Table of Contents Transformational Leadership

Central East Local Health Integration Network CEO Report to the Board July 23, 2014

Table of Contents Transformational Leadership ...... 2 Health Service and System Integration ...... 2 Quality and Safety ...... 8 IHSP Strategic Aims ...... 9 Seniors ...... 10 Vascular Health ...... 11 Mental Health and Addictions ...... 13 Palliative Care ...... 15 Aboriginal Services ...... 17 French Language Services ...... 18 Enablers ...... 19 Improving Access to Primary Care ...... 19 Access and Wait Times – Including Emergency Department, Surgical and Diagnostic Services ...... 21 Fiscal Responsibility ...... 21 Hospital Sector ...... 23 Community Sector: ...... 30 Long-Term Care Sector ...... 30 Cross Sector ...... 31 Community Engagement ...... 32 Operations...... 35 Other Announcements ...... 35 Appendices ...... 37

Community First Keeping at the forefront, the health care needs of our current and future local residents, changing demographics, fiscal realities, Ontario’s Action Plan for Health and the LHIN Mission and Vision, the overarching Central East LHIN Integrated Health Services Plan (IHSP) and its strategic aims can be described as ‘Community First’. The following is a compilation of some of the major activities/events undertaken over the month of July in support of the Central East LHIN’s Strategic Directions;

Transformational Leadership: The Central East LHIN Board will lead the transformation of the health care system into a culture of interdependence.

Quality and Safety: Health care will be people-centred in safe environments of quality care.

Health Service and System Integration: Create an integrated system of care that is easily accessed, sustainable and achieves good outcomes.

Fiscal Responsibility: Resource investments in the Central East LHIN will be fiscally responsible and prudent.

Central East Local Health Integration Network CEO Report to the Board July 23, 2014

The Central East LHIN is working towards achievement of the Strategic Aims of the 2013-2016 Integrated Health Service Plan; 1. Reduce the demand for long-term care so that seniors spend 320,000 more days at home in their communities by 2016. 2. Continue to improve the vascular health of residents so they spend 25,000 more days at home in their communities by 2016. 3. Strengthen the system of supports for people with Mental Health and Addiction issues so they spend 15,000 more days at home in their communities by 2016. 4. Increase the number of palliative patients who die at home by choice and spend 12,000 more days in their communities by 2016.

Transformational Leadership The Central East LHIN Board will lead the transformation of the health care system into a culture of interdependence.

Life or Limb and Repatriation Policy: CritiCall Ontario (CCSO) is gathering information related to specialty services available at hospital sites across Ontario. This information is crucial to the multitude of services that Criticall provides to the hospitals across our province. The information currently resides within CritiCall Ontario’s Provincial Hospital Resource System (PHRS) and is crucial to many of the services that CritiCall Ontario provides to Ontario hospitals, including:

Case Facilitation: ensures CritiCall Ontario knows which hospitals to contact to assist physicians caring for urgent or emergently ill or injured patients, including Life or Limb cases which are time sensitive and may require patients to be transferred to the closest facility with the required services within four hours.

Crisis/Disaster Response: Ensures CritiCall Ontario knows where to decant or relocate patients affected by a crisis or disaster such as flood, fire, pandemic, etc.

Moderate Surge Response: Ensures CritiCall Ontario knows which hospitals to involve in a Moderate Surge Response Call.

Reports and Compliance Monitoring: Enables CritiCall Ontario to ensure the accuracy of its reports including H- SAA and Life or Limb Reports and issue performance monitoring letters when a required service is not available as per the PHRS inventory.

The information will be updated/revised as appropriate, given the responses. The Central East LHIN obtained updated information about the services and resources available at each of the LHIN hospitals. This information has been shared with CCSO. The GTA Life or Limb committee continues to meet on a regular basis to discuss issues related to life or limb patients. CCSO is planning LHIN-based town hall sessions for September/October 2014.

Housing and Homelessness Framework: Central East LHIN management has met three times with Service Managers from Durham, City of Kawartha Lakes/Haliburton, Northumberland and Peterborough. The objective of these meetings is to continue to share/learn and begin to identify opportunities for municipalities and the LHIN to develop a common Framework

to guide joint strategy development and eventually, investments. The impetus behind this initiative is alignment of LHIN and municipal priorities and implementation of strategies to address the shared interest of providing residents access to affordable, accessible housing with health supports. Health Service and System Integration The Central East LHIN organization will create an integrated system of care that is easily accessed, sustainable and achieves good outcomes.

Integrated Orthopaedic Capacity Plan (IOCP) – Implementation: Directional Plans have been submitted to the Central East LHIN by each of the three clusters. On May 13th, a presentation on the Directional Plans was given to the Central East Executive Committee (CEEC), following this, Central East LHIN staff finalized the responses to the three Orthopaedic Planning and Implementation Committees (OPICs). The responses will also provide an opportunity for all three OPICs to review the Directional Plans from all clusters.

The following is a summary of comments in response to the Directional Plans:  OPIC meetings and Directional Plans are a good start (especially for relationship building), but planning needs to be further developed;  Directional Plans have described some action items, responsibilities, timeframes and rationale, but plans need to consider all key system changes;  Detailed Project Plans/Terms of Reference need to be developed;  Standard regular reporting on progress of OPICs needs to be developed;  Common priorities need to be supported through a centralized oversight mechanism (i.e. LHIN or Advisory Committee);  Accountability for implementation of IOCP needs to be confirmed; and  OPICs’ need to proceed as planned considering feedback provided.

During the month of July, the LHIN staff are preparing the feedback from the Directional Plan to be sent specifically to all three clusters. The feedback will provide an opportunity for all three clusters to review the Directional Plans across the LHIN as we prepare to transition to the implementation phase of the IOCP.

Maternal Child Health: Advisory Committee On July 3rd, the Central East LHIN Maternal, Neonatal and Paediatric Advisory Committee met to receive updates on the current state of Physician Remuneration in the Central East LHIN, opportunities with the Sick Kids Paediatric Medicine Complex Care Clinics and provide feedback to the Rouge Valley Health System (RVHS)/The Scarborough Hospital (TSH) Maternal Child Youth Planning Process from their first meeting on June 18th 2014. The Advisory Committee also took the opportunity to discuss the outcomes of the site visit engagement sessions and provide recommendations on moving forward with the development of a strategic plan.

Paediatric Physician Remuneration Survey In April 2014, the Physician Remuneration Survey was disseminated to our hospital partners. The survey is being used to conduct an environmental scan to review remuneration models, call schedules, clinic hours, and service volumes by clinic as well as a number of other variables. Survey questions were related to the following three categories:  Physician Remuneration  Patient Volumes & Clinics  Benefits & Demographics

Central East LHIN staff conducted an analysis of the responses and presented to the Central East Executive Council (CEEC) on May 13, 2014. Staff are continuing to work with hospital partners to identify key issues, areas for action for quality improvement and review current physician subspecialties and determine any gaps for future need. Next steps include continuing to ensure that our hospital partners can provide an accessible and quality-driven paediatric service, equitably across the LHIN. Staff will be presenting the Paediatric Physician Remuneration Survey content to the Central East LHIN Maternal, Neonatal and Paediatric Advisory Committee for updates and feedback.

2014 RVHS-TSH Motion 1B Collaborative On March 27, 2013, the Central East LHIN passed the following motion: “…in partnership with the Rouge Valley Health System (RVHS), local stakeholders and physician leaders, The Scarborough Hospital (TSH) is to develop a Service Delivery Model for Maternal-Child- Youth (MCY) services (which includes obstetrics, neonates and paediatrics) for the Scarborough Cluster, as well as a plan for a LHIN regional program for advanced neonatal and paediatric care as recommended in the 2009 Hospital Clinical Services Plan and endorsed by the respective hospital boards at that time, with a report back to Central East LHIN Board in no more than 90 days.”

Building on the strong work accomplished in 2013, a collaborative interprofessional team – the RVHS-TSH Motion 1B Collaborative – has been established and includes staff, physicians, and midwives from RVHS and TSH, as well as representation from the Central East LHIN, health system partners and community members.

The group (Motion 1B Collaborative) will support the further development of an integrated service delivery model for maternal child youth services, which will include the formal establishment of a Central East LHIN-wide Center for Advanced-Level 2c Inpatient Neonatal and Paediatric Care.

An important part of this planning initiative is to share the work of the Collaborative with our broader stakeholder group and receive feedback. The first meeting of the working group took place on June 18th, where the following three objectives were achieved: 1. The Collaborative heard input from community members and family physicians (the ‘voice of the customer’) so that this input can inform how we describe our future shared vision. 2. The Collaborative drafted a shared vision for a new maternal child youth services model – “We will create a regional program of excellence, including advanced neonatal and paediatric care, renowned for delivering an integrated continuum of community and hospital services that exceeds expectations and delivers an outstanding patient and family experience. The system will continually evolve to use resources efficiently and effectively and instill confidence in our community to ensure that services are sustainable into the future.” 3. The Collaborative identified a draft list of performance metrics to monitor our progress toward the shared vision.

The group will meet again on August 13, 2014.

Health Links: Health Links Coordination and Oversight The Health Link Planning Teams meet together weekly to discuss the coordinated implementation strategy, physician engagement strategy, patient engagement strategy, timelines and communications for each of the four new Health Links. Expressions of Interest (EOIs) for four (4) new Health Links (HL) in the Central East LHIN (Haliburton County - City of Kawartha Lakes, Northumberland County, Scarborough North and Scarborough South) were distributed to health care providers on May 13, 2014 and completed EOIs were returned back by June 11, 2014. An initial meeting with Northumberland County Health Link partners was held on June 26th and well attended by a wide range of health care providers who worked to develop the Health Link

Readiness Assessment for submission to the Central East LHIN in July. Initial meetings for other Health Links are being held in late July 2014.

Durham North East Health Link (DNEHL) The Design Team and the Steering Committee last met in May 2014 and continue to move forward with the implementation of the project plan. The Coordinated Care Plan (CCP) Improvement Team and the Transitions Improvement Team have both begun small tests of change following quality improvement methodology and have reported early results to the Design Team for discussion and feedback. The CCP Improvement Team is currently testing the use of the CCP between the Canadian Mental Health Association – Durham (CMHA-D) and the Oshawa Community Health Centre for two (2) complex patients. This team is also planning an additional Plan, Do, Study, Act (PDSA) cycle testing on how a CCP would be transferred from a non-health information custodian to a health information custodian. This work is supported by the development of a peer-to-peer model for capturing patient stories during these PDSAs. The Transitions Improvement Team has gained insights from patients and hospital staff into the process for booking primary care follow up appointments in the hospital and are finalizing a future state map. Three physicians have been engaged in this process.

Peterborough Health Link (PHL) The PHL continues to move forward with the implementation of the following three (3) Improvement Teams:

Care Coordination Plan (CCP) Improvement Team – A total of 60 Care Plans are in progress. The CCP CECCAC Implementation is moving forward and the group is working to integrate CCP into internal business processes; and tools are being developed for Health Links 101 and CCP education. The CCP & Service Resolution Protocol for MH&A is being worked on and the Service Resolution Coordinator role has started. A Quality Improvement group has been established to enhance case findings and make process improvements.

The group will be developing a PHL CCP Implementation Team comprised of management to define organization roles and responsibilities within CCP work and processes between multi-agencies and transform current CCP improvement teams to support the implementation of CCPs, including multi-agency frontline staff members currently working on CCPs. Next steps include working with the IT working group to brainstorm solutions to reduce duplication of documentation for frontline providers. The implementation of the Health Quality Innovation Collaborative (HQIC) Yammer/eLinks is anticipated to act as a notification center, make CCP accessible to multiple providers and support collaborative conversation surrounding a patients care. The group will also be looking to form a communication and education implementation team to assist surrounding CCP work to support frontline providers in their CCP work.

Transitions Improvement Team The Transitions Improvement Team continues to work on quality improvement initiatives, and currently is on PDSA #5: the notification and follow-up appointment. Currently, Floor A4 (Medicine) at Peterborough Regional Health Centre (PRHC) continues to submit requests for booked follow-up appointments. Data was collected for a 10-week period and results indicate that 43% of the patients received a booked follow-up appointment with their Peterborough Family Health Team Primary Care Practitioner.

A Nurse Practitioner and Registered Nurse have been hired by Peterborough Primary Health Care Service FHT to act as a central point of contact to support the booked follow-up appointments. The FHT is to communicate to PRHC and PHL partners surrounding the start date of the process. The following two future opportunities have been identified as next steps to examine: Risk of Readmission & Medication Reconciliation.

