for the various populations.
Impacts on Labour: Lay-offs are not anticipated Communication with staff has taken place in order to ensure that staff understand the rationale for the change and how they will play a positive role Unions will be consulted should the LHIN not object to the intended integration
Impacts on Health Service Provider (HSP) Management / Board Structure: There are no anticipated impacts to HSP management or Board
Implications for the LHIN Financial: There will be no financial impact as the integration will be achieved through a transfer of existing resources between LHSC and SJHC Funds ($227,102) related to the realignment of prostate cancer diagnostic assessment services will be transferred from LHSC to SJHC Impact to Service Accountability Agreements (SAAs): There will be a minor impact on SAAs to accommodate volume and funding adjustments related to the realignment of prostate cancer diagnostic assessment services from LHSC to SJHC
Report to the Board of Directors – Prostate Cancer Diagnostic Assessment Program Integration Page 4
Conclusions and Recommendations
LHIN staff have confirmed due diligence related to the proposed integration between LHSC and St. Joseph’s Health Care, London and, therefore, recommend that the LHIN not issue an integration decision to stop or amend the integration.
Next Steps
Subject to LHIN Board consideration of the integration proposal: The hospitals will begin to implement the realignment. Goal is to complete transition by late summer 2016. LHSC and SJHC H-SAAs and funding will be adjusted as required to reflect the volume and funding adjustments related to the realignment.
Agenda Item 6.3 Report to the Board of Directors Stage 2, Part A Capital Submission Grey Bruce Health Services – Markdale Hospital Redevelopment
Meeting Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director, System Design & Integration Jana Fear, System Design & Integration Specialist Bob DeRaad, Project Lead Betty Wang, Financial Analyst
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Suggested Motion
THAT the South West Local Health Integration Network (LHIN) Board of Directors endorses Part A of the Grey Bruce Health Services (GBHS) Markdale Hospital Redevelopment Stage 2 (Functional Program) Capital submission to the Ministry of Health and Long Term Care.
Purpose
The purpose of this report is to provide information to the South West LHIN Board of Directors to enable the Board to determine whether or not it wishes to endorse Part A of the Stage 2 (Functional Program) Capital submission from Grey Bruce Health Services (GBHS) for redevelopment of Markdale Hospital. A Stage 2 Capital submission defines and justifies the scope of the capital project with regards to programs and services being proposed, associated workloads, staffing, equipment, and both architectural and environmental space requirements.
Supporting documentation is provided in the appendices as optional reading: Appendix A outlines the Capital Planning and Stage 2 Capital Review Process; Appendix B provides background information and a description of the Capital project; and Appendix C contains the South West LHIN staff review of the Stage 2 submission.
Report to the Board of Directors – GBHS, Markdale Stage 2 Capital Page 2
Brief Background & Project Description
Grey Bruce Health Services (GBHS) provides programs and services to a large population in a number of communities. Its facilities offer acute and ancillary health care services across each of its six hospital sites: Owen Sound hospital provides regional specialty services across Grey and Bruce Counties; hospitals located in Lion’s Head, Markdale, Meaford, Southampton and Wiarton offer a wide range of primary and ambulatory care services to their communities. The Markdale site serves a catchment area of approximately 35,000 people and provides the only emergency care between Orangeville and Owen Sound, a driving time of 1.5 hours.
The initial Stage 1 Business Case and Stage 2 Functional Program were submitted in May 2007 and October 2007, respectively. In September 2009, with the establishment of the South East Grey Community Health Centre (SEGCHC), the ministry provided direction to GBHS to work with SEGCHC and South West LHIN to develop a Rural Health Centre concept that integrated primary care and acute care services into one facility, providing a “one-stop shop” for the health care needs of rural communities. The combined Stage 1 and 2 Markdale Rural Health Centre Capital proposal was submitted to the ministry in February 2011 and endorsed by the South West LHIN Board of Directors at its March 21, 2011 meeting.
Since that time, discussions continued among GBHS, the ministry, and South West LHIN to advance the project, culminating in the presentation of the Markdale Rural Health Centre Scoping document in July 2013 that outlined four options for the redevelopment. The selected option will retain core services needed for a small rural hospital and will also align with primary care and community based partners in the region. The option will also replace the traditional inpatient beds with shorter stay beds (up to 72 hours length of stay), retain the 24/7 Emergency Department, and reduce the surgical program to outpatient procedure service. Given that the new option significantly changed the scope of the Capital project, the ministry requested that a new Stage 2 proposal be submitted.
The following services are proposed for the new Markdale hospital: 24-hour Emergency Department Short Stay Inpatient Beds: Four short stay inpatient beds (up to 72 hours length of stay) will be available; A ‘flex bed’ will also be available to provide admitted palliative care, and will be used as a short stay inpatient bed when not in use by a palliative patient Procedures Room: Inpatient surgery will be discontinued and general anaesthesia will not be available at Markdale; Outpatient surgery will be continued but some procedures will be consolidated across GBHS sites Laboratory and Diagnostic Imaging Outpatient Rehab Services Ambulatory Clinics – Includes new focus of three ambulatory services at Markdale: Pre- surgical Screening; Diabetic Education; and Geriatric Clinics Visiting Community and Outpatient Specialty Clinics Inter-Professional Teams Expanded telemedicine capabilities to bridge the socio-economic and geographical isolation of the area Flexible building design to adapt to changing needs and circumstances that may arise as system transformation evolves
Report to the Board of Directors – GBHS, Markdale Stage 2 Capital Page 3
Potential Risks
In addition to the review criteria outlined in Appendix C, LHIN staff considered potential risks that may impact the proposed capital development.
Potential Risk Description Further delays in the Capital review Further delays may result in declining pledges of support process from the Markdale community and may contribute to challenges in raising community share of the project cost. In addition, delays may result in escalating project costs.
South West LHIN Conclusions and Recommendations
LHIN staff confirmed that the GBHS Stage 2, Part A submission meets all identified requirements and provides sufficient evidence of the need for development. Therefore, South West LHIN staff recommend that the South West LHIN Board endorse Part A of the submission.
Next Steps
Should the South West LHIN Board of Directors approve the recommended motion, the LHIN will forward a letter (including motion) to the Health Capital Investment Branch (HCIB), providing them with written rationale and advice regarding the submission. Upon finalization of its review of GBHS’s Part A responses and completion of its review of Part B, HCIB will finalize its review and advise the LHIN of its findings and expected next steps. Pending approval by HCIB, GBHS will receive written permission from HCIB to proceed to Stage 3 (Preliminary Design).
Encl. – Optional Reading:
Appendix A: Overview of Capital Planning and Stage 2 Capital Review Process Appendix B: Background Information and Project Description Appendix C: South West LHIN Stage 2, Part A Capital Review
Appendix A GBHS, Markdale Stage 2 Capital
OPTIONAL READING Appendix A: Overview of Capital Planning and Stage 2 Review Process
1 Appendix A GBHS, Markdale Stage 2 Capital
Stage 2 Functional Program Review Process
LHIN Joint MOHLTC HSP and/or LHIN
Planning
Functional Program Service
Alignment Review and
A
Elements)
Part LHIN Board YES NO endorsement (Program for Part A?
Spatial Requirements; Design Objectives
Phasing Plan; Project Schedule Cost
and NO
Review
Alignment B
Elements) YES Part MOHLTC approval (Physical of Stage 2 and approval to proceed
The objective of Stage 2: Functional Program (FP) is to define and justify the scope of the capital project with regards to programs and services being proposed, associated workloads, staffing, equipment and space requirements including architectural and environmental. Development of a Functional Program is normally required if a capital project affects program or service delivery. Viewed as a link between program planning and facility planning, the FP will allow the Health Service Provider (HSP) to provide specific justification for the introduction of new or expanded services or programs and any proposed infrastructure investment required to support the program needs. Specifically, the FP will: Define the provider’s operational program requirements; Determine interdepartmental relationships and space requirements of the project; Provide the necessary data required for architectural and engineering design for the project; Prepare block diagrams to demonstrate that the FP can be accommodated in the proposed space; Form the basis for determining project-related furniture and equipment needs; Form the basis for developing a more detailed cost estimate and local share plan; and Form the basis for a more detailed Post Construction Operating Plan. Part A of the Stage 2 Functional Program submission will help the HSP define the program parameters of the programs and services affected by the capital project, including: Future demand for services and its relationship to the other services and programs offered by the HSP;
2 Appendix A GBHS, Markdale Stage 2 Capital
HSP’s new vision with the proposed programs and services and its relationship to the LHIN and government priorities; Anticipated linkages with stakeholders within a defined service/catchment area; and Detailed space requirements to accommodate the programs and services proposed. Should the South West LHIN Board of Directors endorse Part A of the Stage 2 Functional Program, the South West LHIN will forward a letter (including motion) to the MOHLTC Health Capital Investment Branch providing them with written rationale and advice regarding the submission. The HSP will be copied on this correspondence. Upon finalization of its review of GBHS’s Part A responses and completion of its review of Part B, HCIB will finalize its review and advise the LHIN of its findings and expected next steps. Pending approval by HCIB, GBHS will receive written permission from HCIB to proceed to Stage 3 (Preliminary Design).