Patient Engagement Plan The Patient Engagement working group continues to develop the PHL engagement strategy. A recommendation from Patients Canada is being reviewed by the working group. Patient and Provider Frequently Asked Questions (FAQs) have been completed. The Central East Community Care Access Centre (CCAC) volunteer application package has been modified. PHL will be linking with Durham North East Health Link to work on application and orientation packages for potential patient volunteers. Furthermore, PHL and Durham North East Health Link Patient Engagement working groups will be meeting via OTN to further enhance communications and relationships. Next steps include the development of a patient engagement framework to provide structure and guidance to patient engagement work and tools and processes to assist PHL partners and frontline staff in capturing patient stories. The group will be clarifying the roles and responsibilities for patient/caregiver involvement within PHL. They will be utilizing patient stories to assess and measure progress and explore possibilities of utilizing PHL and Durham North East Health Link volunteer management programs.

Community Health Services (CHS) Integration Strategy: Integration Planning Process in Haliburton County and City of Kawartha Lakes (CKL) On June 25, 2014, the Central East LHIN Board received a presentation on the integration planning in Haliburton County and the City of Kawartha Lakes. The Transition Plan was reviewed with a particular focus on the following two elements:

One Entity Haliburton County Integration – Voluntary merger between Community Care Haliburton County (CCHC) and Haliburton Highlands Health Services (HHHS) into one entity and the transfer of LHIN-funded services, currently being provided by Supportive Initiative for Residents in the County of Haliburton (SIRCH) and Victorian Order of Nurses (VON), to one entity.

An update was provided on the voluntary merger between Community Care Halliburton County (CCHC) and Halliburton Highlands Health Services (HHHS) into one entity, and the transfer of LHIN-funded services currently being provided by Supportive Initiative for Residents in the County of Haliburton (SIRCH) and Victoria Order of Nurses (VON) to the one entity. These initiatives are proceeding on course. In support of the Final Transition Plan, the Central East LHIN Board approved the following motions:

Be it resolved that the Central East LHIN Board of Directors has received the Haliburton County Health Services Transition Plan, outlining a plan for the transfer of Community Hospice services from Supportive Initiatives for Residents in the County of Haliburton (SIRCH) to Haliburton Highlands Health Services.

Be it further resolved that the Central East LHIN Board of Directors issue a minimum 60 day notice of termination of the 2104-17 Multi-Sector Service Accountability Agreement (M-SAA) with SIRCH in accordance with Article 12.1 (a) of the M-SAA.

Be it resolved that the Central East LHIN Board of Directors has received the Haliburton County Health Services Transition Plan, outlining a plan for the integration of Community Care Haliburton County Services with those of the Haliburton Highlands Health Services.

Be it further resolved that the Central East LHIN Board of Directors issue a minimum 60 day notice of termination of the 2014-17 Multi-Sector Service Accountability Agreement (M-SAA) with Community Care Haliburton County in accordance with Article 12.1 (a) of the M-SAA.

Confirmation of Two Entities in the City of Kawartha Lakes – The transition plan for the transfer of the VON-Acquired Brain Injury (ABI) Adult Day Services to Four Counties Brain Injury Association Transition was presented to the Central East LHIN Board on June 25, 2014. The benefits of this transition include aligning a specialized program with an organization that focuses on the needs of individuals with an acquired brain injury. In support of the transition plan, the Central East LHIN Board passed the following motions:

Be it resolved that the Central East LHIN Board of Directors has received the transition plan for the transfer of Acquired Brain Injury (ABI) Adult Day Service from Victoria Order of Nurses (VON) to Four County Brain Injury Association (FCBIA).

Be it further resolved that the Central East LHIN Board of Directors approve:  FCBIA receive a one-time funding allocation of $23,130 for the transitional integration expenses for the ABI Day Service from VON Canada.  VON – Canada – Ontario Branch receive one-time funding allocation of $1,600 for facilitation/consulting expenses related to the integration of ABI Day services with FCBIA.

In addition, an update was provided regarding the transition of the Adult Day Program from VON to Community Care City of Kawartha Lakes (CCCKL). The final transition plan will be presented to the Central East LHIN Board in September.

Northumberland County Implementation On June 25th, 2014, the Northumberland County Hospital and Community Health Services (CHS) Integration Transition Plan – Progress Report was presented to the Central East LHIN Board of Directors. High level progress updates focused on the following priority areas:  Rural Health Hub (Trent Hills) o CMH and CMML fully integrated back office services; currently looking at similar integrations between CCN and CMH.  Coordinated Approach for Assisted and Supportive Housing o Developing consistent service delivery models, as well as access and awareness to programs.  Legion Village and VON – Supportive Housing o Boards agreed that risks out-weighed benefits to system and therefore provided recommendation not to proceed.  Integrated Strategy for Hospice Palliative Care o Implemented common referral form, direct admission from community to CMH, providing consistent education and support materials for families.  Integrated Strategy for Diabetes o Working alongside the LHIN, developing integrated strategy for diabetes throughout Northumberland.  Port Hope CHC & NHH Strategic Alliance o Identified opportunities for improve patient services include; IT connectivity for Port Hope CHC and NHH Information.  Integrated Information Technology Capacity o Have completed assessment of current state and identification of what information needs to be exchanged.  Transformation Council o Council has been meeting twice per month since March.

The Board deferred discussions/motions regarding next steps until July 23, 2014, where all CHS Integration Teams will have the opportunity to highlight action items/next steps and requests for Board endorsement.

Durham Cluster CHS Integration Strategy a) Durham Hospice and Victorian Order of Nurses (VON) Central East LHIN staff met with staff and Board members of VON and Durham Hospice. It was expected that the Integration Implementation Plan would be submitted for staff review in early-July with significant due diligence being undertaken by both parties. Recent correspondence addressed to the Central East LHIN indicated that the Board of Directors of Durham Hospice decided to indefinitely suspend further discussions with VON concerning the integration. Staff will be consulting with both parties in the coming weeks to further understand the decision to not proceed with the integration.

b) Oshawa Community Health Centre (CHC) and The Youth Centre The Central East LHIN has received the decisions of The Youth Centre and the Oshawa Community Health Centre Boards. A meeting was scheduled with the Chairs and Executive Directors for July 14th to discuss the LHIN Management analysis for next steps.

Scarborough Cluster CHS Integration Strategy The Governor Liaisons received an update from the Integration Planning Team on June 19, 2014 where the Final Integration Plan was presented and reviewed prior to the full Boards from each organizations receiving the plan for approval.

Feedback from those in attendance was well received on the recommended key elements and components of the Final Integration Plan and the Integration Planning Team members took the opportunity to discuss expectations and confirm the next steps and future direction on the key elements of the Plan which includes the following:

 Best Practices Committee  Standard Intake and Referral Task Group  Procurement of Supplies  Volunteer Recruitment and Training

The Health Service Provider Integration Planning Team Boards will be reviewing the Plan and tabling the elements for approval in July, this item will be presented to the Central East LHIN Board on July 23, 2014.

Peterborough City/County CHS Integration Strategy On June 25th, 2014, the Peterborough CHS Integration IPT presented their Final Integration Plan to the Central East LHIN Board of Directors. The following motions were passed during the meeting:

Be it resolved that the Central East LHIN Board of Directors receives the Peterborough City and County CHS Integration Plan and acknowledges the foundation created for integration and the significant effort made by IPT members and their Governors

Be it resolved that the Central East LHIN Board endorses the creation of a Peterborough City and County Community Health Services (CHS) Leadership Council

Be it resolved that the Central East LHIN Board of Directors defers the decision on the remaining key elements of the Plan including request for one-time funding to July 23rd, 2014 to support a due diligence review by the LHIN management regarding common elements across the CHS Plans and resourcing requirements

Staff Recommendations for Community Health Services Integration Strategy With monetary requests and some similarities across all plans (e.g. Project Management), the Central East LHIN Board asked staff to look across the plans and come back to the July 23rd, 2014 meeting with recommendations. LHIN staff, during the month of July, will prepare a recommendation for the Board by reviewing the requests for resources across all the plans: Northumberland, Peterborough, Durham and Scarborough for the Board’s consideration.

Quality and Safety Health care will be people-centred in safe environments of quality care.

Behavioural Supports Ontario (BSO) Program: 1. Long Term Care: Redesign of the key supporting tool, the Behavioural Assessment Tool (BAT) for the long-term care homes continued in June and July through stakeholder engagement in five (5) Kaizen workshops. The workshops were attended by over 200 participants; and two (2) focus groups attended by 33 frontline staff and members of the Integrated Care Team. Work will continue through July and August to test and validate the revised tool with expected implementation in September through October 2014.

A Masters of Public Health student completing a practicum with the Central East LHIN is conducting a survey with Phase 2 Long-Term Care Homes to evaluate perceptions of the BSO program. The survey was sent to 56 homes by July 5, 2014 with a return date of July 25, 2014. The analysis and final report will be completed in August 2014.

2. Metrics and Evaluation: The metrics submission rate for Long-Term Care Homes (LTCHs) for May was 87% (60 of 69 homes). It is anticipated that this number will increase with the June submissions as the homes become accustomed to the new reporting template. The metrics analysis of 2013/2014 LTCH data is underway and will be completed in July.

3. Training and Education: The BSO Education committee is evaluating the inclusion of a course developed by the Toronto Regional Geriatric Program (RGP), titled Building a Behaviour Support Resource Team, to the BSO curriculum. The course will be reviewed for suitability and alignment to the Central East BSO framework in July.

4. Community: The BSO Community Practitioner Role Development Committee continued to expand membership with now four BSO clinicians hired and Psychogeriatric Resource Consultant joining the committee. Work on defining the current state for responding to behaviours in the community and beginning to develop a future state is well underway. Discussion on establishing an early set of indicators to support program measurement and evaluation from the onset has been initiated. The committee continued its work on developing what is required for staff orientation and ongoing training, sample activity plans, toolkits and supporting educational materials, tools (e.g. BAT, P.I.E.C.E.S.), and quality improvement elements. Early spread activity included a BSO client case study shared by the Port Hope CHC community team at the GAIN Grand Rounds.

IHSP Strategic Aims

Seniors Seniors Care Network (formerly RSGS) - Capacity Building in Specialized Geriatrics Services: The Seniors Care Network Regional Conference took place on June 12th, 2014. Over 170 participants attended the event. The former visual identity and brand of ‘Regional Specialized Geriatric Services (RSGS)’ was officially change from RSGS to the ‘Seniors Care Network’. The Seniors Care Network recently participated in the Centre for Excellence (COE) in Dementia Care Roundtable on June 13th, 2014 at Ontario Shores Centre for Mental Health Sciences. A call for participants has been circulated, asking for volunteers who will help contribute to the development of a Request for Proposal for a new curriculum for an orientation covering a comprehensive geriatric assessment (CGA) to be used by GAIN. The GAIN Team Leads have been working with the Seniors Care Network to plan and initiate an evaluation of team function using the Regional Geriatric Program’s (RGP) Dimensions of Teamwork (DTEAM) survey tool.

Geriatric Assessment and Intervention Network (GAIN) Community Teams: The GAIN strategy made significant design and implementation advancements in June and July. With much system design well advanced, including a now well-developed set of Operating Principles, a shift in the group structure supporting design development was made. Three of the four design working groups (Engagement, Assessment, and Integrated Care Plan) are to be disbanded as GAIN moves away from the broad-based design phase it was in, to focus on specific design tasks needed to refine the operating principles and focus on the issue of implementation.

The Metrics, Monitoring and Evaluation working group reviewed over a hundred possible indicators, eventually reducing the recommended number to be collected to fifteen. These indicators are to be reviewed and approved by the Operations, Performance and Sustainability Committee (OPS).

The Cluster Groups will formalize their work beyond the initial implementation and create cluster-specific terms of reference. The focus at the cluster-level is continued to focus on knowledge transfer between hospital and community team, installing intake and information sharing processes and protocols, avoid intake duplication, beginning to formalize clinical supervision, and in particular clinical reviews of Comprehensive Geriatric Assessments (three of the six community teams are now conducting).

The community teams are actively engaging and providing care to clients/patients. Current client volumes range from 20 to 70 people. On average, the teams are indicating that about 25-30% of these clients will be suitable (sufficiently complex and in need of frequent intervention) for enrollment in Intensive Case Management (ICM). Organizations are looking to have their Care Coordinator in place (estimated start date late July), before formally enrolling the ICM clients.

The BSO Community Practitioner Role Development Committee continued to expand membership Work on defining the current state for responding to behaviours in the community and beginning to develop a future state is well underway. Discussion on establishing an early set of indicators to support program measurement and evaluation from the onset has been initiated. The committee continued its work on developing what is required for staff orientation and ongoing training.

The GAIN Communication Plan was finalized and includes: detailed background descriptors, a summary communication strategy, key messages, identified stakeholders, communication goals and objectives mapped to various target audiences, and a template for the roll-out of various communication tactics/tools (to be completed regularly by the GAIN Teams, Central East LHIN, CECCAC, and the Seniors Care Network). Supporting the teams in meeting the Plan’s goals and objectives is a package complete with: Communication

Package Cover Note, Launch Sample Media Release, Local Media E-mail Message, Fact Sheet for HSPs, Fact Sheet for Seniors and Caregivers, Key Messages and Questions and Answers.

Geriatric Emergency Management: A work plan has been developed and the Geriatric Emergency Management Metrics Working Group has been meeting bi-weekly in order to complete this work plan. A large number of potential indicators have been identified and the Working Group is currently employing a decision matrix to select potential metrics that will be used by all GEMs in the Central East. It is anticipated that a set of draft metrics will be brought back to the CE GEM Network Group by the end of September 2014 for approval. The group will also steer customization of the CE GEM software package once the new CE GEM metrics have been identified to enable standardized data collection from GEM nurses across the region.

Senior Friendly Hospital (SFH) Strategy: A Senior Friendly Hospital media release for Seniors' Month was developed and distributed to each hospital in the Central East LHIN to assist hospitals with discussing their senior friendly practices.

The Ontario Senior Friendly Hospital Provincial Leads Steering Committee met on June 18th , 2014. The discussions included an update on the SFH provincial project, MOHLTC’s Health System Research Fund Capacity Award, SFH Environmental Scan Refresh, the inaugural SFH Newsletter and updates from each LHIN / other SFH provincial leads on recent initiatives related to SFH.

The first meeting of the Advisory Committee for the Capacity Award - Senior Friendly Hospital Advanced Leadership Training Program was conducted on June 18th , 2014. An overview of the Terms of Reference and work plan was provided. The members provided feedback on the draft curriculum. The first meeting of the provincial Senior Friendly Hospital Environmental Refresh Working Group was conducted on June 2nd , 2014. A draft Senior Friendly Hospital Self-Assessment Template 2014-15 was reviewed. It is anticipated that the document will be ready for distribution to the hospitals in August 2014 with an October completion date. The Seniors Care Network continues to participate as an active member on the following provincial committees:

 Ontario Senior Friendly Hospital Strategy Provincial Leads Steering Committee;  Senior Friendly Hospital Capacity Grant Planning Team;  Advisory Committee for Capacity Award - Senior Friendly Hospital Advanced Leadership Training Program;  Senior Friendly Hospital Indicator Pilot Subworking Group; and  Senior Friendly Hospital Environmental Refresh Working Group.

Vascular Health Vascular Health Strategic Aim Coalition: The Coalition members were pleased to welcome new Co-Chair, Dr. Joseph Ricci who is the Program Chief, Cardiac Care at Rouge Valley Health System. Dr. Ricci was previously a long standing member of the Coalition and brings extensive vascular and system expertise to the table. The Coalition has also added a very important piece to the membership, Mr. Ken McCaw. Mr. McCaw is our designated patient representative, who will help ensure the patient’s perspective is added to the LHIN-wide work of an integrated, seamless and coordinated health system. We recognize the challenges and barriers patients’ face while accessing services and this perspective will provide additional opportunities for improvement.

The meeting objectives included presentation, updates and next steps in regards to:  Centralized Diabetes Intake and Centre for Complex Diabetes Care  Central East Self- Management

 Overview of the Vascular Health Care Pathway  Ontario Renal Network  Telehome Care

The next meeting is scheduled for October 2014, where a review of the priorities and our outcomes to dates will be presented.

Stroke Quality-Based Procedure (QBP): The Stroke Quality Based Procedure (QBP) planning process continues to make progress on building structures to support collaborative and appropriate engagement for decision-making on stroke QBP options which include:  Final approval from the Health System Funding Reform-Local Partnership on the decision making framework criteria; and  Using the conceptual models of stroke care delivery for each cluster to weight and rate prior to determining which facility would be most appropriate to do what service.

Next steps includes training the hospital delegates on the weighting tool, submission of their criteria to be collated based on rating tool, presentation of rating the options against the criteria and the LHIN creation of a data package.

Diabetes: Diabetes Reporting To promote and add incentives for quality improvements in coordinating diabetes care across the region, the Central East LHIN has used six sigma principles to create target amendments. A regional meeting with all Diabetes Education Programs is being planned to negotiate the amended targets and staff will be working with each program on local quality improvements within each cluster.

Diabetes Quality Improvement Plans (QIP) The Scarborough DEP cluster continues to meet bi-weekly to develop process improvements and monitoring of changes identified in 2013/14 Quality Improvement Plans. The four areas reported monthly to the LHIN include:

 Communications with referring parties;  Enhancing collaboration initiatives;  Metrics on re-referral patterns within the cluster and caseload changes; and  Development and utility of a patient experience survey to consolidate best-quality health outcomes.

The group will continue to present these updates to the LHIN with an expectation of ongoing evaluation and appropriate action plans for identifying opportunities for improved coordination of care amongst the programs. A similar process is to be completed with the Durham and North East clusters in the coming months.

Centralized Diabetes Intake (CDI) and Regional Cardiac Care Program: A new initiative is being implemented to integrate the Regional Cardiac Care Program with Centralized Diabetes Intake (CDI) to increase access and streamline referrals. A Value Stream Mapping event was arranged with all key front line providers and coordinators. An action plan identifying trigger points to refer to each program centrally was developed and a patient experience survey revealing patient values that the quality improvements will be built on was created. In July and August, staff will be identifying a small cohort of people who flow through both intakes and who qualify for services for the other and categorize metrics to capture value-add for patients, leading to streamlined service access for people within the Central East LHIN.

Centralized Diabetes Intake (CDI) Working Group The CDI working group met this month to discuss and finalize the evaluation and feedback survey. This survey will be targeted to key stakeholders, such as primary care physicians, Diabetes Education Program staff and patients who have used the CDI service. This will provide opportunities for improvement to the service as well as the ability to identify the effectiveness and efficiency of CDI. Many efforts will continue to be made to utilize this service to set the criteria and meet the Ministry of Health funding expectations. A memo was distributed to Primary Care physicians across the Central East LHIN that informed them of the benefits of the service and how to access and use CDI. The working group has scheduled their next meeting for September 2014.

Centre for Complex Diabetes Care (CCDC) In May 2014 a total of 29 new CCDC patient referrals were received and assessed by the Central East CCAC for the three care delivery sites: Lakeridge Health, Peterborough Regional Health Centre and The Scarborough Hospital. This adds to the 567 active patients at the end of Q4 (March 31, 2014). The Ministry is placing a strong emphasis on data collection and plans site visits to all CCDCs in the province this summer to review gaps and expectations.

Mental Health and Addictions Implementation Strategy for the Central East LHIN’s Mental Health and Addiction Strategic Aim: The Central East LHIN Mental Health and Addictions Coordinating Council met for its inaugural meeting on Friday, June 20, 2014. The meeting was chaired by Dr. Ian Dawe of Ontario Shores. Brent Robinson, who is a Community Service Provider Representative from The Youth Centre, was elected as the Council Co-Chair. The Council accepted the draft Terms of Reference with some revisions. Presentations were received from each of the Priority Projects, which include “ACTT Now” (Implementation of ACTT Quality Improvement and “Step Down” model recommendations; Paediatric and Adolescent Hospital-Based Psychiatric Services Recommendation Implementation Plan; and Community Crisis Review Project. The Council will also monitor the Hospital-to-Home Strategy and Evaluation as well as the Opiate Strategy Evaluation. The Council will meet on a quarterly basis, with the next meeting scheduled to take place on September 30th , 2014.

Central East LHIN Strategic Coordinating Council: Membership List as of July 11, 2014: Member Current Role Affiliation and Project End Date (if applicable) Priority Project Lead: ACTT Steering Committee Lead. Central East LHIN Priority Project: Assertive Community ACTT NOW Project. Treatment Team (ACTT): Project Concludes as of March 31, Scott Pepin, Director MH: 2015 CMH and NHH Service Users: Mark Individuals residing in the Central East Service Users and their Supporters. Graham, ED CMHA LHIN who self-identify as having either HKPR, Kim English, Trent “Lived Experience” or experience as a University supporter of a person who is dealing with either a Mental Health and/or Addictions issue. Priority Project Lead: Child Child and Adolescent Hospital Based Central East LHIN Priority Project: and Adolescent Hospital Psychiatric Services Project Steering Child and Adolescent Hospital Based Based Psychiatric Service Committee Co-Lead Psychiatric Services Project. Project:1: Sheila Project Concludes as of March 31, Neuberger, VP Clinical 2015 Services, Ontario Shores

Priority Project Lead: DMHS and CMHA HKPR with PM Central East LHIN Priority Project: Community Crisis Review : support housed at Ontario Shores. Community Crisis Review Partnership between Project Manager has been hired and Project Concludes as of March 31, Durham Mental Health will be in place as of May 5, 2014. 2015 Services and CMHA HKPR These organizations will provide the These Leads are at the Council Council Member who will represent this Table in other capacities, and will project. need to decide if they require alternate representation. Addictions Service Provider: Health Care Provider who receives Addictions Services Provider. Donna Rogers, ED funding from the Central East LHIN to FOURCAST provide Addiction Services in the Northeast Cluster Community Based Service Community-based Health Care Central East LHIN Mental Health Providers: Rob Adams, Providers who provide Mental Health and/or Addiction Services Provider. ED, DMHS and Brent and/or Addiction Service and receive Robinson, The Youth funding from the Central East LHIN. Centre, Central East MH&A A member of the Central East MH&A MH&A Network in the Central East Network Susan Engels Network who is elected by the members LHIN. of that organization to serve on the Council. Hermann Amon, The Entity 4, (Francophone) Entity 4 Francophone Entity4

Hospital Based Service Hospitals offering Mental Health and/or Hospital based Mental Health and/or Providers: Paul McGary, Addiction Services who receive funding Addictions Service Provider. Director MH and the from the Central East LHIN. Pinewood Centre, LH, Thomas Jones, Manager, MH Services at HHH and RMH Primary Care Professional who offers Primary Health Primary Care Providers. Representative: Leanne Care Services within the Central East Kerr TYC CHC LHIN. This member is a Physician. Central East LHIN Central East LHIN MH&A Physician Central East LHIN. Physician Lead: Dr. Ian Lead. Dawe Central East LHIN Staff: MH&A Lead. Central East LHIN. Jai Mills

Community Crisis Review Priority Project: The Community Crisis Review Priority Project is a comprehensive scan of the Community Crisis System throughout the Central East LHIN. This project will include an analysis of the Current State, Best Practices and recommendations for improvement. The guiding premise is that a strong Community Crisis system provides a viable alternative to Emergency Room visits for people who are experiencing a Mental Health and/or Addictions Crisis.

The Business Case submitted jointly by the Canadian Mental Health Association, HKPR and Durham Mental Health Services has been approved. With a Project Manager in place, the Leads have been working to form the

Steering Committee for the project and the Steering Committee will be meeting on a regular basis throughout July.

Assertive Community Treatment Team (ACTT) Value Stream Mapping (VSM): The Assertive Community Treatment Teams (ACTT) provide intensive services to people with a diagnosed serious mental health issue that can also include a Concurrent Disorder. In FY 2011/12, a Value Stream Mapping exercise provided a series of recommendations to improve patient access and flow. One component of these recommendations included the implementation of a “Step Down” service, that would transition existing ACTT clients to a less intensive model of care, while still maintaining their connection to the team. The implementation of this model not only provides for an improved client experience, but it allows ACTT to take on an additional 20-25 high intensity clients per year.

The “ACTT Now” Project has been moving forward with monthly Steering Committee meetings. The Teams have been working to fully implement the “Step Down” model and the recommendations that arose from the first phase of the project. A report providing the actual number of clients who have been transitioned to the “Step Down” component of ACTT will be available to the Board in the September 2014 CEO Report.

Child and Adolescent Hospital-Based Psychiatric Services: The aim of the Child and Adolescent Hospital-Based Psychiatric Services Project is to implement the recommendations of the Central East LHIN Clinical Services Plan (2008/09) as they relate to child and adolescent hospital based psychiatric services. The current aim of this project is to implement the improvements developed in the earlier stages of the project that will standardize the system and ensure care is available closer to home.

The project is moving forward to develop an Implementation Plan for the recommendations developed during its first phase. The Implementation Plan will be submitted to the Central East LHIN by March 31, 2015.

Home First @ Ontario Shores: Home First continues to work well at Ontario Shores. In addition to this specific strategy, Community Mental Health and Addictions Service Providers, Central East LHIN staff and staff of the CECCAC have been meeting in order to explore opportunities for collaboration. It is anticipated that as new working relationships are developed, there will be increased housing and community support opportunities for people who are declared ALC in hospital due to a Mental Health or Addictions issue. Often these ALC designations are due to a lack of appropriate community supports and housing that will be appropriate to those with very complex needs.