3 Appendix B GBHS, Markdale Stage 2 Capital
OPTIONAL READING Appendix B: Grey Bruce Health Services, Markdale Hospital Redevelopment Background and Capital Project Description
Background Grey Bruce Health Services (GBHS) provides programs and services to a large population in a number of communities. Its facilities offer acute and ancillary health care services across each of its six hospital sites: Owen Sound hospital provides regional specialty services across Grey and Bruce Counties; hospitals located in Lion’s Head, Markdale, Meaford, Southampton and Wiarton offer a wide range of primary and ambulatory care services to their communities. The Markdale site serves a catchment area of approximately 35,000 people and provides the only emergency care between Orangeville and Owen Sound, a driving time of 1.5 hours. GBHS has been involved in planning for the replacement of the Markdale site since 2001. A planning and design grant was confirmed by the Ministry of Health and Long Term Care in July 2006. The planning progressed from the initial Functional Assessment/Master Program/Master Plan to submitting Stage 1 Business Case in May 2007 and Stage 2 Functional Program in October 2007.1 In September 2009, a new dimension was added to the planning in the form of the newly established South East Grey Community Health Centre (SEGCHC). The ministry provided direction to GBHS to work with SEGCHC and South West LHIN to develop a Rural Health Centre concept that integrated primary care and acute care services into one facility, providing a “one-stop shop” for the health care needs of rural communities. The combined Stage 1 and 2 Markdale Rural Health Centre Capital proposal was submitted to the ministry in February 2011. At its March 21, 2011 meeting, the South West LHIN Board of Directors passed the following motions: THAT the South West Local Health Integration Network (LHIN) Board of Directors endorse Part A of the combined Stage 1 (Master Program) and 2 (Functional Program) Grey Bruce Health Services’ Markdale Rural Health Centre Capital submission; and THAT the South West Local Health Integration Network (LHIN) Board of Directors conditionally endorse the South East Grey Community Health Centre (CHC) Functional Program component of the Rural Health Centre submission. The endorsement is subject to an alignment meeting with the Primary Care Branch of the Ministry of Health and Long-Term Care regarding the Functional Program for the South East Grey CHC. Since that time, discussions continued among GBHS, the ministry, and South West LHIN to advance the project, culminating in the presentation of the Markdale Rural Health Centre Scoping document in July 2013 that outlined four options for the redevelopment. The selected option is described below.1 Given that the new option significantly changed the scope of the Capital project, the ministry requested that a new Stage 2 proposal be submitted.
Capital Project Description Markdale currently provides the following: 24/7 Emergency Services Ambulatory Care (including clinics conducted by visiting specialists) Surgical/Procedures Services (including outpatient surgery for cases such as general surgery, orthopaedic, gynecology, and limited inpatient based surgery Inpatient Care is provided for a number of types of medical and surgical inpatient cases Basic Laboratory and Diagnostic Imaging Services Pharmacy Support
1 New Markdale Hospital, Stage 2 Functional Program Submission, January 30, 2015
1 Appendix B GBHS, Markdale Stage 2 Capital
Rehabilitation Therapy The proposed Capital project will retain core services needed for a small rural hospital and will also align with primary care and community based partners in the region. The option approved by the ministry will replace the traditional inpatient beds with shorter stay beds (up to 72 hours length of stay), retain the 24/7 Emergency Department, and reduce the surgical program to outpatient procedure service. The following services are proposed for the new Markdale hospital: 24-hour Emergency Department: o CTAS levels 1 through 5 will be seen at Markdale o If inpatient bed is required and care needed is within scope of Markdale hospital, patient will be admitted o If specialist care is required, patient will be transferred to Owen Sound o If tertiary service is required, patient will be transferred to a centre such as London Health Sciences Centre or St. Mary’s in Kitchener Short Stay Inpatient Beds o Four short stay inpatient beds (up to 72 hours length of stay) will be available o Acute inpatient beds will focus on providing care to patients who require stabilization of treatment prior to transfer to Owen Sound or a tertiary centre, those patients who require some time for further diagnostic investigation in order to make a clinical determination of care, as well as those patients who require short term treatment or care to ensure a safe transfer home or to their home facility o A ‘flex bed’ will also be available to provide admitted palliative care where the patient cannot remain at home and transfer out of the community is against their wishes and may also represent a hardship to their families; This bed will be used as a short stay inpatient bed when not in use by a palliative patient Procedures Room o Inpatient surgery will be discontinued o General anaesthesia will not be available at Markdale o While outpatient surgery will be continued, orthopaedic cases will be consolidated at the Meaford site, and other types of procedural cases such as scoping will be consolidated at Markdale in order to achieve improved operational efficiencies Laboratory and Diagnostic Imaging Outpatient Rehab Services Ambulatory Clinics – Includes new focus of three ambulatory services at Markdale, reflecting shifts in service delivery strategies among GBHS sites and changes in local population that uses the Markdale site: o Pre-surgical Screening: Some local cases will have screening performed at Markdale, avoiding travel to Owen Sound; cases that require pre-screening, but previously have not been screened, can now be screened at Markdale o Diabetic Education: Growth in visits is driven by the prevalence of projected endocrinology cases in the hospital’s catchment area o Geriatric Clinics: Reflects a transfer to Markdale of some program activity currently being done at Owen Sound and the increasing number of elderly within the Markdale catchment area Visiting Community and Outpatient Specialty Clinics Inter-Professional Teams Expanded telemedicine capabilities to bridge the socio-economic and geographical isolation of the area Flexible building design to adapt to changing needs and circumstances that may arise as system transformation evolves
2 Appendix B GBHS, Markdale Stage 2 Capital
The goal of the proposed Capital project and Rural Health Centre concept is to not only meet the needs of the community but to also represent a model for the future of small hospitals across the province. The proposed new model of care: Recognizes and is adaptable to the demographic changes and challenges of an aging rural population Maintains vital access to health care services in rural communities, specifically access to 24 hour emergency care Integrates well with the broader health system in Grey Bruce and the GBHS network of care Nurtures and enhances current strong linkages with primary care and long term care Supports the concept of a local rural health hub Accommodates for geographic and socio-economic isolation and the lack of any public transportation options in the region Is less capital intensive than traditional rural hospital models, and Provides a flexibility of design that is adaptable to changing community needs and the transforming health care system Other highlights of the proposal include: Partnerships – The innovative service model will enable integration with community partners such as North Grey Bruce Health Link, South East Grey Community Health Centre, Mental Health Grey Bruce, and Hospice Grey Bruce. Flexibility of Design – The redevelopment will be a flexible and adaptable building envelope that can optimize capital investment and keep pace over time with changing care protocols, technology, demographics, regulatory environments, and patient expectations Clinical Liaison – The proposal identifies a dedicated Clinical Liaison position within the Markdale site that will have responsibility for (a) organizing needed community support to help patients transition from the hospital setting back into the community; (b) organizing logistics to allow patients to be transferred to an acute care facility; (c) supporting patients discharged back to the Markdale community from Owen Sound and other hospitals in the region; (d) assisting with frail senior screening in the ER to ensure that care plans (Health Links) are in place upon discharge and admissions are avoided, and an active participant in the Comprehensive Geriatric Assessments provided by physicians at the Markdale site; and (e) performing a discharge planning function to support both inpatients and the Emergency Department to maintain flow through the small number of inpatient beds.
3 Appendix C GBHS, Markdale Stage 2 Capital
OPTIONAL READING Appendix C: Grey Bruce Health Services, Markdale Hospital Redevelopment South West LHIN Stage 2, Part A Capital Review
Question/Criteria South West LHIN Assessment
1) Summary Element a) Programs and services affected by capital project Yes Somewhat No Does the submission provide a comprehensive description of Comments: each program/service affected by the project? A Functional Additional document, An Innovation Model for Small Rural Health Program should include only those programs/services whose Services, was provided in February 2016 and describes the proposed space will impacted by the proposed project. rural health model. o Does the description of each program/service include major operating parameters such as model of care, organizational A number of consultations and correspondence with HCIB and GBHS (reporting) structure and hours of operation? resulted in additional supporting documentation. b) Justification for new or expanded programs Yes Somewhat No Does the submission provide a full justification for all new or Comments: expanded programs/services? This may include: Across the GBHS sites, there will be no new or expanded o Projections showing increased future demand programs/services. Alignment with provincial or local health system strategic o To better serve Markdale and surrounding area, some programs and priorities services will be discontinued or reduced, and consolidated at other o Alignment with HSP strategic priorities and role sites; while others (e.g., scoping procedures) will be consolidated at Markdale. o Program/service transfer or integration o Community needs assessment o Stakeholder feedback c) How the project supports local health system priorities Yes Somewhat No Does the submission describe how the programs/services align Comments: with local health system priorities? The Rural Health Model has the potential to be a template for similar o Is clear alignment demonstrated between LHIN IHSP Capital redevelopments in rural areas across the province. and/or CSP and the proposed programs/services?