Palliative Care Provincial Hospice Palliative Care Data and Performance Subcommittee: The Provincial Data and Performance Subcommittee came together for another full day face to face discussion on June 26, 2014 at the Michener Institute for Health Sciences. During these discussion participants:

 Reviewed Data and Performance Year 1 Deliverables and Progress to Date;  Highlighted supplementary research aligned with Data and Performance deliverables including Health System Performance Research Network (HSPRN) Palliative Applied Health Research Questions #1 and #2;  Reviewed Patient and Caregiver Experience Working Group discussions, as well as reviewed an overview presentation by the Caregiver Voice Survey; and  Discussed the Technical Specifications Working Group document and identified concepts.

Meeting outcomes and next steps included:  Patient and Caregiver Experience Working Group to update presentation with additional information in order to be presented to the Provincial Steering Committee;  Technical Working Group to revise Specifications document and concepts based on discussions;  Subcommittee to identify and rank five (5) top priority concepts, moving forward; and  Cancer Care Ontario and Central East LHIN representatives to draft and share Year Two Subcommittee deliverables based on discussions and send out to Subcommittee for feedback.

Central East Hospice Palliative Care Network (CEHPCN): Network representatives continue to move forward with identified next steps as highlighted in the Regional Palliative Plan. This includes the following high level updates to be further discussed during the July 8, 2014 CEHPCN meeting:

 Establishment of LHIN-Wide Palliative Communication Plan Network Coordinator and LHIN Communications Lead continue to draft a Shared CEHPCN Communications and Community Engagement Plan to guide roll out and implementation of the Regional Palliative Plan, as approved by the Board of the Central East LHIN in April 2014.  Enhance HPC Education and Training Opportunities The Central East Hospice Palliative Care Education Working Group continues to review current and future palliative interprofessional and physician course offerings. Based on the latter, the Working Group aims to draft recommendations and next steps regarding enhancements in education and training opportunities, to be presented to the LHIN.  Creation of Hospice Hub Programs The Central East Community Hospice Working Group is currently drafting an environmental scan identifying all visiting hospices services, allocated funding and identified gaps. This information will support the development of a functional plan, complete with recommendations to the LHIN regarding common baskets of services.  Dedicated Interprofessional Palliative Community Teams The Central East CCAC Community Palliative Care Nurse Practitioner and CEHPCN Vice-Chair, Franzis Henke has been identified as the Network representative leading this recommendation. As a next step, the Network coordinator and Vice Chair are drafting high level “guidelines” to support consistent implementation of Palliative Care Teams based on current best practice, local initiatives and established programs. These “guidelines” will help director a standard set of LHIN criteria/expectations regarding the establishment of formal teams, for example: o Physician Lead Support o Care Coordinator/Navigator with clinical background o Interdisciplinary team approach (i.e. pharmacy support, personal support workers, hospice volunteers, Palliative Pain and Symptom Management Consultants (PPSMCs), Visiting Hospice etc.) o Consistent communication and collaboration with the Central East CCAC Community Palliative Care Nurse Practitioner Care Program, the Central East Cancer Regional Cancer Care Program and local GAIN Clinics/Community Teams o Patients/Client 24-7 access to a health provider o Health providers 24-7 access to a palliative care expert

The Coordinator and Vice Chair have also identified a number of community based initiatives/collaboratives currently underway, that have either expressed readiness and/or interest, in supporting formal palliative teams. These groups are collaborating with local hospitals, visiting

hospices, the CCAC (including Nurse Practitioner Teams, other services), primary care, as well as other key players. High level updates include: o Trent Hills Palliative Collaborative is supporting high level discussions regarding community/hospital based palliative care teams and linkages with the local GAIN Clinic/Community Teams o Scarborough Hospice Integration Project Team is supporting discussions surrounding establishment of a palliative community teams and development of a care coordinator/navigator position

Residential Hospice- Hospice Peterborough: In early July 2014, Hospice Peterborough provided an update on their Residential Hospice Planning. The following highlights were provided:  Current Status, Analysis and Planning – With the launch of the capital campaign in February 2014, a Request for Proposal was developed to advance Communication strategies for the campaign. In June 2014, a presentation was given on the campaign at the Annual General Meeting of Hospice Peterborough to broaden recruitment of volunteers and engagement.

 Future State and Next Steps – Summer/Fall 2014 – A Quiet phase of campaign continues with approach to upper tier donors underway. Hospice Peterborough will continue to participate in Hospice Palliative Care Ontario’s Residential Hospice Working Group to ensure the design and model of care meet all provincial standards.

 Risks/Challenges – include the capacity of the organization to meet growing demand for services, especially when awareness increases during the campaign.

 Benefits identified – Hospice Peterborough Care Centre will provide the community with infrastructure to respond to priority recommendations identified in the Central East LHIN Regional Palliative Plan. The establishment of a residential hospice will support increases in the number of people who receive hospice palliative care in the community and will offer an alternative to a hospital death for approximately 250 families each year. Hospice Peterborough has a strong board and staff plus a large pool of volunteers possessing a wide range of skills to support this project as well as the current and future operations of the organization. The Capital Campaign is to be financed through Hospice Peterborough funds, support from the Ontario Trillium Foundation and fundraising dollars

Palliative Education: The Central East CCAC and LHIN have submitted a College of Family Physicians of Canada (CFPC) Mainpro-C Accreditation Application. This application must be completed every 18 months in order to support physicians to receive Mainpro C credits upon completion of a LEAP course. The application has been submitted, payment has been received and the CFPC Lead Facilitator has confirmed. As such, the CFPC will now commence their review and advise of its status over the next few weeks. Once approved, the LHIN will commence coordination of its next LEAP course to be offered in the Scarborough Region, by facilitator Dr. Rahim Abdulhussein.

. Aboriginal Services

Métis, Non-Status and Inuit Health Advisory Circle: The Métis, Non-Status, Inuit Circle has welcomed a new member, Marian Vella of Oshawa. Marian is an Elder and a welcomed addition to the Circle. The Circle is scheduled to meet on July 7th , 2014.

First Nations (FN) Health Advisory Circle: The Central East LHIN First Nations Health Advisory Circle met at the Hiawatha First Nation on June 12th, 2014. The meeting was well attended. Circle Members were very interested in the processes of the Central East LHIN and the upcoming development of the next Integrated Health Service Plan (IHSP) (2016-19). The Curve Lake First Nation is preparing a call for Expressions of Interest to review their Elder Programs. They are working on a Strategy to enhance their Elder Services. This includes the potential of a Long Term Care Home that would serve Curve Lake and other communities. The Circle will meet again at the Scugog First Nation on September 11th, 2014.

Ontario Telemedicine Network (OTN) Capacity for First Nations: The Alderville, Scugog and Curve Lake First Nations have had their OTN equipment installed. They are continuing to train staff. The machines and services are not operational as of yet. It is hoped that the training will be completed soon. Completing the training is challenging, as this takes staff away from their front-line duties. Therefore, as the training is very detailed, it is taking some time to complete.

Mental Health and Addictions: Members of both Central East LHIN Aboriginal Advisory Circles met with Mental Health and Addictions Service Providers on June 25, 2014 at the Hiawatha First Nation. The meeting was well attended by all parties. It was clear from the discussions that the issue of Cultural Safety is central to moving forward with a specific strategy related to Mental Health and Addictions service provision. Circle members made the decision to invite the Mental Health and Addictions Providers to meet with them again following the First Nations meeting on September 11th, 2014. Members of both Circles will develop the agenda for this meeting.

One-Time Aboriginal Project Funding: The initial aim of this project, which was supported with one-time LHIN funding, was to develop and provide a standardized training curriculum for Health Service Providers that is culturally appropriate and safe for their Indigenous Clients. The Project focused on building the capacity of the system to provide treatment services to Indigenous People who required treatment for a Concurrent Disorder. The additional funding form the MOHLTC allowed for additional workshops to be offered in each Cluster of the Central East LHIN.

The Maa’ooki Project concluded with several workshops held throughout the LHIN in June 2014. The training was very well received. They Project produced a manual that has been shared with the LHIN and with other community partners.

French Language Services

Coalition For Healthy Francophone Communities in Scarborough (CHFCS): The Coalition for Healthy Francophone Communities in Scarborough met in May and June to continue developing the 2013/16 work plan. To date, planning is underway for the next French language Self- management chronic disease session at TAIBU. The CECCAC will be supporting this session.

The Francophone Heath Promoter at TAIBU, together with the Coalition, is conducting a survey regarding Primary Care services for the Francophone community in Scarborough. The Coalition and TAIBU Community Health Centre are committed to increasing and improving access to Primary Care for Francophones and support Francophones in the Scarborough cluster in having a French-speaking physician and to provide them with the opportunity to access Health Promotion Programs offered in French. The survey will help to understand the situation faced by the Francophone population of Scarborough regarding Primary Care needs.

Francophone Adult Day Program (ADP) in Oshawa: The Francophone Adult Day Program (ADP) is operational in Oshawa and the demand for registration has increased. Transportation continues to be an issue for the service to better to respond to seniors needs. The provider is looking at ways to mitigate this problem.

French Language Steering Committee for Seniors: The French Language Steering Committee for Seniors held its meeting on June 19th, 2014 at Bendale Acres. The Communication Plan has been reviewed and promotional materials have been printed and distributed to several French Language Services stakeholders across the GTA. To date, twelve (12) Francophone residents have been placed at Bendale Acres, and promotional activities have been initiated followed by the prioritization of Francophone seniors on the CECCAC waiting list.

Enablers

Improving Access to Primary Care Primary Health Care Advisory Group (PHCAG): The PHCAG held a meeting on Wednesday, June 11, 2014 with the following objectives achieved:  Receive the 2013-2016 Central East LHIN Diabetes and Vascular Health Strategy presentation;  Overview of progress to date with the Canadian Diabetes Association (CDA) Interprofessional Workshops;  Receive a demonstration of the Vascular Flow Sheet (VFS) as an e-solution tool for Primary Care; and  Provide PHCAG members with an opportunity to update the group on any emerging ideas/initiatives currently taking place in Primary Care across the Central East LHIN.

The group will meet again on September 10, 2014.

Transitions in Care & Electronic Health Information Management Central Ontario Cluster Report: The Central Ontario Cluster (six LHINS) have developed their project plan based on the new three-year planning and funding cycle with the objective to provide opportunities.

The Plan has been approved and the eHealth Leads for the cluster are now preparing the first quarter report to eHealth Ontario.

Hospital Information Systems Visioning: This is a facilitated integration planning process to develop a longer term vision or directional plan for hospital information systems as they support a regional integrated health information system. Hospital leadership is participating with the LHIN in a facilitated process to provide recommendation to the LHIN Board in September 2014.

The Integration Leadership Committee (ILC) met on July 8 and was presented with the visioning elements and guiding principles developed through consultation with the stakeholder working groups and themselves. The Vision elements will be used to develop the criteria for evaluation and measurements on which to base the report recommendations to the Central East LHIN Board.

All materials have not yet been provided for the current state review. Follow-up visits with each of the hospitals are continuing to ensure that any gaps or questions are answered.

On July 15, a joint workshop was held with the three working groups: Clinical, Financial, and Technical. The CEOs will meet on July 28 to review the results of the current state, future state and the environmental scan. There will then be a report out at the second Governor’s check-in which is scheduled for the evening of July 28. It is expected that the results will be available for discussion by the next ILC meeting (including governor feedback) on August 12 to gather feedback prior to the report submission to the stakeholders on September 4. This item will be tabled for the Board’s decision at the September meeting.

Connecting GTA (cGTA): cGTA is the initiative to build a clinical repository of multi-sector patient information and a clinical viewer for the Central Ontario Cluster providing real-time recent data for providers from a large range of sectors and organizations in the Central Ontario Cluster including CCAC, Long-Term Care, Hospital, and Physician Electronic Medical Records as well as the provincial repositories such as Ontario Laboratory information System (OLIS).

Phase I (Early Adopters to feed the repository and develop the viewer) The technical portion of the Limited Production Release (LPR) has been successfully completed and Limited Production Release is progressing on schedule. This will allow for five (5) physicians from each site to test the live system prior to the full rollout in the Fall 2014. In addition to the three hospitals (Lakeridge Health, Rouge Valley Health and The Scarborough Hospital) which are participating in Phase I, additional hospitals have implemented the Ontario Laboratory information System (OLIS) access through the cGTA project and Ross Memorial Hospital, Haliburton Highlands Health Services, Peterborough Regional Health Centre, Campbellford Memorial Hospital and Northumberland Hills Hospitals will be contributing.