1 Appendix C GBHS, Markdale Stage 2 Capital
Question/Criteria South West LHIN Assessment
Does the submission support the HSPs role in the local health system? o Are the programs/services proposed consistent with the HSPs role in the local health system? d) Definition of special terms Yes Somewhat No Does the submission provide a clear definition for any special Comments: or technical terminology that may be used?
e) Methods used to define the projected workload Yes Somewhat No Does the submission describe the methodology used to Comments: develop the workload projections? Methodology used to calculate bed numbers and utilization projections Does the methodology use a recognized model? was based on consultations with HCIB, and used Ministry of Finance Does the methodology use Ministry of Finance population projections. estimates?
2) Program Element a) Assumptions Yes Somewhat No Does the submission clearly outline the assumptions on which Comments: it is based? These may include: The innovative service model will enable integration with community o Program/service linkages, collaborations and partnerships partners. Current partnerships with mental health, primary care, and EMS were described. Additional opportunities were also outlined. o Considerations regarding shared or purchased service arrangements, shared space, or joint programs A Clinical Liaison position was identified in the model. o Impact on other programs/services not provided by the HSP (e.g. provided by other agencies in the local health system) b) Functions Yes Somewhat No Does the submission clearly describe the function(s) of each Comments: program/service?
o Description of the program/service scope and major area(s)
2 Appendix C GBHS, Markdale Stage 2 Capital
Question/Criteria South West LHIN Assessment
of focus? o Description of clients served and activities performed? o Summary of specific linkages with other programs/services, either internal or external to the HSP? c) Procedures Yes Somewhat No Does the submission provide a clear description of patient Comments: flow? This could be accomplished by way of a diagram that
describes how patients typically move through the program/service. Does the submission provide basic operational details such as hours of operations and key staffing requirements? Does the submission describe key dependencies or internal relationships (e.g., Allied health services; Non-clinical services such as security, housekeeping, etc.)? d) Projected workload Yes Somewhat No Does the proposal provide projected utilization (demand) data Comments: for each program/service over a period of 5 years? Projected utilization (demand) data for each program/service is o Are the utilization projections aligned with provincial provided for 2019/20. Projected utilization data over a period of 10 and capacity planning projections and/or LHIN clinical service 20 years was not provided in the most recent proposal. planning projections? o Do any assumptions employed meet industry standard best-practices? o Does the data demonstrate evidence of consultation with stakeholders to determine expected future changes to care delivery? For example, does program/service growth simply mirror population growth, or are particular programs/services expected to grow more rapidly than others? Is rationale or evidence provided to support any such assumptions?
o If program/service volumes are projected to remain level or decrease, has rationale been provided to link with expected demand?
3 Appendix C GBHS, Markdale Stage 2 Capital
Question/Criteria South West LHIN Assessment e) Projected staffing Yes Somewhat No Does the submission describe projected staffing requirements? Are Comments: these requirements aligned with projected workload? The staffing requirements are adequate to meet the programmatic Have alternative staffing models been considered? needs of the organization. The new building will enable the Have Health Human Resources challenges been considered (e.g. implementation of a much more efficient staffing model that will provide attracting and retaining appropriate numbers of qualified staff)? additional supports to patients.
South West LHIN Staff Recommendation for Stage 2, Part A: Endorse Endorse with Conditions Reject
4
Agenda Item 6.4 Report to the Board of Directors Specialized Units Update
Meeting Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director Julie Girard, Team Lead Carolyn Ridley, Financial Analyst
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
Suggested Motion: THAT the South West Local Health Integration Network Board of Directors, subject to receipt of a Long-Term Care Home Specialized Unit designation by the Ministry of Health and Long-Term Care, approves the allocation of $1,227,047 annualized base funding, of which $609,830 will be transferred from CMHA Middlesex to McGarrell Place, in support of the Specialized Behavioural Supports Unit at McGarrell Place;
AND
THAT the South West Local Health Integration Network Board of Directors approves an additional $46,089 base funding for enhanced training in year one in support of the Specialized Behavioural Supports Unit at McGarrell Place.
Purpose: The South West LHIN’s work associated with Access to Care and Behavioural Supports Ontario have influenced the direction to create specialized units in LTC homes. These two initiatives have identified a population of individuals that consistently occupy acute and post-acute hospital beds and are unable to have their needs met by current resources. These individuals are often characterized as psycho- geriatric or behavioural with advanced dementia, acquired brain injury or neurological disease or have mental health diagnoses and/or substance abuse issues.
In September, 2013, the South West LHIN Board approved base funding of $680,000 for a 14-bed specialized unit in LTC for people living with Acquired Brain Injuries (ABI). In October 2014, the Board approved base funding of $1,794,600 for behavioural support units in LTC for people who have responsive behaviours such as wandering, verbal and physical abuse, resisting care, and socially inappropriate behaviours. The funds were identified through the Priorities for Investment Plans in each of these fiscal years.
This briefing provides an update on the progress of the development and designation of these specialized units.
Report to the Board of Directors- Specialized Units Update Page 2
Specialized Unit for People Living with Acquired Brain Injury Working with Kensington Village Nursing Home, Dale Brain Injury Services (DBIS), and the South West Community Care Access Centre (CCAC), the LHIN submitted a proposal in April 2014 to the Ministry of Health and Long-Term Care (Ministry) to request designation of a specialized unit for people living with Acquired Brain Injuries. The model of care included the residents regularly attending a brain injury day program offered by DBIS. DBIS rents purpose-built day program space from the LTC home (Earls Court Village) which is owned by the same licensee of Kensington Village Nursing Home.
After a series of discussions over an extended period of time with Ministry staff representing multiple departments within the Ministry, and a number of minor revisions being made to the original proposal in response to initial Ministry feedback, the LHIN received a formal response from the Ministry in April 2016 indicating that it is not able to support a model that entails off-site daily programming at the DBIS ABI day program location at Earls Court Village. With this new information, Kensington Village and DBIS are adjusting the model of care where DBIS staff will work at the Kensington Village site to provide the necessary wellness, interpersonal skills and meaningful activity programming alongside the enhanced staffing at Kensington Village. This change in the model of care is expected to increase the amount of resources needed to support the residents in the specialized unit at Kensington Village. As a result, a proposal for additional funding will be brought forward to the LHIN Board as part of the 2016/17 Priorities for Investment Plan and then a revised proposal will be submitted to the Ministry to request the ABI specialized unit designation at Kensington Village.
When the funding for the ABI specialized unit of 14 beds was approved by the Board, base funding was approved for allocation to DBIS to support the 14 residents of the specialized unit to attend the day program. The day program has been operating since the summer of 2014. Since that time DBIS has been providing temporary interim caregiver support services for people from the community that are waiting to access the day program. With the proposed change in the model of care, DBIS will now offer the permanent 14 spaces at the day program to other individuals in the community waiting for this service.
Behavioural Support Units
Following the Board’s approval of base funding of $1,794,600 in October, 2014 for additional specialized units, a stakeholder engagement process unfolded to create a framework to guide the development of long-term care home behavioural support units throughout the South West LHIN. Based on the 2011 Mental Health Commission of Canada national guidelines for comprehensive mental health services for older adults in Canada, the following chart shows the projected specialized unit beds required by the South West LHIN:
Location LTC Home: Specialized Unit Beds Current Beds Current Rate Benchmark Per 10,000 (7.5 beds/10,000 Adults 65+ Adults 65+) Grey/Bruce 0 0 26.8 Huron/Perth 0 0 19.3 Oxford/Norfolk 0 0 14.4 London/Middlesex 29 4 54.4 Elgin 0 0 11.3 Total 128.2 Note: South West LHIN has 7,428 LTC Home beds. 128/7428 beds = 1.7%
Report to the Board of Directors- Specialized Units Update Page 3
In the spring of 2015, an expression of interest survey was sent out to all LTC homes in the South West LHIN. Six LTC homes identified an interest in operating a behavioural support specialized unit. Although one home in Huron County identified an interest, it was determined that the first phase of implementation should be focused on areas with greater Alternate Level of Care (ALC) challenges. Therefore, tours and interviews were conducted with five homes in Grey/Bruce and London/Middlesex counties. Interview panel members included staff from the CCAC, Schedule 1 hospitals, other LTC homes, the Alzheimer Societies, and Parkwood Institute.