Phase II – View Only Expansion This phase is focussing on additional view access for community sector organizations. Overview sessions will be held at the end of July and begin engagement with our identified participants in August. This selection was made as a cluster in August 2013 and includes: West Durham Family Health Organization, Ontario Shores Centre for Mental Health Sciences, Port Hope Community Health Centre, Brock Community Health Centre, TAIBU Community Health Centre and as contributors Peterborough Regional Health Centre, Northumberland Hills Hospital and Campbellford Memorial Hospital will be added. The ‘View access’ is expected to be completed by Spring 2015.

Diagnostic Imaging Common Services: Regional PACX systems are now implemented regionally to store the images and reports from hospitals and private DI systems but access is limited to each region. eHealth Ontario is piloting the ability to view from any of the provincial systems through a single portal.

The Local Registration Authority (LRA) for the Central East CCAC has been registered with eHealth Ontario and scheduled for training on the system. Once completed, they will begin to register the nurse practitioners participating in the pilot. The system is now live and available.

Health Links – Coordinated Care Plan (CCP) and Support (Interim Solution) Support for Health Links includes the provincial development of a coordinated care plan tool that can support the diverse circle of care and provide input from the patient. Technology solutions within the LHIN are also included here to improve the use and function of Health Links in the LHIN.

The Yammer / SharePoint solution pilot (for the Peterborough Health Links) documentation has been developed and is in review for signoff (i.e. Charter, Risk, Communication, etc.). Meetings are underway with the Healthcare Quality Innovation Collaborative (HQIC) team (support) and the CCAC privacy officer to review the setup and processes and ensure the system meets privacy and security requirements. The Yammer/SharePoint test environment will be in place by the end of July. An implementation team has been formed with members from HQIC, Central East LHIN, and CECCAC to roll-out the elinks and Yammer solution. This team has been tasked with designing, identifying processes, and implementing training. The team continues to work with stakeholders from Peterborough Health Link agencies to develop multi-agency process and solutions. Demos of the pilot tool were provided to the Peterborough Health Links. The Privacy officer is reviewing the materials with the HQIC team (supporting the tool) and training and testing using test data is underway. Discussions are ongoing with the MOHLTC team involved in the Coordinated Care Tool and the team is keeping them updated on the progress.

Resource Matching and Referral (RM&R): Resource Matching and Referral (RM&R) initiative 14/15 is to implement the remaining 2 of 4 provincial standards that were approved spring 2014. This requires the Central East LHIN to implement using the data standards pathway Acute Care to Complex Continuing Care and Acute to Rehabilitative Care.

Evaluation of the electronic options for RM&R solutions are almost complete and will be provided to the Steering Committee and then to the LHIN early in August to support a determination of the solution.

Regional SharePoint Site The regional SharePoint environment is being upgraded to support additional users, increase in speed and provide better functionality through implementation of SharePoint 2013. This project now includes the migration of collaboration sites from the Ektron system on www.centraleastlhin.on.ca as it will be unavailable after August 2014.

The testing of the new system is almost complete and expected turnover to the new system by August. Sites and access are being migrated as they are requested including the Behavioural Supports Ontario (BSO) exchange.

Access and Wait Times – Including Emergency Department, Surgical and Diagnostic Services HRM – Hospital Report Manager: TDIS/HRM are systems designed to provide hospital reports from the Hospital Information System directly into the Physician Electronic Medical Record (EMR). The TDIS system is the Central East version developed prior

to the provincial equivalent Hospital Report Manager (HRM) developed by OntarioMD, the provincial standard. The Central East LHIN is working to transition all members onto HRM by 2016.

The steering committee, comprised of participants of HRM, eHealth and Ontario MD members held their first meeting on June 25th. The Technical Reviews in preparation for completion of the agreements are underway with Peterborough Regional, Northumberland Hills and Campbellford Memorial. The statements of work for PRHC, CMH, and NHH are currently under review by the hospitals to be signed and returned to OntarioMD. As Lakeridge Health (LH), Ross Memorial Hospital (RMH), and Haliburton Highlands Health Services (HHHS) have all identified that they would like to move forward with HRM, and have completed their assessments, the team has requested the modifications to the agreement to include the next hospitals.

TDIS review will begin once funding is received, to identify and determine the changes required to “keep the lights on” while the region transitions to the HRM application (expected by 2016). In addition, monthly meetings with the TDIS team, have been set to determine the transition process and to ensure that all reports reach the intended recipient during the transition period.

Emergency Department LHIN Lead: Dr. Gary Mann, the Central East LHIN ED Lead, along with Central East LHIN staff, visited Campbellford Memorial Hospital and Northumberland Hills Hospital on June 19, 2014. The purpose of the visits was to familiarize the ED LHIN Lead with the two sites, and meet with the hospital Chiefs, discussing their particular concerns and suggestions.

The ED LHIN Lead continues to work with LHIN staff, Health Force Ontario, the Ministry of Health and Long Term Care, and when necessary, other ED LHIN Leads across the province to monitor ED staffing issues. The LHIN submits a weekly dashboard to the Ministry tracking any Emergency Departments at risk of closure due to physician staffing.

Emergency Department Chiefs: The North East Cluster ED Chiefs (NHH, CMH, HHHS, PRHC and RMH) meeting was held on June 19, 2014 in Cobourg, and the South West Cluster (LH, RVHS and TSH) ED Chiefs meeting was held on June 20, 2014 in Ajax, Ontario (Central East LHIN office). The cluster meetings allowed for discussions regarding ED physician human resources, ED staffing issues, ED performance, Pay For Results 2013/14 reconciliation and enhancing emergency services in Ontario. An update was provided on the implementation of the Life or Limb Policy.

Emergency Department Pay for Results (P4R): In the 2013/14 fiscal year, the Central East LHIN provided hospitals with a one-time P4R allocation. As stipulated in the funding agreement between the LHIN and the respective hospital, any unspent funds, and any allocated funds not used for the intended and approved purposes are subject to recovery in accordance with the year-end reconciliation policy. The Central East LHIN is now engaging the hospitals in the reconciliation process for these funds. Once the reconciliation is completed at the LHIN level, the MOHLTC has requested that the LHINs provide the final LHIN report by August 18th , 2014.

Resource Matching and Referral (RM&R): Resource Matching & Referral Provincial Standards Sustainability Office (PSSO) has been established within the Toronto Central LHIN for a one year term. The PSSOs mandate for FY 2014/15 is to: 1. Build upon foundational investments made to date through ALC Resource Matching and Referral Business Transformation Initiative (RMR BTI); 2. Monitor and evaluate ongoing implementation and use of developed Provincial Referral Standards; and

3. Finalize a sustainability model for beyond FY 2014/15 and decisions related to possible future planning endeavors.

The RM&R Provincial Standards Sustainability Office (PSSO) is overseeing the implementation of the Provincial Referral Standards. PPSO held a kick-off webinar to provide details around roles, responsibilities and deliverables. One of the discussion items was around opening up intra-facility rehab beds as system resources. The PPSO indicated that the Provincial Referral Standards need to be implemented irrespective of the referral environment being intra or inter-facility. It is up to each LHIN as to how they will be proceeding with both opening up intra-facility beds as system resources by March 2015 and implementing the Provincial Referral Standards by March 2015.

PPSO has further communicated that the implementation of the four (4) pathways (Acute to CCAC, Acute to LTC, Acute to Rehab/Complex Continuing Care (CCC)) are to be completed in 14/15 across all hospitals. At the Central East LHIN, staff are in the process of validating existing electronic tool options.

The Central East LHIN Resource Matching and Referral Operations Steering Committee met on June 18th, 2014. Various issues in relation to upcoming implementation of the Acute to Rehab and Acute to Complex Continuing Care pathways were discussed.

Vision Strategy Working Group: Resulting from the impetus of Health System Funding Reform (HSRF) and the adoption of Quality Based Procedures, new recommendations for Ophthalmology in Ontario have been developed to help with launching the Provincial Strategy Task Force. A Central East LHIN Vision Plan Working Group (VPWG) composed of representatives from across the LHIN has been established. The VPWG will prepare an Action Plan that provides recommendations to foster a system that is accountable for ensuring that Ontarians can access high quality ophthalmology services when they need them most.

Initial meetings of the VPWG provided the opportunity to complete an environmental scan and agree upon key principles to support the development of a local Vision Care Plan. The VPWG acknowledged the provincial report and the included recommendations for ophthalmology services, and identified a strong commitment to strengthen existing models in the Central East LHIN. Next steps include using the Central East LHIN decision making framework to facilitate transparency and accountability as the recommendations provided in the provincial report are more thoroughly reviewed.

Fiscal Responsibility Resource Investments in the Central East Local Health Integration Network will be fiscally responsible and prudent.

Hospital Sector Hospital Funding and Allocations: There were no funding letters issued in the month of June for the Hospital sector.

Hospital Capital Issues: Lakeridge Health – Port Perry Site – Inpatient Unit Upgrade Lakeridge Health submitted a Pre-Capital Submission for a $2.5 million project to increase the size of the patient washrooms in the inpatient unit patient rooms at their Port Perry site. This project is not requesting funds; rather it will be funded directly by the hospital’s foundation as well as a grant from the Township of Scugog. The Central East LHIN Board endorsed this project at the June 2014 meeting.

Lakeridge Health – Capital request to designate and operate a Single Photon Emission Computed Tomography (SPECT/CT) camera Lakeridge Health (LH) submitted a request to designate and operate a SPECT/CT camera for their nuclear medicine unit under Healing Arts Radiation Protection Act (HARPA). This project is not requesting funds; and will be funded internally by LH. The Central East LHIN Board endorsed this project at the June 2014 meeting.

The Scarborough Hospital – Timothy Eaton-Hemodialysis and Chronic Kidney Disease Program The Scarborough Hospital (TSH) submitted a Pre-Capital Submission for a $1.1 million project to build a new building on the former Timothy Eaton School property in Scarborough which will house the hemodialysis program from TSH. This project is not requesting funds; rather it will be funded by the YMCA with expenses being recovered by the YMCA through a tenant-lease arrangement (with TSH) over a 20-25 year period. TSH is in the process of confirming the support of the Ontario Renal Network (ORN) (i.e. that ORN agrees to fund the increase in operating funds required for the additional capacity). The Central East LHIN Board endorsed this project at the June 2014 meeting; however, TSH will be required to submit approvals from the ORN at a later date before proceeding.

2008-15 Hospital Service Accountability Agreement (H-SAA): The 2008-15 H-SAA and Private-Hospital Service Accountability Agreement (P-SAA) Amending Agreements to March 31, 2015 were executed and returned to all nine hospitals and the one private hospital within the Central East LHIN prior to the June 30th expiration date. The hospitals also received their 2014/15 H-SAA schedules although many of the indicators were left as to-be-determined (TBD) because of the writ period. Schedules will be updated quarterly to reflect appropriate volumes.

Hospital Risks: Quality-Based Procedures (QBP) Funded Volumes Funded volumes for medical QBPs were based on reported volumes from 2011/12. Medical QBPs, unlike the elective QBPs such as hip and knee replacements, cannot be controlled by hospitals. Given the demographic composition and growth in the Central East LHIN, the assumption of static volumes of medical QBPs is placing a financial hardship on Central East LHIN hospitals. For 2013/14, Central East LHIN hospitals have forecasted the volumes of patients qualifying as a QBPs case to exceed funded volumes. For the Central East LHIN, this represents $6.4 million in unfunded procedures across the Central East LHIN.

The Central East LHIN Health System Funding Reform Local Partnership (HSFR LP) has directed the Central East LHIN Decision Support working group to develop consistent reporting, monitoring and forecasting of medical QBP volumes. The HSFR LP will actively review these results and recommended actions to mitigate financial pressures where possible. The HSFR LP prepared a briefing note for the Ministry of Health and Long- term Care (MOHLTC) highlighting the issue and proposed potential solutions. The MOHLTC has modified its QBP reconciliation process to reflect the volume risk associated with medical QBPs. QBP funding will be reconciled on the QBP envelope level and not on a QBP-by-QBP basis.

Hospital Service Accountability Agreement (H-SAA) – Hospital Performance Results: The H-SAA performance results were updated for YTD (year-to-date) March, and highlights of those results are as follows:

Cancer Surgery: All Central East LHIN hospitals were above their respective targets for the percent of priority IV cases completed within the 84 day access target.

Cataract Surgery: All Central East LHIN hospitals were above their respective targets for the percent of priority IV cases completed within the 182 day access target.

Hip Replacement: All Central East LHIN hospitals were above their respective H-SAA targets with the exception of TSH as at the end of Q3. As at Q4, only TSH was forecasting not being able to meet the HSAA target of 90%. As at yearend all hospitals met the H-SAA target (corridor + / - 3%). This is a significant improvement. Through the efforts of the Wait Time Strategy Working Group (WTSWG), all hospitals have made improvements in performance and focused on improved data quality.