As a result of this process, two LTC homes, one in the Grey Bruce area and one in London, were identified as the preferred locations for 16-bed specialized units. The identified home in the London area recently withdrew from the process due to the inability under current policy to receive occupancy protection to ensure funding is not negetaively impacted if occupancy targets are not met. Lee Manor Home in Owen Sound has been identified as the Grey Bruce location for establishment of a new16-bed specialized unit.While the interview process was unfolding, work was also underway to adjust the McGarrell Place model of care for the special care unit that it has been operating since 2003. The McGarrell Place unit was originally approved by the Ministry prior to the LHIN’s existence and includes 29 LTC home beds for individuals with persistent mental illness ready to be discharged from Parkwood’s Regional Mental Health Care. McGarrell Place has historically received $609,830 to enhance resources to care for these residents and has also had access to Parkwood’s Discharge Liaison Team. These LHIN funds are flowed to the LTC Home under a paymaster arrangement with Canadian Mealth Health Association Middlesex.
Over the past number of months, many partners including London Health Sciences Centre, Parkwood institute, CCAC, and LHIN staff have been meeting to adjust the model of care to one that is transitional, receives referrals from other LTC homes, acute and tertiary hospitals, and people living in their homes where there has been an identification of a change in the level of care required due to their responsive behaviours. Given the adjustments to the model of care and the fact that the LTC home has not received an increase in funding in over 12 years, it has been identified that a base funding increase of $617,217 is required to adequately support the residents. Following South West LHIN Board approval of allocation of existing funding in support of the specialized unit, a proposal will be submitted to the Ministry to request designation of a 25-bed specialized unit for McGarrell Place. To enhance the environment and programming space of the specialize unit, two 2-bed rooms will be converted to programming space.
Under the proposed model, the costs to run the 25-bed specialized unit will be $1,227,047 annually however additional funding of $46,089 will be required for enhanced training in the first year. Upon approval by the Ministry for the designation of the 25-bed specialized unit, the funds of $609,830 would be transferred from CMHA Middlesex to McGarrell Place and will be used to supplement the $617,217 base funds for a total allocation of $1,227,047.
Of the $1,794,600 the Board approved for LTC home specialized units, as noted above, $617,217 is required to enhance McGarrell Place resources. This will leave $1,177,383 available for Lee Manor and a potential other 16 bed unit. It is estimated that in total two, 16-bed specialized units will require approximately $400,000 in additional base funding and this is expected to be identified through the 2016/17 priorities for investment process. A proposal to request specialized unit designation will be created for Lee Manor and submitted to the Ministry. In addition, additional work will be done to identify a new location for a 16-bed specialized unit in the London area.
Report to the Board of Directors- Specialized Units Update Page 4
Unallocated for additional 2 - 16-bed Board McGarrell Place units Source of Funding Approval Year 2 and 2013/14 Year 1 onward Year 1 Year 2 Mental Health & Addictions Strategy $1,794,600 $ 617,217 $46,089 $617,217 $1,131,294 $1,177,383
CMHA Middlesex 609,830 609,830 - -
Total $1,794,600 $1,227,047 $46,089 $1,227,047 $1,131,294 $1,177,383
Next Steps
LHIN staff will continue to work with Kensington Village and DBIS in the creation and submission of the new proposal for the revised model of care for the designation of the ABI Specialized Unit at Kensington Village. The Board will receive a progress report at a later date and it is expected that an additional funding request will come forward with the 2016/17 Priorities Investment Plan. LHIN staff will work with McGarrell Place to finalize the proposal to the Ministry for the designation of a 25-bed specialized unit. Upon approval by the Ministry, the LHIN will work with McGarrell Place and other partners to transition to the new model of care as well as work with the Ministry in the reallocation of existing and allocation of enhanced funding to McGarrell Place. LHIN staff will move forward with next steps to identify a recommended location for a behavioural unit in the London area.
Item 6.5 Report to the Board of Directors 2016/17 Hospital Service Accountability Agreement (H-SAA) Extension and Schedules
Meeting Date: June 21, 2016
Submitted By: Mark Brintnell, Senior Director, System Design and Integration
Submitted To: Board of Directors Board Committee
Purpose: Information Only Decision
The board report for the 2016/17 Hospital Service Accountability Agreement extension process is delayed and not ready to be released as part of the board package at this time. LHIN staff continue to work closely with a few hospital corporations to finalize the service, financial and performance assumptions in forming the H-SAA terms and conditions. Health System Funding Reform funding allocations, clinical services planning impacts and hospital operational changes are a few factors resulting in changes that need to be clearly worked through and considered in the service, financial and performance impacts.
LHIN staff and hospital staff continue to work through these issues with the shared goal of reaching agreement on the terms and conditions of the H-SAA extension. It is expected the H-SAA Board Report will be issued on or before Friday, June 17, 2016.
Item 7.1 Report to the Board of Directors 2014/15 South West LHIN Stroke Report Card
Report Date: June 21, 2016
Submitted By: Kelly Gillis, Senior Director, System Design & Integration Paula Gilmore, Regional Director, Southwestern Ontario Stroke Network
Submitted To Board of Directors Board Committee
Purpose: Information Decision
Purpose The purpose of this report is to provide the South West LHIN Board of Directors with an overview of the South West LHIN performance on the 2014/15 Ontario Stroke Report Card.1 The 2014/15 Ontario Stroke Report Card was released publically on June 1, 2016.
Background The Ontario Stroke Report Cards were developed by the Ontario Stroke Network’s (OSN) Ontario Stroke Evaluation and Quality Committee (SEQC) in 2009 to provide a consistent mechanism for communicating stroke care performance in the province. The report cards are made up of 20 key indicators considered integral to system efficiency and effectiveness. The report cards serve as a valuable stakeholder tool that allows for consistent planning across the 11 Ontario Regional Stroke Networks and support the implementation of the stroke care Quality-Based Procedures (QBPs). Report cards are produced annually for Ontario and each of the 14 LHINs. Since 2015/16, the LHINs have also received a progress report.2 In contrast to the report card, where LHIN performance is compared to provincial high performers, the progress report evaluates each LHIN’s progress in achieving best practice by comparing their current performance to their previous 3-year performance.
Performance Overview The 2014/15 report card1 and progress report2 show ongoing progress across key performance indicators. For indicators where comparative performance results are available, the following is noted: 11 of 16 indicators2 [indicators 1, 3, 5-8, 10, 15, 17, 19, 20] display a trend towards progress; 5 of the 11 indicators2 showing progress [3, 5, 7, 8, 15] display a statistically significant improvement compared to the previous 3 years; and 2 indicators1 [2, 7] demonstrate exemplary performance achieving the provincial benchmark.
1 Ontario Stroke Report Card, 2014/15: South West Local Health Integration Network 2 Stroke Progress Report: South West Local Health Integration Network – 2014/15 compared to 2011/12-2013/14
Report to the Board of Directors – 2014/15 South West LHIN Stroke Report Card Page 2
Areas of Progress The South West LHIN progress report2 reflects steady improvement in stroke prevention, acute stroke management, and stroke rehabilitation. Improvements noted on the report card include: Proportion of ischemic stroke patients receiving thrombolytic therapy (tPA) [7] is progressing well at 12.3% reaching the Provincial Benchmark. In addition, all tPA sites have decreased their door to needle times [6] showing progress from 62.5 minutes to 50.5 minutes. Mortality rate at 30 days is progressing well decreasing from 14.4 to 11.9 per 100 patients [3]. The provincial mean is 10.58 per 100 patients. Proportion of Alternate Level of Care days [10] has improved by decreasing from 26.3% to 16.7% of the total length of stay (LOS) in acute care. Proportion of stroke patients achieving rehabilitation length of stay targets [15] is progressing well over the last 3 years at 57.8%. While not specifically reflected on the report card, the 3 LHIN-funded Community Stroke Rehabilitation Teams (CSRT) across the region who provide in home stroke rehabilitation after hospital have helped to provide care to the right patients, at the right time, in the right place.
Areas for Improvement While steady progress is being made for most indicators on the report cards, LHIN variation remains. There are a number of current and planned activities in place focusing on the areas for improvement. These include: Proportion of patients who arrive at an emergency department by ambulance [1] has decreased from 59% to 56.3%. The South West LHIN provided funding for the development of local videos promoting the FAST (face, arms, speech, and time) signs and symptoms of stroke and to call 911. Release of videos will take place over the next fiscal year during the implementation of the realignment of stroke care from 28 to 7 hospitals. In 2014/15, there was limited access (3.3%) to care in a stroke unit [8] that meets the provincial definition. However, during 2014 and 2015, significant quality improvements were being made at all designated stroke centres. Huron Perth Healthcare Alliance (Stratford General Hospital) opened an integrated stroke unit in December 2014, and London Health Sciences Centre (University Hospital) and Grey Bruce Health Services (Owen Sound Hospital) opened acute stroke units in April 2015. St. Thomas Elgin General Hospital (STEGH) opened an integrated stroke unit in April 2016 to further improve access. Recent data from the South West LHIN Regional Stroke Dashboard indicates that, from January 2014 to December 2015, 51% of people with a stroke were treated on a stroke unit. Proportion of patients accessing inpatient rehabilitation [11] has decreased (33.5%) including a reduction in the proportion of patients with severe stroke (39.8%) [18]. It is also taking longer to be admitted to inpatient rehabilitation (10 days) [13]. However, the implementation of the LHIN future state directional recommendations is driving uptake of Quality Based Procedures (QBPs) including length of stay targets and the appropriateness of care. In addition, the LHIN has enhanced the CSRT funding to improve patient flow providing rehabilitation to mild stroke patients discharged from acute care allowing greater access to inpatient rehabilitation for moderate- severe stroke patients. Median Functional Independence Measure (FIM) efficiency for moderate stroke in inpatient rehabilitation [16] is not progressing (0.9) and is below the provincial benchmark (1.5). All inpatient rehabilitation units have been focusing on achieving QBP LOS targets through the implementation of best practices such as increasing daily rehabilitation intensity, therapy on the weekends and initiatives to improve patient flow.
Next Steps Implementation planning is currently underway with all LHIN partners to realize the Phase 1 South West Stroke Project’s directional recommendations for the realignment of stroke care from 28 to 7 hospitals
Report to the Board of Directors – 2014/15 South West LHIN Stroke Report Card Page 3
including the designation of an additional District Stroke Centre (STEGH) to improve access to best practice care. Phase 2 of the South West Stroke Project has been launched to develop directional recommendations for the future state of secondary stroke prevention and community stroke rehabilitation and recovery across the LHIN with the overall goal of implementing a complete system of care across the continuum. The target date for completion of this work is March 31, 2017. ONTARIO STROKE REPORT CARD, 2014/15: SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK
1 2 3 Data not available or Poor performance Acceptable performance Exemplary performance benchmark not available LHIN Variance High Performer7 Indicator Care Continuum Provincial Indicator4 FY 2014/15 Within LHIN5 No. Category Benchmark6 (2013/14) (Min–Max) Sub-LHIN/Facility LHIN 1 Public awareness and Proportion of stroke/TIA patients who arrived at the ED by ambulance. 56.3% (59.0%) 46.7–61.6% 64.9% (64.8%) Essex Sub-LHIN 1, 3 patient education 2 Prevention of stroke Annual age- and sex-adjusted inpatient admission rate for stroke/TIA (per 1,000 population). 1.3 (1.3) 1.3–1.7 1.2 (1.1) Ottawa Centre Sub-LHIN 7, 8, 9,11 3§ Prevention of stroke Risk-adjusted stroke/TIA mortality rate at 30 days (per 100 patients). 11.9 (14.4) 0.0–42.0 – – 7 4 Prevention of stroke Proportion of ischemic stroke/TIA patients with atrial fibrillation prescribed or recommended – – – – – anticoagulant therapy on discharge from acute care (excluding those with contraindications). 5 Prevention of stroke Proportion of ischemic stroke inpatients who received carotid imaging. 74.8% (71.6%) 0.0–88.6% 90.4% (88.3%) Bluewater Health, Sarnia 7, 6 6 Acute stroke management Median door-to-needle time among patients who received acute thrombolytic therapy (tPA) 50.5 (62.5) 44.0–61.0 38.0 (33.0) Niagara Health System, Greater 4, 8 (minutes). Niagara § 7 Acute stroke management Proportion of ischemic stroke patients who received acute thrombolytic therapy (tPA). 12.3% (11.9%) 6.3–16.8% 17.3% (17.0%) South Etobicoke – Toronto Sub-LHIN 6, 14 § 8 8 Acute stroke management Proportion of stroke/TIA patients treated on a stroke unit at any time during their inpatient 3.3% (2.5%) 0.0–8.4% 72.3% (62.7%) Urban Guelph Sub-LHIN 3, 10 stay. 9 Acute stroke management Proportion of stroke (excluding TIA) patients with a documented initial dysphagia screening – – – – – performed during admission to acute care. § 10 Acute stroke management Proportion of ALC days to total length of stay in acute care. 16.7% (26.3%) 0.0–66.7% 8.2% (11.7%) Rouge Valley Health System, Ajax 3 § 11 Acute stroke management Proportion of acute stroke (excluding TIA) patients discharged from acute care and admitted 33.5% (37.2%) 27.5–41.1% 45.4% (46.3%) Manitoulin-Sudbury Sub-LHIN 9, 1 to inpatient rehabilitation. 12 Stroke rehabilitation Proportion of stroke (excluding TIA) patients discharged from acute care who received a referral – – – – – for outpatient rehabilitation. § 13 Stroke rehabilitation Median number of days between stroke (excluding TIA) onset and admission to stroke inpatient 10.0 (9.0) 7.0–16.0 6.0 (5.0) BH Sarnia, LH Oshawa, PRH, QHC 8, 9 rehabilitation. Belleville and SRHC9 14 Stroke rehabilitation Mean number of minutes per day of direct therapy that inpatient stroke rehabilitation patients – – – – – received. § 15 Stroke rehabilitation Proportion of inpatient stroke rehabilitation patients achieving RPG active length of stay target. 57.8% (54.4%) 56.0–65.2% 80.8% (76.6%) Bruyère Continuing Care Inc. 3, 8 16 Stroke rehabilitation Median FIM efficiency for moderate stroke in inpatient rehabilitation. 0.9 (0.8) 0.8–1.0 1.5 (1.3) Grand River Hospital Corp., Freeport 12, 3 17 Stroke rehabilitation Mean number of CCAC visits provided to stroke patients on discharge from inpatient acute care 5.8 (5.0) – 10.8 (8.6) South East CCAC 10, 13 or inpatient rehabilitation in 2013/14-2014/15. 18 Stroke rehabilitation Proportion of patients admitted to inpatient rehabilitation with severe strokes (RPG = 1100 39.8% (42.2%) 35.0–66.7% 58.7% (57.3%) Grand River Hospital Corp., Freeport 3 or 1110). § 19 Reintegration Proportion of stroke/TIA patients discharged from acute care to LTC/CCC (excluding patients 5.4% (6.3%) 2.3–11.0% 2.5% (2.8%) Urban Guelph Sub-LHIN None originating from LTC/CCC). § 20 Reintegration Age- and sex-adjusted readmission rate at 30 days for patients with stroke/TIA for all diagnoses 7.2 (7.4) 0.0–17.3 – – None (per 100 patients).
1 Performance below the 50th percentile. Hospital Service Accountability Agreement indicators, 2010/11 2 Performance at or above the 50th percentile and greater than 5% absolute/relative difference from the benchmark. – Data not available n/a = Not applicable § = Contribute to QBP performance 3 Benchmark achieved or performance within 5% absolute/relative difference from the benchmark. 4 Facility-based analysis (excluding indicators 1, 2, 7, 8, 11, 12 and 19) for patients aged 18–108. Indicators are based on CIHI data. Low rates are desired for indicators 2, 3, 6, 10, 13, 19 and 20. 5 Excludes sites or sub-LHINs with fewer than six patients. 6 Benchmarks were calculated using the ABC methodology (Weissman et al. J Eval Clin Pract. 1999; 5(3):269–81) on facility/sub-LHIN data; the 2013/14 benchmarks are displayed in brackets. 7 High performers include acute care institutions treating more than 100 stroke patients per year, rehabilitation facilities admitting more than 58 stroke patients per year, or sub-LHINs with at least 30 stroke patients per year. 8 Revised definition obtained through consensus with Ontario Stroke Network regional directors (February 2014). In 2012/13 there were 14 stroke units, in 2013/14 there were 16 stroke units, and in 2014/15 there were 21 stroke units. 9 High performers include Bluewater Health (BH) Sarnia site, Lakeridge Health (LH) Oshawa site, Pembroke Regional Hospital (PRH), Quinte Health Care (QHC) Belleville site, and Southlake Regional Health Centre (SRHC).