Knee Replacement: All Central East LHIN hospitals are performing above their respective H-SAA targets, with the exception of TSH, as at the end of Q3. Through the significant efforts of the WTSWG, all hospitals have realized significant performance and data quality capture improvements. Only TSH experienced challenges in meeting target, but as at year-end, all hospitals including TSH met their yearend target (corridor + /- 3%) of H- SAA target of 90%. Once again this represents a significant improvement for TSH.

Magnetic Resonance Imaging (MRI): Unlike other performance targets, which are set to the LHIN's Ministry- LHIN Performance Agreement (MLPA) target, MRI has individually negotiated targets for each hospital. Northumberland Hills Hospital (NHH), Ross Memorial Hospital (RMH), LH and TSH are all operating above their H-SAA target as at the end of Q3. MRI performance is being closely monitored and managed through the WTSWG. Through these efforts and incremental funding received after Q2, all hospitals met or exceeded their H-SAA performance target for MRI (corridor + / - 3%).

Computed Tomography (CT): All hospitals excluding Rouge Valley Health System (RVHS) were performing at or above their access target for CT. The WTSWG is closely monitored performance through Q4. As at yearend, all hospitals including RVHS met the performance target of 90% (+ / - 3%).

Total Margin: All hospitals were forecasting to be in a balanced or surplus position by March 31, 2014 as at the end of Q3. As at year-end, all hospitals balanced or were in a surplus position. There were significant pressures in the hospital sector resulting from the combination of Health Service Funding Reform (HSFR) activities and 0% increases in base budgets. Hospital non-elective QBP volumes impacted global funds, where many of the QBP actual volumes exceeded QBP funding and resulted in a global funding subsidy, for these cases. In spite of this, all hospitals met their balanced budget requirement.

Current Ratio: As at yearend, all hospitals are performing above their respective performance targets.

Total Inpatient Acute Weighted Cases: All hospitals, excluding LH were above their respective lower performance corridor. In Q4, LH monitored performance relative to H-SAA target but as at yearend, all hospitals met their H-SAA target with the exception of LH who had a shortfall of 1500 weighted cases. This shortfall was attributed to a delay in the Post-Construction Operating Plan (PCOP) implementation plan, and therefore anticipated new volumes were not achieved.

Day Surgery Weighted Cases: All hospitals were above their respective lower performance corridor.

Complex Continuing Care Weighted Days: All hospitals were above their respective lower performance corridor.

Rehab Patient Days: Peterborough Regional Health Centre (PRHC), RMH and LH were performing above their respective performance corridors, with RVHS performing slightly below the performance corridor. This can partially be attributed to efficiencies with respect to hip and knee replacement and discharging over 90% of their patients home rather than to inpatient rehab. TSH closed their Rehab beds in early 2013/14.

Mental Health Patient Days: All hospitals were above their respective lower performance corridor.

Emergency Department (ED) Weighted Cases: ED weighted cases are reported as a result of patients presenting to the ED, requiring admission to an inpatient bed, but unfortunately no inpatient bed was available. The patient was then discharged directly from the ED. All hospitals were above their respective lower performance corridor, but ultimately, the goal would be to realize a reduction in the number of ED weighted cases. Further mitigation strategies will be explored in 2014/15, with consideration of the current ALC day’s challenge.

Ambulatory Care Visits: All facilities have exceeded their H-SAA performance standards with the exception of LH. In 2013/14 LH's performance standard initially included activity related to Chemotherapy Systemic Treatment volumes which occurred at PRHC. During the course of the fiscal these volumes were divested back to PRHC, resulting in a shortfall of volumes achieved at LH. TSH submitted a reduction in Ambulatory Care visits as the hospital was providing ambulatory services that should have been counted as physician office visits. This reduction is now incorporated into the performance standard.

Hospital Sector Working Groups: Wait Time Strategy Working Group (WTSWG) The Wait Time Strategy Working Group (WTSWG) met at the end of June. The Terms of Reference were reviewed, edited and adopted by the members.

The WTSWG reviewed the Operational Status report submitted by each facility reflecting results for year-to-date May. The current targets reflect 2013/14 access targets and opening allocation volume (including base volumes) targets. These targets will be updated as new information becomes available from the Ministry of Health (MOH). Many facilities have met or exceeded access targets and volumes. There was concern expressed regarding the timeline of the announcement of 2014/15 volume and access targets. The current estimated timeline is September and some facilities are struggling to meet access targets for Computed Tomography (CT) and MRI, where there is a current variance of approximately 5,000 operating hours, comparing the initial MOH Wait Time Strategy (WTS) Allocation with facility capacity and need. Reduced hours have resulted in two facilities (NHH and PRHC) being unable to meet their access targets for MRI. Mitigation strategies are being developed, and facilities are sharing their plans, with further information to follow after next month’s meeting.

The challenges for MRI are two-fold: • Allocations do not include additional operating hours funded in-year by the Central East LHIN; and • Historical allocations do not address inequities of incremental volumes relative to base volumes

Since the 2014/15 Central East LHIN MRI performance target will be used as the hospitals’ performance target this fiscal (i.e. no negotiation of target on a facility by facility basis) the allocation of MOHLTC incremental volume should be equitable relative to base volumes, where appropriate.

Collaboration on MRI Wait Time Incremental Volume Allocation: Concept of allocating to achieve more equitable incremental to base discussed in the following forums:

 HSFR Local Partnership Meeting - June 3, 2014  Hospital-Community Care Access Centre Financial Leadership Group (HCFLG) Meeting - June 20, 2014  WTSWG Meeting - June 26, 2014  HCFLG/WTSWG Teleconference – June 26, 2014  Final Recommendations are going to the Central East Executive Council (CEEC) – July 8, 2014

Elements of MRI Incremental Volume Allocation: Initially examine potential to create equitable distribution of incremental to base volume in all Central East LHIN hospitals (based on total Central East LHIN base and incremental volumes that would be 58%):  Adjustment - confirm capacity for each hospital and limit allocation to capacity;  Adjustment - since 2014/15 H-SAA negotiation assumption for all Wait Time (WT) procedures was assumed opening 2013/14 allocation as necessary increase allocation to that level; and  In Year Extra Volume (MOHLTC or LHIN) – only available to those hospitals with identified capacity greater than opening allocation amount. Same accountability requirements as applied to in-year allocation in 2013/14.

There have been some updates to the QBPs definitions, which are monitored within the WTSW. In some cases the QBP definitions may not be consistent with the original Access to Care (ATC) Wait Time Information System (WTIS) definitions. In those instances, the Central East Executive Council will use the QBP definition to determine volumes and access target performance.

Diagnostic Imaging (DI) Working Group: The Diagnostic Imaging Working Group (DIWG) met in mid-June. The DIRECT project was discussed. As reported in the May CEO report, the objectives of the project include electronic standardization of diagnostic imaging requisitioning, tracking and reporting. Improved timely data capture will provide physicians, organizations and regions with information that improves access (wait times) to services close to home. The project team is currently collaborating with key stakeholders such as Diagnostic Imaging Medical Directors, Radiologists and family physicians to identify any barriers or challenges. This information will be incorporated in the updated Request for Proposal prior to its release.

The 2014/15 Access to Care (ATC) Wait Time Information System (WTIS) - Expansion Project was also discussed, where it was noted that there has been some expense incurred by facilities, where software vendors are being required to make programming changes to meet the new mandated data element capture. Other discussion included results of the following reports:

 Delay Affecting Readiness to Treat (DART) – days flagged where the patient is not available to have the diagnostic procedure performed (for various reasons) – application of DARTs continues to be slightly reduced for the month of April, which has historically been the case, based on seasonal fluctuations; and  MRI Efficiency – where key MRI indicators of efficiency are highlighted. Key indicators include wait times, wait lists, operating hour utilization, number of procedures performed, and no show / same day cancelations – this report was not yet available for review, and deferred to the next meeting, which will be held in September.

Hospital-Community Care Access Centre Financial Leadership Group (HCFLG): The HCFLG met on June 20, 2014. There was continuing review and discussion of the 2014/15 opening volume allocation methodology. Methodology components included principles, parameters (how much to allocate), accountabilities, and ultimately determination of volume allocation. Most of the methodology components were adopted by the group and will be taken forward to the CEEC.

Further work continues to ultimately define the “demand” component of the opening volume allocation methodology which will be introduced for fiscal 2015/16. The following outlines considerations being developed to date:

 2015/16 Demand Methodology Scope: Demand methodology is not intended to quantify actual demand in the Central East LHIN, but rather quantify the Central East LHIN demand shares at the facility level.  2015/16 Demand Methodology Components: Identification of Hospital catchment area, agreement on Patient Groupings, weighting Patient Groupings, demand formula; and calculating demand.  2015/16 Demand Methodology – Hospital Catchment: Obtain MOHLTC HSFR listing of geographic definition of Central East LHIN and detail facility catchment area, including, forward sorts and postal code;

We have been in contact with the MOHLTC, who have indicated that the definition of the catchment area for the Central East LHIN is postal code, but that the definition at the facility level includes an additional overlay, to address “close proximity” facilities; and subsequently the Canadian Institute for Health Information (CIHI) coded abstract data will be analyzed for fiscal 2013/14 to determine potential impact on 2015/16 methodology results.

Moving forward, there are other demand methodology components that will be addressed and the LHIN will confirm the outcome of Demand discussion with hospitals. The 2013/14 Year end data will be used to run Demand shares as per final methodology with results that will be discussed and model adjustments considered as appropriate.

Health System Funding Reform Local Partnership (HSFR LP): The HSFR LP met on June 3, 2014 and discussion took place on the following topics – 2014/15 Opening Allocations Methodology related to Quality-Based Procedures Wait Time for Hip/Knee replacement/revision, Cataracts – unilateral and bilateral, Non-Quality-Based Procedures Wait Time Surgery and Diagnostic Imaging (DI). There was discussion on the Non-Central East LHIN-managed and Non-Elective QBP opening and In-Year allocations.

The group was informed that opening allocations will be based on facility percentage of total Central East LHIN allocations from previous fiscal year and further that In-Year Allocations will be adjusted (removed and reallocated) to facility based on wait time only in consideration of meeting accountabilities and capacity. This is past practice.

2014/15 Opening Allocation Methodology Members of the group were provided with the recommendations from the HCFLG. Subsequent discussion occurred related to the “demand” component, which will be introduced in the 2015/16 allocation methodology, with additional work yet to be done, but endorsed the methodology components which were to be sent forward as recommendations, to be presented to the CEEC for endorsement, as outlined below:

 WT Volumes should be shifted from lower-performing providers to higher-performing providers;  Results from reallocation efforts must ensure an acceptable level of stability for all stakeholders;  Attempt to maximize Central East LHIN-funded volumes by completing all volumes and achieving 90% completed target;  Demand should be introduced in allocation model over time;  Proportion of total LHIN opening allocation to be allocated based on wait time performance – 10%;  Proportion of total LHIN opening allocation to be allocated based on demand – 10% (but demand still needs to be defined);  Recovered incremental volumes from the prior fiscal year should be allocated as part of this initial allocation;  Volumes should be adjusted to first compensate hospitals that have completed hospital-funded volumes;  Any shifts in allocations should be consistent with provincial planning initiatives;

 Non-recurring, voluntary inter-hospital reallocations of volume will not negatively impact initial allocation in following fiscal year;  Preferred performance corridor for wait times (not volumes) +/ - 3%;  Any reallocations should consider the impact on PCOP funding for those hospitals receiving this funding; and  The same accountability conditions will apply to new reallocated opening allocation amounts and in-year incremental volumes.

Health System Funding Reform (HSFR) Update: Plans are underway with the Ministry to arrange an HSFR “In Person” Engagement session. A rough draft of the agenda items for this session was reviewed by the HSFR LP, and members were asked to identify additional topics of interest. Additional discussion and engagement will occur with the MOHLTC next month, with a tentative date for the session, as yet to be confirmed, sometime in the fall.

Quality-Based Procedures Summary – Status and Risk: QBP Summary - Status and Risk Report has been termed as the tracking tool being used to identify the HSFR LP liaison for each QBP and also provides a snapshot summary of the status and potential risk related to each QBPs. The LP liaison will provide an assessment and update at each HSFR LP meeting under the following:  QBP clinical handbooks – outlines clinical pathways which can be used to derive gap analysis and implementation strategies and quality indicators which will support best practice;  QBP volume variance analysis – which will highlight over/under achievement of volume targets; and  QBP data quality analysis – which will highlight the need for potential mitigation strategies and / or process improvements in data capture and documentation practices.

Many of the clinical handbooks have already been developed for the QBPs. Where clinical handbooks are available, a gap analysis is being conducted for the QBPs, with additional analysis to occur over the current fiscal. Current volume variance analysis YTD February, indicates that volumes, particularly for Chronic Obstructive Lung Disease (COPD), Congestive Heart Failure (CHF) and Stroke, are projected to exceed QBP funded volumes, and have therefore been identified as a risk for the Central East LHIN. Data quality can directly impact funding, especially where data capture is not standardized across all QBPs. Regular quarterly monitoring of data capture, timeliness and trending has occurred, with facility follow up, as necessary.