STROKE PROGRESS REPORT: SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK 2014/15 COMPARED TO 2011/12 – 2013/14
Progressing Well1 Progressing2 Not Progressing3 Data not available
LHIN Variance within LHIN5 Greatest Improvement6 Indicator Care Continuum FY 2014/15 2014/15 (2011/12) Indicator4 No. Category (previous 3- Min Max Sub-LHIN/Facility LHIN year average) 1 Public awareness and Proportion of stroke/TIA patients who arrived at the ED by ambulance. 56.3% (54.8%) 46.7% (39.7%) 61.6% (58.3%) Woodbridge (Vaughan) Sub-LHIN 3 patient education 2 Prevention of stroke Annual age- and sex-adjusted inpatient admission rate for stroke/TIA (per 1,000 population). 1.3 (1.3) 1.3 (1.3) 1.7 (1.7) Algoma Sub-LHIN None 3§ Prevention of stroke Risk-adjusted stroke/TIA mortality rate at 30 days (per 100 patients). 11.9 (14.9) 0.0 (0.0) 42.0 (24.9) North Bay Regional Health Centre 6, 2 4 Prevention of stroke Proportion of ischemic stroke/TIA patients with atrial fibrillation prescribed or recommended – – – – – anticoagulant therapy on discharge from acute care (excluding those with contraindications). 5 Prevention of stroke Proportion of ischemic stroke inpatients who received carotid imaging. 74.8% (65.9%) 0.0% (6.7%) 88.6% (86.7%) Brockville General Hospital 2, 12 6 Acute stroke management Median door-to-needle time among patients who received acute thrombolytic therapy (tPA) 50.5 (66.0‡) 44.0 (65.4‡) 61.0 (73.2‡) Royal Victoria Regional Health Centre 12 (minutes). 7§ Acute stroke management Proportion of ischemic stroke patients who received acute thrombolytic therapy (tPA). 12.3% (10.0%‡) 6.3% (2.0%‡) 16.8% (11.1%‡) Flamborough Sub-LHIN 2, 6 8§ Acute stroke management Proportion of stroke/TIA patients treated on a stroke unit7 at any time during their inpatient 3.3% (1.5%) 0.0% (0.0%) 8.4% (4.1%) Belleville Sub-LHIN 10, 3 stay. 9 Acute stroke management Proportion of stroke (excluding TIA) patients with a documented initial dysphagia screening – – – – – performed during admission to acute care. 10§ Acute stroke management Proportion of ALC days to total length of stay in acute care. 16.7% (24.5%) 0.0% (0.0%) 66.7% (67.8%) Rouge Valley Health System, Ajax None 11§ Acute stroke management Proportion of acute stroke (excluding TIA) patients discharged from acute care and admitted 33.5% (36.2%) 27.5% (26.8%) 41.1% (37.0%) Central York Region Sub-LHIN 8, 5 to inpatient rehabilitation. 12 Stroke rehabilitation Proportion of stroke (excluding TIA) patients discharged from acute care who received a referral – – – – – for outpatient rehabilitation. 13§ Stroke rehabilitation Median number of days between stroke (excluding TIA) onset and admission to stroke inpatient 10.0 (9.0) 7.0 (7.0) 16.0 (11.0) Grand River Hospital Corp., Freeport, 8, 3 rehabilitation. and Hamilton Health Sciences Corp., General Regional Rehab 14 Stroke rehabilitation Mean number of minutes per day of direct therapy that inpatient stroke rehabilitation patients – – – – – received. 15§ Stroke rehabilitation Proportion of inpatient stroke rehabilitation patients achieving RPG active length of stay target. 57.8% (51.9%) 56.0% (40.0%) 65.2% (75.0%) Bruyère Continuing Care Inc. 3, 8 16 Stroke rehabilitation Median FIM efficiency for moderate stroke in inpatient rehabilitation. 0.9 (0.9) 0.8 (0.8) 1.0 (1.7) Grand River Hospital Corp., Freeport 3, 12 17 Stroke rehabilitation Mean number of CCAC visits provided to stroke patients on discharge from inpatient acute care 5.8 (5.6) – – North East CCAC 13, 6 or inpatient rehabilitation in 2013/14-2014/15. 18 Stroke rehabilitation Proportion of patients admitted to inpatient rehabilitation with severe strokes (RPG = 1100 39.8% (41.2%) 35.0% (32.5%) 66.7% (62.5%) Providence Healthcare 8, 5 or 1110). 19§ Reintegration Proportion of stroke/TIA patients discharged from acute care to LTC/CCC (excluding patients 5.4% (5.6%) 2.3% (1.8%) 11.0% (13.7%) Dufferin County Sub-LHIN 3, 6, 10 originating from LTC/CCC). 20§ Reintegration Age- and sex-adjusted readmission rate at 30 days for patients with stroke/TIA for all diagnoses 7.2 (8.0) 0.0 (2.5) 17.3 (19.4) Peterborough Regional Health None (per 100 patients). Centre
1 Statistically significant improvement. Hospital Service Accountability Agreement indicators, 2010/11 2 Performance improving but not statistically significant. – Data not available n/a = Not applicable § = Contribute to QBP performance 3 No change or performance decline. 4 Facility-based analysis (excluding indicators 1, 2, 7, 8, 11, 12 and 19) for patients aged 18–108. Indicators are based on CIHI data unless otherwise specified. Low rates are desired for indicators 2, 3, 6, 10, 13, 19 and 20. 5 Excludes sites or sub-LHINs with fewer than six patients. 6 Greatest Improvement sites/sub-LHINs include acute care institutions treating more than 100 stroke patients per year, rehabilitation facilities admitting more than 58 stroke patients per year, or sub-LHINs with at least 30 stroke patients per year. 7 Revised definition obtained through consensus with Ontario Stroke Network regional directors (February 2014). In 2012/13 there were 14 stroke units, in 2013/14 there were 16 stroke units, and in 2014/15 there were 21 stroke units. ‡ Includes Ontario Stroke Audit data (2010/11 and/or 2012/13).
Agenda item 7.2 Report to the Board of Directors South West LHIN Report on Performance Scorecard & Ministry-LHIN Accountability Agreement Dashboard - 2015/16 Fourth Quarter
Meeting Date: June 21, 2016
Submitted By: Mark Brintnell, Senior Director, Performance and Accountability Jennifer McCullough, Performance Improvement Lead
Submitted To: Board of Directors Board Committee
Purpose: Information Decision
Purpose The purpose of this report is to highlight 2015/16 fourth quarter results against our 2013-16 Integrated Health Service Plan (IHSP) objectives and Ministry-LHIN Accountability Agreement (MLAA) performance obligations. Attached is the South West LHIN 2015/16 Q4 Report on Performance Scorecard, MLAA Scorecard and Interventions Report detailing how we are progressing against key metrics and associated actions.
Progress Update In the fourth quarter, the following intervention strategies were added or strengthened: The LHIN and St. Thomas Elgin General Hospital (STEGH) have established a plan to spread the evidence-based practice of scheduling post-discharge follow-up appointments as developed through the IDEAS (Improving & Driving Excellence Across Sectors) project. The Clinical Quality Table will propose to establish key standards for evidence- based care including this practice to better support transitions of care for patients with chronic conditions. 24/7 walk-in access to the Crisis Centre was launched to provide support for individuals with a mental health and/or addictions crisis in London. The LHIN began participating in the London-Middlesex Drug Strategy led by Public Health. Connecting Care to Home (CC2H)—a collaborative Integrated Funding Model project led by LHSC and CCAC—continued to enroll chronic obstructive pulmonary disorder (COPD) patients on a standardized care pathway, enabled by technology, and monitor results. For 32 patients enrolled to-date, this innovative project has demonstrated reduced Emergency Department visits, readmissions, and length of stay in hospital and is evolving toward implementation of an integrated funding bundle.
Report to the Board of Directors Page 2
Background The South West LHIN Strategy Map is the LHIN’s execution plan to achieve 2013-16 IHSP objectives. The Report on Performance (RoP) Scorecard shows a set of measures to track and report progress against three Big Dot outcome measures, twelve outcome indicators, and four key drivers or enabling strategies.
The MLAA outlines obligations and responsibilities of both the South West LHIN and the Ministry of Health and Long-Term Care (MOHLTC) and specifies indicators targeted for improvement. The 2015-2018 MLAA reflects alignment with the new government priorities and initiatives including the Patients First Action Plan for Health Care, and transformation activities including: Health System Funding Reform (HSFR), Health Links, Home and Community Care, Comprehensive Mental Health and Addictions Strategy, and Palliative Care.
The combined RoP and MLAA scorecard is updated and communicated quarterly to the Board, Health Service Provider Boards and to the public via the South West LHIN website. The accompanying Scorecard Interventions Report summarizes current strategies and programs targeting improvement in Report on Performance and MLAA scorecard indicators. In addition, the LHIN has the Report on Performance e-tool tracking over 36 metrics and showing comparative and drill-down information at the provincial, LHIN and provider levels. (Link to all performance tools).
Highlights of the 2015/16 Fourth Quarter Report on Performance Scorecard With data as recent as Q4 2015/16 now available for the Big Dots, noted progress includes: Big Dot 1 — 138 more clients saw their family health care provider within 7 days of discharge from hospital. Big Dot 2 —3759 Emergency Room (ER) revisits saved. Big Dot 3 — improvements have been realized by reducing the number of Alternate Level of Care (ALC) days in hospital, reducing readmissions, and improving the hospital length of stay for hip and knee surgeries for a combined total of 23,475 fewer days spent in hospital—or 23,475 hospital days saved—than the baseline rate. This exceeds the target of 17,000 days saved but as the ALC rate has recently climbed higher than the baseline rate, the cumulative days saved at quarter four are less than in previous quarters.
Indicators where current performance is an improvement over baseline: Rate of ER visits best managed elsewhere Percent of discharge summaries sent from hospital to community care provider within 48 hours ER revisits within 7 days Percent of clients seeing family health care provider within 7 days of discharge (from hospital) Hospital acquired infection rates (c. diff)
2
Report to the Board of Directors Page 3
Indicators where current performance is worse than baseline: Rate of ER visits resulting from falls Pressure ulcer related hospitalizations Timeliness of diagnostic services1 LHIN cost variance (HBAM hospitals) for acute/day surgery and ER ALC rate2
Note: Hospital readmission rate within 30 days for selected Case Mix Groups (CMGs) has not been updated this quarter.
Highlights of the 2015/16 Fourth Quarter MLAA Report: The South West LHIN has met the provincial target for the following MLAA indicators: ER length of stay (wait time) for complex patients and non-admitted minor uncomplicated patients ALC Rate Wait time (in days) for Community Care Access Centre (CCAC) in-home services (application from the community setting)
The South West LHIN is within 10% of meeting the provincial target for the following MLAA indicators: Percentage of home care patients with complex needs who received their first personal support visit within 5 days of authorization Percentage of home care patients who received their first nursing visit within 5 days of authorization Completing CT scans within the access targets Percentage of Alternate Level of Care (ALC) Days Repeat unscheduled ER visits within 30 days for substance abuse conditions Hospital readmission rate within 30 days for selected HIG Conditions
The South West LHIN’s performance is off by more than 10% of meeting the provincial target for the following MLAA indicators: Completing MRI scans within the access targets Completing hip or knee replacement surgeries within the access targets Repeat unscheduled ER visits within 30 days for mental health conditions
Next Steps 1. Work to develop a new suite of performance monitoring tools to follow and evaluate the outcomes and achievements made through the 2016-19 IHSP is underway. Mock-up
1 Though current MRI and CT wait time performance has declined from the IHSP baseline period (i.e. 4 quarter average prior to start of IHSP), current performance is better than the 2015/16 MLAA baseline value.
2 Current ALC rate is better than the IHSP target and, for consistency, the baseline has been updated to reflect the 2015/16 MLAA baseline period which is much lower than the original IHSP baseline and therefore requires even greater changes to match or improve.
3
Report to the Board of Directors Page 4
reports were reviewed by the Board in February and education is planned for LHIN staff, Board, and Health Service Providers over the summer and fall to align with a September launch.
2. Regular monitoring of measures by LHIN staff and quarterly strategic reviews by the internal LHIN Alignment Team with a focus on transitioning to the new 2016-19 IHSP priorities.
4
REPORT ON PERFORMANCE SCORECARD FOURTH QUARTER, 2015/16 Progress 1. Increasing the availability of family health care – 2. Reducing emergency room visits – 3. Increasing availability and access on Big to community supports for people— Our goal is that 745 more clients see their Our goal is to save 15,000 revisits to the big Dots: family health care provider within 7 days emergency department within 7 days. Our goal is to reduce 17,000 days spent dot of discharge from hospital 138 more clients in hospital over the next 3 years. and
big (for selected CMGs).
the
objectives Improve coordination and transitions of care for Increase the value of our health care system for the Improve access to family health care Drive safety through evidence‐based practice those most dependent on health services people we serve
achieving 2016
‐ 1. Reduce wait time to specialist from family 1. Reduce ER revisit rates within 7 days (per total 1. Reduce rate of ER visits resulting from falls (per 1. Increase timeliness of diagnostic services (percent within health care unscheduled emergency visits) 100,000 population aged 65 and over) target) home 2013
at Coming Soon Baseline:000 Baseline: 15.7 Baseline:1,434 Baseline:70.3
towards
IHSP Current: Current: 15.1 Current: 1,451 Current: 64.0 days
as work
Target: TBD Target: 14.9 Target: 1,362 Target:>80.0 will well
more
as
2. Reduce rate of ER visits best managed elsewhere 2. Reduce hospital readmission rate within 30 days for 2. Reduce pressure ulcer related hospitalizations 2. Reduce LHIN cost variance (HBAM hospitals) for (per 1,000 population aged 1‐74) selected CMGs (per 100 discharges for selected CMGs) (percent of all discharges) acute/day surgery and ER (actual/expected costs)
measures spending
Baseline:12.3 Baseline:16.8 Baseline: 0.47 Baseline:1.0/1.0 indicators
Current: 10.7 Current: 16.9 Current: 0.59 Current:1.0/1.0 these
people
Target: 11.1 Target: 16.0 Target: 0.45 Target:<=1.0 in
years,
3
result
performance 3. Increase percent of discharge summaries sent from 3. Increase percent of clients seeing family health care 3. Reduce hospital acquired infection rates (c diff) (per 3. Reduce ALC rate (per total inpatient days) next
hospital to community care provider within 48 hours provider within 7 days of discharge (from hospital) 1,000 patient days) will
the Baseline:22.9 Baseline:39.6 Baseline: 0.27 Baseline: 9.6
and
provincial Current:43.1* Current: 43.2 Current: 0.21 Current: 11.9
over
Target: 50.0 Target: 45.0 Target: 0 Target: 12.7 with
* HPHA data outcomes not available
Collectively aligned
is
South West LHIN Ontario
Increase the communication between Increase providers using Clinical Connect. Increase organizations using the ‘Regional Increase the proportion of key initiatives health care providers through SPIRE/HRM. Integrated Decision Support System’ (P4R, BSO, P4Q) meeting LHIN Experience
outcomes. (2015/16). Based Design criteria. Scorecard Baseline: 54% Baseline: 0 dot Current: 633/824 clinicians (77%) Current: 15,034/13,000 users Baseline: 0 active organizations Baseline: 0 The Current: 14/20 active organizations Current: 17/18 criteria met by early adopter programs South West LHIN - Ministry LHIN Accountability Agreement (MLAA) Performance Indicators - Q4 2015/16
Home and Community System Integration and Access % of Home Care Patients with Complex % of Home Care Patients with Complex 90th Percentile Wait Time 90th Percentile ED Length of 90th Percentile ED Length of Needs Who Received 1st Personal Needs Who Received 1st Personal Stay (hrs) for Non-Admitted Support Visit within 5 days of NursingVisit within 5 days of (Days) from community for Stay (hrs) for Complex Patients Authorization of Services Authorization of Services CCAC In-Home Services Minor Uncomplicated Patients 12 100% ↑ Better 100% ↑ Better 40 ↓ Better ↓ Better 6 ↓ Better
6 50% 50% 20 3
0 0% 0% 0 Q1 14/15 Q4 15/16 0 Q4 13/14 Q3 15/16 Q4 13/14 Q3 15/16 Q4 13/14 Q3 15/16 Q1 14/15 Q4 15/16 Baseline: 88.9% 15/16 Target: 95% Baseline: 92.5% 15/16 Target: 95% Baseline: 21 15/16 Target: 21 Baseline: 8.3 15/16 Target:8 Current: 8 Baseline: 3.6 15/16 Target: 4 Current: 87.41% Current: 92.79% Current: 21 Current: 3.78 System Integration and Access
% Priority II, III and IV Cases % Priority II, III and IV Cases % Priority II, III and IV Cases % Priority II, III and IV Cases % of Alternate Level of Care Completed Within Access Completed Within Access Completed Within Access Completed Within Access Days Target - MRI Target - CT Target - Hip Replacement Target - Knee Replacement ↓ Better 100% ↑ Better 100% 100% ↑ Better 20% 100% ↑ Better ↑ Better
50% 10% 50% 50% 50%
0% 0% 0% 0% 0% Q1 14/15 Q4 15/16 Q1 14/15 Q4 15/16 Q1 14/15 Q4 15/16 Q1 14/15 Q4 15/16 Q4 13/14 Q3 15/16 Baseline : 34% 15/16 Target: 90% Baseline : 77% 15/16 Target: 90% Baseline : 76% 15/16 Target: 90% Baseline : 77% 15/16 Target: 90% Baseline: 8.93% 15/16 Target: 9.46% Current: 37.74% Current: 83.69% Current: 67.175 Current: 69.80% Current: 9.48% System Integration and Access Sustainability and Quality Health and Wellness of Ontarians - Mental Health
Readmissions Within 30 days Repeat Unscheduled ER Visits Repeat Unscheduled ER Visits D ALC Rate for Selected HIG Grouper within 30 Days - Mental Health within 30 Days - Substance LEGEND Conditions Abuse 16% 20% ↓ Better 50% South West LHIN ↓ Better ↓Better 40% ↓Better Ontario
8% 10% 25% 20%
0% 0% 0% 0% Q4 13/14 Q3 15/16 Q4 13/14 Q3 15/16 Q1 14/15 Q4 15/16 Q3 14/15 Q2 15/16 Baseline: 19.62% 15/16 Target: 22.4% Baseline: 9.61% 15/16 Target: 12.7% Baseline: 16.74% 15/16 Target: 15.5% Baseline: 17.36% 15/16 Target: 16.3% Current: 23.71% Current: 11.86% Current: 16.05% Current: 17.9% South West LHIN Report on Performance Scorecard Interventions Q4 2015/16