Orthopaedic Quality Scorecard (OQS): The Central East LHIN receives the Orthopaedic Quality Scorecard (OQS) report from the MOHLTC on a quarterly basis. The report includes performance results at the Provincial, Local Health Integration Network (LHIN) and Facility level. It defines and monitors indicators related to Orthopaedic Surgery – Unilateral Hip and Knee Replacements. The performance indicators are broken down into three main categories:

 Efficiency – Patient Length of Stay and discharge disposition;  Effectiveness / Safety – Readmission rates and revision rate of the primary hip or knee replacement; and  Accessibility – Wait Time days for access to surgery.

4th quarter results will be made available in the next report.

Community Sector: Community Support Services (CSS), Community Health Centre (CHC), and Community Mental Health & Addictions (CMHA)

Community Sector Capital Issues: Brock Community Health Centre – New Build Project Brock Community Health Centre has submitted a report pertaining to the parking issue related to their capital project. Central East LHIN staff are currently reviewing this report. As well, the MOHLTC should be submitting their comments to Brock Community Health Centre shortly.

Central East LHIN Multi-Sector Service Accountability Agreement (M-SAA): The 2013/14 Q4 Reports were received on June 7th, 2014. Upon reconciliation with the 2013/14 Q4 M-SAA schedules, a number of inconsistencies were discovered and therefore the release to the agencies will occur by late July. A quarterly refresh of the schedules ensures that each HSP is being monitored appropriately.

The current M-SAA dashboard is in process and will be presented at the Audit & Finance Committee meeting on July 23rd, 2014.

The M-SAA termination process for Supportive Initiative for Residents in the County of Haliburton (SIRCH) is in process as the services from SIRCH are being transferred to Haliburton Highlands Health Services.

Performance and Risks: Central East Community Care Access Centre (CECCAC) The Base budget and special initiatives are expected to be in a balanced or surplus position at year end. The Base budget has factored in a necessary surplus of about $0.5M at year end to cover over-expenditures in initiatives such as Care connectors, Rapid Response Nurses and Mental Health & Addiction Nurses where approved funding does not match program requirements (i.e. travel, supplies and equipment).

The CECCAC has assumed a 0% increase to base funding for 2014/15. The CECCAC has experienced growth in the number of chronic and complex patients over the past several months. Services for chronic and complex patients removed from the personal support waitlist were anticipated. However, they are also experiencing increasing numbers of patients referred to them through ‘case finding’ from initiatives such as Geriatric Assessment Intervention Network (GAIN) and Health Links. Because these also are chronic and complex patients who typically have long lengths of stay, they have seen high admit to discharge ratios through the past 4 months. This is not sustainable in the long term.

Strategies have been developed to ensure a balanced budget if this trend continues.

School Speech waitlists continue to be addressed. $2M was allocated to this effort.

Long-Term Care Sector Long-Term Care Home (LTCH) Service Accountability Agreement (L-SAA): Compliance Indicator Status Report The L-SAA Compliance Indicator Report, produced by the Health Data Branch, Health System Information Management Investment (HSIMI) Division, was generated May 21, 2014. This report reflects L-SAA compliance by LHIN. The Central East LHIN Long Term Care Homes were all in compliance as at March 31, 2014.

Temporary Long-Term Care Licenses have been issued again for Fairhaven, Extendicare Peterborough as well as Peterborough Regional Health Centre.

Long-Term Care Sector Performance and Risks: On June 27, 2014 the City of Toronto had a meeting with the Central East LHIN to share their Long-Term Care Homes & Services Capital Renewal Draft Strategy. It outlines the process in which Seven Oaks, a long-term care facility within the Central East LHIN will be retrofitted by 2027 (Appendix A).

Long-Term Care System Report: The Long-Term Care System Report, produced by the Health Data Branch, HSIMI Division was received in July 2014 and summarizes activity as of January 31, 2014. In general, the report makes the following observations, at the provincial level:

 Adjusted Utilization in January was 98.7%, down from December and up slightly from one year ago.  Long-Stay Supply increased by 185 (to 76,484), up 0.2% from December and up 0.4% from one year ago. Supply is expected to grow by 827 (1.1%) in the next 6 months and grow by 848 (1.1%) in the next 24 months.  The number of Homes below 97% was 82, (up 13.9%) from December and down 24.8% from one year ago.  Placements for the fiscal year-to-date were 9,125 up by 121 (1.3%) from the previous fiscal year.

The Central East LHIN has 117,106 people over the age of 75, which measures the second highest of all the LHINs in Ontario. The total population of people over 75 is 947,464 in Ontario. The total bed supply for the Central East LHIN is 9,707 with an average Long Stay Utilization of 98.7%. The total provincial supply of beds is 78,100 with an average long stay utilization of 99.1%. The Long Stay Demand for the Central East LHIN is 13, 850, which is the highest in the province. Our waitlist is also the highest across the province at 6,569 (was 4,428 as at October).

On March 1, 2012, the MOHLTC announced the extension of the 2011 interim measure in the LTCH Occupancy Targets Policy with amendments. The purpose of the interim measure was to provide interim relief to LTCHs experiencing occupancy between 90 to less than 97 percent, provided that Homes meet certain conditions. A fundamental change from the 2011 interim measure was the active involvement of the LHINs in working collaboratively with Homes to ascertain the root cause(s) of their occupancy challenges and to review and endorse Action and Implementation Plans developed by the Home to address their occupancy issues, and then to evaluate the effectiveness of those plans. If the LHIN endorses the Home’s Action and Implementation Plans, and provided the evaluation of those Plans is positive, funding will be provided as follows:

 for occupancy between 90% to less than 94% - actual occupancy + 1% of maximum resident days  for occupancy between 94% to less than 97% - actual occupancy + 2% of maximum resident days.

For 2013, the LHINs must submit to the LHIN Liaison Branch a list of LTCHs which the LHIN does endorse and those LTCHs which the LHIN does not endorse to receive the actual plus 1-2% funding. This list must be received by the LHIN Liaison Branch before May 30, 2014.

None of the Central East LHIN Homes anticipate occupancy rates below 97%, however, one home submitted an occupancy improvement plan which was reviewed by the senior team. This was subsequently endorsed by the LHIN to receive “top up funding”, in the event that the MOHLTC’s data demonstrates occupancy is less than 97% for 2013. Ongoing monitoring of this performance indicator will continue through fiscal 2014/15. LTC Home occupancy is a key indicator in projecting improvements in the number of Alternate Level of Care (ALC) days percentage indicator for hospitals.

Cross Sector Quarterly Report Highlights – Ministry of Health and Long-Term Care (MOHLTC): The 2014/15 Q1 reports were completed and submitted to the MOHLTC on June 27, 2014.

Self Reporting Initiative (SRI): The deadline for the Q4 SRI report was June 6, 2014. LHIN staff assisted the few agencies who experienced challenges in uploading the completed reports and overall, approximately 80% of the reports were submitted on time.

The Annual Reconciliation Reports (ARR) submission in SRI were to be completed by June 30, 2014. The ARR process went well for this quarter, with more than half of the submission uploaded, as of June 27th, 2014. Central East LHIN staff will work together with Financial Management Branch (FMB) staff to review 2012/13 ARR submissions and Q4 submission and follow up with agencies on any data quality issues.

Personal Support Services Wage Increase: The MOHLTC issued the Personal Support Services Wage Enhancement Directive to the LHINs on April 1, 2014, which aligns with the Personal Support Worker Workforce Stabilization Strategy and calls for funding allocations to be introduced in FY 2014/15. Collaboration is taking place at the pan-LHIN level to meet the growing need for home and community-based community services in Ontario and assist the Ministry with flowing the funding to support this initiative to applicable providers. The Directive states:

CCACs are required to amend their contracts with service providers who provide PSS to require that these service providers:

 Increase the hourly wages for individuals providing LHIN-funded PSS by $1.50 per hour retroactive to April 1, 2014; and  Establish a new minimum base wage of $14.00 per hours for these individuals retroactive to April 1, 2014.

Other providers subject to this Directive are required to:

The Directive applies to LHIN-funded Health Service Providers (HSPs) and services as follows: CCAC for personal support services purchased from contracted service providers, any health service provider where personal support services are offered under contract with the CCACs and other health service provider (home and community care agency) that provide personal support services. Exceptions to health service providers include personal support services provided under the MOHLTC’s policy “Self-Managed Attendant Services in Ontario – Direct Funding Pilot Project – Policy Guidelines”; Long-Term Care Homes; Hospitals; and other LHIN- funded services provided by health service providers in the home and community sector.

LHINs received confirmation that the Ministry funding package will provide the LHINs with a “lump sum” allocation that the LHINs will administer, including determining the individual Health Service Provider allocations. Each LHIN submitted a total estimate of Personal Support Service hours, below is the approximate Central East LHIN calculation, using the FTE methodology:

Sector PSS Funding Up to 16% for Potential Total Hours Allocation Employer Contributions CCAC 3,045,778 $4,568,667 $730,987 $5,299,654

CSS 1,130,738 $1,696,107 $271,377 $1,967,484

Total $7,267,138

The very tight timelines that are required to make this happen are as follows:

 July 25 – letters out to all with funding and hours included;  August 5 – sign-backs (CEO & Board chair) must be returned to LHIN;  September 1 – payment will be provided to HSPs;  Q3 reconciliation process will begin;  November 30 – compliance certificate to be sent to LHINs by HSPs; Community Engagement Community Engagement is the foundation of all activity at the Central East LHIN. Being more responsive to local needs and opportunities requires ongoing dialogue and planning with those who use and deliver health services. Engagement with a wide range of stakeholders can be conducted at various levels including informing and educating; gathering input; consulting; involving and empowering.

Calendar of Events To assist us in tracking our Community Engagement activities, an ongoing Calendar of Events is kept up to date and shared weekly with staff. It documents all engagement activities with a wide range of stakeholders. Many of these events are also posted on the Central East LHIN website: www.centraleastlhin.on.ca/showcalender.aspx.

On April 24th, Joanne Hough, Deborah Hammons and LHIN staff participated in the announcement of the eight publicly funded physiotherapy clinics that are located in the Northeast Cluster. The announcement was held at Total Physiotherapy in Peterborough and was made by Peterborough MPP Jeff Leal.

On April 25th, Wayne Gladstone, Deborah Hammons and LHIN staff participated in the announcement of the six publicly funded physiotherapy clinics that are located in Durham Region. The announcement was held at Pickering Sports Medicine and Wellness Centre in Pickering and was made by Ajax Pickering MPP Joe Dickson and supported by Pickering Scarborough East MPP Tracy MacCharles.

MPP Brad Duguid issued a news release on April 30th to announce the publicly funded physiotherapy clinics in Scarborough.

Many of our health service provider governors attended a Central East LHIN board sponsored governance engagement session on quality on May 2nd, with key note speaker Dr. Joshua Tepper.

Our Spring MPP engagement was completed on May 2nd with a meeting with Scarborough Agincourt MPP Soo Wong.

On June 27th Central East LHIN staff member, Indra Narula was a panel speaker at a press conference held by Carefirst Seniors and Community Services Association, to discuss the services they offer to seniors in the Scarborough community. The press conference generated coverage in the local Chinese media.

Engagement Tables and Communication Support As noted previously in this report, Central East LHIN staff continue to engage with stakeholders on a regular basis to manage the local health care system. For more information on these engagement tables see http://www.centraleastlhin.on.ca/getinvolved.aspx?ekmensel=e2f22c9. Communications staff assists their colleagues in sharing stories that arise from this engagement through public communications. Additionally Communications staff is involved in a number of integration planning team tables.

Media Relations/Tell a Story Engaging with our media partners includes the development and distribution of news stories either through Central East LHIN news releases or repurposing information shared by our health service providers or the Ministry of Health. The goal is to share information that supports the LHIN’s Strategic Aims. See http://www.centraleastlhin.on.ca/pressrelease.aspx?ekmensel=e2f22c9a_72_190_btnlink_20.

In May and June 2014, this included the following stories:

Jun 17, 2014 First Annual Regional Conference Focuses on Issues Related to Health and Older Adults Over 170 health service providers and researchers from across the Central East Region and province gathered together at the first annual regional conference focused on health care for seniors...

Jun 22, 2014 Kelly Kay Appointed Executive Director for Seniors Care Network The Board of Directors of Seniors Care Network (formerly Regional Specialized Geriatric Services) serving the Central East Local Health Integration Network is pleased to announce the appointment of Kelly Kay as its Executive Director effective May 19, 2014.