yy Progress Report on Performance Scorecard Indicator or Against Key Current South West LHIN Interventions & Actions for Improvement MLAA Indicator Priorit MOHLTC Baseline? Improve Access to Family Healthcare Reduce wait time to specialist from family health care Information will not be publicly available for monitoring 2013‐16 IHSP. Reduce rate of ER visits best managed elsewhere (per Health Links: the LHIN continues to support and facilitate the development of six Health Links: Huron Perth, Improved 1,000 population aged 1‐74) London‐Middlesex, South Grey Bruce, North Grey Bruce, Oxford, and Elgin. Hospital Service Accountability Agreements (SAA) Reporting: Local obligation to encourage hospitals and Increase percent of discharge summaries sent from physicians to understand their critical role in connecting discharged patients to family health providers. Improved hospital to community provider within 48h Provincial IDEAs improvement interventions (STEGH & LHSC): spread targeted improvement ideas/learnings to ensure timely discharge summaries sent to primary care providers from hospital. Improve Coordination and Transitions of Care for Those Most Dependent on Health Services Partnering for Quality: Increase adoption of Advanced Access Scheduling through Primary Care Leads’ leadership, eHealth training and encouraging utilization of HQO resources. Quality improvement learning collaboratives that support best practices in managing chronic disease and Increase percent of clients seeing family health care Improved the use of information systems to enhance patient flow and care. provider within 7 days of discharge (from hospital) STEGH IDEAs – scheduling post‐discharge follow‐up appointments. Discharge planning toolkit and care planning for high users – to improve transitions and continuity of care for clients who have been discharged from hospital. Health Links: Care planning & process to define target population of high users – Health Link teams are Reduce emergency revisits within 7 days (per total Improved working to continually identify patients with ‘high care needs’ and develop care planning processes to unscheduled ER visits) improve their support in the community. Enhanced Community Capacity: Crisis Response & Transitional Case Management – Five stabilization beds Repeat Unscheduled Emergency Visits within 30 Days for and 24/7 walk‐in access to the Crisis Centre plus 24 hour crisis response and support by the Mobile Worse Mental Health Conditions Response Team provide short‐term support for individuals with a mental health and/or addictions crisis. Case Managers are supporting clients living with mental health and substance abuse conditions. Partners Wellness
&
also collaborating to develop a Coordinated Access model of care and Supportive Housing units will be Repeat Unscheduled Emergency Visits within 30 Days for expanded. Supporting local Drug Strategy and evaluating current state of sobering and withdrawal services. Worse Substance Abuse Conditions Focus on London Emergency Department Frequent Users: partners are working to identify gaps and Health improvement opportunities and connect patients with community services and supports. Reduce hospital readmission rate within 30 days for Health Links; Chronic Disease Prevention & Management; and Technology to Connect & Communicate: Not updated selected Case Mix Groups (CMGs) (per 100 discharges for care planning, telehomecare & processes to identify target population of high users, as above.
this quarter selected CMGs) South West LHIN Local Partnership Committee: QBP Implementation Assessment‐ to identify and promote cross‐provider sharing and collaboration related to reducing clinical practice variation, implementation of Quality
& Clinical Handbooks, and improved quality and cost efficiencies.
Sustainability Readmissions within 30 Days for Selected HIG Conditions Improved Connecting Care to Home (CC2H): ‐ A collaborative Integrated Funding Model project led by LHSC and CCAC caring for COPD patients on a standardized care pathway, enabled by technology. Drive Safety through Evidence‐based Practice South West LHIN Falls Prevention Program: Exercise and Falls Prevention classes ‐ evidence‐based Reduce rate of ER visits resulting from falls (per 100,000 Worse tools/protocols/training to screen, identify, manage and/or refer individuals to appropriate services, population aged 65 and older) implemented through Physiotherapy Reform.
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South West LHIN Report on Performance Scorecard Interventions Q4 2015/16
yy Progress Report on Performance Scorecard Indicator or Against Key Current South West LHIN Interventions & Actions for Improvement MLAA Indicator Priorit MOHLTC Baseline? Reduce pressure ulcer related hospitalizations (percent of South West Regional Wound Care Program: Engagement and partnership activities – broadening Worse all discharges) resources and toolkit availability to Long‐Term Care (LTC) Homes, community and hospital sectors. Reduce hospital acquired infection rates (c diff) (per 1,000 Hospital Service Accountability Agreements (SAA): Performance Management & Accountability ‐plans for Improved patient days) improvement reported following quarterly SAA reviews and in annual hospital Quality Improvement Plans. Increase the Value of Our Health Care System for the People We Serve Reduce LHIN cost variance (HBAM hospitals) for Health System Funding Reform (HSFR) Implementation: A focus on Quality Based Procedures (QBPs) and Worse acute/day surgery and ER (actual/expected costs) CCC/Rehab bed realignment has heightened awareness of need for efficiency improvements. Increase timeliness of diagnostic services (percent within MRI Performance Improvement Program (PIP) Scorecard: ongoing monitoring of key performance Worse target) (NOTE:different baseline than two measures below) indicators (access, timeliness, quality). The scorecard is helping to better understand referrals, demand, Percent of priority 2, 3,and 4 cases completed within complexity of cases and efficiency. Demand for this modality is increasing. Improved access target for MRI scans ED Pay for Results (P4R) & Knowledge Transfer Initiatives: Process improvement initiatives to realize gains Percent of priority 2, 3,and 4 cases completed within in cost avoidance. Improved Patient Flow: Working with a subgroup of leaders (hospital and CCAC) to prioritize improvement
access target for CT scans 90th percentile ER length of stay for complex (CTAS I‐III) opportunities and identify high impact solutions to improve patient flow in the South West LHIN. Improved patients Clinical Services Planning: Improved delivery of stroke, cataract, orthopaedic and endoscopy services. Access Surgical Wait List Management System Planning and Implementation: Pilot led by STEGH. Two sites in
& 90th percentile ER length of stay for non‐admitted minor Worse uncomplicated (CTAS IV‐V) patients Huron and Perth will also implement Novari. All South West hospitals have been engaged to understand Percent of priority 2, 3,and 4 cases completed within their readiness to undertake implementation. The CEO/CCAC leadership forum supports further expansion Worse access target for hip replacement across the South West. The system will assist with managing wait lists in surgeons’ offices, and will integrate with other systems such as hospital booking and the Wait Time Information System. Integration South West LHIN Orthopaedic Steering Committee: created to investigate quality improvement Percent of priority 2, 3,and 4 cases completed within opportunities, including hip and knee wait times. Worse System access target for knee replacement Hospital Service Accountability Agreements (SAA): Performance Management & Accountability – LHIN‐ driven analysis, and formal cross‐sector provider follow‐up for SAA performance indicators. Plans for improvement reported and tracked following quarterly reviews. Access to Care (Coordinated Access—Complex Continuing Care/Rehab, Assisted Living/ Supportive Reduce ALC rate (per total inpatient days) Worse Housing/ Adult Day Programs): Implementation of redesign recommendations to improve access to the right service at the right time by the right provider, including improved access to Assisted Living spaces. Percentage of Alternate Level of Care (ALC) Days Worse Access to Care (Home First): Completed Home First implementation across the South West LHIN including Percentage of home care patients with complex needs screening for potential high needs patients who frequent the emergency department and hospital and who who received their first personal support visit within 5d of Worse require complex discharge plans. Value for Money assessment confirmed positive impact of investments authorization made and that most practices have been sustained, including ALC reviews. Additional funding was provided to CCAC to continue to support sustainability of Home First outcomes.
Community Percentage of home care patients who received their first Improved
& Behavioral Supports Ontario (BSO): Implementing coordinated prevention, care and educational strategies nursing visit within 5d of authorization 90th Percentile Wait Time for CCAC In‐Home Services ‐ across sectors including hospitals, primary care, Alzheimer Societies, Long‐Term Care homes, CCAC and Same
Home Application from Community Setting to first CCAC Service community organizations. NOTES: 1. Interventions included in this report were limited to: a. interventions identified as having a primary alignment with the noted indicators, b. those that are happening now (implementation) or those that will be implemented within the next quarter. 2. Progress is measured as current quarter performance over established baseline for each of the indicators noted.
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