Jun 23, 2014 STEP 1 IN DELIVERING SEAMLESS TRANSITIONS OF CARE The Peterborough Regional Health Centre is pleased to officially open the new Integrated Stroke Unit (ISU). The unit transitioned its model of care beginning in late April and is now fully functional.

Jun 26, 2014 HEALTH CARE PROVIDERS CREATE STRONGER PARTNERSHIPS Residents from across Haliburton County, the City of Kawartha Lakes, Peterborough City and County and Northumberland County are all benefitting as health care organizations in each of their communities take the next steps in a number of integration processes facilitated by the Central East Local Health Integration Network (Central East LHIN).

Jun 30, 2014 PCMCH’s Maternal-Child Benchmarking Report Informing Planning in the Central East LHIN A Newsletter from the Provincial Council for Maternal and Child Health (PCMCH). Reposted on the Central East LHIN website with permission from PCMCH

Website The Central East LHIN website continues to be a primary vehicle for both communication and engagement with our stakeholders with ongoing information posted on the 2013-16 IHSP, integration activities, health service

provider activities and accomplishments, performance results and accountability agreements. In May and June, 2014 there were 8,748 visits made by 5,978 unique visitors. There were 26,862 pages viewed over this two month period which is consistent with our historical activity.

Social Media Communications staff are continuing to use Twitter to generate awareness of LHIN initiatives and opportunities with our followers and those who “retweet” our “tweets.” At the time of the April 2014 CEO report we had 1,383 followers. At the time of the creation of this report we now have 1,494 followers. Tweets can be seen by following the Central East LHIN twitter account – see www.twitter.com – CentralEastLHIN. Operations Finance: The first quarter consolidated report covering April 1 through to June 30, 2014 was finalized by staff and submitted to the Ministry, this will also be tabled at the Audit and Finance Committee for review. The Committee will receive a report on the Board budget variance, travel expenses and per diem claims. These reports are reviewed on a quarterly basis by the Audit and Finance Committee, as identified in the Audit and Finance Committee work plan. In managing the Minister of Health’s request for all LHINs to publish expenses for the Board of Directors, CEO and Senior Directors, the Central East LHIN will be posting the first quarter expenses to support our commitment in being accountable and transparent. This information will be available online following review by the Audit and Finance committee.

Records Management: The Archives & Recordkeeping Act Provincial Working Group continues to work with the Ministry on the development of the Provincial LHIN Record & Retention schedule. The LHIN-specific record series consists of nine (9) series and three (3) have been reviewed by the Ministry. The group is on track with finalizing the remainder of series for Ministry review by the end of July. These LHIN-specific series will require full approval from all 14 LHIN CEOs once they have been completed for review. The LHIN Shared Services Office (LSSO) has started research on the third party module to support SharePoint on the proper enterprise tool for archiving across the LHINs. Currently, the working group is testing the new taxonomy and file plan that will be implemented on SharePoint.

Health & Safety and Emergency Management Awareness at the Central East LHIN: The Central East LHIN employees participated in the new mandatory Health and Safety awareness training in a group workshop ensuring a consistent and user-friendly approach. All future employees will complete the training as part of their on-boarding with Human Resources. The new regulation training was broken down into four steps: Get on Board; Get in the Know; Get Involved and Get More Help.

Representatives from the Ministry of Health and Long-Term Care Emergency Management Branch were onsite on June 24th and provided a half-day training session on our local LHIN responsibilities under the Emergency Management protocol. Highlights of the training session included staff reviewing the vision and mission of this branch of the Ministry, learning about emergency management “neighbours” or planning partners to the LHIN, and recognizing the circles of impact. An MOHLTC-LHIN implementation working group will be assembled with representation from the 14 LHINs to strengthen the training to ensure protocol matches practices across the province. The three-year implementation period includes tools, education and training and service agreements that are being rolled out to all emergency management planning partners in the province.

Other Announcements Province releases ‘A Vision for Home and Community Care in Ontario’: On April 24, 2014, the Ministry announced a new initiative aimed at improving care for patients who receive health care services at home or through community supports. A series of summits are being scheduled to gather feedback from providers, patients and their families, see – http://www.health.gov.on.ca/en/news/bulletin/2014/hb_20140424_1.aspx

Lakeridge Health Ranked #1 in Providing Clot-Busting Stroke Drug: The Ontario Stroke Report Card ranks Lakeridge Health as number one in providing tPA (acute thrombolytic therapy) to eligible stroke patients. Administering tPA can dissolve a blood clot and restore normal blood flow to the brain, but the drug must be given within 4.5 hours of the onset of stroke symptoms, congratulations Lakeridge Health.

Respectfully Submitted,

ORIGINAL SIGNED BY

Deborah Hammons Chief Executive Officer Central East Local Health Integration Network

Appendices

LTCH Cap.Ren.Strat..pdf

Appendix A

NR_CDI BKGND_CDI Outbreak Outbreak_FINAL.pdf Final.pdf

Appendix B

Long-Term Care Homes & Services Capital Renewal Strategy DRAFT

June 27, 2014 Background

• 2012 Service Efficiency Study recommends • focus on redevelopment of homes • consolidating to fewer homes • shifting to continuing care campuses (service integration) • selling surplus lands

• Provincial mandatory redevelopment • Six of City’s ten homes (1,569 of its 2,641 Ministry approved beds) • redevelopedDRAFT or retrofitted over a 10-15 year period commencing in 2009 • Ministry of Health and Long-Term Care (MOHLTC) and City Council approved redevelopment of Kipling Acres (337 beds), project is underway with completion targeted for 2015

• City Council unanimously adopted in principle the direction to integrate long-term care as part of the Seaton House/George Street revitalization project

Guiding Principles

• Deliver current level of service to support high-quality specialized resident- focused care while seeking to maximize cost savings and efficiencies

• Promote and preserve partnerships, including cultural and community linkages

• Respond to emerging community needs and serve vulnerable individuals

• Minimize resident disruption related to capital renewal DRAFT • CARE values (Compassion, Accountability, Respect and Excellence) provide framework for all decision making; redevelopment allows LTCHS to advance Toronto Seniors Strategy as leaders in excellence and ground- breaking services for healthy aging Challenges & Opportunities

• The City’s allocation of long-term care beds cross the boundaries of 5 Local Health Integration Networks (LHINs)

• Redevelopment of long-term care homes requires approvals from City Council, the MOHLTC and the LHINs

• Newer and DRAFTmore energy efficient building systems help address climate change and efficient service delivery is attainable with co-location of services in community hubs

Census Data Population of Seniors

•Toronto has a higher proportion of seniors 65+ (14.4%) than the GTA Regions (11.5%) •The age structure of Toronto's population is continuing to shift gaining more older adults. •According to City Planning projections, between 1996 and 2011, the number of seniors was expected to grow by 39,315DRAFT persons or by 12.3%. Census data show that the population change among Toronto seniors 65+, is 18.0% and above estimates. •The number of older adults is forecasted to grow by up to 60% in the next 20 years.

Existing LTC Home Distribution

DRAFT 7 LTCHS Redevelopment Strategy Estimated cost $332.5M George Street Castleview Seven Oaks

Existing Home Existing Castleview Existing Fudger and Existing Lakeshore and Carefree consolidated Seven Oaks CWT FH CFL LL SO (456 beds) (250 beds) (127 beds) (150 beds) (249 beds) New Build – LEED Silver DRAFT Home Expanded George Street CWT Site Seven Oaks Partnership 512 beds (retrofit plus addition) 384 beds (FH site surplus) 336 beds Existing LEED Silver LEED Silver After Redevelopment 5 homes; 1,232 beds Est. $116.5M Est. $155.0M Est. 61.0M 3 homes; 1,232 Beds 2020 2024 2027

Strategy Options

1. George Street – Build a new 384 bed home at the George Street location. When complete, decant residents from Castleview Wychwood Towers (CWT). 2. CWT – Demolish existing CWT and re-use site to build a 512 bed home. When complete, decant Fudger House (FH) and Carefree Lodge (CFL) to potentially vacate both locations; beds from LakeshoreDRAFT Lodge (LL) could also be transferred. 3. Seven Oaks – 160 bed addition to the Seven Oaks (SO) existing home and retrofit remaining beds.

Note: the renewal strategy is based on the existing inventory of long- term care beds and does not include the potential for expansion Contact InformationDRAFT: Reg Paul, General Manager Long-Term Care Homes & Services

MEDIA BACKGROUNDER July 16, 2014

PRHC DECLARES C. DIFFICILE OUTBREAK OVER OUTBREAK IS OVER, BUT THE BATTLE AGAINST INFECTIOUS DISEASES CONTINUES

Outbreak Declared

4 months Below Baseline Outbreak Over!

Baseline lowered in Dec/13 ~ Baseline Improved Hospital results (drive ongoing improvements)

PRHC Blitz declared on Jan.28, 2014

 Improvement s on Hospital Acquired C. diff  Community and Relapse burdens Hospital Acquired continue

THE FOLLOWING VISITOR RESTRICTIONS AND ALL OTHER HEIGHTENED INFECTION PREVENTION AND CONTROL MEASURES INTRODUCED DUE TO THE OUTBREAK WILL REMAIN IN PLACE FOR THE COMING WEEKS TO ENSURE CONTINUED VIGILANCE.  PRHC’S VISITING POLICY STATES THAT PATIENTS’ ARE ALLOWED A MAXIMUM OF 2 VISITORS PER ROOM AT ONE TIME.

For More Information: Rebecca Kerrivan, Communications Assistant 705-743-2121 x. 2234 or [email protected]

www.prhc.on.ca

 VISITORS SHOULD CLEAN THEIR HANDS UPON ENTERING AND LEAVING THE HOSPITAL AND AS MANY TIMES AS POSSIBLE WITHIN THE HOSPITAL (E.G. WHEN ENTERING OR LEAVING A PATIENTS’ ROOM, AND BEFORE AND AFTER PATIENT CONTACT).  PLEASE DO NOT VISIT THE HOSPITAL IF YOU ARE FEELING ILL.  VISITORS ARE REQUIRED TO WEAR PERSONAL PROTECTIVE EQUIPMENT (PPE), INCLUDING GOWNS AND GLOVES, WHEN VISITING PATIENTS WHO ARE ON ADDITIONAL PRECAUTIONS. (LOOK FOR SIGNAGE POSTED OUTSIDE OF ISOLATED PATIENT ROOMS OR SPEAK TO A NURSE AT THE COMMUNICATION CENTRE FOR INFORMATION ON HOW TO PUT ON PPE).

www.prhc.on.ca

NEWS RELEASE July 16, 2014

PRHC DECLARES C. DIFFICILE OUTBREAK OVER OUTBREAK IS OVER, BUT THE BATTLE AGAINST INFECTIOUS DISEASES CONTINUES

(Peterborough, ON) In consultation with Peterborough County-City Health Unit (PCCHU), PRHC has declared the C. difficile outbreak over.

“We’re committed to our new value - ‘Depend on Us’ at PRHC,” stated Ken Tremblay, President and CEO of PRHC. “The past seven months have been challenging for our patients, visitors, staff and physicians. Their support and commitment were instrumental. This outbreak is over, but the battle will never be over against infectious diseases. We must remain vigilant and we need everyone’s help to protect our patients and everyone at PRHC,”

“PRHC has sustained four months below the baseline,” noted Dr. Jamie Brown, Infection Prevention and Control Physician at PRHC. “It’s vital that we sustain all the hard work and efforts made by staff and physicians to date and build on what we have achieved to ensure we continue to keep our patients healthy and safe.”

Over the course of the outbreak, regular discussions with Public Health and other infectious disease specialists were key factors in bringing the outbreak to an end. Thank you to our community partners, especially PCCHU and local Family Healthcare Teams who have been instrumental in providing guidance and support during the outbreak. “We commend the diligent work of PRHC staff, patients and their families who have proven that, by working together, tough infectious diseases can be controlled. We all owe them a huge debt of gratitude for reducing the spread of C. Difficile in our community - it’s not an understatement to say that hand washing truly saves lives.” noted Dr. Rosana Pellizzari, Medical Officer of Health at PCCHU.

The visitor restriction below and all other heightened infection prevention and control measures introduced due to the outbreak will remain in place for the coming weeks to ensure continued vigilance by everyone.

PRHC’s visiting policy states that patients’ are allowed a maximum of 2 visitors per room at one time. Visitors should clean their hands upon entering and leaving the hospital, and as many times as possible within the hospital (e.g. when entering or leaving patient rooms, and before and after contact with patients). Please do not visit the hospital if you are feeling ill. Visitors are required to wear personal protective equipment (PPE), including gowns and gloves, when visiting patients who are on additional precautions. (Look for signage posted outside of isolated patient rooms or speak to a nurse at the communication centre for information on how to put on PPE).

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For More Information: Arnel Schiratti 705-876-5151 or [email protected] www.prhc.on.ca